Non-Rebate Sample Notice for IU65 Subscriber (PDF) - Florida Blue

Florida BlueP.O. Box 45074Jacksonville, FL 32232< | | | | | | | | B a r C o d e | | | | | | | | | | | | | | | | | | >Dear ,We are required to provide this notice:Medical Loss RatioThis is a federal regulation.The Affordable Care Act requires health insurers in the individual and small groupmarkets to spend at least 80 percent of the premiums they receive on health careservices and activities to improve health care quality (in the large group market,this amount is 85 percent). This is referred to as the Medical Loss Ratio (MLR) ruleor the 80/20 rule. If a health insurer does not spend at least 80 percent of thepremiums it receives on health care services and activities to improve health carequality, the insurer must rebate the difference.A health insurer’s Medical Loss Ratio is determined separately for each State’sindividual, small group and large group markets in which the health insurer offershealth insurance. In some States, health insurers must meet a higher or lowerMedical Loss Ratio. No later than August 1, 2012, health insurers must send anyrebates due for 2011 and information to employers and individuals regarding anyrebates due for 2011.You are receiving this notice because your health insurer had a Medical Loss Ratiofor 2011 that met or exceeded the required Medical Loss Ratio. For moreinformation on Medical Loss Ratio and your health insurer’s Medical Loss Ratio,visit www.HealthCare.gov.SEE REVERSE FOR ADDITIONAL NOTICESFlorida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Crossand Blue Shield Association.74119 0712

The Women’s Health and Cancer Rights Act of 1998 NoticeThere is no action required on your part.The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protectionto patients who choose to have breast reconstruction in connection with a mastectomy.Breast reconstruction surgery can be performed at the same time as the mastectomy or later. You arecovered for both the reconstruction of the breast on which the mastectomy is performed, as well asthe other breast to produce a symmetrical appearance. In addition, your health plan covers prosthesisand treatment of physical complications at all stages of the mastectomy, including lymphedema. Thetype of procedure is determined in consultation between you and your attending physician. Coverageis subject to the terms of your contract.Spread the word …Mammograms help detect breast cancer early, when it’s easier to treat. If you or a family member isdue for a mammogram, schedule this important screening today. Visit the U.S. Preventive ServicesTask Force website at uspreventiveservicestaskforce.org for breast cancer screeningrecommendations.For breast cancer facts, information about treatments, patient forums and more, visit the AmericanCancer Society website at cancer.org, Komen for the Cure ® at komen.org or the National BreastCancer Foundation at nationalbreastcancer.org.Please also review the Gramm-Leach-Bliley Act Privacy Notice enclosed.If you have any questions about the MLR rule, please call 1-866-728-7034.If you have any other questions, please call our customer service number at1-800-352-2583, Monday through Friday 8 a.m. to 9 p.m.