▶ Next Annual Enrollment Guide Retired Represented Employees (retired on/before October 15, 2015) Click on a topic below to go directly to the information you need. Annual Enrollment for 2018 has arrived! Annual Enrollment is your once-a-year opportunity to review your benefit options for the coming year and select the coverages that will work best for you and your family. Please review this Guide in its entirety. You and your family are eligible to enroll in or make changes to your dental coverage and update beneficiary information with Avaya during this Annual Enrollment period. We encourage you to review the available online resources to become familiar with the benefits choices available to you. You will not need to actively enroll in dental benefits for 2018 during Annual Enrollment if you do not wish to make changes. However, if you are enrolled in the Dental DMO in 2017 and want to continue your DMO coverage in to 2018, you need to call Aetna at 1-877-508-6927 in January to re-enroll. Your DMO election does not carry over from year to year. Annual Enrollment 2018 October 11 – 24, 2017 Benefits selected during this enrollment period will be effective January 1, 2018. Important Reminders Helpful Links & Tools to Take Control of Your Health Legal Reminders Important Contacts What’s New for 2018 Important Reminders Helpful Links & Tools to Take Control of Your Health Legal Reminders Important Contacts Click on a topic below to go directly to the information you need.
Youwillnotneedtoactivelyenrollindentalbenefitsfor2018duringAnnualEnrollmentifyoudonotwishtomakechanges.However, if you are enrolled in the Dental DMO in 2017 and want to continue your DMO coverage in to 2018, you need to call Aetna at 1-877-508-6927 inJanuary to re-enroll.YourDMOelectiondoesnotcarryoverfromyeartoyear.
Annual Enrollment 2018October 11 – 24, 2017
Benefits selected during this enrollment period will be effective January 1, 2018.
Potentialmembersmaylogontowww.aetna.com>FindaDoctor>Under“Orsearchwithoutloggingin”,selectPlans through your job or spouse’s/partner’s job>WhenaskedtoSelectaPlan,chooseAetnaChoicePOSII(OpenAccess)
Health Plan Administration and Operation.WemayuseanddiscloseyourPHIforPlanoperations.TheseusesanddisclosuresarenecessarytorunthePlan.Wemayusemedicalinformationinconnectionwithconductingqualityassessmentandimprovementactivities;enrollment,premiumrating,andotheractivitiesrelatingtoPlancoverage;submittingclaimsforstop-loss(orexcess-loss)coverage;conductingorarrangingformedicalreview,legalservices,auditservices,andfraudandabusedetectionprograms;businessplanninganddevelopmentsuchascostmanagement;andbusinessmanagementandgeneralPlanadministrativeactivities.Forexample,wemayuseyourclaimsdatatoalertyoutoanavailablecasemanagementprogramifyoubecomepregnantorarediagnosedwithdiabetesorliverfailure.WemayalsodiscloseyourPHItoanotherhealthplanorhealthcareproviderwhohasarelationshipwithyoufortheiroperationsactivitiesifthedisclosureisforqualityassessmentandimprovementactivities,toreviewthequalificationsofhealthcareprofessionalswhoprovidecaretoyou,orforfraudandabusedetectionandpreventionpurposes.
Family and Friends.WemaydisclosePHItoafamilymember,friend,orotherpersoninvolvedinyourhealthcareifyouarepresentandyoudonotobjecttothesharingofyourPHI,or,ifyouarenotpresent,intheeventofanemergency.
As Required by Law.WewilldiscloseyourPHIwhenrequiredtodosobyfederal,stateorlocallaw.Forexample,wemaydiscloseyourPHIwhenrequiredbynationalsecuritylawsorpublichealthdisclosurelaws.
Public Health Reasons.WemaydiscloseyourPHIforpublichealthactions,including(1)toapublichealthauthorityforthepreventionorcontrolofdisease,injuryordisability;(2)toapropergovernmentorhealthauthoritytoreportchildabuseorneglect;(3)toreportreactionstomedicationsorproblemswithproductsregulatedbythe
Health Oversight Activities.WemaydiscloseyourPHItoahealthoversightagencyforactivitiesauthorizedbylaw.Theseoversightactivitiesinclude,forexample,audits,investigations,inspections,andlicensure.Theseactivitiesarenecessaryforthegovernmenttomonitorthehealthcaresystem,governmentprograms,andcompliancewithcivilrightslaws
Government Audits.WearerequiredtodiscloseyourprotectedhealthinformationtotheSecretaryoftheUnitedStatesDepartmentofHealthandHumanServiceswhentheSecretaryisinvestigatingordeterminingourcompliancewiththePrivacyRules.
Lawsuits and Disputes.Ifyouareinvolvedinalawsuitoradispute,wemaydiscloseyourPHIinresponsetoacourtoradministrativeorder.WemayalsodiscloseyourPHIinresponsetoasubpoena,discoveryrequest,orotherlawfulprocessbysomeoneelseinvolvedinthedispute,butonlyifeffortshavebeenmadetotellyouabouttherequestortoobtainanorderprotectingtheinformationrequested.
