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Mandatory Notices The federal government requires the following notices to be provided to you. • HIPAA Privacy Notice • HIPAA Special Enrollment Rights • Women’s Health and Cancer Rights Act of 1998 (WHCRA) • Medicare Prescription Drug Coverage - Part D • Children’s Health Insurance Program (CHIP) • Children’s Health Insurance Program Reauthorization Act (CHIPRA) • Exchange Notice • Health Reimbursement Arrangement (HRA) Waiver Rights HIPAA Privacy Notice The Health Insurance Portability and Accountability Act of 1996 (HIPAA) governs how group health plans and other “covered entities” use and disclose “protected health information.” CIS is considered a covered entity and is therefore required to notify you of how your protected health information is allowed to be used and your rights related to that information. The Notice is available on CIS’ website at www.cisbenefits.org. HIPAA Special Enrollment Rights The HIPAA legislation also included a “Special Enrollment Rights” provision. Employees who decline to participate in a group health plan may enroll themselves and their dependents within 30 days of these events: • Losing coverage provided through a group health plan or health insurance, whether coverage is canceled due to job loss, disability, divorce, or death • Marriage, birth, adoption, or the placement of a child for adoption Employees have 30 days from the date of the event – the job loss, marriage, birth or placement – to request enrollment in the plan. Women’s Health and Cancer Rights Act of 1998 (WHCRA) WHCRA includes important protections for breast cancer patients who choose to have breast reconstruction in connection with a mastectomy. The coverage outlined below is included in your medical plan: • Reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance. ---PAGE BREAK--- • Prothesis and treatment of physical complications of all stages of Mastectomy, including and • Inpatient care related to the Mastectomy and post-Mastectomy services. The attending physician and the patient will determine together the manner of treatment. All coverage is subject to any deductibles, copayments, and/or coinsurance according to the provisions of your medical insurance benefits and federal requirements. Please see your benefits booklet for additional information. Medicare Prescription Drug Coverage - Part D See the “Important Notice About Your Prescription Drug Coverage and Medicare” notice below. When prescription drug coverage was added to Medicare (“Part it was mandated that employees be told whether their employer’s medical coverage is “creditable” or “non- creditable.” Creditable means it is, on average, as good as the standard Medicare Part D coverage. Noncreditable means it is not, on average, as good. For most active employees and some retirees, this notice doesn’t apply because you are not yet covered by Medicare. However, for those who are covered by Medicare or have a dependent covered by Medicare, this information is very important. Children’s Health Insurance Program (CHIP) See attached “Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)” Notice. The Notice is required to inform employees of the opportunities that “currently exist” for premium assistance under Medicaid and CHIP for coverage for employees or dependents. Children’s Health Insurance Program Reauthorization Act (CHIPRA) – Special Enrollment Rights Employees who experience either of the following events have 60 days to enroll in group coverage through their employer. • The termination of an individual’s Medicaid or CHIP coverage due to a loss of eligibility; or • The individual becomes eligible for a premium assistance subsidy through Medicaid or CHIP. Exchange Notice See attached “Health Insurance Marketplace Coverage Options and Your Health Coverage” Notice. The Notice is required to provide basic information about the Health Insurance Marketplace to assist employees with evaluating options. Health Reimbursement Arrangement (HRA) Waiver Rights Employees (including former employees) eligible for reimbursement of medical expenses under a Health Reimbursement Arrangement (HRA) can elect each year, and upon termination of employment, to opt-out of and waive future reimbursements from the HRA. This opt-out right is required because the benefits provided by the HRA generally constitutes employer-provided health coverage under the Affordable Care Act. Therefore, this will disqualify the individual from eligibility for a premium tax credit for an insurance policy purchased through the Health Insurance Marketplace. ---PAGE BREAK--- Important Notice from CIS About Your Prescription Drug Coverage and Medicare Please 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’s medical plan 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 premium. 