RETIREE BENEFITS - Moreno Valley Unified School District

Important Information about Your Benefits
Notice of Health Insurance Portability and Accountability Act 1996 (HIPAA)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that affects your rights to
obtain health benefits and to safeguard your privacy regarding Protected Health Information (PHI). Specifically,
HIPAA includes, but is not limited to, the following.
• Limitations on pre-existing conditions exclusions
• Prohibitions against discriminating against individual participants and beneficiaries based on health status.
• Special enrollment periods under certain conditions for qualified individual
• Privacy standards
Newborns and Mothers’ Protection Act
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for 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 delivery. 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 newborn earlier than 48 hours after delivery (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).
Notice of COBRA Rights
In accordance with the Consolidated Omnibus Budget Reconciliation Act (COBRA), when you or your covered
dependents would otherwise lose benefits coverage under the MVUSD plan, you or your covered dependents
may be eligible to continue benefits at your own expense. For you to be eligible, a “qualifying event” causing the
loss of coverage must take place. Note that Domestic partners and child(ren) of a domestic partner are not
eligible for COBRA unless they qualify as a dependent under the IRS guidelines.
Qualifying events include (but are not limited to) an employee’s termination (other than for “ gross misconduct”),
resignation, reduction in hours, divorce, legal separation, death, and dependent children becoming no longer
eligible for coverage. Qualified beneficiaries will be notified by the District’s COBRA Administrator, SISC, and will
receive election information.
Please Direct Questions to the District’s COBRA Administrator
SISC III
Attn: COBRA
PO Box 1847
Bakersfield, CA 93303
(800)972-1727
Appealing a Claim
If a claim has been denied for you or your eligible family members, you may appeal the claim. Each carrier has its
specific appeal process to follow. Please call your insurance carrier member services for the specific grievance and
appeals process.
Filing a Complaint or Grievance
Each insurance carrier has a specific process for effectively handling complaints and grievances. Please contact
your insurance carrier member services about the appeals process. A Provider Directory is found in this packet.