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Benefits Effective January 1, 2026 - December 31, 2026
Medical: Medical Mutual
Prescription: CVS Caremark / RX Benefits
Specialty Prescription Assistance: ImpaxRX and PrudentRX
NEW! GLP-1 Medication Program: WellnessIQ - TB2
Flexible Spending Accounts: iSolved
Dental: Guardian
Vision: Guardian
Basic and Voluntary Life: Symetra
NEW! Accident, Critical Illness, Hospital Indemnity: Symetra
Telemedicine: First Stop Health
Employee Assistance Program: All One Health
Wellness: Personify Health
Pet Insurance: Nationwide
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?
When Does My Coverage Start?
New Hire: Your benefits begin first of the month following date of hire.
Open Enrollment: Benefits are effective January 1.
Qualifying Event: Benefit changes are effective date of event.
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 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. Coverage ends the end of the month of the 26th birthday.
Your legal spouse: If your spouse has coverage through his/her employer, they are not eligible for Painesville's Medical Coverage. To enroll your spouse, you must complete the attached spousal waiver.
Action Required!
All elections must be submitted by November 14.
This is an ACTIVE enrollment.
This means that you must log in to BenXpress to enroll yourself and your dependents for benefits. All employees will use our benefit enrollment system to confirm or change benefit elections. After this deadline you must wait until the next open enrollment period or experience a qualifying event in order to:
To enroll in benefits please use the link below to BenXpress.
Employee Username: First letter of first name, plus last name, then last two digits of your birth year (example John Doe, Login: jdoe78)
Employee Password: Last four digits of your social security number (example:1876)
SPOUSAL WAIVER
The City of Painesville implemented a spousal waiver effective 1/1/2013. Should your spouse be considered full time AND eligible for health and prescription drug coverage with their own employer, they will not be eligible for this plan.
Please remember:
All employees must complete the online spousal waiver form. This applies to employees on single coverage, waiving coverage, covering their spouse or covering only themselves and their children.
If you are waiving spousal coverage or if your spouse is not employed, completion of the second side of the form is not required
TOBACCO FREE AFFIDAVIT
The City of Painesville has implemented a Wellness Program for Tobacco Cessation. With this program all applicants covered under the medical program that are Tobacco Free qualify for a premium contribution incentive (reduction) and must be nonusers of tobacco and tobacco products prior to January 1, 2026. This
status must be retained at all times whether on or off company premises while employed at the City and receiving the premium contribution incentive (reduction).
The City of Painesville reserves the right to randomly test all employees and their spouses (if covered) that sign this affidavit.

The City of Painesville offers 3 medical plan options through Medical Mutual.
Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept Medical Mutual's 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.
The Core Plan utilizes the SuperMed Plus Network. The below illustrates the In and Out of Network coverage
**Please refer to your Summary of Benefits/Certificate of Coverage from Medical Mutual for a full description of benefits and exclusions**
The Buy Up Plan utilizes the SuperMed Plus Network. The below illustrates the In and Out of Network coverage.
This plan is not offered to new enrollees. If you are currently on the plan, you may remain on the plan. However, if you change plans, you cannot return to the Buy Up plan in the future.
**Please refer to your Summary of Benefits/Certificate of Coverage from Medical Mutual for a full description of benefits and exclusions**
The Lake Blue Plan is a 3 tier plan. Tier 1 offers additional savings with a lower copay if you use a provider in the Lake Health or UH System in Lake County. Tier 2 is the standard MMO SuperMed Plus Network, including the Cleveland Clinic. Tier 3 is your Non-Network providers.
Please remember, deductibles do not accumulate between tiers. (i.e.. You met your deductible for Tier 1, but now use a Tier 2 provider. You will still need to meet the Tier 2 deductible)
My Health Plan is Medical Mutuals secure website specifically for Medical Mutual members. It makes it easy to manage your plan and your health online. It allows you to compare your healthcare options so you can make better decisions and minimize cost.
On My Health Plan you can:
To create your account:
Nurse Line
Members have direct access to MMO nurses. Nurses provide easy to understand explanations about tests and results, how to treat minor illnesses at home, and help determine if you or a dependent need to seek further medical care from a doctor, urgent care, or the ER.
There is no charge to use the MMO nurse line. This is a 24/7 support line.
Reminder: have your group number and member ID readily available. This can be found on your MMO ID card.
1-888-912-0636
Care Navigation Program
Members have access to MMO nurses to assist with goals and developing condition specific care plans. A dedicated care navigator will serve as a personal advocate and single point of contact to help manage a member's conditions and overall health, improve the quality of care they receive and control the cost of their care.
