HIPAA Privacy Notice
In accordance with the privacy standards contained in the Health Insurance
Portability and Accountability Act (HIPAA) of 1996, Maricopa County, in its role
as the administrator and/or sponsor of the Maricopa County Health Insurance
Program, or in its role as the health plan makes available a notice setting
forth its privacy practices through the EBC/Intranet
http://ebc.maricopa.gov/ehi home page. This notice describes the potential
uses and disclosures of Protected Health Information (PHI), the individual’s
rights and the plan’s legal duties with respect to PHI. The privacy notice may
be updated occasionally and such updates will be communicated through notices
posted on the EBC.
Click here to view
Maricopa County's Group Health Plan Notice of Privacy Practices
Social Security Number or Health Insurance Claim Number use:
Disclosure of your Social Security Number (SSN) or your health insurance claim
number (if enrolled in Medicare) for purposes of enrollment and other
benefit-related uses is voluntary except when required under Section 111 of
Public Law 100-173.
COBRA Initial Notification
You are receiving this notice because you are currently covered under Maricopa
County’s Health Insurance Program (the Plan). This notice contains important
information about your right to COBRA continuation coverage, which is a
temporary extension of coverage under the Plan.
This notice generally
explains COBRA continuation coverage, when it may become available to you and
your family, and what you need to do to protect the right to receive it.
The right to COBRA continuation coverage was created by a federal law, the
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA
continuation coverage can become available to you when you would otherwise lose
your group health coverage. It can also become available to other members of
your family who are covered under the Plan when they would otherwise lose their
group health coverage. For additional information about your rights and
obligations under the Plan and under federal law, you should review the Plan’s
Summary Plan Description or contact the Plan Administrator.
The Plan Administrator is Maricopa County Employee Benefits, located at 301 West
Jefferson Street, Suite 3200, Phoenix, AZ 85003, and available via telephone by
dialing 602-506-1010, press 2 and then 2 again to speak to a Representative or
by emailing to
BenefitsService@mail.maricopa.gov. The Plan Administrator is responsible for
administering COBRA continuation coverage.
Under federal COBRA law, should you lose your group health insurance because of
one of the below listed qualifying events, covered employees and covered family
members (called qualified beneficiaries) will be offered the opportunity for a
temporary extension of health coverage (called Continuation Coverage) at group
rates which you will be required to pay. This notice is intended to inform all
plan participants, in a summary fashion, of your potential future options and
obligations under the continuation coverage provisions of federal law. Should an
actual qualifying event occur in the future, the plan manager will send you
additional information and the appropriate election notice at that time.
Please take special
note, however, of your notification obligations and procedures which are
highlighted in this notification!
What is COBRA Continuation Coverage?
COBRA continuation coverage is a continuation of Plan coverage when coverage
would otherwise end because of a life event known as a “qualifying event.”
Specific qualifying events are listed later in this notice. After a qualifying
event, COBRA continuation coverage must be offered to each person who is a
“qualified beneficiary.” You, your spouse, and your dependent children could
become qualified beneficiaries if coverage under the Plan is lost because of the
qualifying event. Under the Plan, qualified beneficiaries who elect COBRA
continuation coverage may be required to pay for COBRA continuation coverage. If
you are required to pay for COBRA continuation coverage, you will be notified at
the time you are offered COBRA continuation coverage of the amount and the date
payment is due.
If you are an employee, you will become a qualified beneficiary if you will lose
your coverage under the Plan because either one of the following qualifying
Your hours of
employment are reduced, or
Your employment ends
for any reason other than your gross misconduct.
If you are the spouse of an employee, you will become a qualified beneficiary if
you will lose your coverage under the Plan because any of the following
qualifying events happens:
Your spouse dies;
Your spouse’s hours of
employment are reduced;
employment ends for any reason other than his or her gross misconduct;
Your spouse becomes
entitled to Medicare benefits (under Part A, Part B, or both); or
You become divorced or
legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they will lose
coverage under the Plan because any of the following qualifying events happens:
hours of employment are reduced;
employment ends for any reason other than his or her gross misconduct;
becomes entitled to Medicare benefits (Part A, Part B, or both);
The parents become
divorced or legally separated; or
The child stops being
eligible for coverage under the plan as a “dependent child.”