Law Enforcement.WemaydiscloseyourPHIifaskedtodosobyalawenforcementofficial(1)inresponsetoacourtorder,subpoena,warrant,summonsorsimilarprocess;(2)toidentifyorlocateasuspect,fugitive,materialwitness,ormissingperson;(3)aboutthevictimofacrimeif,undercertainlimitedcircumstances,weareunabletoobtainthevictim’sagreement;(4)aboutadeaththatwebelievemaybetheresultofcriminalconduct;and(5)aboutcriminalconduct.
Coroners, Medical Examiners and Funeral Directors.WemayreleasePHItoacoronerormedicalexaminer.Thismaybenecessary,forexample,toidentifyadeceasedpersonordeterminethecauseofdeath.Wemayalsoreleasemedicalinformationtofuneraldirectorsasnecessarytocarryouttheirduties.
Military and Veterans. Ifyouareamemberofthearmedforces,wemayreleaseyourPHIasrequiredbymilitarycommandauthorities.WemayalsoreleasePHIaboutforeignmilitarypersonneltotheappropriateforeignmilitaryauthority.
To Plan Sponsor. ForthepurposeofadministeringtheHealthPlan,wemaydisclosePHItocertainemployeesofAvaya.However,thoseemployeeswillonlyuseordisclosethatinformationasdescribedabove,unlessyouhaveauthorizedfurtherdisclosures.YourPHIcannot be used for employment purposeswithoutyourspecificauthorization.
Business Associates.Wemayenterintoagreementswithentitiesorindividualstoprovideservices(forexample,claimsprocessingservices)tooneormoreoftheHealthPlan.Theseserviceproviders,called“businessassociates,”maycreate,receive,haveaccessto,use,and/ordisclose(includingtootherbusinessassociates)PHIinconjunctionwiththeservicestheyprovidetotheHealthPlan,providedthatwehaveobtainedsatisfactorywrittenassurancesthatthebusinessassociateswillcomplywithallapplicablePrivacyRuleswithrespecttosuchHealthPlan.
Research Purposes.Wemayuseordisclosea“limiteddataset”ofyourPHIwithvariousidentifyinginformationexcludedforcertainresearchpurposes.
Personal Representatives.WewilldiscloseyourPHItoindividualsauthorizedbyyou,ortoanindividualdesignatedasyourpersonalrepresentative,attorney-in-fact,etc.,solongasyouprovideuswithawrittennotice/authorizationandanysupportingdocuments(i.e.,powerofattorney).Note:UnderthePrivacyRules,wedonothavetodiscloseinformationtoapersonalrepresentativeifwehaveareasonablebeliefthat:
Spouses and Other Family Members.Withonlylimitedexceptions,wewillsendallmailtotheemployee.Thisincludesmailrelatingtotheemployee’sspouseandotherfamilymemberswhoarecoveredunderthePlan,andincludesmailwithinformationontheuseofPlanbenefitsbytheemployee’sspouseandotherfamilymembersandinformationonthedenialofanyPlanbenefitstotheemployee’sspouseandotherfamilymembers.IfapersoncoveredunderthePlanhasrequestedRestrictionsorConfidentialCommunications(seebelowunder“YourRights”),andifwehaveagreedtotherequest,wewillsendmailasprovidedbytherequestforRestrictionsorConfidentialCommunications.
Right to request restrictions.YouhavetherighttorequestarestrictionorlimitationontheHealthPlan’suseordisclosureofyourPHI.Forexample,youmayaskustolimitthescopeofyourPHIdisclosurestoacasemanagerwhoisassignedtoyouformonitoringachroniccondition.BecauseweuseyourPHIonlyasnecessarytopayHealthPlanbenefits,toadministertheHealthPlan,andtocomplywiththelaw,itmaynotbepossibletoagreetoyourrequest.
Right to receive confidential communications. YouhavetherighttorequestthattheHealthPlancommunicatewithyouaboutyourPHIatanalternativeaddressorbyalternativemeansifyoubelievethatcommunicationthroughnormalbusinesspracticescouldendangeryou.Forexample,youmayrequestthattheHealthPlancontactyouonlyatworkandnotathome.
Right to inspect and copy your PHI.YouhavetherighttoinspectandcopyyourPHIthatiscontainedinrecordsthattheHealthPlanmaintainsforenrollment,payment,claimsdetermination,orcaseormedicalmanagementactivities,orthatweusetomakeenrollment,coverage,orpaymentdecisionsaboutyou.IfPHIismaintainedinanelectronichealthrecord,youshallhavetherighttoobtainacopyofsuchPHIinanelectronicformatandmaydirecttheHealthPlantotransmitsuchcopydirectlytoanentityorperson,providedthatyouclearlyandconspicuouslycommunicateyourinstructions.However,wewillnotgiveyouaccesstoPHIrecordscreatedinanticipationofacivil,criminal,oradministrativeactionorproceeding.WewillalsodenyyourrequesttoinspectandcopyyourPHIifalicensedhealthcareprofessionalhiredbytheHealthPlanhasdeterminedthatgivingyoutherequestedaccessisreasonablylikelytoendangerthelifeorphysicalsafetyofyouoranotherindividualortocausesubstantialharmtoyouoranotherindividual,orthattherecordmakes
Right to amend your PHI. YouhavetherighttorequestanamendmentofyourPHIifyoubelievetheinformationtheHealthPlanhasaboutyouisincorrectorincomplete.YouhavethisrightaslongasyourPHIismaintainedbytheHealthPlan.WewillcorrectanymistakesifwecreatedthePHIorifthepersonorentitythatoriginallycreatedthePHIisnolongeravailabletomaketheamendment.