Maternity Management
Medical Mutual provides digital resources to help members prepare for babys arival through age 2. During pregnancy members receive weekly updates and have access to tools to look up symptoms and issues.
Once baby arrives members can track feeding, diaper changes, and milestones through age 2.
You can find the app by searching MedMutual Maternity.
There is no cost associated with the app or its tools for members enrolled on the health plan.
NICU Management with Progeny Health
Medical Mutual has partnered with Progeny Health to increase the level of NICU support. Progeny will reach out to members who may need this support to offer care management to babies and their families through the baby's first birthday.
The Transitional Care Program provides nurse-led health coaching and support with home visits after a high-risk hospital stay. Nurses will help members prepare for their hospital release, visit them at home to check on their progress for up to 30 days after release, and connect them with local resources that can help them stay healthy while living at home.
With the Palliative Care Program, members with advanced illness have access to non-hospice community-based in-home support led by physicians, nurses and social workers, to help improve their quality of life as they manage their treatment plan.
These programs are free to Medical Mutual members on the health plan.
Medical Mutuals digit coaching is provided through LARK for members with Diabetes and Hypertension.
Digitial health coaching provides smartphone based coaching customized to meet a member's needs. Depending on your health condition, you may receive free supplies, including scale, glucometer, blood pressure cuff, or more, at NO COST.
See attached flyers for more information on each plan for Diabetes and Hypertension.
Telephonic Health Coaching
MMO nurses help educate and support members, and work with them to set individualized goals and develop condition-specific care plans.
Nurses are available Monday through Friday, 8am-4pm.
1-800-590-2583
All health plans recognize routine preventive services at 100%, no coinsurance, no deductible if the claim is submitted as routine or preventive abd 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.
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.
SPECIALTY DRUGS
TIER 4 | Lowest Specialty Drug copay: Tier 4 specialty drugs are generally more effective and less expensive than nonpreferred specialty drugs in tier 5.
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.
The City of Painesville has partnered with WellnessIQ to offer GLP-1 Medications to employees and spouses at a discounted price.
You do not need to be enrolled on the medical plan to have access to this program.
Register in 2 simple steps:
All plans include:
Along with medication, all plans include Wellness Coaching to help you develop sustainable habits for long-term health.
All employees and spouses have access to the Wellness Coaching - you do not need to register for GLP-1 medication.
Click the link below to register!
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 Painesville 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.
Specialty medications are used to treat complex chronic conditions; they mimic compounds found within the human body. These high-cost oral or injectable medications are typically biology-based and highly complex. City of Painesville offers the PrudentRx Co-Pay program to help you manage the cost of these medications by applying financial co-pay assistance from drug manufacturers. By enrolling in the PrudentRx program, your out-of-pocket costs for covered medications would be $0.
If you currently take one or more medications included in the PrudentRx Program Drug List, you will receive a welcome letter and phone call from PrudentRx with specific information about the program and your medication. The PrudentRx patient advocate will help you enroll in the PrudentRx Co-Pay Program if you choose, along with other available manufacturer copay assistance programs.
For more information, please contact PrudentRx at 1.888.203.1768
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 care expenses* for yourself, your spouse and your dependent children. In order to participate in the FSA, you must enroll each year. Your annual contribution stays in effect during the entire year (January 1st through December 31st). The only time you can change your election is during the enrollment period or if you experience a change in-status event. Also, you must elect this benefit within 30 days of your hire date or first date of benefits eligibility.
The Dependent Care FSA allows you to pay for eligible dependent care expenses with tax-free dollars so that you and your spouse can work or attend school FT.
Unlike the Health Care FSA, funds in a Dependent Care FSA are only available once they have been deposited into your account and you cannot use the funds ahead of time
*You cannot enroll or contribute to an FSA if you are enrolled in and contribute to an HSA.
The maximum Medical Reimbursement amount for 2026 is $3,400.00 with a $680.00 maximum carryover amount.
The 2026 limit for Dependent Care Flexible Spending Accounts is $7,500.00.
Your Flexible Spending Account is through iSolved.

Dental Benefits through Guardian 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.
NETWORK: DentalGuard Preferred
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.
The City of Painesville offers vision coverage through Guardian to help pay for eye exams, prescription glasses and contact lenses. You receive a higher level of benefits when you see a provider in network, however, out-of-network coverage is provided but may only be handled as reimbursements in some situations.
There are 2 network options with you vision coverage.
DID YOU KNOW?
HOW OFTEN CAN I OBTAIN SERVICES?
