Regulatory Information

There are many complex laws and regulations surrounding the administration of our benefit plans. To comply with these laws and regulations, Carilion Clinic may be required to provide notice to employees and plan participants of their rights under these laws. More information on some of these laws and regulations is provided below:

Non-Discrimination Notice effective January 1, 2017 -  Section 1557 of the Affordable Care Act (ACA), considered the non-discrimination provision of the ACA, prohibits an employer that receives federal financial assistance and is principally engaged in health care, such as a hospital or clinic, from discriminating on the basis of age, gender, race, color, national origin, language, culture, sexual orientation, gender identity and/or expression, pregnancy or disability, when providing employee health benefits.Under Section 1557, Carilion Clinic cannot provide employee health benefits in a discriminatory manner; therefore, we cannot take any of the following related actions if they differentiate on the basis of age, gender, race, color, national origin, language, culture, sexual orientation, gender identity and/or expression, pregnancy or disability:

• Deny, cancel, limit or refuse to issue or renew an insurance policy;
• Deny or limit coverage of a claim, or
• Impose additional cost sharing or other limitations or restrictions

Section 1557 also prohibits Carilion from denying any claim, or imposing additional cost sharing or other limitations, on any health care services that are ordinarily or exclusively available to individuals of one gender, based on the fact that an individual’s sex assigned at birth, gender identity, or recorded gender is different than the one to which the health care services are ordinarily or exclusively available. Additionally, we cannot deny or limit coverage, or deny a claim for any health care services related to gender transition, if such denial or limitation results in discrimination against a transgender employee.

Annual Funding Notice (AFN) for Carilion's Pension Plan (.pdf)—The AFN is intended to provide you with information—no changes are being made to your pension plan benefit and no action is needed. The plan's funding status and funding policy are outlined in the notice.

Pension Plan Form 5500 (.pdf)—The Form 5500 is filed with the Department of Labor and provides information on the plan. No changes are being made to your pension plan benefit and no action is needed. This file is large and may take a few minutes to download.

Children's Health Insurance Program Notice (.pdf)—States that if you are eligible for health coverage from your employer, but are unable to afford the premiums, you may be eligible for a state premium assistance program that can help pay for coverage. This notice provides contact information for each participating state for more information on eligibility.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) Overview (.pdf)—COBRA gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods under certain circumstances.

Eligible Automatic Contribution Arrangement (EACA)—This notice covers whether the retirement savings plan's automatic enrollment feature applies to you, what amounts will be automatically taken from your pay and contributed to the plan, what other amounts Carilion may contribute to the plan for you, when your plan account will be vested (that is, not lost when you leave your job), and when you can receive a distribution of your plan account.

• EACA—Carilion Clinic 403(b) Retirement Savings Plan (.pdf)
• EACA—Carilion Clinic 401(k) Retirement Savings Plan (.pdf)

Family and Medical Leave Act (FMLA) Notice (.pdf)—FMLA provides that eligible employees have a right to take job-protected leave for qualifying events. This notice summarizes major provisions of FMLA and provides information about the procedures for filing complaints of violations of the act with the Department of Labor.

Health Insurance Portability and Accountability Act (HIPAA) Overview (.pdf)—HIPAA provides rights and protections for participants and beneficiaries in group health plans.

HIPAA and Privacy Notification (.pdf)—This document explains our medical and dental plans' privacy practices and how the plans may use your protected health information.

Medical Plan Uniform Summary of Benefit and Coverage (SBC)—These documents have information about medical plan costs.

• Carilion Clinic Medical Plan SBC (.pdf)
• Carilion Clinic Out-of-Area Medical Plan SBC (.pdf)

Medicare Part D Notice (.pdf)—This notice has information about your current prescription drug coverage with Carilion Clinic and about your options under Medicare's prescription drug coverage. This information can help you decide whether you want to join a Medicare drug plan.

Mental Health Parity Act (.pdf)—This fact sheet provides a brief overview of the law.

Michelle's Law (.pdf)—This law requires healthcare plans to continue coverage for college students who are forced to take a leave of absence or change their enrollment status due to serious illness or injury. A list of Frequently Asked Questions about the law is provided here.

The Newborns' and Mothers' Health Protection Act (.pdf)—Provides rules on minimum coverage for hospital lengths of stay following childbirth.

New Health Insurance Marketplace Coverage Options and Your Health Coverage (.pdf)—As part of the Affordable Care Act (also called healthcare reform), government health insurance marketplaces (also known as exchanges) will be set up so people can buy insurance if they don't have access to it. The Notice of Health Insurance Marketplace provides information about the exchanges.

Summary Annual Reports (.pdf)—Carilion Clinic is required to file full financial reports on each of our benefit plans with the Department of Labor (DOL) each plan year to comply with the federal regulations surrounding our benefit plans. These summaries of the most important facts, including financial performance, are known as Summary Annual Reports.

Summary Plan Descriptions (SPDs)—A summary plan description is an important document that tells participants what a benefit plan provides and how it operates. It provides information on when an employee can begin to participate in the plan, how service and benefits are calculated, when benefits become vested, when and in what form benefits are paid, and how to file a claim for benefits.

• Carilion Clinic Medical Plan SPD (.pdf)
• Carilion Clinic Out-of-Area Medical Plan SPD (.pdf)
• Dental Plan (.pdf)
• Life Insurance (.pdf)
• Short-term Disability (.pdf)
• Long-term Disability (.pdf)
• Healthcare Flexible Spending Account (.pdf)
• Dependent Care Flexible Spending Account (.pdf)
• Retirement Plan of Carilion Clinic (pension plan) (.pdf)
• Carilion Clinic 403(b) Retirement Savings Plan (.pdf)
• Carilion Clinic 401(k) Retirement Savings Plan (.pdf)
• Paid Time Off (PTO) Plan (.pdf)

Women's Health and Cancer Rights Act (.pdf)—Offers protections for breast cancer patients who elect breast reconstruction in connection with a mastectomy. 

 

Listed below is the unique link (URL) for the machine-readable file for the Aetna Medical Plan offered through Carilion Clinic.
https://Health1.Aetna.com/app/public/#/one/insurerCode=AETNACVS_I&brandCode=ALICSI/machine-readable-transparency-in-coverage?searchTerm=85178518&lock=true