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Plan and Policy Documents

Important Notices

Health Insurance Portability and Accountability Act (HIPAA)

Medicare Part D Creditable Coverage Notices (Updated 10/15/25)

Benefit Plan Information

See the web pages for each benefit program to access its plan documents.

Retirement Plan Information

Summary Plan Descriptions

Summary Annual Reports

Transparency in Coverage

Important Notices

Special Enrollment Notice

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage). However, you must request enrollment within 31 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage or within 60 days from the birth, adoption or placement for adoption.

To request special or enrollment or get more information, call HR Services at 412-268-4600.

Newborns' and Mothers' Health Protection Act

Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Women's Health and Cancer Rights Act Enrollment Notice

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. Contact HR Services for more information.

Women's Health and Cancer Rights Act Enrollment Notice

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

  • All stages of reconstruction of the breast on which the mastectomy was performed;
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance;
  • Prostheses; and
  • Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Therefore, to see the applicable deductibles and coinsurance that would apply, see the Summary of Benefits and Coverage for your plan. Contact HR Services for more information.

Denial of Coverage Appeals

If a claim submitted to one of our benefit plans is denied by the carrier and you disagree with the denial, follow these procedures:

  • For Medical Appeals: Appeals concerning a medical treatment plan or medical assessment can only be appealed through the carrier. Please follow the procedures outlined in your plan booklet to appeal a medical decision.
  • For Other (Administrative) Appeals: If you believe the denial was made in error, contact the carrier to begin the appeals process. If you are unable to resolve the situation with the carrier, please contact HR Services at 412-268-4600 for assistance.

Carnegie Mellon University reserves the right to amend, modify, suspend, replace or terminate any of its plans, policies or programs, in whole or in part, including any level or form of coverage, by appropriate action of the university (or its delegate), without the consent or concurrence of persons affected.

The information presented is not intended to create, nor is it to be construed to create, a contract between the university (or its affiliates) and any one of the university's employees, former employees, or other plan participants or beneficiaries.

Please note that a summary of the benefits provided under each plan is contained in the summary plan description for such plan. Full details are provided in the official plan documents, which govern the operation of the respective plan. In the event that the content provided or any oral representations made by any person regarding a plan conflict with or are inconsistent with the provisions of the applicable plan document, the provisions of the applicable plan document will control.