Health Care Reform Update
By: Kathy Vosmus

5/25/2010 - HEALTH PLAN ANNOUNCEMENTS

Health Care Reform Update:

Many of you may be reading about the newly enacted federal health care reform law. Together with Anthem, our health plan administrator, the City of Portland continues to review the key health care reform issues and await federal agencies such as Health and Human Services and the IRS to define details, issue implementation guidelines or regulations, and resolve any ambiguous areas in the Act. Last week, we announced the implementation of coverage for children to the age of 26 to be effective July 1, 2010. We will keep you informed as we learn of any additional changes that need to be implemented as a result of federal law changes.


Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Care Coverage to Children and Families:

• If you are eligible for health coverage from the City of Portland, but are unable to afford the premiums, you may want to contact the State of Maine Medicaid office to find out if premium assistance is available.

• If you or your dependents are already enrolled in Medicaid, you can contact the State Medicaid office to find out if premium assistance is available.

• If you or your dependents are NOT currently enrolled in Medicaid, and you think you or any of your dependents might be eligible for this program, you can contact the State Medicaid office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid, the City’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the City’s plan.

You should contact State of Maine Medicaid for further information on eligibility:

• Website: http://www.maine.gov/dhhs/oms/
• Phone: 1-800-321-5557


The federal Women’s Health and Cancer Rights Act requires all health plans to provide benefits related to breast cancer surgery and reconstruction and to notify its participants annually. Employees participating in the City’s health plan and their covered dependents are eligible for benefits for mastectomies and subsequent breast reconstructive surgery which includes:

• Reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
• Prostheses and treatment of physical complications in all states of mastectomy, including lymphedema.

Benefits available under this mandate are subject to the same terms and conditions as all other
benefits under the City’s health plan.


Notice of Privacy Practices:

Employee Group Health Plan and the Medical Reimbursement Plan Notice of Privacy Practices available upon request by calling 874-8624 and at the City of Portland’s website www.portlandmaine.gov. Select: Departments→Human Resources→Benefits→Privacy Practices.


Maine Health Management Coalition:

The City of Portland is a member of the Maine Health Management Coalition (MHMC). The Coalition is made up of employers, hospitals, health plans and doctors working together to provide you with patient safety and quality information. Better quality healthcare not only save lives, it can make a difference in how fast your health improves. To view physician and hospital data collected, go to www.mhmc.info.