Sometimes, filing a proceeding in bankruptcy under title 11 of the United States
Code can be a qualifying event. If a proceeding in bankruptcy is filed with
respect to Maricopa County, and that bankruptcy results in the loss of coverage
of any retired employee covered under the Plan, the retired employee is a
qualified beneficiary with respect to the bankruptcy. The retired employee’s
spouse, surviving spouse, and dependent children will also be qualified
beneficiaries if bankruptcy results in the loss of their coverage under the
When is COBRA Continuation Coverage Available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only
after the Plan Administrator has been notified that a qualifying event has
occurred. When the qualifying event is the end of employment or reduction of
hours of employment, death of the employee, commencement of a proceeding in
bankruptcy with respect to the employer, or the employee’s becoming entitled to
Medicare benefits (under Part A, Part B, or both), the employer must notify the
Plan Administrator of the qualifying event (1) within 30 days of any of these
events or (2) within 30 days following the date coverage ends.
You Must Give Notice of Some Qualifying Events
For the other qualifying events (divorce or legal separation of the employee and
spouse or a dependent child’s losing eligibility for coverage as a dependent
child), you must notify the Plan Administrator. Generally Plans require that
notification of such events be provided to the Plan Administrator within 60 days
after the qualifying event has occurred. However, your Plan may allow a longer
period of time to provide notification. Please consult your Plan’s SPD to
determine the Plan’s qualifying event notification requirements. You must send
this notice to: Maricopa County Employee Benefits and as directed under the
terms of the Plan located in the SPD.
How is COBRA Continuation Coverage Provided?
Once the Plan Administrator receives notice that a qualifying event has
occurred, COBRA continuation coverage will be offered to each of the qualified
beneficiaries. Each qualified beneficiary will have an independent right to
elect COBRA continuation coverage. Covered employees may elect COBRA
continuation coverage on behalf of their spouses, and parents may elect COBRA
continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage. When the
qualifying event is death of the employee, the employee’s becoming entitled to
Medicare benefits (under Part A, Part B, or both), your divorce or legal
separation, or a dependent child's losing eligibility as a dependent child,
COBRA continuation coverage lasts for up to a total of 36 months. When the
qualifying event is the end of employment or reduction of the employee's hours
of employment, and the employee became entitled to Medicare benefits less than
18 months before the qualifying event, COBRA continuation coverage for qualified
beneficiaries other than the employee lasts until 36 months after the date of
Medicare entitlement. For example, if a covered employee becomes entitled to
Medicare 8 months before the date on which his employment terminates, COBRA
continuation coverage for his spouse and children can last up to 36 months after
the date of Medicare entitlement, which is equal to 28 months after the date of
the qualifying event (36 months minus 8 months). Otherwise, when the qualifying
event is the end of employment or reduction of the employee's hours of
employment, COBRA continuation coverage generally lasts for only up to a total
of 18 months. There are two ways in which this 18-month period of COBRA
continuation coverage can be extended.
Disability extension of 18-month period of
If you or anyone in your family covered under the Plan is determined by the
Social Security Administration (SSA) to be disabled at any time during the first
60 days of COBRA continuation coverage and you notify the Plan Administrator in
a timely fashion, you and your entire family may be entitled to receive up to an
additional 11 months of COBRA continuation coverage, for a total maximum of 29
months. You must make sure that you provide a copy of the SSA’s disability
determination to the Plan Administrator prior to the last day of the initial
18-month COBRA continuation coverage period AND within 60 days of
the latest of the dates listed below:
the date the qualified
beneficiary was informed (through the Summary Plan Description (SPD) or Initial
General Notice of COBRA Rights) of the responsibility and procedures for
informing the plan of the disability determination;
the date on which the
qualifying event occurred;
the date coverage was
the date the SSA made
their determination (date of the determination notice of award).
