November 1, 2020
Women’s Health and Cancer Rights Act of 1998 (WHCRA)
Annual Notice Reminder
If you are covered under the AlaskaCare Employee
Health Plan, you or your dependents may be entitled
to certain benefits under the Women’s Health and
Cancer Rights Act of 1998 (WHCRA). For individuals
receiving mastectomy-related benefits, coverage will
be provided in a manner determined in consultation
with the attending physician and the patient for:
- All stages of reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedema.
Plan limits, deductibles, copayments, and coinsurance
apply to these benefits. For more information on
WHCRA benefits, see the AlaskaCare Employee
Health Plan booklet or contact the Aetna concierge at (855) 784-8646.
COBRA Coverage Reminder
NOTE: The deadlines for electing COBRA
coverage, paying COBRA premiums, and for
notifying the health plan of a Qualifying Event
that is a divorce, separation, loss of dependent
status or a disability are suspended during the
Outbreak Period and will not restart until after
the Outbreak Period ends. Please contact the
Division for more information
In compliance with a federal law referred to as
COBRA Continuation Coverage, this plan offers
AlaskaCare members and their covered dependents
(known as qualified beneficiaries) the opportunity to
elect temporary continuation of their group health
coverage when that coverage would otherwise end
because of certain events (called qualifying events).
Qualified beneficiaries are entitled to elect COBRA
when certain events occur, and, because of the event,
coverage of that qualified beneficiary ends (together, the event and the loss of coverage are called a qualifying event). Qualified beneficiaries who elect
COBRA Continuation Coverage must pay for it at
their own expense. Current defined benefit retirees
COBRA rates are available here
and current active COBRA rates are available
here.
Qualifying events may include termination of
employment, reduction in hours of work making the
employee ineligible for coverage, death of the
employee, divorce/legal separation, or a child ceasing
to be an eligible dependent child under the terms of
the plan, if a loss of coverage results.
In addition to considering COBRA to continue
coverage, there may be other coverage options for you
and your family. You may want to look for coverage
through the Health Care Marketplace at healthcare.
gov. In the Marketplace, you could be eligible for a tax
credit that lowers your monthly premiums for
Marketplace coverage, and you can see what your
premium, deductibles, and out-of-pocket costs will be
before you decide to enroll. Being eligible for COBRA
does not limit your eligibility for Marketplace
coverage or for the tax credit. Additionally, you may
qualify for a special enrollment opportunity for
another group health plan for which you are eligible
(such as a spouse’s plan) if you request enrollment
within 30 days, even if the plan generally does not
accept late enrollees. The maximum period of COBRA
coverage is usually either 18 months or 36 months,
depending on which qualifying event occurred.
To have the chance to elect COBRA coverage after a
divorce/ legal separation or a child ceasing to be a
dependent under the plan, you and/or a family
member must inform the plan in writing of that event
no later than 60 days after that event occurs.
Notices must be sent via first class mail to:
Division of Retirement and Benefits
P.O. Box 110203
Juneau, AK 99811-0203
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or
CHIP and you’re eligible for health coverage from
your employer, your state may have a premium
assistance program that can help pay for coverage,
using funds from their Medicaid or CHIP programs.
If you or your children aren’t eligible for Medicaid or
CHIP, you won’t be eligible for these premium
assistance programs but you may be able to buy
individual insurance coverage through the Health
Insurance Marketplace. For more information, visit
healthcare.gov.
If you or your dependents are already enrolled in
Medicaid or CHIP and you live in a State listed on the
next page, contact your State Medicaid or CHIP office
to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled
in Medicaid or CHIP, and you think you or any of
your dependents might be eligible for either of these
programs, contact your State Medicaid or CHIP office
or dial (877) KIDS NOW or insurekidsnow.gov to find
out how to apply. If you qualify, ask your state if it has
a program that might help you pay the premiums for
an employer-sponsored plan.
If you or your dependents are eligible for premium
assistance under Medicaid or CHIP, as well as eligible
under your employer plan, your employer must allow
you to enroll in your employer plan if you aren’t
already enrolled. This is called a “special enrollment”
opportunity, and you must request coverage within
60 days of being determined eligible for premium
assistance. If you have questions about enrolling in
your employer plan, contact the Department of Labor
at askebsa.dol.gov or call (866) 444-EBSA (3272).
If you live in one of the states listed on the
following page, you may be eligible for assistance
paying your employer health plan premiums. The
following list of states is current as of July 31,
2020. Contact your State for more information.
To see if any other states have added a premium
assistance program since July 31, 2020, or for more
information on special enrollment rights, contact
either:
- U.S. Department of Labor
Employee Benefits Security Administration
Website: dol.gov/agencies/ebsa
(866) 444-EBSA (3272).
- U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
Website: cms.hhs.gov
(877) 267-2323, Menu Option 4, Ext. 61565.
