coverage). However, you must request enrollment within 60days after your or your dependents’ other coverage ends (or afterthe employer stops contributing toward the other coverage).Loss of Coverage for Medicaid or a State Children’s HealthInsurance Program. If you decline enrollment for yourselfor for an eligible dependent (including your spouse) whileMedicaid coverage or coverage under a state children’s healthinsurance program is in effect, you may be able to enrollyourself and your dependents in this plan if you or your dependentslose eligibility for that other coverage. However, youmust request enrollment within 60 days after your or your dependents’coverage ends under Medicaid or a state children’shealth insurance program.New Dependent by Marriage, Birth, Adoption, or Placementfor Adoption. If you have a new dependent as a result ofmarriage, birth, adoption, or placement for adoption, you maybe able to enroll yourself and your new dependents. However,you must request enrollment within 60 days after the marriage,birth, adoption, or placement for adoption.Eligibility for Medicaid or a State Children’s HealthInsurance Program. If you or your dependents (including yourspouse) become eligible for a state premium assistance subsidyfrom Medicaid or through a state children’s health insuranceprogram with respect to coverage under this plan, you may beable to enroll yourself and your dependents in this plan. However,you must request enrollment within 60 days after your or yourdependents’ determination of eligibility for such assistance.HIPAA PRIVACYThe Health Insurance Portability and Accountability Act of1996 (HIPAA) imposes numerous requirements on the use anddisclosure of individual health information by Toll Brothers,Inc. health plans. The Notice will explain your rights underHIPAA. The Health Plans and the Plan Sponsor strongly believein protecting the confidentiality and security of informationreceived about you during the course of administering theHealth Plans.The Notice describes how the Health Plans protect the PersonalHealth Information (under HIPAA, this is referred to as“Protected Health Information” or “PHI”) obtained about yourelating to your health coverages, and how the Health Plansmay use and disclose this information. PHI includes individuallyidentifiable information which relates to your past,present or future health, treatment or payment for health careservices. The Notice also describes your rights with respect toyour PHI and how you can exercise those rights.The Health Plans are required to provide this Notice to youunder HIPAA. For additional information regarding the HealthPlans HIPAA Medical Information Privacy Policy or generalprivacy policies, you may consult the Privacy Policies andProcedures Statement maintained by Barbara Colaizzi, thePrivacy Officer for the Health Plans, please see the PrivacyNotices contained on the Toll Brothers intranet site,https://intranet.Tollbrothersinc.com. You may submitquestions to the Health Plans there or you may write directlyto Barbara Colaizzi, HIPAA Privacy Officer, Toll Bros., Inc., 250Gibraltar Road, Horsham, PA 19044.The full HIPAA notice can be found on the Toll Brothersintranet: https://intranet.Tollbrothersinc.com and click onBenefit Programs.FOR MORE INFORMATION ABOUT YOUR RIGHTSMore information about your rights can be found in yourSummary Plan Description, insurance certificates or booklets,as well as any required notices that are sent to you separatelyregarding these rights. If you would like more informationabout any of these notices, please contact the Toll Brothers<strong>Benefits</strong> Department.AFFORDABLE CARE ACTStarting January 1, 2014, the health care reform law willrequire almost all Americans to have health care coverage orbe subject to a penalty tax. If you have questions on thisinformation, you have a number of resources:■■Visit the Toll Human Resources Intranet(https://tnet.tollbrothersinc.com/departments/HR) orcall 866-947-3378 to learn more about the Toll BrothersHealth Coverage■■Visit www.healthcare.gov for information about healthcoverage available in the Marketplace, the cost of the coverage,as well as contact information for a Health InsuranceMarketplace in your area. You will also find an online applicationfor health insurance in the Marketplace on this site.If you are not eligible for Toll Brothers’ health plans, you shouldconsider other options available to you, such as coveragethrough your spouse’s employer plan, your parent’s employerplan, Medicaid, Medicare or your state’s Marketplace.If you decide to enroll through the Marketplace, you will needto provide the Marketplace with the following informationabout Toll Brothers’ and our plans:Employer Identification Number (EIN): 23-2417123Employer address: 250 Gibraltar Road, Horsham PA 19044Employer telephone number: 866-947-3378Name of contact for employee health coverage: The <strong>Benefits</strong>Group/Human ResourcesEmail address of contact: benefits@tollbrothersinc.com23
24ADDITIONAL NOTES