Legal Statements and Disclosures

Dear Team Member:

Each year we are required to notify you of your rights under certain federal laws, and to provide you with a Summary Annual Report (SAR) for the 401(k) Retirement and Savings Plan, a Summary Annual Report for the Team Member Benefit Plan and a Creditable Coverage Notice regarding the prescription drug coverage and Medicare.

Below are brief descriptions of these laws.  You may also contact the Team Member Benefits Department, 806-791-0220 (toll-free 1-888-791-0220), for additional information or to request a paper copy.

 

HIPAA Portability Rights

The Health Insurance Portability and Accountability Act (HIPAA) requires that group health plans reduce the period of pre-existing condition exclusions by an individual’s “Creditable Coverage” under another group health plan, individual health policy, Medicare, or certain other medical plans or coverage. Creditable Coverage includes coverage an individual has as an employee, primary insured, dependent or beneficiary. You may be required to provide evidence of prior Creditable Coverage.

 

Special Enrollment Rights

If you are declining enrollment for yourself or you dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in the medical plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage).  However, you must request enrollment within 30 days after the other coverage ends. 

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents.  However, you must request enrollment within 30 days after the event.

 

General Notice of COBRA Continuation Coverage Rights

If you are covered under United Supermarkets’ Team Member Health Plan, or if you choose to be covered effective Jan. 1, 2012, you have rights to COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, review the Summary Plan Description located on the website.

 

Women’s Health and Cancer Rights Act

The Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema.

 

Notice of Privacy Practices

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 Privacy Rule gives individuals a fundamental right to be informed of the privacy practices of their health plans and of most of their health care providers, as well as to be informed of their privacy rights with respect to their personal health information.  Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices.  The notice is intended to focus individuals on privacy issues and concerns, and to prompt them to have discussions with their health plans and health care providers and exercise their rights.

 

Children’s Health Insurance Program Reauthorization Act

The Children’s Health Insurance Program Reauthorization Act of 2009 created two new special enrollment rights for Team Members and their dependents. The Act states that if you or your dependents lose coverage under Medicaid or a state child health plan, you may request to enroll yourself and/or your dependents in United Supermarkets’ Team Member Health Plan no later than 60 days after the date you coverage ends. The Act also states that if you and/or your dependents become eligible for financial assistance from Medicaid or a state child health plan and you are currently enrolled in our group health plan, you have the option of terminating enrollment in our group health plan for you and your dependents and the other plan no later than 60 days after becoming eligible for coverage under one of those plans. Please note that once you terminate your enrollment in our group health plan, your dependents’ enrollment will also be terminated. Failure to notify us within 60 days will prevent your enrolling in our plan and/or making any changes to your coverage until the 2013 enrollment period.

 

Medicaid and the Children’s Health Insurance Program (CHIP)

If you are eligible for health coverage, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. If you or your dependents are already enrolled in Medicaid or CHIP and you can contact the State of Texas Medicaid office at 1-800-440-0493 or online at www.gethipptexas.com.

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, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW, or go to www.insurekidsnow.gov to find out how to apply.  If you qualify you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

 

Newborns Act

The United Supermarkets Team Member Health Plan and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal 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, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable).  In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

 

Grandfathered Health Plan

United Supermarkets believes the United Supermarkets Team Member Health Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act).  As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when the law was enacted.  Being grandfathered health plan means that your  plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing.  However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status, can be directed to the benefits department. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform.  This website has a table summarizing which protections do and do not apply to grandfathered health plans. You may also contact the U.S. Department of Health and Human Services at www.healthreform.gov.

 

Wellness Program Disclosure

If it is unreasonably difficult due to a medical condition for a Team Member to achieve the standards for the incentives or rewards under the become wellness program, or if it is medically inadvisable to attempt to achieve the standards for the incentives under this program, contact the Team Member Benefits Department to try to develop another way to qualify for the incentives.

 

Dependent Coverage to Age 26

Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in United Supermarkets' Team Member Health Plan. You may request enrollment for such children for 30 days during the annual enrollment process beginning in November 2011. Enrollment will be effective January 1, 2012.

 

Lifetime Limit No Longer Applies

The lifetime limit on the dollar value of benefits under United Supermarkets' Team Member Health 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 during the annual enrollment period beginning in November 2011 to request enrollment. Enrollment will be effective January 1, 2012.

 

Affordable Care Act

You do not need prior authorization from the administrator of the United Supermarkets' Team Member Health Plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology.  The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals.  For a list of participating health care professionals who specialize in obstetrics or gynecology, contact BlueCross BlueShield of Texas, toll-free, at 1-800-521-2227, or go to www.bcbstx.com.

 

Respectfully,

Lou L. Moore, SPHR
Director of Team Member Benefits

 

For Your Information

This Web site highlights the main features of many of the benefit plans sponsored by United Supermarkets, LLC. Full details of these benefits are contained in the legal documents governing the plans. If there is any discrepancy or conflict between the plan documents and the information presented here, the plan documents will govern. In all cases, the plan documents are the exclusive source for determining rights and benefits under the plans. United Supermarkets, LLC, reserves the right to change or discontinue the plans at any time. Participation in the plans does not constitute an employment contract. United Supermarkets, LLC, reserves the right to modify, amend, or terminate any benefit plan or practice described in this Web site. Nothing in this Web site guarantees that any new plan provisions will continue in effect for any period. This Web site serves as a summary of material modifications as required by the Team Member Retirement Income Security Act of 1974 (ERISA), as amended. Plan documents are available by calling the Team Member Benefits Department, United Supermarkets Store Support Center, at 1-888-791-0220.