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Table of Content

  1. Header
  2. Page
    1. What's New?
    2. Helpful Video Links
    3. Benefits Overview
    4. Enroll & Qualifying Event Changes
    5. Medical
    6. Health Reimbursement Account (HRA)
    7. Flexible Spending Account (FSA)
    8. Dental
    9. Vision
    10. Basic & Voluntary Life
    11. Voluntary Life
    12. Long Term Disability
    13. Univeral Life with Long Term Care
    14. Accident & Critical Illness
    15. Critical Illness
    16. First Stop Health
    17. Vitality
    18. Additional Resources
    19. Contact Us
  3. Footer

What's New?

Medical Mutual

  • Medical Mutual will be moving their network outside of Ohio from Aetna to Cigna effective 1/1/23
  • All employees will receive new ID cards for 2023 with updated network information
  • If you or your dependents are impacted by this network change, you will receive a letter from Medical Mutual.


First Stop Health

  • Virtual Mental Health benefit added to First Stop Health effective 1/1/23
  • Talk to a counselor via phone or video M-F, 8am-8pm
  • First Stop Health services available to you at NO COST

Helpful Video Links

Understanding an EOB

Understanding an EOB

What is COBRA Covergae?

What is COBRA Covergae?

Benefits Overview

Medical Mutual: is your medical carrier for 2023 with the below plan options.

  1. Base Plan - PPO 1000
  2. Low Plan - PPO 500
  3. Med Plan - PPO 250

 

Express Scripts: is your Prescription Drug carrier.

 

MetLife: is your Dental carrier.


Guardian: administers your Vision, Critical Illness and Accident insurance coverage.

 

Symetra: is your Basic Life, Voluntary Life, Long Term and Short-Term Disability carrier.

 

Vitality: is your wellness program vendor.

 

First Stop Health: will continue as your telemedicine virtual health carrier, with Virtual Mental Health now offered in 2023.

Enroll & Qualifying Event Changes

Full-Time Employees

*Employees are eligible for benefits the first of the month following date of hire. If you are hired on the first of the month, benefits begin on the hire date. Benefits are terminated on the last day on the month following date of termination.

 

EMPLOYEE ELIGIBILITY: If you do not enroll during the Open Enrollment period, you must wait until the next Open Enrollment period unless you experience a Qualifying Life Event. If you experience a Qualifying Life Event (i.e., birth or adoption of a child, marriage, divorce, loss of other coverage, etc.) you must enroll within 30 days of the Qualifying Event.

 

DEPENDENT ELIGIBILITY: You may also enroll eligible dependents for benefits coverage. A ‘dependent’ is defined as the legal spouse and/or ‘dependent child(ren)’ of the plan participant or the spouse.

  • Your Legal Spouse: You must submit a copy of your marriage license, if you have submitted documentation previously, you do not need to resubmit.
  • Your Dependent Children: Children are eligible up to the end of the month of 26th birthday regardless of marital or student status. You must submit a copy of each child's birth certificate, if you have submitted documentation previously, you do not need to resubmit.

 

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 Medicaid

 

If you have a Qualifying Life Event and want to request a mid-year change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation to support the Qualifying Life Event.

What is a Qualifying Life Event?

What is a Qualifying Life Event?

Medical

Medical Mutual is your Medical carrier.

  1. Base Plan - PPO 1000
  2. Low Plan - PPO 500
  3. Med Plan - PPO 250

 

When you utilize providers that are in MMO’s network to receive higher benefits. Employees who seek care from a provider that is not in MMO’s network, will be responsible for higher costs. 


Access your health insurance plan and information 24/7 with the member online portal or mobile app.

