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News/New MILA Benefits in 2016-2017

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June 6, 2016

Dear MILA Participant,

On behalf of the MILA Trustees and the MILA Co-Chairmen, Benjamin Holland and Dave Adam, I am pleased to announce coverage for three new benefits under the MILA National Health Plan. Effective July 1, 2016, MILA will provide the following benefits under the Cigna medical program:

BENEFIT WHO IS COVERED COVERAGE
Hearing Aids All actives and retirees, including all spouses and dependents Your Hearing Aid Program Offered Through Cigna/MILA will provide a hearing aid benefit through Cigna’s relationship with Amplifon (Call 1.877.778.5417 to select your nearest hearing healthcare professional). The benefit will be $1,500 per ear, once every three years.

Read more about the Amplifon hearing aid program.
Intrauterine Devices (IUDs) All actives and retirees, including all spouses and dependents MILA will provide coverage for IUD’s. Coverage under Premier, Basic and Core will be covered in-network at 100%. There will be no out of network coverage.
Infertility Benefits All actives, retirees and spouses from 21 to 44 years of age

This benefit does NOT apply to other dependents
MILA will provide coverage for infertility treatments. The coverage will be provided through Cigna Infertility Treatment Centers of Medical Excellence.

A list of the infertility centers is enclosed, but the list is subject to change. Please contact Cigna for a current list or to check if your provider is a network provider.

There is a lifetime cap on the benefit provided by MILA of $40,000: $30,000 of the maximum will apply to covered medical services and $10,000 of the maximum will apply to covered drugs.

The medical maximum will apply to all covered drugs administered in a medical setting.

View a list of Cigna Infertility Clinics.

Effective January 1, 2017, the Plan is amended as follows:

BENEFIT WHO IS COVERED COVERAGE
Benefits for Gender Dysphoria All actives and retirees, including all spouses and dependents MILA will now cover services and supplies related to gender dysphoria including, but not limited to, medically necessary services and supplies for counseling, surgery, durable medical equipment and prescription drugs, in the same way as other medical or surgical services and supplies subject to the Plan’s general medical management requirements.


CIGNA COVERAGE POLICY UPDATES

We are updating the way we pay claims for digital breast tomosynthesis (DBT), also called 3D mammography. Starting August 23, 2016, DBT will be a covered as a preventive benefit under most Cigna plans.

  • How does DBT differ from 2D digital mammography?

    Mammography is a test, usually done every year or two, that uses a low-dose X-ray to screen for breast cancer and other breast diseases and to diagnose breast conditions when a screening test shows a problem. A standard mammogram takes digital images of the breast from two angles (also known as 2D digital mammography).

    DBT is different from standard 2D mammography because instead of taking images from two angles, it takes many images in an arc around the breast and creates a 3D image.

  • Are DBT screening tests a covered service?

    Yes. Based on recent guidance from the National Comprehensive Cancer Network, a not-for-profit alliance of leading cancer centers that sets standards for high-quality cancer care, we have changed our screening mammography coverage policy to cover DBT.

    For services done on or after August 23, 2016, we will process claims for DBT under your plan's preventive care benefit. Depending on your benefit plan, you may not have a cost-share for claims for DBT services.

  • Questions or concerns?

    We're happy to help! Please call us at the number on the back of your Cigna ID card. Our Customer Service Advocates are available 24/7.

If you have any questions about your coverage, you can call Cigna using the number on the back of your Cigna I.D. card or you can contact the MILA office at 212-766-5700.

This notice constitutes a Summary of Material Modifications. You should file this notice with your copy of the Summary Plan Description (“SPD”) for the Plan because it changes certain information contained in the SPD. The Board of Trustees may, from time to time and at any time, adopt such rules and procedures that it determines to be necessary or desirable with respect to the operation of the Plan, and amend, modify or eliminate any provision of the Plan. Please direct any questions you may have about this Notice or the Plan in general to the Plan Office: MILA National Health Plan, 111 Broadway, Suite 502, New York, NY 10006, 212-766-5700.

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Statement of Grandfathered Status. The Board of Trustees is currently operating this Plan as a “grandfathered health plan” under the Affordable Care Act. Because of this “grandfathered” status, our Plan can preserve certain basic health coverage already in effect before the law was passed. As with all grandfathered health plans, the Plan is not required to include certain consumer protections of the Affordable Care Act that apply to non-grandfathered plans (for example, providing preventive health services without any cost sharing). However, the Plan must comply with certain other provisions of the Affordable Care Act (for example, eliminating lifetime limits on benefits). Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Plan Administrator at 212-766-5700.

You can contact the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) if you have questions about what it means for a health plan to have grandfathered status and what might cause a plan to lose its grandfathered status. You can reach the EBSA by phone at 866-444-3272 or by accessing their website at www.dol.gov/ebsa/healthreform, where you can see a chart summarizing the protections that do and do not apply to grandfathered health plans. Alternatively, you also may contact the Plan Office with your questions.

Very truly yours,

LaVerne Thompson
Executive Director