Your 2024 City of Middletown Health Benefits

Medical: UMR

Dental: Anthem

Vision: EyeMed

Basic and Voluntary Life: Anthem

Short Term Disability: Anthem

Accident: Guardian

Critical Illness: Guardian

Hospital Indemnity: Guardian

GAP Coverage: Reliance Standard

Pet Insurance: Nationwide

Identity Theft Protection: Norton LifeLock

Flexible Spending Account: BASIC

Wellness: Virgin Pulse

Eligibility

When Does My Coverage Start?

Your Coverage is effective date of hire.

Who is Eligible for Benefits?

Regular full-time employees working 30 hours per week or more are eligible to participate in the benefit plans.

Who are my legal dependents?

Your legal spouse

Your children (up to age 26) including natural children, stepchildren, legally adopted children, children placed for adoption, children for whom you serve as legal guardian.

Disabled dependent child(ren) of any age.

Qualifying Life Events

The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.

You can, however, modify your elections under certain circumstances, called "Qualifying Events" These are events such as marriage, divorce, birth or adoption of a child, loss of eligibility under another plan. If you experience a qualifying event, you may make changes to your benefits within 30 days of the event or 60 days if the event is due to birth or adoption of a child.

What is a Qualifying Life Event?

Marriage
Divorce
Birth/Adoption of a child
Death of a spouse or other enrolled dependent
Change in spouse’s benefits or employment status
A dependent becomes eligible for Medicare or Medical

What is a Qualifying Life Event?

How To Enroll

Action Required:

All elections must be submitted by: November 17th.

This is an ACTIVE enrollment.

This means that you must log into BenXpress to enroll yourself and your dependents for benefits. You must take action no later than November 17th. After this deadline you must wait until the next open enrollment period or experience a qualifying event in order to:

Waive any benefits.
Change or drop the coverage of your current plan.
Participate, if you did not enroll during open enrollment or within the first 30 days of becoming eligible.

To enroll in benefits please use the link below to BenXpress.

Employee Username: First six letters of last name, plus first initial of first name, then last four digits of your social security number.

Employee Password: Full first name and birth year.

**Please contact Megan Ellis with questions regarding your elections for January 1, 2024.

UMR - Insurance Coverage for Drug and Alcohol Rehab

The City of Middletown offers medical coverage through UMR, with 5 health plans to select from.

Plan 10
Plan 11 (Minimum Value Plan)
Plan12 (Police and Fire only)
Plan 13 (High Deductible Health Plan/HSA)
Plan 14

Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept UMRs contract rate as the final charge and members are not balance billed. Employees who receive care from an Out of Network provider will be responsible for higher costs.

Please see attached Summary of Benefits and Coverage (SBC) for your selected medical plan for specific details and exclusions.

Medical Plans

*Per IRS Guidelines the deductibles for the HDHP Plan (Plan 13) will be increased to $3,200/$6,400.

*The City of Middletown has increased the Coinsurance to 100% for this Plan.

UMR Member Portal and Mobile App

The UMR app is a faster way to stay connected to your health care benefits information, on demand, anytime, anywhere. Click the link below to learn more about the UMR app.

Preventive Care Covered 100%

All health plans recognize routine preventive services at 100%, no coinsurance, no deductible if the claim is submitted as routine or preventive and the services performed falls within the approved list of preventive services.

For a complete and updated list of preventive services, please use the link below.

During your wellness visit, proactively let your physician know the reason for the appointment is for a wellness visit and that your physician needs to submit and code the visit as routine or preventive in nature. If your visit is submitted with a diagnosis, the wellness visit will not be paid at 100%, but instead will be subject to deductible and coinsurance. Below are a few examples of services that can be recognized as preventive.

Routine wellness exams, including well baby and child routine exams.
Cholesterol and lipid level screening
Pelvic exam, pap test and screening mammograms
Colorectal cancer screening, colonoscopies, sigmoidoscopies (age limits apply)
Vaccines & immunizations
Contraceptives (specific list applies)
Diabetes screenings

The City of Middletown partners with Regenexx. Regenexx procedures provide non-surgical treatment options for those suffering from pain related to orthopedic issues including osteoarthritis, joint injuries, spine pain, overuse conditions, and common sports injuries.

Regenexx procedures use your body's natural healing ability to help repair damage to bone, muscles, tendons and ligaments without surgery. These procedures are performed by highly skilled doctors trained specifically in Interventional Orthopedic procedures to help reduce pain and improve function.

Commonly treated conditions include, ACL tears, hip arthritis, shoulder rotator cuff tears, back/neck pain due to herniated discs, ankle sprains or ligament tears, plantar fasciitis, golfers' elbow, carpal tunnel and more.

