2018 Aflac Incorporated Benefits Guide

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HEALTH BENEFI TS COVERAGE UNDER FEDERAL LAW
Women’s Health and Cancer Rights Act of 1998
If 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 the medical benefits option.
Therefore, the deductibles and coinsurance as noted in your
SPD may apply. If you would like more information on WHCRA
benefits, call the claims administrator at the number listed on
the back of your medical identification card.
Newborns’ Act Disclosure
The medical benefits offered under the Aflac Employee Health
and Welfare Benefits Plan 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, the Aflac Employee Health
and Welfare Benefits Plan and insurance 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).
SPECIAL ENROLLMENT
You and your eligible dependents may enroll in the Aflac
Employee Health and Welfare Benefits Plan’s medical benefit
option under the following circumstances:
• Individuals losing other coverage – If you declined
coverage under the medical benefit option when it was
first available because of other health coverage, and that
coverage is later lost on account of:
oo Exhaustion of COBRA continuation coverage,
oo Lost eligibility for other coverage or
oo Termination of employer contributions toward
the other coverage,
you and your eligible dependents may enroll in the medical
benefit option within 31 days after the date you lost that other
coverage. Your enrollment will take effect on the first day of the
calendar month following receipt of your request for enrollment.
The change in your benefits contributions will begin on the first
payroll period following your election change request.
“Lost eligibility for other coverage” means a loss of other
health coverage as a result of your legal separation or divorce,
a dependent’s loss of dependent status, death, termination of
employment or reduction in number of hours of employment, or
you no longer reside, live or work in the service area of a health
maintenance organization in which you participated.
• Newly eligible dependents – If you initially declined
enrollment for yourself or your eligible dependents and
you later have a newly eligible dependent because
of marriage, registered domestic partnership, birth,
adoption or placement for adoption, you may enroll
yourself and your newly eligible dependents (including
a previously eligible dependent spouse, if you have a
newly eligible dependent child) as long as you request
enrollment within 31 days after the marriage, registered
domestic partnership, birth, adoption or placement for
adoption. For example, if you and your previously eligible
dependent spouse have a child, you may enroll yourself,
your previously eligible dependent spouse and your
new child in the medical benefit option, even if you were
not previously enrolled. You will not, however, be able
to enroll existing eligible dependent children for whom
coverage has been waived in the past.
Your or your eligible dependent’s participation will start
as of the date of the birth, adoption or placement for
adoption, or for marriage/domestic partnership, the first
day of the calendar month following the date you submit
your election change, so long as you timely request
How to Apply for
Aflac Coverage