Resources
Where state or local law conflicts with a particular policy the law of that jurisdiction will apply. Nothing in the policies contained in this guide is intended or shall be construed to create any contractual obligation (express or implied) or to constitute a contract or promise of continued employment. Employment with the City of Stow is at will and, therefore, for no definite period. Nothing in the policies contained in the guide limits or restricts the right of the City or any team member to terminate the City or the team member. This Guide contains a non-technical explanation of some of the important features of certain benefit plans that are covered in detail in official plan documents. Copies of the governing instruments of these plan documents, and the Summary Plan Descriptions, which are modified from time to time, are readily available for inspection during normal business hours in Human Resources. These documents are determinative of the precise benefits, terms, conditions, exclusions, and restrictions that apply to coverage under the aforementioned plans. They supersede all other documents. If a question should arise concerning the nature of these benefits, the actual legal documents will govern and not the contents of this guide. No team leader has any authority to interpret the plan documents or to make any promises about the plans.
The City of Stow and its Plan Administrators and Fiduciaries reserve the maximum discretion permitted by law to administer, interpret, enhance, modify, discontinue, or otherwise change any benefit plan, practice, or procedure.
While you may receive feedback in response to your questions about the benefit plans we offer, none of those responses can modify the terms of the official plan documents and, consequently, do not represent a promise or guarantee of benefits. Please always refer to the plan documents rather than relying on anyone’s interpretation of the benefit plans.
The City reserves the right to modify or eliminate any of its benefits, plans, policies, procedures or practices at any time, as to present or future team members, generally or in individual cases, with or without advance notice.
Special Enrollment Rights
You may be eligible to enroll yourself and your dependents in a medical plan without waiting for an open enrollment period if:
- You or your eligible dependents declines the Medical Plan because you have other group medical coverage, then you lose the other coverage because you are no longer eligible, or because the employer failed to pay the required premium. In such cases, you must enroll in the Medical Plan within 30 days after losing the other coverage. You will have to provide proof that you had other coverage.
- You or your eligible dependents declines the Medical Plan because you have COBRA coverage under another group medical plan, then you exhaust your COBRA coverage. In such cases, you must complete your entire COBRA coverage period, and you must enroll in the Medical Plan within 30 days after completing your COBRA coverage period. You will have to provide proof that you completed your COBRA coverage period.
- You decline the Medical Plan and then a new dependent is added to your family due to marriage, birth, adoption or placement for adoption. In such cases, you must enroll in the Medical Plan within 30 days after the marriage, birth, adoption or placement for adoption. You will have to provide proof of the event.
- You or your eligible dependents become eligible for premium assistance through a state Medicaid or Children’s Health Insurance program (CHIP) and when you lose coverage under one of these programs. In such cases, you must request enrollment not later than 60 days after the loss of Medicaid or CHIP coverage or not later than 60 days of the determination of eligibility for Medicaid or CHIP premium assistance.
For more information please contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply.
Newborns’ and Mothers’ Health Protection Act
Under federal law, health care plans may not restrict any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a normal 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 and with the mother’s consent, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable).
Continued coverage under COBRA
Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you and your covered dependents may be able to continue your medical and dental coverage if you lose your health care coverage as the result of certain qualifying events. Contact Human Resources for more information.
Women’s Health and Cancer Rights Act of 1998
Under the Women’s Health and Cancer Rights Act, group health plans must make certain benefits available to participants of health plans who have undergone a mastectomy. In particular, a plan must offer mastectomy patients benefits for:
- Reconstruction of the breast on which the mastectomy was performed;
- Any necessary surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical conditions related to the mastectomy, including lymphedema.
Our medical plan complies with these requirements. Benefits for these items are similar to those provided under the plan for similar types of medical services and supplies.
HIPAA regulations help to protect your privacy
The privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) help to ensure that your health care-related information stays private. New team members will receive a Privacy Practice Notice which outlines the ways in which the medical plan may use and disclose protected health information (PHI). The notice also describes your rights. For more information, contact Human Resources.
Extension of dependent coverage to age 26
The Medical Plan will cover eligible dependent children of a team member to age 26, regardless of student status, marital status, residence or financial dependence on the team member.
Your Rights under Michelle’s Law
Effective January 1, 2010, full-time students covered under the group health plan, who would otherwise lose eligibility under the plan because of a reduction in their full-time class status due to a medically necessary leave of absence from school, may be eligible to extend their coverage under the plan for up to one year, or to age 26, whichever occurs first. The child must be a dependent child of a plan participant and be enrolled in the company group health plan on the basis of being a student at a post-secondary educational institution immediately before the first day of the leave.
Mental Health Parity
Effective January 1, 2010, the City of Stow sponsored medical plan was modified to cover mental health and substance abuse expenses subject to the same treatment limits, deductibles, copayments, coinsurance and out-of-pocket requirements that apply to other medical and surgical expenses. This change applies to both inpatient and outpatient services.
Lifetime Limit
Effective January 1, 2011, the lifetime limit on the dollar value of benefits under the medical plan no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this notice to request enrollment. For more information contact Human Resources.
Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)
The Children’s Health Insurance Program (CHIP) was created in 1997 to provide affordable health coverage to low-income children in working families who make too much money to be eligible for Medicaid but not enough to afford private coverage. The program currently covers more than 7 million children. On February 4, 2009, CHIPRA was signed into law which formally reauthorizes the program. CHIPRA took effect on April 1, 2009.