This notice should be sent to: Maricopa County Employee Benefits or other party
as indicated in the COBRA Election Notice you receive at the time you are
offered COBRA continuation coverage.*
Second qualifying event extension of 18-month
period of continuation coverage
If, while receiving COBRA continuation coverage, your spouse and/or dependent
child(ren) experiences another qualifying event which causes a loss of coverage,
they can get additional months of COBRA continuation coverage, for a total of up
to a maximum of 36 months from the date of the first qualifying event. This
extension is available only to the spouse and dependent children if the employee
or former employee dies, becomes entitled to Medicare benefits (under Part A,
Part B, or both), or gets divorced or legally separated, or if the dependent
child stops being eligible under the Plan as a dependent child, but only if the
event would have caused the spouse or dependent child to lose coverage under the
Plan had the first qualifying event not occurred. In all of these cases, you
must make sure that the Plan Administrator is notified of the second qualifying
event within 60 days of the second qualifying event. This notice must be sent to
Maricopa County Employee Benefits or other party as indicated in the COBRA
Election Notice you receive at the time you are offered COBRA continuation
At the time you are being provided with this Initial General Notice of COBRA
Rights, ADP Benefit Services is your employer’s COBRA administrator. In the
future, you should refer to the COBRA Election Notice you receive at the time
you are offered COBRA continuation coverage to confirm that ADP Benefits
Services still performs this function for your employer and that ADP Benefits
Services remains the appropriate place for you to send notice of a Social
Security Disability or Second Qualifying event.
If You Have Questions
Questions concerning your Plan or your COBRA continuation coverage rights should
be addressed to the contact or contacts identified below. For more information
about your rights under ERISA, including COBRA, the Health Insurance Portability
and Accountability Act (HIPAA), and other laws affecting group health plans,
contact the nearest Regional or District Office of the U.S. Department of
Labor's Employee Benefits Security Administration (EBSA) in your area or visit
the EBSA website at
www.dol.gov/ebsa. (Addresses and phone numbers of Regional and
District EBSA Offices are available through EBSA's website.)
Keep Your Plan Informed of Address Changes
In order to protect your family’s rights, you should keep the Plan Administrator
informed of any changes in the addresses of family members. You should also keep
a copy, for your records, of any notices you send to the Plan Administrator.
Plan Contact Information
Maricopa County Employee Benefits Division
301 West Jefferson Street, Suite 3200
Phoenix, Arizona 85003
Telephone number 602-506-1010
Fax number: 602-506-2354
COBRA continuation coverage for the Plan is
Telephone number 1-800-770-7981
The American Recovery and Reinvestment Act of 2009 (ARRA)
The American Recovery and Reinvestment Act of 2009 (ARRA) as amended by the
Department of Defense Appropriations Act (2010 DOD Act) on December 19, 2009 and
the Temporary Extension Act of 2010 (TEA) on March 2, 2010, provides for premium
reductions for health benefits under COBRA. Eligible individuals pay 35 percent
of their COBRA premiums; the remaining 65 percent is reimbursed to the coverage
provider through a tax credit. The premium reduction applies to periods of
health coverage that began on or after February 17, 2009 and lasts for up to 15
To qualify, individuals must experience a COBRA qualifying event that is the
involuntary termination of a covered employee’s employment. The involuntary
termination must generally occur during the period that began September 1, 2008
and ends on March 31, 2010. However, TEA also provides that an involuntary
termination of employment is a qualifying event for purposes of ARRA if the
occurs on or after March 2,
2010 and no later than March 31, 2010; and
follows a qualifying event that
was a reduction of hours that occurred at any time from September 1, 2008
through March 31, 2010.
If an individual’s modified adjusted gross income for the tax year in which the
premium assistance is received exceeds $145,000 (or $290,000 for joint filers),
then the amount of the premium reduction during the tax year must be repaid. For
taxpayers with adjusted gross income between $125,000 and $145,000 (or $250,000
and $290,000 for joint filers), the amount of the premium reduction that must be
repaid is reduced proportionately. Individuals may permanently waive the right
to premium reduction but may not later obtain the premium reduction if their
adjusted gross incomes end up below the limits. If you think that your income
may exceed the amounts above, consult your tax preparer or contact the IRS at
Women’s Health and Cancer Rights Act (WHCRA)
Do you know that your plan, as required by the Women’s Health and Cancer Rights
Act of 1998, provides benefits for mastectomy-related services including all
stages of reconstruction and surgery to achieve symmetry between the breasts,
prostheses, and complications resulting from a mastectomy, including lymphedema.
