Legal Notices

Chubb reserves the right to change, amend, or terminate any benefits plan at any time for any reason. Participation in a benefit plan is not a promise or guarantee of future employment. Receipt of benefits documents does not constitute eligibility.

The Benefits Decision Guide, combined with these legal notices, provides an overview of the benefits available to eligible employees and their dependents. In all cases, the official plan documents govern and this Benefits Decision Guide is not, and should not be relied upon as a governing document. In the event of a discrepancy between the information presented in the Benefits Decision Guide and official plan documents, the official plan documents will govern.

STATEMENT OF MATERIAL MODIFICATIONS

This enrollment guide constitutes a Summary of Material Modifications (SMM) or Summary of Material Reductions (SMR), as applicable, to the Summary Plan Description (SPD) under the Chubb Employee Medical and Welfare Benefits Plan. It is meant to supplement and/or replace certain information in the SPD, so retain it for future reference along with your SPD. Please share these materials with your covered family members.

MERCER’S ROLE AND COMPENSATION

Mercer Health & Benefits LLC facilitates the placement of insurance coverage on behalf of its clients. Mercer is compensated through commissions that are calculated as a percentage of the insurance premiums charged by insurers. This compensation may include payment from insurers for marketing related expenses, technology investments or service fees. Our compensation may vary depending on the type of insurance purchased, the insurer selected and other factors such as the volume, growth and/or retention of Mercer’s book of business with the insurer or service provider.

You may obtain additional information regarding our compensation by sending an email to mercermarketplace.compensation@mercer.com.

TAXATION OF BENEFITS

The taxation of certain benefits may vary at the local, state and federal level. You should consult your tax advisor if you have any questions about the proper treatment of any benefits.

NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996

Group health plans 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, plans and 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). If you would like more information on maternity benefits, call your medical carrier at the phone number listed on the back of your ID card.

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 symmetrical appearance; and,
  • 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 this plan. If you would like more information on WHCRA benefits, call your medical carrier at the phone number listed on the back of your ID card.

If you would like more information on WHCRA benefits, contact the Chubb Benefits Marketplace Call Center at 1-844-58Chubb (1-844-582-4822).

SPECIAL ENROLLMENT RIGHTS

If you declined enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you or your dependents may be able to enroll in some coverages under this plan without waiting for the next Open Enrollment period, provided you request enrollment within 30 days after your other coverage ends.

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

Chubb will also allow a special enrollment opportunity if you or your eligible dependents either:

  • Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible, or
  • Become eligible for a state’s premium assistance program under Medicaid or CHIP.

For these enrollment opportunities, you will have 60 days – instead of 30 – from the date of the Medicaid/CHIP eligibility change to request enrollment in the Chubb group health plan. Note that this 60-day extension does not apply to enrollment opportunities other than due to the Medicaid/CHIP eligibility change.

Note: If your dependent becomes eligible for special enrollment rights, you may add the dependent to your current coverage or change to another medical plan.

To request a HIPAA special enrollment based on the events described above or obtain more information, contact the Chubb Benefits Marketplace Call Center at 1-844-58Chubb (1-844-582-4822).

NOTICE REGARDING WELLNESS PROGRAM

Ensure Your Health is a voluntary wellness program available to all employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program, you and your spouse/domestic partner will also be asked to complete a biometric screening, which will include a blood test to measure cholesterol and glucose levels. You and your spouse/domestic partner are not required to participate in the blood test or other medical examinations.

However, employees who choose to participate in the wellness program will avoid a surcharge on their medical insurance in the following plan year, if they enroll in Chubb’s medical plans. Although you are not required to participate in the biometric screening, only employees who do so will avoid the surcharge.

Additional incentives in the form of cash and other prizes, may be available for employees who participate in certain health-related activities, such as healthy-eating, mindfulness, and weight loss challenges. If you are unable to participate in any of the health-related activities or achieve any of the health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting Joo Young Kang at 908-903-4239.

The information from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as condition management programs and behavioral services. You also are encouraged to share your results or concerns with your own doctor.

PROTECTIONS FROM DISCLOSURE OF MEDICAL INFORMATION

We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and Chubb may use aggregate information it collects to design a program based on identified health risks in the workplace, Ensure Your Health Wellness Program will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements.

In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Talia Roach, Privacy Officer, 202A Hall's Mill Road, Whitehouse Station, NJ 08889.

