Miami Beach Fraternal Order of Police Health Trust

Notice of Group Health Plan's Exemption from the
Mental Health Parity Act

This notice is being provided to you under the requirements of the Mental Health Parity Act (MHPA) because your group health plan is a self-funded plan eligible for exemption from certain requirements of MHPA. Under MHPA, a group health plan offering both medical/surgical and mental health benefits generally can no longer set annual or aggregate lifetime dollar limits on mental health benefits or substance abuse disorders that are lower than any such dollar limits for medical/surgical benefits. In addition, a plan that does not impose an annual or aggregate lifetime dollar limit on medical/surgical benefits generally may not impose such a limit on mental health benefits and substance abuse disorders. However, a group health plan that is self-funded, such as the MBFOP Plan can claim an exemption from certain requirements so long as an election to do so is filed with the Centers for Medicare & Medicaid Services, Private Health Insurance Group (CMS) and notice is provided to enrollees.

This notice is to inform you that the Miami Beach FOP Health Plan is claiming exemption from the following requirements:

Parity in the application of certain limits to mental health benefits. Group health plans (of employers that employ more than 50 employees) that provide both medical and surgical benefits and mental health or substance use disorder benefits must ensure that financial requirements and treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant financial requirements and treatment limitations applicable to substantially all medical and surgical benefits covered by the plan.

The exemption is effective as of plan year January 1, 2010. This exemption results in NO change of benefits to your current health plan.  The Plan provides for certification and disclosure of creditable coverage for covered employees and their dependents that lose coverage under the Plan.

Your plan currently provides, and will continue to provide for the coverage for treatment of mental health and substance abuse.  You may access your benefits via the websites of the Miami Beach FOP (http://www.mbfop.com/health/healthtrustINFO/Health%20Trust1info.htm)
As well as the United HealthCare site. (http://www.myuhc.com)

Summary of Miami Beach FOP Health Trust
Mental Health & Substance Abuse Benefits

Non-PPO Benefits Payable:

1. The following benefits for Outpatient treatment of Mental and Nervous Disorders and alcohol and drug abuse shall apply and are payable at 50% after satisfaction of the $1,000 individual calendar year deductible:

           
                        Physician Visits . . . . . . . . ……………………... $70 per visit ($35 payable).
                        One visit per day. 25 visits in any calendar year.
                        Maximum of 25 visits combined in or out of network. 

1. Hospital expense for in-patient treatment for a psychiatric, mental and nervous disorder, and alcohol and drug abuse shall be covered, but confinement is limited to thirty one (31) days per plan year.

PPO Benefits Payable:

            Mental health or psychiatric . …. ……………………….. $200.00 co-payment *
                                      per day (facility), not to exceed $1,000 per admission*
                                                  . . ……….. . . . .  ……………….. $30.00 co-payment
                                                per visit (physician)

            Admissions for alcohol and/or            drug detoxification………. $200.00 co-payment *
                                                   per day, not to exceed $1,000 per admission*                                                            
                                                ... . ……….. . . . .  ……………….. $30.00 co-payment
                                                per visit (physician)

                        One visit per day. 25 visits in any calendar year.
                       
                        Maximum of 25 visits combined in or out of network. 

Hospital expense for in-patient treatment of psychiatric, mental and nervous disorders, and alcohol and drug abuse shall be covered, but confinement is limited to thirty one (31) days per plan year.

*Note:  Changes identified to the PPO benefit will be effective January 1, 2010