Important Reminder - Taxpayer Identification Number
Provide the Plan with the Taxpayer
Identification Number (TIN) or
Social Security Number (SSN) of
Each Enrollee in a Health Plan
Employers are required by law to collect the taxpayer
identification number (TIN) or social security number
(SSN) of each medical plan participant and provide
that number on reports that will be provided to the
IRS each year. Employers are required to make at least
two consecutive attempts to gather missing
TINs/SSNs.
If a dependent does not yet have a social security
number, visit socialsecurity.gov/online/ss-5.pdf to
complete a request form. Applying for a social
security number is FREE.
The SSN will also be used to help fulfill mandatory
reporting requirements to the Centers for Medicare
and Medicaid (CMS) for the purposes of permitting
Medicare to coordinate benefits for individuals
enrolled in both an employer-sponsored medical plan
and Medicare.
If you have not yet provided the social security
number (or other TIN) for each of your dependents
that you have enrolled in the health plan, please
contact the concierge at (855) 784-8646
Availability of Summary of Benefits and Coverage (SBC) Document(s)
The health benefits that are available to you from the
State of Alaska AlaskaCare Employee Health Plan
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.
In accordance with law, our employee plan provides
you with Summary of Benefits and Coverage (SBC)
documents to help you understand and compare
medical plan benefits. Each SBC document
summarizes and compares essential information
including what is covered, what isn’t, what you need
to pay for diverse benefits, and where to get answers
to questions. The SBC documents are updated when
there is a change to the benefits information.
To get a free copy of the most current SBC documents
for our State of Alaska medical plan options and the
Uniform Glossary that defines many terms in the
SBC, go to AlaskaCare.gov, or for a paper copy,
contact the Division of Retirement and Benefits toll
free at (800) 821-2251 or (907) 465-4460 in Juneau.
We Value Your Feedback!
As an AlaskaCare Retiree member, your input is valued and important. Below, please see a list of ways to contact us with your feedback.
AlaskaCare—Plan Administrator
Send us a letter:
State of Alaska
Division of Retirement and Benefits
P.O. Box 110203
Juneau, AK 99811-0203
Come visit us:
State Office Building
6th Floor
333 Willoughby Avenue
Juneau, AK 99801
Notice of HIPAA Privacy Practices
AlaskaCare Health Plans
This Notice describes how medical information
about you may be used and disclosed and how
you can get access to this information. Please
review it carefully
This Notice is required by law. Your Information. Your Rights. Our
Responsibilities.
Your Rights
You have the right to:
- Get a copy of your health and claims records
- Correct your health and claims records
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and
share information as we:
- Answer coverage questions from your family and friends
- Provide disaster relief
- Market our services and sell your information
Our Uses and Disclosures
We may use and share your information as we:
- Help manage the health care treatment you receive
- Run our organization
- Pay for your health services
- Administer your health plan
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests and work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
Effective Date
The effective date of this Notice is October 1, 2020,
and this notice replaces notices previously distributed
to you.
Privacy Officer
The Plan has designated a Privacy Officer to oversee
the administration of privacy by the Plan and to
receive complaints. The Privacy Officer may be
contacted at:
Your Protected Health Information
The term Protected Health Information (PHI) includes
all information related to your past, present or future
health condition(s) that individually identifies you or
could reasonably be used to identify you and is
transferred to another entity or maintained by the
Plan in oral, written, electronic, or any other form.
PHI does not include health information contained in
employment records held by the State of Alaska in its
role as an employer, including but not limited to:
health information on disability benefits, life
insurance, accidental death and dismemberment
insurance, sick leave, Family or Medical Leave
(FMLA), drug testing, etc.
Your Rights
When it comes to your health information, you
have certain rights. This section explains your rights
and some of our responsibilities to help you.
Get a copy of health and claims records
- You can ask to see or get a copy of your health
and claims records and other health information
we have about you. Ask us how to do this.
- We will provide a copy or a summary of your
health and claims records, usually within 30
days of your request. We may charge a
reasonable, cost-based fee.
Ask us to correct health and claims records
- You can ask us to correct your health and claims
records if you think they are incorrect or
incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll tell
you why in writing within 60 days.
- Request confidential communications
- You can ask us to contact you in a specific way
(for example, home or office phone) or to send
mail to a different address.
- We will consider all reasonable requests and
must say “yes” if you tell us you would be in
danger if we do not.
Ask us to limit what we use or share
- You can ask us not to use or share certain health
information for treatment, payment, or our
operations.
- We are not required to agree to your request, and
we may say “no” if it would affect your care.
- Get a list of those with whom we’ve shared
information.
- You can ask for a list (accounting) of the times
we’ve shared your health information for six
years prior to the date you ask, who we shared it
with, and why.