2. Regence BlueCross BlueShield (BCBS) and Kaiser have determined that the prescription drug coverage offered by your employer 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 Oct. 15 to Dec. 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two 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, you can continue your Regence BCBS or Surest (UHC) medical coverage and benefits will coordinate with Part D coverage. If you decide to join a Medicare drug plan and drop your Regence BCBS or Surest (UHC) medical coverage, be aware that if you are an active employee, you and your dependents will not be able to re-enroll until the next open enrollment period. If you are a retiree, you will not be able to get this coverage back. If you are enrolled on a Kaiser medical plan, you are not eligible to enroll in Medicare Part D because of Kaiser’s arrangement with Medicare. Doing so will cause your active Kaiser coverage to be terminated. ---PAGE BREAK--- When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan? If you drop or lose your current coverage with your employer and don’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. If you go 63 continuous days or longer without creditable prescription drug coverage, your 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 organization 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.gov • Call 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 help • Call 1-800-MEDICARE (1-[PHONE REDACTED]). TTY users should call 1-[PHONE REDACTED]. 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-[PHONE REDACTED] (TTY 1-[PHONE REDACTED]). 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: September 30, 2025 Name of Entity/Sender: CIS Benefits Address: 15875 Boones Ferry Rd., #1469 Lake Oswego, OR 97035 Phone Number: 1-[PHONE REDACTED] (within Oregon) or [PHONE REDACTED] ---PAGE BREAK--- 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 July 31, 2023. Contact your State for more information on eligibility – ALABAMA – Medicaid ALASKA – Medicaid Website: http://myalhipp.com/ Phone: 1-[PHONE REDACTED] The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-[PHONE REDACTED] Email: [EMAIL REDACTED] Medicaid Eligibility: ARKANSAS – Medicaid CALIFORNIA – Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP ([PHONE REDACTED]) Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] Email: [EMAIL REDACTED] COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) FLORIDA – Medicaid Health First Colorado Website: Health First Colorado Member Contact Center: 1-[PHONE REDACTED]/State Relay 711 CHP+: CHP+ Customer Service: 1-[PHONE REDACTED]/State Relay 711 Health Insurance Buy-In Program (HIBI): HIBI Customer Service: 1-[PHONE REDACTED] Website: y.com/hipp/index.html Phone: 1-[PHONE REDACTED] ---PAGE BREAK--- GEORGIA – Medicaid INDIANA – Medicaid GA HIPP Website: insurance-premium-payment-program-hipp Phone: [PHONE REDACTED], Press 1 GA CHIPRA Website: liability/childrens-health-insurance-program-reauthorization- act-2009-chipra Phone: [PHONE REDACTED], Press 2 Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-[PHONE REDACTED] All other Medicaid Website: Phone: 1-[PHONE REDACTED] IOWA – Medicaid and CHIP (Hawki) KANSAS – Medicaid Medicaid Website: Medicaid Phone: 1-[PHONE REDACTED] Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-[PHONE REDACTED] HIPP Website: a-to-z/hipp HIPP Phone: 1-[PHONE REDACTED] Website: Phone: 1-[PHONE REDACTED] HIPP Phone: 1-[PHONE REDACTED] KENTUCKY – Medicaid LOUISIANA – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: Phone: 1-[PHONE REDACTED] Email: [EMAIL REDACTED] KCHIP Website: Phone: 1-[PHONE REDACTED] Kentucky Medicaid Website: Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-[PHONE REDACTED] (Medicaid hotline) or 1-[PHONE REDACTED] (LaHIPP) MAINE – Medicaid MASSACHUSETTS – Medicaid and CHIP Enrollment Website: _US Phone: 1-[PHONE REDACTED] TTY: Maine relay 711 Private Health Insurance Premium Webpage: Phone: 1-[PHONE REDACTED] TTY: Maine relay 711 Website: Phone: 1-[PHONE REDACTED] TTY: 711 Email: [EMAIL REDACTED] MINNESOTA – Medicaid MISSOURI – Medicaid Website: families/health-care/health-care-programs/programs-and- services/other-insurance.jsp