The following are summaries of legal notices regarding your rights and procedures to protect those rights. You may view, download or print a copy of the notices directly from the My MonteBenefits Resource section. To request a print version of these notices, contact the HR Benefits Office by email at [email protected] or call 914.349.8531.

Children’s Health Insurance Program (CHIP) Notice – If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from Montefiore, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs.

Claiming Healthcare Benefits − Federal law requires your healthcare coverage to provide a process for filing claims for services and supplies that are urgent in nature in addition to procedures for post service claims.

Consolidated Omnibus Budget Reconciliation Act (COBRA) − COBRA gives workers and their families who lose their health benefits under certain circumstances the right to continue their group health benefits for limited periods of time.

Genetic Information Nondiscrimination Act (GINA) − GINA prohibits employers, employment agencies, and labor unions from discriminating against employees based on genetic information. It also prohibits insurers from charging higher premiums based on genetic information or from using genetic information in underwriting decisions.

HIPAA Special Enrollment Rights – You may request a special enrollment in Montefiore’s healthcare coverage under the following circumstances:

• Within 30 days of the date:

• You or a family member loses other group health plan coverage (such as a spouse’s plan)
• You acquire a new family member through marriage, birth, adoption or legal guardianship

• Within 60 days of the date you or a family member:

• Is no longer eligible for coverage under the State’s Children’s Health Insurance Program (CHIP) or Medicaid
• Becomes eligible for premium assistance under the State’s Children’s Health Insurance Program (CHIP) or Medicaid.

Health Insurance Marketplace Notice – This notice provides basic information about the Marketplace and employment-based health coverage offered by Montefiore-sponsored group health plans.

Non-Discrimination Notice – Montefiore complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, religion, sex, national origin, disability, sexual orientation, gender identity or expression, physical appearance, or age.

Medicare Part D Notice – If you and/or your family members are Medicare-eligible, federal law offers more choices for prescription drug coverage.

Notice of Privacy Practices − These rules set limits on how health plans, pharmacies, hospitals, clinics, nursing homes and other direct-care providers use individually identifiable health information.

Family and Medical Leave Act (FMLA) − FMLA provides up to 12 work weeks of unpaid leave for certain family and medical reasons. If you utilize FMLA leave, you can elect to continue your health coverage provided that you pay the required premium. At the end of the leave, you generally have the right to return to the same job or an equivalent position.

NY Paid Family Leave (PFL) – New York Paid Family Leave provides job security and paid time off from work for a specified period of time to care for a new child, a seriously ill family member or if a family member is called to active military service.

Summary of Benefits and Coverage (SBC) – An SBC is a standardized summary describing the benefits and limitations of each medical option.

2022 Summary Annual Reports – SARs are financial statements for certain Montefiore plans in which you may have participated.

Transparency in Coverage Disclosure – Transparency in Coverage (TIC) regulations require that Montefiore make machine-readable files (MRFs), for the plan we administer and maintain, available to the public. The files contain the negotiated rates for in-network providers and allowed amounts derived from historical claims for out-of-network providers.   A machine-readable file is a digital representation of data or information in a file that can be imported or read by a computer system for further processing. They are not meant for use by members.  

Montefiore Medical Center Employee Health & Wellness Benefit Plan

EIN: 13-1740114