  • View, email or fax your ID card
  • Search for a provider
  • Track claims
  • Manage coinsurance, deductibles and out of pocket costs


**Please refer to attached Summary of Benefits and Coverage (SBC) for more complete plan details**

Low Plan 500 Summary of Benefits

Low Plan 500 Summary of Benefits

Med Plan 250 Summary of Benefits

Med Plan 250 Summary of Benefits

Base Plan 1000 Summary of Benefits

Base Plan 1000 Summary of Benefits

Health Reimbursement Account (HRA)

Understanding an HRA

Understanding an HRA

Health Reimbursement Accounts (HRA) are a type of tax-favored program offered in conjunction with a health plan, usually a High Deductible Health Plan. HRA's allow employers to fund employees' individual HRA's using premium savings.


  • HRA's are funded by the employer
  • No specific dollar limits on the amount an employer can credit to an HRA
  • HRA's are funded by a lump sum or on a per pay period basis
  • Employers can allow a portion of the balance to roll over from year to year
  • Funds must be used for qualified medical expenses


Your Health Reimbursement Account is through American Benefits Group.

Flexible Spending Account (FSA)

Flexible Spending Accounts (FSA) allow you to reduce your taxable income by setting aside pre-tax dollars from each paycheck to pay for eligible out-of-pocket health care and dependent expenses for yourself, your spouse and your dependent children. You must enroll each year to participate in an FSA and your annual contribution stays the same during the entire year. You are only able to change your elections during enrollment or if you experience a qualifying life event. You must make your election within 30 of your hire date or first date of benefits.


Health Care FSA

  • Deductibles
  • Medical and RX Copays
  • Dental Expenses
  • Vision Expenses
  • Maximum Contribution: $3,050


Dependent Care FSA

  • Care* for dependent children under 13
  • Care* for dependent children who are physically or mentally incapable of caring for themselves
  • Care* for your spouse, parent or grandparent who is physically or mentally incapable of caring for themselves
  • Funds only available once they have been deposited
  • Up to $5,000 annually or $2,500 if you are married and file separate taxes


*Care is defined as in home babysitting, care by a licensed nursery or day care, before and after school care, summer day camp and in home dependent care.


Health Care FSAs have a $500 roll over limit into the next year, any funds over $500 will be forfeited. You have 2.5 months to use your roll over funds in the new year, and unused funds will be forfeited

FSA

FSA

Dental

MetLife will continue as your Dental carrier.


You may go to any dentist. However, those who are in network will be most cost effective.


Find a dental provider in 3 easy steps.



**Please refer to attached Benefit Summary for more complete plan details**


Dental Insurance

Dental Insurance

Dental Benefit Summary

Dental Benefit Summary

How to Register on MyBenefits

How to Register on MyBenefits

Vision

Guardian remains as your vision carrier.


You may go to any eye care provider. However, those who belong to the VSP network will be most cost effective.


How often can I obtain service?

  • Exams: Once a year
  • Lenses: Once a year
  • Frames: Once every other year
  • Materials: Once a year


**Please refer to attached Benefit Summary for more complete plan details**


Vision Insurance

Vision Insurance

Vision Benefit Summary

Vision Benefit Summary

Basic & Voluntary Life

Symetra is the carrier for your Basic and Voluntary Life benefits.


Your Basic Life Benefit

  • Eligible when working a minimum of 40 hours per week.
  • 100% company paid benefit, no cost to you
  • Flat $50,000 benefit
  • Portable: Continue your term insurance if your employment ends
  • Convertible: To individual life policy when coverage ends under the plan


**Please refer to attached Benefit Summary for more complete plan details**


Life Insurance

Life Insurance

Your Voluntary Life Benefit

  • Eligible when working a minimum of 40 hours per week.
  • 100% employee paid benefit
  • Up to $300,000 or 5x earnings
  • Increments of $10,000
  • Portable: Continue your term insurance if your employment ends
  • Convertible: To individual life policy when coverage ends under the plan


**Please refer to attached Benefit Summary for more complete plan details**

Basic Life Benefit Summary

Basic Life Benefit Summary

Voluntary Life Benefit Summary

Voluntary Life Benefit Summary

Long Term Disability

Long Term Benefit Summary

Long Term Benefit Summary

Symetra is the carrier for your Long Term Disability benefits.