GROUP HEALTH PLAN NOTICE OF PRIVACY PRACTICES

This Notice of Privacy Practices describes your privacy rights under HIPAA as they relate to the Group Health Plan. If you have questions or concerns about benefits provided through Chubb Healthcare’s benefits program, please contact your HR contact to resolve those issues.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices is intended to comply with the Standards for Privacy of Individually Identifiable Health Information (the “Privacy Standards”) set forth by the U.S. Department of Health and Human Services (“HHS”) pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”). The Medical Benefit Option and Dental Benefit Option under the Chubb Employee Medical and Welfare Benefits Plan (excluding HMOs) (collectively known as the “Plan”) to which the HIPAA regulations apply, are required by law to take reasonable steps to ensure the privacy of you/your (“individual participants in the Plan”) individual health information (“Protected Health Information”).

Although in many cases your Protected Health Information related to the Plan is created or maintained by others, such as the health insurance company providing benefits under the Plan, we are required to provide you with this notice and abide by the terms of the current notice. The effective date of this notice is September 23, 2013. The Plan is required to use or disclose the minimum amount of information required to reasonably provide necessary services.

The Plan reserves the right to change this notice at any time and to make the changes apply to all health information about you maintained by the Plan before and after the effective date of the new notice. The new notice will be provided to all participants covered by the Plan at that time and will be posted on Chubb’s enrollment website.

Understanding Your Protected Health Information

The Plan provides health benefits to you as described in your summary plan description(s). The Plan receives and maintains health information about you in the course of providing these health benefits to you.

The term “Protected Health Information” (PHI) includes all “Individually Identifiable Health Information” transmitted or maintained by the Plan, regardless of form (oral, written or electronic).

The term “Individually Identifiable Health Information” means information that:

  • is created or received by a healthcare provider, health plan, employer or healthcare clearinghouse;
  • relates to the past, present or future physical or mental health or condition of an individual; the provision of healthcare to an individual; or the past, present or future payment for the provision of healthcare to an individual; and
  • identifies the individual, or the information can be used to determine the identity of the individual.

Understanding what PHI is and how it is used will help you make more informed decisions if you are asked to sign an authorization to disclose your PHI to others, as required by the HIPAA regulations.

Health information held by the Company in your employment records is not PHI: The privacy policy and practices described in this Notice do not apply to health information that the Company or a Company-sponsored employee benefit plan holds in your employment records or in records relating to pre-employment screenings, disability benefits or claims, on-the-job injuries, workers’ compensation claims, medical leave requests, return to work reports, life insurance, retirement benefits, accommodations under the Americans with Disabilities Act, or any records not pertaining to Protected Health Information from the group health plans.

Your Health Information Privacy Rights

Although your medical record is the property of the Plan, the information is about you, and you have legal rights regarding your Protected Health Information, which are described below. In many cases, your Protected Health Information is created or maintained by third parties, known as the Plan’s Business Associates, and you may be asked to contact them directly regarding the exercise of your rights. To exercise any of these rights, the corresponding request form must be completed, signed and submitted to:

Talia Roach
Privacy Officer
202A Hall's Mill Road
Whitehouse Station, NJ 08889

Requests that do not follow these guidelines may be denied. Your legal rights include a:

  • RIGHT TO REQUEST RESTRICTIONS ON CERTAIN USES AND DISCLOSURES OF YOUR HEALTH INFORMATION AND THE PLAN’S RIGHT TO REFUSE

  • You have the right to ask the Plan to restrict the use and disclosure of your health information for treatment, payment, or health care operations, except for uses or disclosures required by law. You have the right to ask the Plan to restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your care or payment for your care. You also have the right to ask the Plan to restrict use and disclosure of health information to notify those persons of your location, general condition, or death — or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request to the Plan must be in writing.

    The Plan is not required to agree to a requested restriction. If the Plan does agree, a restriction may later be terminated by your written request, by agreement between you and the Plan (including an oral agreement), or unilaterally by the Plan for health information created or received after you’re notified that the Plan has removed the restrictions. The Plan may also disclose health information about you if you need emergency treatment, even if the Plan has agreed to a restriction.

    An entity covered by these HIPAA rules (such as your health care provider) or its business associate must comply with your request that health information regarding a specific health care item or service not be disclosed to the Plan for purposes of payment or health care operations if you have paid out of pocket and in full for the item or service.

  • RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS OF YOUR HEALTH INFORMATION

  • If you think that disclosure of your health information by the usual means could endanger you in some way, the Plan will accommodate reasonable requests to receive communications of health information from the Plan by alternative means or at alternative locations.