Regenexx Flyer

Prescriptions

TRADITIONAL DRUGS

TIER 1 (GENERIC) | Lowest copay: Most drugs in this category are generic drugs. Members pay the lowest copay for generics, making these drugs the most cost-effective option for treatment.

TIER 2 | Higher copay: This category includes preferred, brand name drugs that don't yet have a generic equivalent. These drugs are more expensive than generics, and a higher copay.

TIER 3 | Highest copay: In this category are nonpreferred brand name drugs for which there is either a generic alternative or a more cost-effective preferred brand. These drugs have the highest copay. Make sure to check for mail order discounts that may be available.

WHERE CAN I FIND A DRUG LIST?

Typically, a full listing of covered drugs is found on your provider’s website. A drug list, also called a formulary, is a list of generic and brand-name drugs covered by a health plan. Although a drug may be on the drug list, it might not be covered under every plan. Review the plan materials for details on specific benefits.

You can use drug lists to see if a medication is covered by your health insurance plan. You can also find out if the medication is available as a generic, needs prior authorization, has quantity limits and more.

Prescriptions

ImpaxRX

ImpaxRX is a prescription advocacy program that assists employees and their family members with the high cost of certain eligible medications. If the medications you or a family member are taking is identified as eligible under the Medication Under Management (MUM) program, an ImpaxRX advocate will reach out to you to confirm your enrollment in the program and obtain additional information needed to secure the medication at no cost.

Timely participation with ImpaxRX is required to receive these programs for your high-cost medications. Please respond if ImpaxRX contacts you! This will allow them to work on your behalf to obtain you medication at no cost.

There is no cost to you to participate in this program, and there will be no copayments for eligible medications approved by the program. Additionally, by using the program, the cost of these medications is lowered under the City of Middletown Health Plan which allows for savings to keep employee premium contributions to a minimum for all.

Please call ImpaxRX at 844-467-2979, option 1 with questions.

ImpaxRX Info Flyer

MiCSC - State Vision Plan

Vision

The City of Middletown offers vision coverage through EyeMed to help pay for eye exams, prescription glasses, and contact lenses. You receive higher benefits when you visit and in network provider, however, out of network coverage is provided. Those who receive care from an out of network provider may be responsible for higher costs.

You have the option to elect 1 of 2 vision plans. Please see attached benefit summaries for details and exclusions for each plan.

DID YOU KNOW?

Eye exams can help detect serious eye and general health conditions sooner: high blood pressure, diabetes, heart disease, high cholesterol.
Babies should receive their first professional eye exam at 6 months.
80% of learning in the first 12 years comes through the eyes.

Vision

Base Plan Benefits Summary

Buy Up Plan Benefits Summary

Anthem - Independent Health Agents

Dental

Dental Summary

Dental Benefits through Anthem provide comprehensive coverage to help you and your family maintain good dental health. Your coverage will be greater when you visit a participating in-network dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf.

You have the option to elect 1 of 2 dental plans. Please see attached benefit summaries for details and exclusions for each plan.

PREVENTION FIRST!

Your dental health is an important part of your overall health. Make sure you take advantage of your preventive dental visits.

Preventive care services are covered at 100% if you visit an In-Network provider. They are also not subject to the annual deductible.

Dental Base Benefit Summary

Dental Buy Up Benefit Summary

Life Insurance

Life insurance is an important part of your financial security. Life insurance helps protect your family from financial risk and sudden loss of income in the event of your death. Accidental Death & Dismemberment (AD&D) insurance is equal to your Life benefit in the event of your death being a result of an accident and may also pay benefits for certain injuries sustained.

Basic - Employer Paid Benefit

A sudden accident or death can leave you or your loved ones in a vulnerable position. The City of Middletown provides a flat Basic Life and AD&D benefit to all full-time employees. Amount based on job class.

Voluntary - Employee Paid Benefit

Coverage is also available for your spouse and/or child dependents, but only after you've elected coverage for yourself. A sudden accident or death can leave you or your loved ones in a vulnerable position. Employees have the opportunity to enroll in Term Life and Accidental Death & Dismemberment insurance which will supplement lost income in the event of an accident or death. If you choose to enroll in employee coverage, this will be in addition to your employer provided Basic Life coverage. Review the attached full benefit summary below for details on reductions, portability and conversion options.

Employee: Amount from $1,000 to $300,000, or 5x annual earnings

Spouse: $1,000 increments up to $300,000

Children: Amounts of $2,000, $5,000, or $10,000

*Please see attached Summary of Benefits for more plan details and exclusions.