Call CIGNA Customer Service for more information.
Obtaining a Certificate of Creditable Coverage under This Plan
Upon loss of coverage under this Plan, a Certificate of Creditable Coverage will
be mailed to each terminating individual at the last address on file. You or
your dependent may also request a Certificate of Creditable Coverage, without
charge, at any time while enrolled in the Plan and for 24 months following
termination of coverage. You may need this document as evidence of your prior
coverage to reduce any pre-existing condition limitation period under another
plan, to help you get special enrollment in another plan, or to obtain certain
types of individual health coverage even if you have health problems. To obtain
a Certificate of Creditable Coverage, contact CIGNA Customer Service. ADP also
provides Certificates of Creditable Coverage and may also be contacted to
request a replacement copy.
General Notice of the Plan’s Pre-existing Condition Exclusion
The Open Access Plus and the Choice Fund Medical Plan impose a pre-existing
condition exclusion. This means that if you have a medical condition before
coming to a Maricopa County-sponsored plan, you might have to wait a certain
period of time before the plan will provide coverage for that condition. This
exclusion applies only to conditions for which medical advice, diagnosis, care,
or treatment was recommended or received within 60 calendar days prior to your
effective date of coverage. The pre-existing condition exclusion does not apply
to pregnancy or to a child under age 19 (effective July 1, 2011).
This exclusion may last up to 12 months from your first day of coverage.
However, you can reduce the length of this exclusion period by the number of
days of your prior “creditable coverage”.
Most prior health coverage is
creditable coverage and can be used to reduce the pre-existing condition
exclusion if you have not experienced a break in coverage of at least 63 days.
To reduce the 12-month
exclusion period by your creditable coverage, you should give CIGNA a copy of
any Certificates of Creditable Coverage you have.
If you do not have a
certificate, but you do have prior health coverage, you should contact your
prior plan and ask them for a Certificate of Creditable Coverage. Please contact
the EB Division at (602) 506-1010 if you need help demonstrating creditable
Notice of Special Enrollment Rights
In general, IRS restrictions prevent you from making changes to your coverage
elections during the plan year. This means that once you make your health plan
elections at Open Enrollment, you may not drop dependents or change your
coverage until the next Open Enrollment period. You may be able to add or drop
dependents during the plan year (but not change your plan coverage) if you
experience and report a life event, also known as a qualified status change.
These changes include the following:
You get married or divorced.
You acquire a dependent child
through birth, adoption or placement for adoption.
Your spouse or dependent dies.
Your dependent no longer meets
the plan’s eligibility requirements.
Your spouse terminates
employment or begins new employment.
You or your spouse change from
part-time work to full-time work (or vice-versa).
You or your spouse has a
significant change in the cost of health care coverage.
You are required to provide
dependent medical coverage as a result of a valid court decree that meets the
requirements of a Qualified Medical Child Support Order (QMCSO).
You or your dependent’s
Medicaid or SCHIP coverage is terminated as a result of loss of eligibility. (An
employee must be given at least 60 days after the date of termination of the
coverage to request special enrollment.)
You or your dependent become
eligible for a state premium assistance subsidy under the plan from Medicaid or
SCHIP. (An employee must be given a period of at least 60 days after the date on
which eligibility for premium assistance has been determined to request special
Any benefit enrollment change you make must be consistent with your qualified
status change. To change your coverage, enter the status change online through
the Benefit Enrollment System via the ADP portal within 30 calendar days (or 60
days as noted above) of the date you experience the status change. A request for
the required documentation of your status change will be mailed to your home
address. Your new elections will be effective on either the date of your status
change or the date your status change was processed, and retroactive payroll
deductions may be withheld. If you do not complete your status change online
within the 30 calendar day (or 60 days as noted above) period, you must wait
until the next Open Enrollment period to change your benefits.