    If you want to exercise this right, your request to the Plan must be in writing and you must include a statement that disclosure of all or part of the information could endanger you.

  • RIGHT TO INSPECT AND COPY YOUR HEALTH INFORMATION

  • With certain exceptions, you have the right to inspect or obtain a copy of your health information in a “designated record set.” This may include medical and billing records maintained for a health care provider; enrollment, payment, claims adjudication and case or medical management record systems maintained by a plan; or a group of records the Plan uses to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. The Plan may deny your right to access, although in certain circumstances, you may request a review of the denial.

    If you want to exercise this right, your request to the Plan must be in writing. Within 30 days of receipt of your request (60 days if the health information is not accessible on site), the Plan will provide you with one of these responses:

    • The access or copies you requested.
    • A written denial that explains why your request was denied and any rights you may have to have the denial reviewed or file a complaint.
    • A written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.

    You may also request your health information be sent to another entity or person, so long as that request is clear, conspicuous and specific. The Plan may provide you with a summary or explanation of the information instead of access to or copies of your health information, if you agree in advance and pay any applicable fees. The Plan also may charge reasonable fees for copies or postage. If the Plan doesn’t maintain the health information but knows where it is maintained, you will be informed where to direct your request.

    If the Plan keeps your records in an electronic format, you may request an electronic copy of your health information in a form and format readily producible by the Plan. You may also request that such electronic health information be sent to another entity or person, so long as that request is clear, conspicuous and specific. Any charge that is assessed to you for these copies must be reasonable and based on the Plan’s cost.

  • RIGHT TO AMEND YOUR HEALTH INFORMATION THAT IS INACCURATE OR INCOMPLETE

  • With certain exceptions, you have a right to request that the Plan amend your health information in a designated record set. The Plan may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the Plan (unless the person or entity that created the information is no longer available), is not part of the designated record set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal or administrative proceedings).

    If you want to exercise this right, your request to the Plan must be in writing, and you must include a statement to support the requested amendment. Within 60 days of receipt of your request, the Plan will take one of these actions:

    • Make the amendment as requested.
    • Provide a written denial that explains why your request was denied and any rights you may have to disagree or file a complaint.
    • Provide a written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.

Use and Disclosure of Your Health Information

Permitted uses and disclosures of PHI: Treatment, payment and healthcare operations, by the Plan, its Business Associates, and their agents/subcontractors, to carry out treatment, payment and healthcare operations:

  • Treatment is the provision, coordination or management of healthcare and related services by one or more healthcare providers. It also includes, but is not limited to, consultations and referrals between one or more of your providers. For example, the Plan may disclose to a treating orthodontist the name of your treating dentist so the orthodontist may ask for your dental X-rays from the treating dentist.
  • Payment means activities undertaken by the Plan to obtain premiums or to determine or fulfill its responsibility for coverage and provision of benefits under the Plan, or to obtain or provide reimbursement for the provision of the healthcare. Payment includes, but is not limited to, actions to make eligibility or coverage determinations, billing, claims management, collection activities, subrogation, reviews for medical necessity and appropriateness of care, utilization review and preauthorization. For example, the Plan may tell a doctor whether you are eligible for coverage or what percentage of the bill might be paid by the Plan. The Plan may also disclose PHI to a close friend or family member involved in or who helps pay for your healthcare.
  • Healthcare operations means conducting quality assessment and improvement activities, population-based activities relating to improving health or reducing healthcare costs, contacting healthcare providers and patients with information about treatment alternatives, reviewing the competence or qualifications of healthcare professionals, evaluating health plan performance, underwriting, premium rating and other insurance activities relating to creating, renewing or replacing health insurance contracts or health benefits. It also includes disease management, case management, conducting or arranging for medical review, legal services and auditing functions including fraud and abuse detection and compliance programs, business planning and development, business management and general administrative activities. For example, the Plan may use information about your claims to refer you to a disease management program, project future benefit costs or audit the accuracy of its claims processing functions.

Individual Participant Communication. The Plan may contact you to give you information about treatment alternatives or other health-related benefits and services that may be of interest to you.

As Required by Law. The Plan must allow the U.S. Department of Health and Human Services to audit Plan records. The Plan may also disclose medical information about you as authorized and to the extent necessary to comply with workers’ compensation or other similar laws.

To Business Associates. The Plan may disclose medical information about you to the Plan’s business associate. Each business associate of the Plan must agree in writing to ensure the continuing confidentiality and security of medical information about you. An example of one of our business associates is the health insurance company providing benefits under the Plan, who assists the Plan in plan administration activities.