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 $25,000 Benefit
A sudden accident or death can leave you or your loved ones in a vulnerable position. The City of Painesville provides a $25,000 Basic Life and AD&D benefit to all full-time employees.
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: $10,000 increments up to 5x your annual salary, to a maximum of $500,000
Spouse: $5,000 increments up to 50% employee amount or $150,000
Children: $1,000 increments up to $10,000 (birth to 26 years)
*Please see attached Summary of Benefits for more plan details and exclusions*
Who's Your Beneficiary?
Naming a beneficiary is a crucial part of electing life insurance. Also, don't forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.
Primary Beneficiary: Your primary beneficiary receives your benefits in the event of your death.
Contingent Beneficiary: Your contingent beneficiary receives your benefit, in the event that your primary beneficiary cannot.
*Please make sure your beneficiary information is up to date with your HR office*
The City of Painesville now offers Accident, Critical Illness, and Hospital Indemnity through Symetra.
All elections will be made through the BenXpress portal.
If you have claims from the 2025 plan year, those can still be submitted to AFLAC.
*Employees who wish to keep their current Aflac coverage and not switch to Symetra can do so but must reach out to HR.**
Accident, Critical Illness and Hospital Indemnity coverage have a Wellness Benefit. This provides an annual benefit payment if you complete a covered health screening test on or after your coverage effective date.
ACCIDENT INSURANCE
A serious injury can cost you a lot of money – not only in medical bills but in things like income from lost work hours. Some injuries are minor, but others are debilitating and require significant medical care. If you get hurt, accident insurance pays you money that you can use to cover personal expenses, bills, and out-of-pocket medical costs. When you have a covered accident or injury, your health insurance company pays your doctor or hospital, but your accident insurance company pays you.
What is covered?
Accident insurance can help you pay for things like:
*Employees who wish to keep their current Aflac coverage and not switch to Symetra can do so but must reach out to HR.**
CRITIAL ILLNESS INSURANCE
How would you pay your bills if you were suddenly diagnosed with cancer and couldn’t work? Critical illness insurance doesn't pay your medical bills; it pays you if you’re diagnosed with a covered illness. The benefit is paid directly to you, and it is your choice how to spend it.
What is Covered?
*Employees who wish to keep their current Aflac coverage and not switch to Symetra can do so but must reach out to HR.**
HOSPITAL INDEMNITY INSURANCE
Hospital indemnity compliments your health insurance to help you pay for costs associated with a hospital stay. The funds can be used to help pay for the out-of-pocket expenses that your medical plan may not cover, such as deductible and coinsurance. When you have a covered inpatient admission, your health insurance company pays your doctor or hospital, but your hospital indemnity insurance company pays you.

First Stop Health and the Virtual Primary Care feature will continue to be offered in 2026.
Members have access to convenient and affordable high-quality primary care with First Stop Health's nationwide network of doctors. Using the app, website or phone call you have access to:
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 its 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.
All One Health can help you reduce stress, improve mental health, and make life easier by connecting you to the right information, resources, and referrals. All services are free, confidential, and available to you and your family members. This includes access to short-term counseling and a wide range of services.
Call: 800-521-3273
Visit: allonehealth.com/member-portal/
Portal Code: painesville
Personify Health will continue as your Wellness Platform.
Sign up using the link below, look for an email from Personify Health, and start earning!
Enrollment pass phrase: tranquil-falcon-17
City of Painesville offers Pet Insurance through Nationwide. This is a voluntary benefit, 100% employee paid and directly billed to the employee.
Pet Insurance helps cover accidents, illness, hereditary and congenital conditions, alternative therapies and behavioral issues.
Medical Mutual
Customer Service: 1-844-583-3072
Website: www.medmutual.com
RXBenefits
Customer Service: Call the Customer Care number on your ID card. If you do not have an ID card, call XXX
Website:
Guardian
Customer Service: 1-888-482-7342
Website: www.guardianlife.com
Symetra
Customer Service: 1-800-796-3872
Website: www.symerta.com
First Stop Health
Customer Service: 888-691-7867
Website: www.fshealth.com
AllOneHealth
Customer Service: 800-521-3273
Website: www.allonehealthmemberportal.mylifeexpert.com/
ImpaxRX
Customer Service: 844-467-2979 option 1
Website: www.impaxRX.com
iSolved
Customer Service: 800-370-3040
Email: crmail@isolvedhcm.com
Personify Health
Customer Service Email: support@personifyhealth.com
Connie Morrison
cmorrison@painesville.com
440-392-5788
Kris Young
kyoung@painesville.com
440-392-5787
Shaila Cullum
scullum@painesville.com
440-392-5786