Voluntary Short Term Disability

Everyday illness or injuries can interfere with your ability to work. Even a few weeks away from work can make it difficult to manage household costs. Short-Term Disability coverage provides financial protection for you by paying a portion of your income, so you can focus on getting better and worry less about keeping up with your bills.

The City of Middletown offers Voluntary Short-Term Disability coverage to all employees through Anthem. This is a 100% employee paid benefit.

Elimination Period

This is the number of days that must pass between your first day of a covered disability and the day you can begin to receive benefits.

Benefits begin on the 1st day of an accident and the 8th day of an illness (including pregnancy)

Benefit Duration

The maximum number of weeks you can receive benefits while you are sick or disabled.

Payments may last up to 13 weeks. You must be sick or disabled for the duration of the waiting period before you can receive a benefit payment.

Coverage Amount

This benefit covers 60% of your weekly income, up to a maximum of $1,500 per week.

Guardian_Insurance_logo - Wireless Warehouse

Voluntary Accident, Critical Illness and Hospital Indemnity

Guardian Benefits Kit

Accident Insurance

Accident insurance pays you benefits after you suffer an insured injury from a covered accident like a severe burn, broken bone, or ER visit.
The money you receive can be used for personal expenses, bills, and out of pocket medical costs.
Your health insurance pays your provider or hospital, accident insurance pays you.

Critical Illness Insurnace

Critical Illness insurance provides financial support following the diagnosis of a covered illness, like heart attack, cancer or stroke. The lump sum benefit is paid to you, so you can focus more on recovery and less on expenses.
Critical Illness insurance pays you directly in cash without any deductible.

Hospital Indemnity Insurance

Hospital Indemnity Insurance benefits are made directly to you based on admission and days hospitalized.
You can use the money to help cover any costs, from out-of-pocket medical expenses to added household costs, like childcare.

GAP Insurance

All full-time employees, who are enrolled in the Medical plan are eligible to enroll in supplemental GAP coverage through Reliance Standard.

You are eligible, as of the first day of the month following date of hire, to participate in the BasicCare Program.

Premiums for the BasicCare Program are payroll deducted on a BEFORE-TAX, pretax basis. By paying premiums pretax, an employee’s TAKE HOME PAY INCREASES when compared to after-tax payments because employment and income taxes are NOT withheld on the amounts used to pay premiums

Norton 360 - Premium Anti-Virus Security - JB Hi-Fi

Identity Theft

Nearly 118 million people were victims of cybercrime in 2021. Help protect your identity and devices with Norton LifeLock.

The City of Middletown offers 2 plan options for you and your family that include:

Identity theft protection
Parental control
Device security
Online privacy
Credit monitoring
Dark web monitoring
And more!

To enroll in a LifeLock benefit, use the link provided below.

For more plan information, please refer to specific Plan Summary below.

Benefit Essential Plan

Benefit Premier Plan

Nationwide Health Care Fact Finder - Agent Xcelerator®

Pet Insurance

The City of Middletown offers employees the opportunity to elect Voluntary Pet Insurance. Pet insurance helps you cover veterinary expenses so you can provide your pets with the best care possible without worrying about the cost.

Coverage Includes:

Accidents
Illness
Hereditary and congenital conditions
Cancer
Behavioral treatments
Prescription therapeutic diets and supplements
Wellness

Pet Insurance Packet

Earn points by competing in various activities from physical activity tracking, healthy habit cards, journeys, daily tip cards and more!

Employees and their spouses can redeem Pulse Cash for workout gear, devices, gift cards and more!

Login to Virgin Pulse to start earning!

Visit the link below or download the mobile app.

City of Middletown Contact Information

Megan Ellis

Human Resources Manager

513-425-7848

megane@cityofmiddletown.org

Carrier Contact Information

UMR

Customer Service: 800-826-9781

Website: www.umr.com

CVS Caremark

Customer Service: 800-776-1355

Website: www.caremark.com

OptumRX

Customer Service: 866-863-7543

Website: www.umr.com

ImpaxRX

Customer Service: 844-467-2979, option 1

Anthem

Customer Service: 877-604-2156

Website: www.anthem.com

EyeMed

Customer Service: 866-939-3633

Website: www.eyemed.com

Guardian

Customer Service: 866-268-2525

Website: www.guardianlife.com

Reliance Standard

Customer Service: 800-351-7500

Website: ww.reliancestandard.com

Norton LifeLock

Customer Service: 800-697-9174

Nationwide Pet Insurance

Customer Service: 877-738-7874

City of Middletown

Table of Content

Your 2024 City of Middletown Health Benefits

Eligibility