Notice of Privacy Practices
Please see the document below for details regarding plan privacy practices.
Patient Protection and Affordable Care Act (PPACA)
Effective January 1, 2013, the UHP medical and prescription drug benefits were enhanced in response to the Patient Protection and Affordable Care Act (PPACA), as amended. Benefit changes include expanded coverage for preventive services provided to women by in-network providers. Additional details are available below:
Effective January 1, 2011, the UHP medical benefits will be enhanced in response to passage of the Patient Protection and Affordable Care Act (PPACA), as amended.
- Recommended preventive care services delivered by SLUCare or Coventry network providers will be covered at 100% (no copays, no coinsurance, no deductibles will be applied).
- Dependent children can be covered to age 26 regardless of student, marital status or financial dependence.
- Lifetime and annual benefit limits have been eliminated.
- The UHP allows the designation of a primary care provider. Members have the right to designate any SLUCare or Mercy network primary care provider available to accept you or your family members. For children, a pediatrician may be designated as the primary care provider.
- Members do not need prior authorization from UHP or from any other person in order to obtain access to obstetrical or gynecological care from SLUCare or Coventry network health care professionals who specialize in obstetrics or gynecology.
Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA):
Effective January 1, 2011, the UHP medical benefits will be enhanced in response to passage of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
- Member financial requirements applicable to mental health and substance abuse benefits have been made comparable to those in place for medical/surgical benefits.
Women’s Health and Cancer Rights Act of 1998
Pursuant to the Women’s Health and Cancer Rights Act of 1998, covered individuals receiving plan benefits in connection with a mastectomy will receive the following services:
- Reconstruction of the breast on which a mastectomy has been performed
- Surgery and reconstruction of the other breast to produce a symmetrical appearance
- Prostheses or prosthetics necessary to restore symmetry; and
- Coverage for physical complications for all sites of a mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes).
Coverage for breast reconstruction and related services will be subject to deductibles and copayment amounts that are consistent with those that apply to other benefits. The plan will continue to determine the manner of coverage in consultation with the attending physician and patient.