To Plan Sponsor. The Plan may disclose to Chubb (the “Plan Sponsor”), in summary form, claims history and other similar information. The Plan Sponsor may use health information for underwriting purposes, but may not use genetic information for underwriting purposes. Such summary information does not disclose your name or other distinguishing characteristics. The Plan may also disclose to the Plan Sponsor the fact that you are enrolled in, or de-enrolled from the Plan.

The Plan may disclose medical information about you to the Plan Sponsor for Plan administration functions that the Plan Sponsor provides to the Plan if the Plan Sponsor agrees in writing to ensure the continuing confidentiality and security of medical information about you. The Plan Sponsor must also agree not to use or disclose medical information about you for employment-related activities or for any other benefit or benefit plans of the Plan Sponsor.

Use and Disclosure of Your Health Information

Your PHI may also be used and disclosed as follows:

  • To comply with legal proceedings, such as a court or administrative order or subpoena.
  • To law enforcement officials for limited law enforcement purposes.
  • To your personal representatives appointed by you or designated by applicable law.
  • To a coroner, medical examiner, or funeral director about a deceased person.
  • To an organ procurement organization in limited circumstances.
  • To avert a serious threat to your health or safety or the health or safety of others.
  • To a governmental agency authorized to oversee the healthcare system or government programs.
  • For specialized government functions (e.g., military and veterans activities, national security and intelligence, federal protective services, medical suitability determinations, correctional institutions and other law enforcement custodial situations).
  • To public health authorities for public health purposes.
  • We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person identified by you, Protected Health Information that is directly relevant to the person’s involvement with your care or payment related to your care.

Please note that we may limit the amount of information we share about you for these purposes in accordance with state laws to the extent such laws further restrict the use or disclosure of Protected Health Information.

Other Disclosures

Except as described above, the Plan cannot use or share your Protected Health Information without your written permission. For example we will not use or share your Protected Health Information for marketing purposes without obtaining your authorization. If we have records for you that include psychotherapy notes, we will not disclose those notes without your permission. We never sell your Protected Health Information unless you have authorized us to do so. You may withdraw that permission in writing at any time and we will no longer use or share that Protected Health Information.

We will not use or disclose your genetic information for underwriting purposes.

Filing a Complaint

If you believe that your privacy rights with respect to the Plan have been violated, you have the right to complain to the Plan. Any complaint can be made in writing or by telephone to the individual shown below under “Contact Information”. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints.

In all cases, your complaint must be submitted within 180 days of when you believe the violation occurred.

Notice of Breaches

In the event the Plan’s privacy obligations regarding your health information are not met and your health information is improperly used or disclosed, you will be notified of the breach of the privacy requirements. Notice will be provided on behalf of the Plan or by a business associate of the Plan. Notice will be provided promptly where prompt notice will assist you with any damage that might be caused by the breach.

Contact Information

If you have questions regarding this Notice or the subjects addressed in it, you may contact the Group Health Plan Privacy Contact at 215-640-2694 or in writing to:

Talia Roach
Privacy Officer
202A Hall's Mill Road
Whitehouse Station, NJ 08889

IMPORTANT NOTICE FROM CHUBB INA HOLDINGS, INC. ABOUT CREDITABLE PRESCRIPTION DRUG COVERAGE AND MEDICARE

The purpose of this notice is to advise you that the prescription drug coverage listed below under the Chubb US Medical Plan is expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in 2020. This is known as “creditable coverage.”

Why this is important: if you or your covered dependent(s) are enrolled in any prescription drug coverage during 2020 listed in this notice and are or become covered by Medicare, you may decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment penalty — as long as you had creditable coverage within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important records.

If you or your family members aren’t currently covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice doesn’t apply to you.

Please read the notice below carefully. It has information about prescription drug coverage with Chubb INA Holdings, Inc. and prescription drug coverage available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage.

Notice of Creditable Coverage

You may have heard about Medicare’s prescription drug coverage (called Part D), and wondered how it would affect you. Prescription drug coverage is available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium.

Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and each year from October 15 through December 7. Individuals leaving employer/union coverage may be eligible for a Medicare Special Enrollment Period.

If you are covered by one of the Chubb INA Holdings, Inc. prescription drug plan[s] listed below, you’ll be interested to know that the prescription drug coverage under the plan is, on average, at least as good as standard Medicare prescription drug coverage for 2019. This is called creditable coverage. Coverage under one of these plans will help you avoid a late Part D enrollment penalty if you are or become eligible for Medicare and later decide to enroll in a Medicare prescription drug plan.

