Mountain Emergency Physicians 2024-2025 Benefits Guide : simplebooklet.com

This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2024 - 2025 Mountain Emergency PhysiciansAs an employee of Mountain Emergency Physicians, enjoying your work and making valuable contributions to business are equally vital. The health, satisfaction and security of you and your family are important, not only to your well-being, but ultimately, in terms of achieving the goals of our organization.For the 2024 – 2025 plan year, Mountain Emergency Physicians has worked hard to offer a competitive total rewards package that includes valuable and competitive benefit plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and Mountain Emergency Physicians is offering an overall benefits package that can be shaped and molded by you to fit your needs.This benefits booklet is a summary description of your Mountain Emergency Physicians benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the plan documents shall prevail. This booklet and plan summaries do not constitute a contract of employment.We hope this benefits booklet, along with our additional communication and decision-making tools, will help you make the best health care choices for you and your family.INTRODUCTIONEligibility & EnrollmentAs a full-time employee working 30+ hours/week you are eligible for benefits. You can enroll or make changes during our annual enrollment period or within 30 days if you experience a qualifying life event during the year. A Qualifying Life Event includes changes in marital status, employment status, birth or adoption of a child, death of a dependent, entitlement to Medicaid or Medicare, loss of other coverage or eligibility of dependents.Benefits Begin 1st day of full-time employmentBenefits End Last day of employmentDependents Your legal spouse, dependent children up to age 26

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2024 - 2025 Mountain Emergency PhysiciansA health savings account (HSA) is a health care account and savings account in one. HSA helps offset the cost of a HDHP while saving for your out-of-pocket eligible health care expenses. The HSA is your personal bank account and can be used for you and your dependents now and in the future.Why Is It A Good Idea To Have An HSA?HSAs benefit everyone who are eligible to have this account, including single individuals, families and soon-to-be retirees. You save money on taxes in three ways:• Tax-Free Deposits: The money you contribute to your HSA isn't taxed (up to the IRS annual limit)• Tax-Free Earnings: Your interest and any investment earnings grow tax-free• Tax-Free Withdrawals: The money used toward eligible health care expenses isn't taxed now or in the futureSetting aside pre-tax dollars into your HSA means you pay fewer taxes and increase your take-home pay by your tax savings. You save money on eligible expenses that you are paying for out of your pocket. The amount you save depends on your tax bracket. For example, if you are in the 30% tax bracket, you can save $30 on every $100 spent on eligible health care expenses.HSA funds roll over from year to year and accumulate in your account. There is no "use-it-or-lose-it" rule with HSAs, and you decide how and when to use your HSA funds, which can be used for eligible expenses you have now, in the future, or during retirement. Also, when you have a certain balance in your HSA, investment opportunities are available.Who is Eligible?You are eligible to contribute to an HSA if:• You are enrolled in a qualified HDHP• You are not enrolled in a copay plan such as a spouse’s non-HDHP, Medicare, Medicaid or Tri-Care• You or your spouse is not enrolled in a full purpose Health Care Flexible Spending AccountRefer to your HSA documentation for more information.HSA Contribution LimitsYou can contribute to your HealthEquity HSA on a pre-tax basis through payroll deductions up to the IRS statutory maximums. The IRS has established the following maximum HSA contributions:2024 Tax Year$4,150 Individual / $8,300 FamilyIf you are age 55 and over, you may contribute an extra $1,000 catch-up contribution. HEALTH SAVINGS ACCOUNT (HSA)

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2024 - 2025 Mountain Emergency PhysiciansWellness and Health ManagementUnderstanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by Mountain Emergency Physicians, all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived.Which Preventive Care Services Are Covered?The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e., Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plans offered this year:• Routine physical exam• Well baby and childcare• Well women visits• Immunizations• Routine bone density test• Routine breast exam• Routine gynecological exam• Screening for Gestational diabetes• Obesity screening and counseling• Routine digital rectal exam• Routine colonoscopy• Routine colorectal cancer screening• Routine prostate test• Routine lab procedures• Routine mammograms• Routine pap smear• Smoking cessation• Health education/counseling services• Health counseling for STDs and HIV • Testing for HPV and HIV• Screening/counseling for domestic violencePREVENTIVE CARE

