Plain-English summaries of the federal and state guidelines that apply to your coverage. These summaries don’t replace the full notices - those are provided at enrollment, and we’re happy to send a copy any time.
If you or a dependent lose Medicaid or CHIP eligibility, or newly become eligible for either program, you have 60 days from that change to enroll in or drop coverage under Lettuce Healthcare outside the normal enrollment window.
If you or your dependents are eligible for premium assistance through Medicaid or CHIP, your state may help pay your Lettuce Healthcare premium. Contact your state’s Medicaid or CHIP office, or call 1-877-KIDS-NOW (1-877-543-7669), or visit insurekidsnow.gov to check eligibility.
Lettuce Healthcare and its carrier partners are required to protect any confidential health information that identifies you or could be used to identify you, including anything related to a physical or mental health condition or the payment of your health care expenses. If you enroll, you’ll be notified of the specific policies that protect the confidentiality of your health information.
If you elect breast reconstruction in connection with a mastectomy, WHCRA requires group health plans to cover the related medical and surgical benefits - including reconstructive surgery and treatment of complications such as lymphedema - under the same deductible and coinsurance terms that apply to your plan’s other medical and surgical benefits.
Group health plans generally can’t limit hospital stays connected to childbirth to less than 48 hours for a vaginal delivery, or 96 hours for a cesarean, and can’t require prior authorization for a stay within those windows. A mother and her attending provider can still choose to leave earlier if that’s the right call for them.
If your dependent child is covered under your plan as a student and has to take a medically necessary leave of absence, they can stay covered for up to one year from when the leave begins - even though they’re no longer enrolled as a student. Your plan will require written certification from the child’s physician confirming the leave is medically necessary.
If your plan covers mental health or substance use disorder benefits alongside medical and surgical benefits, MHPAEA requires those benefits to be treated on equal footing - no lower annual or lifetime dollar limits, and no stricter copays, deductibles, or visit limits than apply to medical and surgical care.
Lettuce has determined that the prescription drug coverage offered through your plan is, on average, expected to pay out as much as standard Medicare prescription drug coverage - which makes it “Creditable Coverage.” Because of that, you can keep your current coverage without paying a higher premium (a late-enrollment penalty) if you decide to join a Medicare drug plan later.
You can join a Medicare drug plan when you first become eligible, or each year from October 15 through December 7. If you lose creditable coverage through no fault of your own, you also get a two-month Special Enrollment Period. If you go 63 or more continuous days without creditable coverage, you may pay a higher premium if you join a Medicare drug plan later - roughly 1% more per month of the Medicare base beneficiary premium for every month you went without coverage.