- We will include all the disclosures except for
those about treatment, payment, and health care
operations, and certain other disclosures (such
as any you asked us to make). We’ll provide one
accounting a year for free but will charge a
reasonable, cost-based fee if you ask for another
one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any
time, even if you have agreed to receive the notice
electronically. We will provide you with a paper copy
promptly.
Choose someone to act for you
If you have given someone medical power of attorney
or if someone is your legal guardian, that person can
exercise your rights and make choices about your
health information. Your Personal Representative will
generally be required to produce evidence (proof) of
the authority to act on your behalf before the Personal
Representative will be given access to your PHI or be
allowed to take any action for you.
Under this Plan, proof of such authority will include a
completed and signed Authorization for the Use and/
or Disclosure of Protected Health Information Alaska.gov/pdf/forms/ben043.pdf .
This Plan will NOT automatically recognize your Spouse as your Personal Representative and vice versa.
In order for your legal Spouse to be your Personal
Representative, you must complete a form,
“Authorization for the Use and/or Disclosure of
Protected Health Information” and submit that
form to the division. The form is available on the
DRB Webpage, Alaska.
gov/pdf/forms/ben043.pdf
You may also present the division with a copy of a
notarized Health Care Power of Attorney allowing
one spouse to make decisions about the other
spouse’s health care if they are unable to do so, or
a document demonstrating you are the courtappointed conservator or guardian for your spouse.
If you have appointed your Spouse as your
Personal Representative, you can indicate the date
the authorization expires. If no expiration date is
listed, this authorization will expire two (2) years
from the date of signature.
File a complaint if you feel your rights are
violated
You can complain if you feel we have violated your
rights by contacting us using the information on
the previous page.
You can file a complaint with the U.S. Department of
Health and Human Services Office for Civil Rights by
sending a letter to:
We will not retaliate against you for filing a
complaint
Your Choices
For certain health information, you can tell us
your choices about what we share. If you have a
clear preference for how we share your information in
the situations described below, talk to us. Tell us what
you want us to do, and we will follow your
instructions.
In these cases, you have both the right and choice to
tell us to:
- Share information with your family, close
friends, or others involved in payment for your
care
- Share information in a disaster relief situation
If you are not able to tell us your preference, for
example if you are unconscious, we may go ahead and
share your information if we believe it is in your best
interest. We may also share your information when
needed to lessen a serious and imminent threat to
health or safety.
In these cases, we never share your information
unless you give us written permission:
- Marketing purposes
- Sale of your information
Our Uses and Disclosures
How do we typically use or share your
health information?
We typically use or share your health information in
the following ways.
Help manage the health care treatment you receive
We can use your health information and share it with
professionals who are treating you.
Example: A doctor sends us information about your
diagnosis and treatment plan so we can arrange
additional services.
Run our organization
- We can use and disclose your information to run
our organization and contact you when
necessary.
- We are not allowed to use genetic information to
decide whether we will give you coverage and
the price of that coverage. This does not apply to
long term care plans.
Example: We use health information about you to
develop better services for you.
Pay for your health services
We can use and disclose your health information as
we pay for your health services.
Example: We share information about you with your
dental plan to coordinate payment for your dental
work.
Administer your plan
We may disclose your health information to your
health plan sponsor for plan administration.
Example: Your company contracts with us to provide a
health plan, and we provide your company with certain
statistics to explain the premiums we charge.
How else can we use or share your health
information?
We are allowed or required to share your information
in other ways – usually in ways that contribute to the
public good, such as public health and research. We
have to meet many conditions in the law before we
can share your information for these purposes. For
more information see: hhs.gov/ocr/privacy/hipaa/
understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain
situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic
violence
- Preventing or reducing a serious threat to
anyone’s health or safety
Do research
We can use or share your information for health
research.
Comply with the law
We will share information about you if state or federal
laws require it, including with the Department of
Health and Human Services if it wants to see that
we’re complying with federal privacy law.
Respond to organ and tissue donation
requests and work with a medical examiner
or funeral director
- We can share health information about you with
organ procurement organizations.
- We can share health information with a coroner,
medical examiner, or funeral director when an
individual dies.
Address workers’ compensation, law
enforcement, and other government requests
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law
enforcement official
- With health oversight agencies for activities
authorized by law
- For special government functions such as
military, national security, and presidential
protective services
Respond to lawsuits and legal actions
We can share health information about you in
response to a court or administrative order, or in
response to a subpoena.
Our Responsibilities
- We are required by law to maintain the privacy
and security of your protected health
information.
- We will let you know promptly if a breach
occurs that may have compromised the privacy
or security of your information.
- We must follow the duties and privacy practices
described in this notice and give you a copy of it.
- We will not use or share your information other
than as described here unless you tell us we can
in writing. If you tell us we can, you may change
your mind at any time. Let us know in writing if
you change your mind.