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2024 - 2025 Mountain Emergency PhysiciansEmployees and dependents enrolled in our medical plan have access to telemedicine through Teladoc. Telehealth provides acute and behavioral care 24 hours a day via phone or video by board-certified doctors and behavioral health specialists. Telehealth is a good option for minor health problems when you can’t see your regular doctor. It is also a convenient choice when you want to speak to a counselor or therapist. Some providers will also offer telehealth appointments. Check with your provider on the availability and cost.How Does Telehealth Work?Your virtual visit will take place via phone, video call on a laptop, tablet or cellphone; or through an app. The provider will ask you the same questions you'd be asked at an in-person visit and may recommend treatment based on their findings.What Can’t Telehealth Be Used For?• Life-threatening or emergency situations • Situations in which diagnostic care (e.g., blood work, imaging or lab tests) are required• Situations of severe illness or complex conditionsHow Do I Access Telehealth?There are 3 ways to access Teladoc:• Download the Teladoc mobile app• Go to www.teladochealth.com and click “Log in/Register”• Call 855-549-2214Refer to your plan documentation for more information.TELEHEALTHWhat Can Telemedicine Be Used For?General, non-life-threatening doctor's visits or consultations for acute care, such as:• Allergies• Cough, cold and flu• Diarrhea, nausea and vomiting• Ear problems• Insect bites• Sinus problems• Urinary problems• And moreBehavioral health issues such as:• Addictions• Anxiety• Depression• Grief and loss• Relationship issues• And more

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2024 - 2025 Mountain Emergency PhysiciansPRESCRIPTION DRUGSManage Your PrescriptionsPrescription drug costs vary according to factors such as the drug type, the tier or drug cost level, and the formulary or the listed of covered drugs. There are three different drug categories: brand-name, generic, and specialty.• GENERIC - Generic drugs have the same active ingredients as brand-name drugs and have received FDA approval. They can have a different shape, size, and color than the brand name drug, but they are just as safe and effective. Generics also tend to cost less than brand-name drugs. • BRAND-NAME - Brand-name drugs are the original version of a medication made by the manufacturer. For example, Tylenol® is the brand-name for acetaminophen. Brand-name drugs tend to be more expensive than their generic alternatives. Brand-name drugs may not be fully covered by insurance if there is a generic version available.• SPECIALITY - Specialty drugs treat complex, rare, or chronic conditions. Many of these drugs are injectable medications or have special administration requirements. These medicines tend to cost more than others and are only sold at specialty pharmacies. You should check your plan for your in-network specialty pharmacy options.Click here to learn more about managing your prescriptions:https://www.brainshark.com/1/player/bcbsnc?fb=0&r3f1=f3c9b7e4e8e5bdafffb5d6b4befaf5e5f3bea18fa0fff5b9&custom=manageyourrxMail Order ResourceBlue Cross NC now offers access to Amazon Pharmacy for your mail order needs. This includes Meds Your Way, a discount card that provides additional savings through Amazon Pharmacy. At check out you’ll see the lowest cost available for your prescription. Sign up and learn more at www.amazon.com/bluecrossnc. Weight Loss Prescription DrugsEffective November 1, 2023, coverage for anti-obesity “weight loss” drugs will be discontinued. These drugs will no longer be covered due to safety concerns, as well as the lack of data supporting long-term use of these drugs. The following products will be excluded as covered medications:Wegovy LomairaSaxenda PhendimetrazineAdipex-P ContraveBenzphetamine QsymiaDiethylpropion

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GET HEALTHY WITHEAT SMART, MOVE MORE, WEIGH LESS ONLINENEW SERIES BEGINS EACH MONTH.REGISTER NOWMOUNTAIN EMERGENCY PHYSICIANS IS OFFERING A NEW WELLNESS INITIATIVEEnter the coupon code: ASONCMSMountainEPAll participants must be covered under employer plan.For questions, please contact Administrator@ESMMWeighLess.comGet healthy with Eat Smart, Move More, Weigh Less Online! Check it out—a 15-week weight management program that works because it is not a diet—it ’s a lifestyle!All weekly classes are conducted online by a live instructor, fostering interaction between the instructor and all participants. Participants can conveniently attendclasses from home or office using a computer.NCMS members will be required to pay $30 completion incentive at the time of registration that is returned uponcompletion of the program and for meeting tracking requirements.Perfect attendance participants receive a free t-shirt.Go to https://esmmweighless.com/enroll-choose-a-class/ to see available class times and to registerfor theupcoming series beginning each month.www.esmmweighless.com

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Know Your BenefitsBrought to you by: Sentinel Risk Advisors, LLCMedical Insurance InformationDeductible: A deductible is the amount of money you or your dependents must pay toward a health claim before your organization’s health plan makes any payments for health care services rendered. For example, a plan participant with a $100 deductible would be required to pay the first $100, in total, of any claims during a plan year.Coinsurance: On top of your deductible, coinsurance is a provision in your health plan that shows what percentage of a medical bill you pay and the percentage a health plan pays.Out-of-pocket Maximum (OOPM): An OOPM is the maximum amount (deductible and coinsurance) that you will have to pay for covered expenses under a plan. Once the OOPM is reached the plan will cover eligible expenses at 100 percent.Explanation of Benefits (EOB): An EOB is a description your insurance carrier sends to you explaining the health care benefits that you received and the services for which your health care provider has requested payment.High Deductible Health Plan (HDHP): An HDHP is a type of insurance plan that offers a low premium offset by a high deductible. Because of the low cost of the plan, the insurer will not cover most medical expenses until the deductible is met. As an exception, preventive care services are typically covered before the deductible is met. HDHPs are often designed to be compatible with heath savings accounts (HSAs), which are tax-advantaged accounts that can be used to pay for qualified out-of-pocket medical expenses before the HDHP’s deductible ismet.This Know Your Benefits article is provided by Sentinel Risk Advisors, LLC and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. © 2005, 2011, 2013-2014, 2020 Zywave, Inc. All rights reserved.

