Required Patient Protection and Affordable Care Act (PPACA) Notices

The annual and lifetime limits on the dollar value of benefits under the Local Government Health Plan (LGHP) no longer apply. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals impacted by this change have been contacted directly by the Plan and may request enrollment during the FY 2012 annual Benefit Choice Period. Enrollments will be effective on July 1, 2011, the first day of the 2012 plan year. For more information contact the Bureau of Benefits, Group Insurance Division at 800/442-1300.

The Local Government Health Plan (LGHP) generally requires the designation of a primary care provider for all members enrolled in a managed care plan. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider.

For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the appropriate plan administrator. Contact information is provided in the FY 2012 Benefit Choice Options book.

You do not need prior authorization from your managed care plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a healthcare professional in our network who specializes in obstetrics or gynecology. The healthcare professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a preapproved treatment plan, or procedures for making referrals. For a list of participating healthcare professionals who specialize in obstetrics or gynecology, contact the appropriate plan administrator. Contact information is provided in the FY 2012 Benefit Choice Options book.

Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in the Local Government Health Plan (LGHP). Individuals may request enrollment for such children during the FY 2012 annual Benefit Choice Period. Enrollments will be effective on July 1, 2011, the first day of the 2012 plan year. For more information contact the Bureau of Benefits, Group Insurance Division at 800/442-1300.