Phone: 1-[PHONE REDACTED] Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: [PHONE REDACTED] MONTANA – Medicaid NEBRASKA – Medicaid Website: Phone: 1-[PHONE REDACTED] Email: [EMAIL REDACTED] Website: http://www.ACCESSNebraska.ne.gov Phone: 1-[PHONE REDACTED] Lincoln: [PHONE REDACTED] Omaha: [PHONE REDACTED] ---PAGE BREAK--- NEVADA – Medicaid NEW HAMPSHIRE – Medicaid Medicaid Website: Medicaid Phone: 1-[PHONE REDACTED] Website: services/medicaid/health-insurance-premium-program Phone: [PHONE REDACTED] Toll free number for the HIPP program: 1-[PHONE REDACTED], ext. 5218 NEW JERSEY – Medicaid and CHIP NEW YORK – Medicaid Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: [PHONE REDACTED] CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-[PHONE REDACTED] Website: Phone: 1-[PHONE REDACTED] NORTH CAROLINA – Medicaid NORTH DAKOTA – Medicaid Website: Phone: [PHONE REDACTED] Website: Phone: 1-[PHONE REDACTED] OKLAHOMA – Medicaid and CHIP OREGON – Medicaid Website: http://www.insureoklahoma.org Phone: 1-[PHONE REDACTED] Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-[PHONE REDACTED] – Medicaid and CHIP RHODE ISLAND – Medicaid and CHIP Website: Program.aspx Phone: 1-[PHONE REDACTED] CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437) Website: http://www.eohhs.ri.gov/ Phone: 1-[PHONE REDACTED], or [PHONE REDACTED] (Direct RIte Share Line) SOUTH CAROLINA – Medicaid SOUTH DAKOTA - Medicaid Website: Phone: 1-[PHONE REDACTED] Website: http://dss.sd.gov Phone: 1-[PHONE REDACTED] TEXAS – Medicaid UTAH – Medicaid and CHIP Website: Health Insurance Premium Payment (HIPP) Program I Texas Health and Human Services Phone: 1-[PHONE REDACTED] Medicaid Website: CHIP Website: http://health.utah.gov/chip Phone: 1-[PHONE REDACTED] VERMONT– Medicaid VIRGINIA – Medicaid and CHIP Website: Health Insurance Premium Payment (HIPP) Program I Department of Vermont Health Access Phone: 1-[PHONE REDACTED] Website: assistance/famis-select assistance/health-insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-[PHONE REDACTED] WASHINGTON – Medicaid WEST VIRGINIA – Medicaid and CHIP Website: Phone: 1-[PHONE REDACTED] Website: Medicaid Phone: [PHONE REDACTED] CHIP Toll-free phone: (1-[PHONE REDACTED]) ---PAGE BREAK--- WISCONSIN – Medicaid and CHIP WYOMING – Medicaid Website: Phone: 1-[PHONE REDACTED] Website: eligibility/ Phone: 1-[PHONE REDACTED] To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-[PHONE REDACTED], Menu Option 4, Ext. 61565 Paperwork Reduction Act Statement According 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 [EMAIL REDACTED] and reference the OMB Control Number 1210-0137. OMB Control Number 1210-0137 (expires 1/31/2026) ---PAGE BREAK--- Health Insurance Marketplace Coverage Options and Your Health Coverage PART A: General Information Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”).To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options in your geographic area. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings on your premium that you're eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs. Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit, that lowers your premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 of your annual household income, or if the coverage through your employment does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income..12 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace. 1 Indexed annually; see for 2023. 2 An employer-sponsored or other employment-based health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services. Form Approved OMB No. 1210-0149 (expires 12-31-2026) ---PAGE BREAK--- When Can I Enroll in Health Insurance Coverage through the Marketplace? You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15. Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan. There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage. Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit HealthCare.gov or call the Marketplace Call Center at 1-800- 318-2596. TTY users can call 1-[PHONE REDACTED]. What about Alternatives to Marketplace Health Insurance Coverage? If you or your family are eligible for coverage in an employment-based health plan (such as an employer-sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employment- based health plan. Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit for more details. How Can I Get More Information? The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.