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Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)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).If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2024. Contact your State for more information on eligibility –ALABAMA – Medicaid ALASKA – MedicaidWebsite: http://myalhipp.com/ Phone: 1-855-692-5447The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspxARKANSAS – Medicaid CALIFORNIA – MedicaidWebsite: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)Health Insurance Premium Payment (HIPP) Program Website:http://dhcs.ca.gov/hippPhone: 916-445-8322Fax: 916-440-5676Email: hipp@dhcs.ca.govCOLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)FLORIDA – MedicaidHealth First Colorado Website: https://www.healthfirstcolorado.com/Health First Colorado Member Contact Center:1-800-221-3943/State Relay 711CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/HIBI Customer Service: 1-855-692-6442Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecover y.com/hipp/index.htmlPhone: 1-877-357-3268

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GEORGIA – Medicaid INDIANA – MedicaidGA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162, Press 1GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization- act-2009-chipraPhone: 678-564-1162, Press 2Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: https://www.in.gov/medicaid/ Phone: 1-800-457-4584IOWA – Medicaid and CHIP (Hawki)KANSAS – MedicaidMedicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/HawkiHawki Phone: 1-800-257-8563HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hippHIPP Phone: 1-888-346-9562Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884HIPP Phone: 1-800-967-4660KENTUCKY – Medicaid LOUISIANA – MedicaidKentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kynect.ky.gov Phone: 1-877-524-4718Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dmsWebsite: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or1-855-618-5488 (LaHIPP)MAINE – Medicaid MASSACHUSETTS – Medicaid and CHIPEnrollment Website: https://www.mymaineconnection.gov/benefits/s/?language=en_USPhone: 1-800-442-6003TTY: Maine relay 711Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-977-6740TTY: Maine relay 711Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840TTY: 711Email: masspremassistance@accenture.comMINNESOTA – Medicaid MISSOURI – MedicaidWebsite:https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and- services/other-insurance.jspPhone: 1-800-657-3739Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005MONTANA – Medicaid NEBRASKA – MedicaidWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084Email: HHSHIPPProgram@mt.govWebsite: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633Lincoln: 402-473-7000Omaha: 402-595-1178

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NEVADA – Medicaid NEW HAMPSHIRE – MedicaidMedicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900Website: https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-program Phone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext. 5218NEW JERSEY – Medicaid and CHIP NEW YORK – MedicaidMedicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831NORTH CAROLINA – Medicaid NORTH DAKOTA – MedicaidWebsite: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825OKLAHOMA – Medicaid and CHIP OREGON – Medicaid and CHIPWebsite: http://www.insureoklahoma.org Phone: 1-888-365-3742Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075PENNSYLVANIA – Medicaid and CHIP RHODE ISLAND – Medicaid and CHIPWebsite: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP-Program.aspxPhone: 1-800-692-7462CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov)CHIP Phone: 1-800-986-KIDS (5437)Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or401-462-0311 (Direct RIte Share Line)SOUTH CAROLINA – Medicaid SOUTH DAKOTA - MedicaidWebsite: https://www.scdhhs.gov Phone: 1-888-549-0820Website: http://dss.sd.gov Phone: 1-888-828-0059TEXAS – Medicaid UTAH – Medicaid and CHIPWebsite: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human ServicesPhone: 1-800-440-0493Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669VERMONT– Medicaid VIRGINIA – Medicaid and CHIPWebsite: Health Insurance Premium Payment (HIPP) Program| Department of Vermont Health Access Phone: 1-800-250-8427Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/famis-selecthttps://coverva.dmas.virginia.gov/learn/premium-assistance/health-insurance-premium-payment-hipp-programsMedicaid/CHIP Phone: 1-800-432-5924WASHINGTON – Medicaid WEST VIRGINIA – Medicaid and CHIPWebsite: https://www.hca.wa.gov/ Phone: 1-800-562-3022Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/Medicaid Phone: 304-558-1700CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

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WISCONSIN – Medicaid and CHIP WYOMING – MedicaidWebsite:https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/Phone: 1-800-251-1269To see if any other states have added a premium assistance program since January 31, 2024, or for more information on special enrollment rights, contact either:U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/agencies/ebsa1-866-444-EBSA (3272)U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.govand reference the OMB Control Number 1210-0137.OMB Control Number 1210-0137 (expires 1/31/2026)