  • Aetna $400 Deductible Plan
  • Aetna $900 Deductible Plan
  • Aetna $1,850 Deductible HSA Plan
  • Aetna $2,850 Deductible HSA Plan
  • Aetna $4,500 Deductible HSA Plan
  • Horizon BCBS $400 Deductible Plan
  • Horizon BCBS $900 Deductible Plan
  • Horizon BCBS $1,850 Deductible HSA Plan
  • Horizon BCBS $2,850 Deductible HSA Plan
  • Horizon BCBS $4,500 Deductible HSA Plan
  • Horizon BCBS Medicare Supplemental Plan
  • Optima $400 Deductible Plan
  • Optima $900 Deductible Plan
  • Optima $1,850 Deductible HSA Plan
  • Optima $2,850 Deductible HSA Plan
  • Kaiser $400 Deductible Plan
  • Kaiser $900 Deductible Plan
  • Kaiser $1,850 Deductible HSA Plan
  • Kaiser $2,850 Deductible HSA Plan
  • Kaiser Senior Advantage Plan
  • HMSA Preferred Provider Plan
  • MSC PPO Plan

If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also continue your employer coverage. In this case, the Chubb INA Holdings, Inc. plan will continue to pay primary or secondary as it had before you enrolled in a Medicare prescription drug plan. If you waive or drop Chubb INA Holdings, Inc. coverage, Medicare will be your only payer. You can re-enroll in the employer plan at annual enrollment or if you have a special enrollment event for the Chubb INA Holdings, Inc. plan, assuming you remain eligible.

If you enroll in a Medicare prescription drug plan and you are a retiree, you and your dependents continue to be eligible for retiree benefits under Chubb INA Holdings, Inc.’s plan. Before you decide to enroll in a Medicare prescription drug plan, you should compare your Chubb INA Holdings, Inc. plan options — including which drugs are covered — with the coverage and cost of the Medicare prescription drug plans available in your area. You will still be eligible to receive retiree medical and prescription drug coverage if you choose to enroll in a Medicare prescription drug plan. However, the Chubb INA Holdings, Inc. plan will pay secondary to Medicare.

You should know that if you waive or leave coverage with Chubb INA Holdings, Inc. and you go 63 days or longer without creditable prescription drug coverage (once your applicable Medicare enrollment period ends), your monthly Part D premium will go up at least 1% per month for every month that you did not have creditable coverage. For example, if you go 19 months without coverage, your Medicare prescription drug plan premium will always be at least 19% higher than what most other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll in Part D.

You may receive this notice at other times in the future — such as before the next period you can enroll in Medicare prescription drug coverage, if this Chubb INA Holdings, Inc. coverage changes, or upon your request.

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. Medicare participants will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. Here’s how to get more information about Medicare prescription drug plans:

For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov or call 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this notice. If you enroll in a Medicare prescription drug plan after your applicable Medicare enrollment period ends, you may need to provide a copy of this notice when you join a Part D plan to show that you are not required to pay a higher Part D premium amount.

For more information about this notice or your prescription drug coverage, contact:
Date: October 15, 2018
Name of Entity/Sender: Chubb
Contact – Position/Office: Joo Young Kang, AVP Benefits
Address: 202A Hall’s Mill Road
Whitehouse Station, NJ 08887
Phone Number: 1.908.903.4239

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 a 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, 2019. Contact your State for more information on eligibility.