Medicare Secondary Payer Mandatory Insurer Reporting Requirements of Sect 111
of the Medicare, Medicaid, and SCHIP Extension Act of 2007(P.L. 110-173 42 U.S.C. § 1395y(b)(7))
Requires the collection and reporting of the Social Security Number (or Medicare
Health Insurance Claim Number “HICN”) from active covered individuals. Active
covered individuals are:
employees and covered family members age 45 to 64,
employees and covered spouses
age 65 and older,
employees and covered
dependents who receive kidney dialysis or have had a kidney transplant, and
any covered individual that the
plan sponsor knows to be entitled to Medicare.
Genetic Information Nondiscrimination Act (GINA)
Under a new federal law, group health plans are prohibited from adjusting
premiums or contribution amounts for a group on the basis of genetic
information. A health plan is also prohibited from requiring an individual or
his/her family member to undergo a genetic test, although the plan may request
that a voluntary test be taken for research purposes.
The Heroes Earnings Assistance and Relief Tax Act (HEART)
HEART amended the Internal Revenue Code Section 125 to allow employers to
provide qualified reservist distributions (QRDs) from health flexible spending
accounts (FSAs) to employee-reservists who are called to active duty for 180 or
more days, or for an indefinite period of time. A QRD is a distribution of all
or a portion of the balance in an employee’s account that is requested during
the period that begins on the date of the call up and ends on the last date that
the reimbursement could otherwise be made under the health FSA for the plan
year. These distributions may be made after June 17, 2008.
Notice of Medicaid or Children's Health Insurance Program (CHIP) Offer of Free or Low-Cost Health Coverage to Children and Families
If you are eligible for employment-based health coverage from Maricopa County,
but are unable to afford the premiums, the State of Arizona may provide a
premium assistance program that can help pay for coverage. The State may use
funds from its Medicaid or CHIP programs to help people who are eligible for
employer-sponsored health coverage, but need assistance in paying their health
If you or your dependents are already enrolled in Arizona’s Medicaid (AHCCCS) or
CHIP (KidsCare) programs, you can contact the State’s Medicaid or CHIP office to
find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid (AHCCCS) or
CHIP (KidsCare), and you think you or any of your dependents might be eligible
for either of these programs, you may contact the Arizona Medicaid or CHIP
http://www.azahcccs.gov/applicants/default.aspx. You may also dial 1-877-KIDS-NOW or
www.insurekidsnow.gov to find out how to apply. If you qualify, you
can ask if Arizona has a program that might help you pay the premiums for an
Once it is determined that you or your dependents are eligible for premium
assistance under Medicaid or CHIP, your employer’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 employer’s plan. This
is called a “special enrollment” opportunity, and you must request coverage
within 60 days of being determined eligible for premium assistance.
For more information on special enrollment rights, you can contact the following
U.S. Department of Labor
Employee Benefits Security Administration
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
1-877-267-2323, Ext. 61565
Mental Health Parity and Addiction Equity Act of 2008
Under a Federal law known as the Health Insurance Portability and Accountability
Act of 1996, Public Law 104-191, as amended (“HIPAA”), group health plans must
generally comply with the requirement listed below. However, the law also
permits local governmental employers that sponsor health plans to elect to
exempt a plan from these requirements for any part of the plan that is
“self-funded” by the employer, rather than provided through a health insurance
policy. Maricopa County has elected to exempt the Maricopa County Accident and
Health Insurance Premium Plan (Second Amendment and Restatement) from the
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 from these Federal requirements will be in effect starting with
the 2010-11 plan year, beginning July 1, 2010 through June 30, 2011. The
election may be renewed for subsequent plan years.
HIPAA also requires the Plan to provide covered employees and dependents with a
“certificate of creditable coverage” when they cease to be covered under the
Plan. There is no exemption from this requirement. The certificate provides
evidence that you were covered under this Plan, because if you can establish
your prior coverage, you may be entitled to certain rights to reduce or
eliminate a preexisting condition exclusion if you join another employer’s
health plan, or if you wish to purchase an individual health insurance policy.
