120 Federal Notice If you need help filing a complaint, please call 1-866-633-2446 or the toll-free member phone number listed on your ID card, TTY 711. You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Phone: Toll-free 1-800-368-1019, 1-800-537-7697 (TDD) Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1For purposes of this Non-Discrimination Notice ("Notice"), "The Claims Administrator" refers to the entities listed in Footnote 2 of the Notice of Privacy Practices and Footnote 3 of the Financial Information Privacy Notice. Please note that not all entities listed are covered by this Notice. Important Notices under the Patient Protection and Affordable Care Act (PPACA) Changes in Federal Law that Impact Benefits There are changes in Federal law which may impact coverage and Benefits stated in the Summary Plan Description (SPD) and Schedule of Benefits. A summary of those changes and the dates the changes are effective appear below. These changes will apply to any "non-grandfathered" plan. Contact your Plan Administrator to determine whether or not your plan is a "grandfathered" or a "non-grandfathered plan". Under the Patient Protection and Affordable Care Act (PPACA) to be grandfathered a plan must have been in effect on March 23, 2010 and had no substantial changes in the benefit design as described in the Interim Final Rule on Grandfathered Health Plans at that time(among other requirements). Patient Protection and Affordable Care Act (PPACA) Effective for policies that are new or renewing on or after September 23, 2010, the requirements listed below apply. • Lifetime limits on the dollar amount of essential benefits available to you under the terms of your plan are no longer permitted. Essential benefits include the following: Ambulatory patient services; emergency services, hospitalization; laboratory services; maternity and newborn care, mental health care and substance-related and addictive disorder services (including behavioral health treatment); prescription drugs; rehabilitative and habilitative services and devices; preventive and wellness services and long-term disease management; and pediatric services, including oral and vision care. • On or before the first day of the first plan year beginning on or after September 23, 2010, the enrolling group will provide a 30 day enrollment period for those individuals who are still eligible under the plan's eligibility terms but whose coverage ended by reason of reaching a lifetime limit on the dollar value of all benefits. • Essential health benefits for plan years beginning on or after January 1, 2014 cannot be subject to annual or lifetime dollar limits. • Coverage for enrolled dependent children is no longer conditioned upon full-time student status or other dependency requirements and will remain in place until the child's 26th birthday. As of September 23, 2010, if you have a grandfathered plan, the group is not required to extend coverage to age 26 if the child is eligible to enroll in an eligible employer-sponsored health plan (as defined by law). For plan years beginning January 1, 2014 and beyond, Grandfathered plans are