Seafarers Health and Benefits Plan Important Notice

January 2011

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Editor’s note: The following letter was mailed in early December to participants in the Seafarers Health and Benefits Plan.

 

SEAFARERS HEALTH AND BENEFITS PLAN
5201 Auth Way
Camp Springs, Maryland 20746-4275
(301) 899-0675

 

December 10, 2010

 

Dear Plan Participant:
The Seafarers Health and Benefits Plan would like to notify you of a number of positive changes to your health benefits, which will go into effect on January 1, 2011. The Plan is making these changes to improve your benefits, in compliance with the Patient Protection and Affordable Care Act (“Affordable Care Act” or “ACA”).

 

As the Plan has already informed you, beginning next year, if you are eligible for benefits the Plan will offer dependent health coverage to your children between ages 19 and 25, provided that the child is not offered health coverage through his or her employer.

 

-You are no longer required to verify your child’s student status as of January 1, 2011.

-Your child does not have to be supported by you to be eligible for coverage.

 

You must enroll your child between ages 19 and 25, even if they are already a participant in the Plan, so that he or she may receive coverage. To enroll a child complete and return an “Enrollment Form and Affidavit for Dependent Child” to the Plan, which confirms that your child is not offered health coverage through his or her employer.

 

The form is available at www.seafarers.org, under the Member Benefits and Resources section or you can contact us at 1-800-252-4674.

 

In subsequent years, the Plan may periodically verify whether the child is offered other coverage through his or her employer.

 

The Plan will no longer apply any preexisting condition exclusions to children under age 19. Therefore, if your child received treatment for a medical condition before enrolling in this Plan, the Plan will still provide coverage for the treatment of that condition, provided that it is a type of service that the Plan covers for other dependents.

 

The Plan currently has lifetime dollar limits on certain benefits. The following lifetime limits will be eliminated in 2011:

 

-$50,000 lifetime limit on treatment of congenital anomalies (birth defects);

 

-$10,000 lifetime limit on home health and hospice services;

 

-$150,000 lifetime limit on organ and tissue transplants at Core-Plus level of benefits;

 

-$50,000 lifetime limit on bone marrow transplants at Core level of benefits.

 

This means that there will be no dollar limit on the amounts that the Plan will pay for these benefits beginning in 2011. Please note however, that at the Core level of benefits, bone marrow transplants are the only transplant benefits that the Plan covers. This will not change; however, the dollar limit will be removed from that benefit.

 

The Plan will also increase its annual limits on certain benefits. The annual limits on the following benefits will be increased to $750,000 a year, in calendar year 2011:

 

-Cardiac Rehabilitation. This benefit is currently limited to $2000 per year.

 

-Home Nursing. This benefit is currently limited to $2000 per year.

 

-Pediatric preventive dental care. Currently dental services for children are limited to $750 at the Core-Plus level, and $350 at the Core level. Pediatric preventive dental care includes all preventive dental services provided to participants under age 19, but does not include orthodontia. Current limits on orthodontia will remain in place.

 

The Seafarers Health and Benefits Plan believes that it is a “grandfathered health plan” under the Affordable Care Act. A grandfathered health plan is a plan that was in existence at the time the ACA was passed. This law allows a plan to preserve the basic coverage that was in effect when the law was enacted, as long as it makes certain required changes, such as elimination of lifetime benefit limits, and other changes described above. However, some of the consumer protections included in the ACA do not apply to grandfathered plans. If you have questions about which provisions of the ACA apply to grandfathered plans, you can direct them to the Plan Administrator at the address listed above. If you wish, you may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 for more information, or view the information about grandfathered plans on their website, www.dol.gov/ebsa/healthreform.

 

The Plan would also like you to know that it will be participating in the Early Retiree Reinsurance Program (ERRP). This new program was created by the ACA. It allows health plans that provide health benefits to retirees between 55 and 64 who are not eligible for Medicare to receive reimbursement from the government for certain Plan costs for some of these early retirees. The Plan expects that it will use any reimbursements that it receives to reduce or offset increases in its own costs for maintaining your health coverage; which will help ensure that the Plan will be able to continue to offer health benefits coverage to retirees, employees and their families for many years in the future.

 

Please keep this letter along with your Summary Plan Description (SPD) booklet so that you have current information about your benefits. The Plan will send you a revised booklet next year which will include these changes. If you have any questions, please contact the Plan’s Claims Department at 1- 800-252-4674.

 

On behalf of the Board of Trustees, we would like to wish you and your families a happy, healthy, and safe holiday season!

 

Sincerely,
Margaret R. Bowen


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