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Women’s Health and Cancer Rights Act NoticeIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan.Therefore, the following deductibles and coinsurance apply:HDHP: $2,700 deductible / 100% coinsurance (plan responsibility)If you would like more information on WHCRA benefits, call your plan administrator David Parker, 828-879-8419.Newborns’ Mother Health Protections Act NoticeGroup health plans 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).HIPAA Special Enrollment NoticeIf you are declining enrollment for yourself or your 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 this 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). 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. You must request enrollment within 30 days of the HIPAA qualifying event.To request special enrollment or obtain more information, contact: David Parker, Office Manager, 828-879-8419, mountainep@msn.com.

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Your Information. Your Rights. Our Responsibilities.This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.Your RightsWhen it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.Get a copy of health and claims records• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.Ask us to correct health and claims records• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.• We may say “no” to your request, but we’ll tell you why in writing within 60 days.Request confidential communications• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.Ask us to limit what we use or share• You can ask us not to use or share certain health information for treatment, payment, or our operations.• We are not required to agree to your request, and we may say “no” if it would affect your care.Get a list of those with whom we’ve shared information• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.Get a copy of this privacy notice• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.Choose someone to act for you• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.• We will make sure the person has this authority and can act for you before we take any action.File a complaint if you feel your rights are violated• You can complain if you feel we have violated your rights by contacting us using the information on page 1.• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.• We will not retaliate against you for filing a complaint.

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Your ChoicesFor certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.In these cases, you have both the right and choice to tell us to:• Share information with your family, close friends, or others involved in payment for your care• Share information in a disaster relief situationIf you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.In these cases we never share your information unless you give us written permission:• Marketing purposes• Sale of your informationOur Uses and DisclosuresHow do we typically use or share your health information?We typically use or share your health information in the following ways.Help manage the health care treatment you receiveWe can use your health information and share it with professionals who are treating you.Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.Run our organization• We can use and disclose your information to run our organization and contact you when necessary.• We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.Example: We use health information about you to develop better services for you.Pay for your health servicesWe can use and disclose your health information as we pay for your health services.Example: We share information about you with your dental plan to coordinate payment for your dental work.Administer your planWe may disclose your health information to your health plan sponsor for plan administration.Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.How else can we use or share your health information?We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.Help with public health and safety issuesWe can share health information about you for certain situations such as:• Preventing disease• Helping with product recalls• Reporting adverse reactions to medications• Reporting suspected abuse, neglect, or domestic violence• Preventing or reducing a serious threat to anyone’s health or safety

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Do researchWe can use or share your information for health research.Comply with the lawWe will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.Respond to organ and tissue donation requests and work with a medical examiner or funeral director• We can share health information about you with organ procurement organizations.• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.Address workers’ compensation, law enforcement, and other government requestsWe can use or share health information about you:• For workers’ compensation claims• For law enforcement purposes or with a law enforcement official• With health oversight agencies for activities authorized by law• For special government functions such as military, national security, and presidential protective servicesRespond to lawsuits and legal actionsWe can share health information about you in response to a court or administrative order, or in response to a subpoena.Our Responsibilities• We are required by law to maintain the privacy and security of your protected health information.• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.• We must follow the duties and privacy practices described in this notice and give you a copy of it.• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.Changes to the Terms of this NoticeWe can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.Effective Date of this Notice: 08/01/2024Privacy contact: David Parker, Office Manager, 828-879-8419, mountainep@msn.com.

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Important Notice from Your Employer About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with your Employer 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. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.2. Your Employer has determined that the prescription drug coverage offered by the Medical Plan(s) is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.When Can You Join A Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?If you decide to join a Medicare drug plan as an active employee, your Employer's coverage will be the primary payer for your prescription drug benefit and Medicare will pay secondary. If you do decide to join a Medicare drug plan and drop your current Employer Sponsored coverage, be aware that you and your dependents may not be able to get this coverage back.When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?You should also know that if you drop or lose your current coverage with your Employer anddon’t join a Medicare drug plan within 63 continuous days after your current coverage ends,you may pay a higher premium (a penalty) to join a Medicare drug plan later.

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If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.For More Information About This Notice Or Your Current Prescription Drug Coverage…Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through your Employer changes. You also may request a copy of this notice at any time.For More Information About Your Options Under Medicare Prescription Drug Coverage…More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.For more information about Medicare prescription drug coverage: Visit www.medicare.govCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized helpCall 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).Date: 08/01/2024Name of Entity/Sender: Mountain Emergency Physicians Contact--Position/Office: David Parker, Office Manager Address: 319 Springwood Dr. Valdese, NC 28680 Phone Number: 828-879-84192

Mountain Emergency Physicians 2024-2025 Benefits Guide

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