Page 16 - 2019 Hess Benefits Decision Guide
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Legal Notices
As a participant in the medical plan, you are entitled
to information regarding your prescription drug coverage, Medicare and your benefits for breast reconstructive surgery after a mastectomy. Please see the Summary Plan Description (SPD) posted online on the Hess Benefits Center at empyrean.hess.com for more detailed information. Hess is required by
the government to provide the following legal notices as written.
Summary of Benefits
Women’s Health and
The Summary of Benefits and Coverage (SBC) summarizes important information about your health coverage in a standard format. Your SBC for the Hess Medical Plan is available on the
Hess Benefits Center at empyrean.hess.com or by calling 1-877-511-4377.
Notice of Privacy Practices
The Notice of Privacy Practices has been updated to reflect modifications to the HIPAA Privacy and Security Rules effective September 23, 2013. The Notice of Privacy Practices is available on the
Hess Benefits Center at empyrean.hess.com or by calling 1-877-511-4377.
Cancer Rights Act
If you receive plan benefits in connection with a mastectomy, you are entitled to coverage for the following under the plan:
n Reconstruction of the breast on which the mastectomy was performed;
n Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
n Prosthesis and treatment for physical complications for all stages of a mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes).
The plan will determine the manner of coverage
in consultation with you and your attending doctor. Coverage for breast reconstruction and related services will be subject to deductibles and co-insurance amounts that are consistent with those that apply to other benefits under the plan.
This guide provides highlights of the Hess Corporation benefits plans for 2019. If there is any discrepancy between the information provided in this guide and the official plan documents, the official plan documents will govern. Hess reserves the right to amend or terminate the plans in its discretion at any time.
0693.0220 October 2018
and Coverage