Your Long Term Disability Benefit:

  • Available to full time employees working 40 hours per week
  • 60% of salary up to %5,000 per month
  • Benefits begin 90 days after the date disability begins or the date short term payments end


*Please refer to attached Benefit Summary for more plan details and exclusions*

Univeral Life with Long Term Care

Employees can enroll in Universal Life insurance with a Long-Term Care Rider through Trustmark.

  • Benefit combines permanent life insurance with benefits that can help with the costs of long-term care services.
  • Can pay benefits for up to 50 months of long-term care services, and the full death benefit remains even if the long-term care benefits are paid
  • Coverage available for spouse and children
  • Available to employees on a guaranteed issue basis up to $75,000 and up to $300,000 with simplified underwriting




Accident & Critical Illness

Guardian remains the carrier for your Accident and Critical Illness benefit.


Accident coverage provides benefits for treatments or procedures due to an accident, including, hospitalization, x-rays, and more.


Critical illness provides coverage for medical and non-medical expenses in the event you become ill.

Your Critical Illness Benefit

  • Lump sum of $5,000
  • Benefits available after 31 day waiting period
  • Coverage portable to a group conversion trust


Your accident Benefit:

  • Employee AD&D: $25,000
  • Spouse AD&D: $12,500
  • Child AD&D: $5,000
  • Yearly Wellness Benefit: $50
  • Coverage is portable



**Please refer to attached Benefit Summary for more complete plan details**

Accident Benefit Summary

Accident Benefit Summary

Critical Illness Benefit Summary

Critical Illness Benefit Summary

First Stop Health

No crowded waiting rooms. No driving. See a doctor when you need a doctor. Talk to a doctor 24/7.

 

When can I use First Stop Health?

  • Your doctor is not available
  • You will become ill when traveling
  • When you are considering a hospital visit for a non-emergency health condition

 

How does it work?

  • Call (888) 691-7867 or log in to fshealth.com or download the mobile app to request your doctor visit
  • Set up your account now so it's ready when you need it
  • Complete patient registration for medical history, pharmacy preference, primary care physician contact information and insurance information
  • Each time you visit you will be asked brief medical questions. If appropriate you will be connected to a doctor using secure live audio and video
  • You and your doctor will discuss your medical issue and if appropriate your doctor may write a prescription


Virtual Mental Health for 2023!



Vitality

Vitality remains your wellness program platform.


  • Earn Points
  • Get Rewarded
  • Stay Healthy





Additional Resources

Medical Plan - Medical Mutual

Medical Plan Customer Service: 877-730-2221

Website: www.medmutual.com/member

 

Prescription Plan - Express Scripts

Customer Service: 800-282-2881

Website: www.express-scripts.com


HRA - American Benefits Group (ABG)

Customer Service: 800-499-3539

Website: www.amben.com

 

Dental - MetLife

Customer Service: 1-800-METLIFE

Website: www.metlife.com

 

Vision - Guardian

Customer Service: 1-888-482-7342

Website: www.vspdirect.com/find-doctor

 

Basic & Voluntary Life AD&D - Symetra

Customer Service: 1-800-796-3872

Website: www.symetra.com


Long Term Disability - Symetra

Customer Service: 1-800-796-3872

Website: www.symetra.com


Accident and Critical Illness - Guardian

Customer Service: 1-888-482-7342

Website: www.guardianlife.com

 

Telemedicine - First Stop Health

Customer Service: 888-691-7867

Website: www.fshealth.com

 

Wellness - Vitality

Customer Service: 312-224-7113

Website: www.vitalitygroup.com

Contact Us

Client Contacts

IV

Isabel Villaplana

ivillaplana@dheo.org

(330) 505-2366

JA

Jared Argiro

jargiro@dheo.org

(330) 505-2848