Right to receive an accounting of disclosures of PHI. YouhavetherighttorequestalistofcertaindisclosuresofyourPHIbytheHealthPlan.Theaccountingwillnotinclude(1)disclosuresnecessarytodetermineproperpaymentofbenefitsortooperatetheHealthPlan,(2)disclosureswemaketoyou,(3)disclosurespermittedbyyourauthorization,(4)disclosurestofriendsorfamilymembersmadeinyourpresenceorbecauseofanemergency,(5)disclosuresfornationalsecuritypurposes,(6)tocertainpersonsinvolvedinyourcareorpaymentforthatcareortonotifycertainpersonsofyourlocation,generalcondition,ordeath,ortoassistindisasterreliefefforts,(7)tocorrectionalinstitutionsorlawenforcementwhenthedisclosurewaspermittedwithoutauthorization;(8)aspartofa“limiteddataset”(asdefinedinthePrivacyRules),whichlargelyrelatestoresearchpurposes;or(9)priortothecompliancedateofApril14,2003.Yourfirstrequestforanaccountingwithina12-monthperiodwillbefree.Wemaychargeyouforcostsassociatedwithprovidingyouadditionalaccountings.Wewillnotifyyouofthecostsinvolved,andyoumaychoosetowithdrawormodifyyourrequestbeforeyouincuranyexpenses.
Right to Receive Notification of Breaches.Wewillnotifyyouinwriting,withoutunreasonabledelay,ofanybreachinvolvingyourunsecuredPHI(ifany)inaccordancewiththefederalbreachnotificationregulations.Generally,“unsecuredPHI”meansPHIwhich
Right to file a complaint.Ifyoubelieveyourrightshavebeenviolated,youshouldletusknowimmediately.WewilltakestepstoremedyanyviolationsoftheHealthPlan’sprivacypolicyorofthisNotice.
YoumayfileaformalcomplaintwithourHealthPlanAdministratorand/orwiththeUnitedStatesDepartmentofHealthandHumanServices-OfficeofCivilRights(“OCR”)attheaddressesbelow.Youshouldattachanydocumentsorevidencethatsupportsyourbeliefthatyourprivacyrightshavebeenviolated.Wetakeyourcomplaintsveryseriously.Avaya prohibits retaliation against any person for filing such a complaint.
Changes to this Notice.WereservetherighttochangetheHealthPlan’sprivacypracticesasdescribedinthisNotice.AnychangemayaffecttheuseanddisclosureofyourPHIalreadymaintainedbytheHealthPlan,aswellasanyofyourPHIthattheHealthPlanmayreceiveorcreateinthefuture.IfthereisamaterialchangetothetermsofthisNotice,youwillautomaticallyreceivearevisedNotice.
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How to obtain a copy of this Notice.YouhavetherighttoreceiveapapercopyofthisNotice.YoumayaskustogiveyouacopyofthisNoticeatanytime.EvenifyouhaveagreedtoreceivethisNoticeelectronically,youstillhavetherighttoapapercopyofthisNotice.YoucanobtainacopyofthecurrentNoticeathttps://my.adp.comundertheForms&PlanDocumentstileonthehomepage(filteron“F”for“Form-HIPAA”).Ifyoudonothaveaccesstoacomputerorotherwiserequestapapercopyoftherevisednotice,contacttheAvayaHealth&BenefitsDecisionCenterat1-800-526-8056 (option 1)torequestyourcopies.
No guarantee of employment. ThisNoticedoesnotcreateanyrighttoemploymentforanyindividual,nordoesitchangeAvaya’srighttodisciplineordischargeanyofitsemployeesinaccordancewithitsapplicablepoliciesandprocedures.
No change to Health Plan benefits. ThisNoticeexplainsyourprivacyrightsasacurrentorformerparticipantinHealthPlan.TheHealthPlanisboundbythetermsofthisNoticeastheyrelatetotheprivacyofyourPHI.However,thisNoticedoesnotchangeanyotherrightsorobligationsyoumayhaveundertheHealthPlan.YoushouldrefertotheHealthPlandocumentsforadditionalinformationregardingyourHealthPlanbenefits.
Notice of Non-Creditable Coverage – Prescription Drug Coverage and Medicare
If this Non-Creditable Coverage notice has been delivered to you by electronic means, you have the right to receive a written notice and may request a copy of this notice on a written paper document at no charge by contacting the person listed below. Also, if you are the participant under Avaya Inc.’s group health plan, you are responsible for providing a copy of this notice to each of your Medicare Part D eligible dependents covered under the plan.
About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Avaya Inc. (Avaya) and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan when you become eligible for such coverage. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