Medicare Part D Creditable Coverage Notice
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
requires group health plans that provide prescription drug coverage to disclose
to individuals eligible for Medicare Part D whether the plan’s coverage is
“creditable,” i.e., whether it is at least actuarially equivalent to the
Medicare Part D coverage. Importantly, individuals who do not enroll in Medicare
Part D when first eligible and who have gone 63 days or longer without
creditable coverage generally will have to pay higher premiums permanently if
they subsequently enroll. Thus individuals need to know the status of their
coverage in order to make an informed decision about enrolling in Part D.
This notice applies to you if you are eligible for Medicare. Please read this
notice carefully and keep it where you can find it. This notice has information
about your current prescription drug coverage with Maricopa County and about
your options under Medicare’s prescription drug coverage. This information can
help you decide whether or not you want to join a Medicare drug plan. If you are
considering joining, you should compare your current coverage, including which
drugs are covered at what cost, with the coverage and costs of the plans
offering Medicare prescription drug coverage in your area. Information about
where you can get help to make decisions about your prescription drug coverage
is at the end of this notice.
There are two important things you need to know about your current coverage and
Medicare’s prescription drug coverage:
Medicare prescription drug
coverage became available in 2006 to everyone with Medicare. You can get this
coverage if you join a Medicare Prescription Drug Plan or join a Medicare
Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All
Medicare drug plans provide at least a standard level of coverage set by
Medicare. Some plans may also offer more coverage for a higher monthly premium.
Maricopa County has determined
that the prescription drug coverage offered by the Employee and Retiree Benefit
Plans is, on average for all plan participants, expected to pay out as much as
standard Medicare prescription drug coverage pays and is therefore considered
Creditable Coverage. Because your existing coverage is Creditable Coverage, you
can keep this coverage and not pay a higher premium (a penalty) if you later
decide to join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare
and each year from November 15th through December 31st.
However, if you lose your current creditable prescription drug coverage, through
no fault of your own, you will be eligible for a two (2) month Special
Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide To Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Maricopa County
coverage will not be affected. Your current coverage will be primary over the
Medicare drug plan.
If you do decide to join a Medicare drug plan, you will not be able to drop your
current Maricopa County prescription coverage until the next Open Enrollment
period that would be effective July 1, 2013. If you drop your current Maricopa
County prescription coverage, you must also drop your medical and behavioral
health coverage. Retirees who drop current Maricopa County coverage will not be
allowed to re-enroll in the Maricopa County Retiree Benefit Plan.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with
Maricopa County and don’t join a Medicare drug plan within 63 continuous days
after your current coverage ends, you may pay a higher premium (a penalty) to
join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug
coverage, your monthly premium may go up by at least 1% of the Medicare base
beneficiary premium per month for every month that you did not have that
coverage. For example, if you go nineteen months without creditable coverage,
your premium may consistently be at least 19% higher than the Medicare base
beneficiary premium. You may have to pay this higher premium (a penalty) as long
as you have Medicare prescription drug coverage. In addition, you may have to
wait until the following November to join.
For More Information About This Notice Or Your Current Prescription Drug Coverage, Refer to the Contact Information Located At The End Of This Notice
NOTE: You’ll get this notice
each year. You will also get it before the next period you can join a Medicare
drug plan, and if this coverage through Maricopa County changes. You also may
request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage
More detailed information about Medicare plans that offer prescription drug
coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook
in the mail every year from Medicare. You may also be contacted directly by
Medicare drug plans.
For more information about Medicare prescription drug coverage:
Call your State Health
Insurance Assistance Program (see the inside back cover of your copy of the
“Medicare & You” handbook for their telephone number) for personalized help
(1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare
prescription drug coverage is available. For information about this extra help,
visit Social Security on the web at
www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY
Remember: Keep this Creditable Coverage notice. If you decide to join one
of the Medicare drug plans, you may be required to provide a copy of this notice
when you join to show whether or not you have maintained creditable coverage
and, therefore, whether or not you are required to pay a higher premium (a
Name of Entity/Sender:
Maricopa County Employee Benefits Division
of the Business Strategies and Health Care Programs Department.
301 West Jefferson Street, Suite 3200, Phoenix, AZ 85003