ALABAMA – Medicaid FLORIDA – Medicaid
Website: http://myalhipp.com/
Phone: 1-855-692-5447
Website: http://flmedicaidtplrecovery.com/hipp/
Phone: 1-877-357-3268
ALASKA – Medicaid GEORGIA – Medicaid
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com/
Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com
Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Website: http://dch.georgia.gov/medicaid
- Click on Health Insurance Premium Payment (HIPP)
Phone: 404-656-4507
ARKANSAS – Medicaid INDIANA – Medicaid
Website: http://myarhipp.com/
Phone: 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.in.gov/fssa/hip/
Phone: 1-877-438-4479
All other Medicaid
Website: http://www.indianamedicaid.com
Phone 1-800-403-0864
COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) IOWA – Medicaid
Health First Colorado Website: https://www.healthfirstcolorado.com/
Health First Colorado Member Contact Center:
1-800-221-3943/ State Relay 711
CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus
CHP+ Customer Service: 1-800-359-1991/State Relay 711
Website:
http://dhs.iowa.gov/hawk-i
Phone: 1-800-257-8563
KANSAS – Medicaid NEW HAMPSHIRE – Medicaid
Website: http://www.kdheks.gov/hcf/
Phone: 1-785-296-3512
Website: https://www.dhhs.nh.gov/ombp/nhhpp/
Phone: 603-271-5218
Hotline: NH Medicaid Service Center at 1-888-901-4999
KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP
Website: https://chfs.ky.gov
Phone: 1-800-635-2570
Medicaid Website:
http://www.state.nj.us/humanservices/
dmahs/clients/medicaid/
Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710
LOUISIANA – Medicaid NEW YORK – Medicaid
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Phone: 1-888-695-2447
Website: https://www.health.ny.gov/health_care/medicaid/
Phone: 1-800-541-2831
MAINE – Medicaid NORTH CAROLINA – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html
Phone: 1-800-442-6003
TTY: Maine relay 711
Website: https://dma.ncdhhs.gov/
Phone: 919-855-4100
MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid
Website: http://www.mass.gov/eohhs/gov/departments/masshealth/
Phone: 1-800-862-4840
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-844-854-4825
MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP
Website: http://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/medical-assistance.jsp
Phone: 1-800-657-3739
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
MISSOURI – Medicaid OREGON – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005
Website: http://healthcare.oregon.gov/Pages/index.aspx
http://www.oregonhealthcare.gov/index-es.html
Phone: 1-800-699-9075
MONTANA – Medicaid PENNSYLVANIA – Medicaid
Website:
http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084
Website:
http://www.dhs.pa.gov
Phone: 1-800-692-7462
NEBRASKA – Medicaid RHODE ISLAND – Medicaid
Website: http://www.ACCESSNebraska.ne.gov
Phone: (855) 632-7633
Lincoln: (402) 473-7000
Omaha: (402) 595-1178
Website: http://www.eohhs.ri.gov/
Phone: 855-697-4347
NEVADA – Medicaid SOUTH CAROLINA – Medicaid
Medicaid Website: https://dhcfp.nv.gov
Medicaid Phone: 1-800-992-0900
Website: https://www.scdhhs.gov
Phone: 1-888-549-0820

To see if any other states have added a premium assistance program since August 10, 2018, or for more information on special enrollment rights, contact either:

U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)

U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov;
1-877-267-2323, 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 ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2019)

NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGE

Note: References to the “Marketplace” in this notice refer to the federal public health insurance marketplace and not Mercer Marketplace 365+.

PART A: GENERAL INFORMATION

To assist you as you evaluate options for you and your family, this notice provides some basic information about the Marketplace and employment-based health coverage offered by your employer.

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. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.

CAN I SAVE MONEY ON MY HEALTH INSURANCE PREMIUMS IN THE MARKETPLACE?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.

DOES EMPLOYER HEALTH COVERAGE AFFECT ELIGIBILITY FOR PREMIUM SAVINGS THROUGH THE MARKETPLACE?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly 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 meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.78% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.1

1An employer-sponsored 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.

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution—as well as your employee contribution to employer-offered coverage—is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

HOW CAN I GET MORE INFORMATION?

For more information about your coverage offered by your employer, please check your summary plan description or contact Carolyn Kennedy at 908-903-2231.

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.

PART B: INFORMATION ABOUT HEALTH COVERAGE OFFERED BY YOUR EMPLOYER

This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

1. Employer name

Chubb INA Holdings Inc.

2. Employer Identification Number (EIN)

58-2457246

3. Employer address

202A Halls Mill Road

4. Employer phone number

908-903-2231

5. City

Whitehouse Station

6. State

NJ

7. Zip Code

08889

8. Who can we contact about employee health coverage at this job?

Carolyn Kennedy, VP HRS Compensation & Benefits

9. Phone number (if different from above)

 

10. Email address

cakennedy@chubb.com

Here is some basic information about health coverage offered by this employer:

As your employer, we offer a health plan to:

  • All employees.
  • Some employees. Eligible employees are: All full-time and part-time salaried employees who work 24 hours per week

  • With respect to dependents:

  • We do offer coverage. Eligible dependents are:
    • Your spouse or domestic partner
    • Your or your spouse’s/partner’s eligible children up to age 26 (eligibility ends on the last day of the month of the child’s 26th birthday)
    • Your disabled children of any age, if they are covered under your medical plan and disabled prior to losing eligibility (and are legally or financially dependent primarily on you, as defined by the IRS)
  • We do not offer coverage.
  • If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.

Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process.