2-Exhibit 2 - HI Ballot Language.pdf
PDF 221 KB Posted
- Attached to
- Benefit Administration with COBRA & FSA/HSA
- Solicitation number
- RFP 3585-7
- Issued by
- Maricopa County, Arizona
About this file
This document is an exhibit containing enrollment disclosure language and regulatory requirements for Hospital Indemnity Insurance, prepared in connection with the Maricopa County Community College District's (MCCCD) solicitation for a Third-Party Administrator to provide comprehensive benefits administration services including COBRA and FSA/HSA management in Arizona. The exhibit specifies federal regulatory requirements mandating that Hospital Indemnity Insurance disclosures be prominently displayed on the first page of enrollment materials in at least 14-point font with contrasting colors, without requiring links or obscuration by other content. The disclosure must clarify that Hospital Indemnity Insurance is a fixed indemnity policy, not comprehensive health insurance, and that coverage provides limited dollar amounts for hospitalization or illness while leaving participants responsible for actual medical costs. The document applies to all states except California, Colorado, Minnesota, New Hampshire, New Mexico, New York, Pennsylvania, and Vermont, with specific acknowledgment language required for Minnesota and Vermont residents declaring that all insured individuals maintain active medical coverage.
The enrollment language requires participants to acknowledge receipt of the policy outline of coverage, review of enrollment documentation, and certification that all provided information is accurate and complete. The disclosure directs participants to HealthCare.gov or 1-800-318-2596 for comprehensive health insurance options and instructs them to contact their State Department of Insurance or employer with policy questions or complaints. This exhibit represents regulatory compliance documentation that the selected Third-Party Administrator must incorporate into their benefits administration platform to satisfy federal disclosure requirements and state-specific enrollment procedures for Hospital Indemnity Insurance offerings within the MCCCD benefits program.
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Text version
EXHIBIT 2
3585-7 Benefit Administration with COBRA & FSA/HSA Page 1 of 3
All states, except CA, CO, MN, NH, NM, NY, PA and VT
Enrollment Regulatory Requirement for
Hospital Indemnity
Requirement
Federal regulation requires that the following disclosure (following this page) be provided to participants at or before the time they enroll or re-enroll in coverage. The regulation indicates the disclosure must be prominently displayed on the “first page” of the enrollment experience, in at least 14-point font. The regulation defines “prominently displayed” to include criteria such as:
using font colors that contrast with background to make it more visible; not requiring that someone click on a link to view it; and not obscuring it with other text or graphics. The heading that appears above the disclosure clarifying that the notice applies to Hospital Indemnity may be omitted as needed if the enrollment experience addresses only Hospital Indemnity.
3585-7 Benefit Administration with COBRA & FSA/HSA Page 2 of 3
This notice applies to Hospital Indemnity Insurance. In certain states, this coverage may be referred to as Accident and Sickness Insurance.
IMPORTANT: This is a fixed indemnity policy, NOT health insurance
This fixed indemnity policy may pay you a limited dollar amount if you’re sick or hospitalized. You’re still responsible for paying the cost of your care.
• The payment you get isn’t based on the size of your medical bill.
• There might be a limit on how much this policy will pay each year.
• This policy isn’t a substitute for comprehensive health insurance.
• Since this policy isn’t health insurance, it doesn’t have to include most Federal consumer protections that apply to health insurance.
Looking for comprehensive health insurance?
• Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
• To find out if you can get health insurance through your job, or a family member’s job, contact the employer.
Questions about this policy?
• For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners’ website (naic.org) under “Insurance Departments.”
• If you have this policy through your job, or a family member’s job, contact the employer.
3585-7 Benefit Administration with COBRA & FSA/HSA Page 3 of 3
Hospital Indemnity Enrollment Language (Please note the language below should appear before completing enrollment)
Your Hospital Indemnity certificate provides limited benefits – read your certificate carefully when you receive it. Hospital Indemnity Insurance may be referred to as Accident and Sickness
Insurance in Colorado – please consult your enrollment materials. By enrolling for Hospital
Indemnity Insurance, if I am a resident of Minnesota or Vermont, I declare all individuals to be insured have medical coverage in force that provides benefits for medical treatment, including hospital, surgical and medical expenses. I acknowledge that I have received and read a copy of the outline of coverage or other disclosure document for the Hospital Indemnity insurance. In addition, I have read the enrollment documentation and declare that all information I have given is true and complete to the best of my knowledge and belief; I have read the applicable
Fraud Warning(s) provided in this enrollment.
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