Federal laws require that Mercury provide you with certain notices that inform you about your rights regarding eligibility, enrollment, and coverage of health care plans. The following sections explain these rules; please read them carefully.
Medicare Creditable Coverage Notice
If you have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. See Your Prescription Drug Coverage and Medicare for details.
This notice advises you that the prescription drug coverage you have through Mercury is expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in 2024. (This is known as “creditable coverage.”) Please read this notice carefully and keep it where you can find it.
Health Care Reform and the Individual Mandate
“Health care reform” refers to the Affordable Care Act (ACA), which was passed in 2010. The law is intended to extend access to medical coverage to nearly everyone in the United States, eliminate restrictions on key benefits, and help control the country’s rising health costs.
The attached Health Insurance Marketplace Exchange Notice provides information about the individual mandate and your coverage options.
Availability of Summary Health Information
As a team member, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury.
Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available an online Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options. You can access your online SBC on Atlas.
Special Enrollment Rights
Special enrollment events allow you and your eligible dependents to enroll for health coverage outside the Open Enrollment period under certain circumstances if you lose eligibility for other coverage, become eligible for state premium assistance under Medicaid or the State Children’s Health Insurance Program (S-CHIP), or acquire newly eligible dependents. This is required under the Health Insurance Portability and Accountability Act (HIPAA).
If you decline enrollment in a Mercury medical plan for you or your dependents (including your spouse/registered domestic partner) because of other health insurance coverage, you or your dependents may be able to enroll in a Mercury medical plan without waiting for the next Open Enrollment period if you:
- Lose other coverage. You must request enrollment within 31 days after the loss of other coverage.
- Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.
- Lose Medicaid or Children’s Health Insurance Program (S-CHIP) coverage because you are no longer eligible. You must request enrollment within 60 days after the loss of such coverage.
- In addition, you may enroll in a Mercury medical plan if you become eligible for a state premium assistance program under Medicaid or S-CHIP. You must request enrollment within 60 days after you gain such coverage.
Women’s Health and Cancer Rights Act of 1998
The act requires that all group health plans providing medical and surgical benefits with respect to a mastectomy must provide coverage for all of the following:
- Reconstruction of the breast on which a mastectomy has been performed
- Surgery and reconstruction of the other breast to produce a symmetrical appearance
- Prostheses
- Treatment of physical complications of all stages of mastectomy, including lymphedemas
This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions, which apply for the mastectomy. For deductibles and coinsurance information applicable to the plan in which you enroll, please refer to the plan descriptions.
Newborns’ and Mothers’ Health Protection Act
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Consolidated Omnibus Budget Reconciliation Act (COBRA)
If you are an team member with medical, dental or vision coverage through Mercury, you have the right to choose continuation coverage if you lose your group health coverage due to reduction in your hours of employment or the termination of your employment for reasons other than gross misconduct. Your eligible dependents may also have the right to elect and pay for continuation of coverage for a temporary period in certain circumstances where coverage under the plan would otherwise end, such as divorce, or dependent children who no longer meet eligibility requirements.
Important Note: This brief summary of the right you and your dependents have to continue insurance is not intended as the official notice of your rights required by federal and state law.
We’ve included this brief summary to inform you that you have these rights. You’ll receive a separate, detailed explanation of your right to continue health insurance coverage when applicable. Specific information is also available from Benefits Administration at 909-607-3195.
You can also call 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at socialsecurity.gov, or call them at 800-772-1213 (TTY 800-325-0778).
Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families
For the latest notice effective July 31, 2023, click here.