NOTICES
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 Cavaliers Holdings, LLC is at will and, therefore, for no definite period. Nothing in the policies contained in the guide limits or restricts the right of the Cavaliers Holdings, LLC or any team member to terminate the employment relationship at any time, with or without cause, with or without notice, and for any reason, at the sole discretion of the Cavaliers Holdings, LLC 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.
Cavaliers Holdings, LLC 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.
Cavaliers Holdings, LLC 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 New Mothers Care Disclosure
This Plan generally does not, consistent with applicable 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, consistent with that same Federal law, this Plan 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, this Plan does not, in accordance with 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).
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 (WHCRA) Annual and Regular Notice
As required by the Women’s Health and Cancer Rights Act (WHCRA) of 1998, notwithstanding anything herein to the contrary, the Plan provides coverage for: 1) all stages of reconstruction of the breast on which the mastectomy has been performed; 2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3) prostheses and physical complications of mastectomy, including lymphedemas, in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other benefits under the plan or coverage. Written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter. Contact the Plan Administrator listed in the Summary Plan Description, or contact the Human Resources department staff for further information.
HIPAA Notice of Privacy Practices
You are receiving this Privacy Notice because you are eligible to participate in an employer sponsored group health plans. The Health Plans are committed to protecting the confidentiality of any health information collected about an individual. This Notice describes how the Health Plan may use and disclose, “protected health information” (PHI). For information to be considered “PHI”, it must meet three conditions:
Information is created or received by a health care provider, health plan, employer, or health care clearinghouse; Information relates past, present, or future physical or mental health condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and the information either identifies the individual or provides a reasonable basis for believing that it can be used to identify the individual.
The Health Plan is required by the Health Insurance Portability and Accountability Act (HIPAA) to provide this Notice to an individual. Additionally, the Health Plan is required by law to:
Maintain the privacy of an individual’s “protected health information” (PHI) and provide you with the Privacy Notice of its legal duties and privacy practices with respect to an individual’s PHI and follow the terms of its Privacy Notice that is currently in effect.
Employees of the plan sponsor who administer and manage this Health Plan may use PHI only for appropriate plan purposes (such as for payment or health care operations), but not for purposes of other benefits not provided by this plan, and not for employment-related purposes of the plan sponsor. These individuals must comply with the same requirements that apply to the Health Plan to protect the confidentiality of PHI.
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 Cavaliers Holdings 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)
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 www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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 1-
877-KIDS NOW or www.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 www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