For more information, see: hhs.gov/ocr/privacy/hipaa/
understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the
changes will apply to all information we have about
you. The new notice will be available upon request,
on our web site, and we will mail a copy to you
AlaskaCare Opioid Guidelines
State and federal guidelines were developed to
address the opioid epidemic in the United States and
Alaska. New safety guidelines were adopted for the
AlaskaCare plans on January 1, 2018 and were
further enhanced on January 1, 2020. The guidelines
limit the dispensing of opioids as follows:
For patients that don’t normally use opioids
- The plan limits the maximum dosage per day to
50 mme and only allows up to a 7-day supply
every 91-days.
- A pre-authorization is required to obtain more
than a 7-day supply within any 91-day period.
For patients that regularly use opioids
- The plan limits the maximum dose per day to 90
mme and only allows up to a 30-day supply.
- A pre-authorization is required periodically.
For patients age 19 or under
- A pre-authorization is required for cough
medications that contain opioids, and the
prescription is limited to a 3-day supply
Members are encouraged to discuss the effect of
the AlaskaCare opioid dispensing policy with their providers and to contact Optum Rx at (855) 409-6999 for support.
Opioids are a type of narcotic pain medication. They
can have serious side effects used incorrectly. For
people who have an opioid addiction, their problem
often started with a prescription.
Opioid Drugs Include:
- Codeine (only available in generic form)
- Hydromorphone (Dilaudid, Exalgo)
- Meperidine (Demerol)
- Methadone (Dolophine, Methadose)
- Morphine (Kadian, MS Contin, Morphabond)
- Fentanyl (Actiq, Duragesic, Fentora, Abstral)
- Oxycodone (OxyContin, Oxaydo)
- Oxycodone and acetaminophen (Percocet, Roxicet)
- Oxycodone and naloxone
- Hydrocodone (Hysingla, Zohydro ER)
- Hydrocodone and acetaminophen (Lorcet, Lortab,
Norco, Vicodin)
Recommendations that influenced the AlaskaCare opioid dispensing policies:
Newborns’ and Mothers’ Health Protection Act Notice
Hospital Length of Stay for Childbirth
Under federal law, group health plans like the
AlaskaCare Employee Health Plan, generally may not
restrict benefits for any hospital stay in connection
with childbirth for the mother or the newborn child
to less than 48 hours following a vaginal delivery, or
less than 96 hours following a cesarean section.
However, the Plan may pay for a shorter stay if the
attending physician (e.g., physician or health care
practitioner), after consultation, discharges the mother
or newborn earlier.
Also, under federal law, plans may not set the level of
benefits or out-of-pocket costs so that any later
portion of the 48-hour (or 96-hour) stay is treated in a
manner less favorable to the mother or newborn than
any earlier portion of the stay.
In addition, the AlaskaCare Employee Health Plan
may not, under federal law, require that a physician or
other health care practitioner obtain authorization for
prescribing a length of stay of up to 48 hours (or 96
hours). However, to use certain providers or facilities
or to reduce your out-of-pocket costs, you may be
required to obtain pre-certification. For information
on pre-certification for a length of stay longer than 48
hours for vaginal birth or 96 hours for C-section,
contact the Aetna concierge at (855) 784-8646 to
pre-certify the extended stay. You may also contact
the Aetna concierge if you have questions about this
notice. Please review the AlaskaCare Employee Health
Plan document for additional information.
Nondiscrimination in Health Care/Elimination of Conflict of Interest
In accordance with the Affordable Care Act, to the
extent an item or service is a covered benefit under
the Plan, and consistent with reasonable medical
management techniques with respect to the
frequency, method, treatment, or setting for an item
or service, the Plan will not discriminate with respect
to participation under the Plan or coverage against
any health care provider who is acting within the
scope of that provider’s license or certification under
applicable state law. In this context, discrimination
means treating a provider differently based solely on
the type of the provider’s license or certification. The
Plan is not required to contract with any health care
provider willing to abide by the terms and conditions
for participation established by the Plan. The Plan is
permitted to establish varying reimbursement rates
based on quality or performance measures.
Additionally, to ensure that the persons involved with
adjudicating claims and appeals (such as claim
adjudicators and medical experts) act independently
and impartially on decisions related to those persons
employment status (such as decisions related to
hiring, compensation, promotion, termination or
retention), will not be made based on whether that
person is likely to support a denial of benefits.
Health Benefit Contact Information
The information provided on this page may or may not be up-to-date. If you are unsure, please contact us.
Please click the Navigation "burger" icon in the top right corner for additional navigation tools.
Click on the "bulb" icon in the main menu at the top to take the Site Tooltip Tour.
For high-contrast version of the DRB site click on the "contrast" icon in the main menu at the top.