2025 Employee Benefits

NEW! Short Term Disability, Long Term Disability, Accident Protection through Guardian

NEW! Pet Insurance through ASPCA

Medical: Medical Mutual

HSA plan: $3300/$6600 deductible then 100% coinsurance.

Prescription: Express Scripts and Smart90

Specialty Prescription Assistance: ImpaxRX and SaveOnSP (through Medical Mutual)

Dental: Guardian

Vision: Guardian

Basic and Voluntary: Guardian

Health Spending Account (HSA): Wealth Care Bank

Telemedicine: First Stop Health

Employee Assistance Program: Ease@Work

Wellness Platform: Personify Health

Open Enrollment Meetings

The City will be holding Open Enrollment meetings, Wednesday October 30th at 10am and 2 pm to review upcoming changes to benefit for 2025.

We will have an onsite enroller to assist with enrollment in the new Guardian coverage, as well as answer any questions. He will be available 9am - 4pm on Wednesday October 30th.

Please use the link below to schedule time with the enroller, Shawn.

How To Enroll

Action Required for all benefits-eligible employees:

During Initial Enrollment, you may:

Elect the same coverage with the same dependents.
Add or delete dependents.
- If adding a dependent, please provide a marriage certificate for spouse and birth certificate for children.
Decline benefits and elect to receive a waiver incentive of $200 per month.
Enroll, if you are not currently enrolled in 2024 plans.
Update Life Insurance beneficiaries.
Enroll in additional Voluntary Life Insurnace coverage through Guardian at your expense.

Every employee who is eligible for benefits must return a 2025 Enrollment Form to HR.

After this deadline, you must wait until the 2026 Open Enrollment period or experience a Qualifying Life Event.

Eligibility

The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire plan year, January 1, 2025-December 31, 2025, unless you experience a qualifying life event. 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?

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

What is a Qualifying Life Event?

When Does My Coverage Start?

Open Enrollment: Coverage will begin January 1, 2025.

New Hire: Your coverage will begin the first of the month following date of hire.

Qualifying Event: Benefit changes are effective date of event.

Who is Eligible for Benefits?

Regular full-time employees and 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.

NEW - Guardian Benefits

City of Maple Heights now offers Short-Term, Long-Term Disability and Accident Protection through Guardian.

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.

Short-Term Disability

Benefit pays 60% of your weekly income, up to a maximum of $500.
Benefits begin on the 1st day of an accident, and the 8th day of a sickness.
Duration of benefits: 13 weeks

Long Term Disability

Benefits pays up to 60% of your monthly income, up to a maximum $5,000.
Benefits begin after 90 days

Accident Protection: A serious injury can cost a lot of money - not only in medical bills but income from lost work hours. If you get hurt, accident insurance pays you money that you can use to cover personal expenses, bills, and out-of-pocket medical costs. Accident insurance pays a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that happen both on and off the job.

When you have an accident or injury, your health insurance company pays your doctor or hospital, your Guardian Accident insurance pays you directly.

Short Term Disability

Long Term Disability

Accident Protection

NEW - ASPCA Pet Insurance

City of Maple Heights s now offers Pet Insurance through ASPCA. 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.

How it Works:

Take your pet to veterinarian of your choice and pay them as usual
Use the app to submit a claim
Receive reimbursement for eligible vet bills by direct deposit or check

Use the link below to get your free pet insurance quote in 2 easy steps!

ASPCA Flyer

Medical

The City of Maple Heights offers a High Deductible Health Plan (HDHP) through Medical Mutual.

Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept Medical Mutuals contract rate as the final charge and the member is not balanced billed**. Employees who receive care from Out of Network providers may be responsible for higher costs.

**Balance Billing: Some Out of Network Providers bill a patient the difference between the total cost of services and the amount insurance pays.

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

NEW! Medical Mutual Total Health

The City of Maple Heights is part of Medical Mutual's Total Health Program. (previously known as Chronic Condition Management)

You have access to the below services, at NO COST.

Self-Service Wellness tools via My Health Plan
24/7 Nurse Line
Maternity Management
Care Navigation
Palliative Care
Transitional Care
Progeny Health: NICU Management
SWORD Health: Virtual Physical Therapy
BLOOM: Virtual Pelvic Health Therapy
Digital and Telephonic Health Coaching

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.

24/7 Nurse Line

Maternity Management

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 City of Maple Heights Health Plan.

Transitional Care

Palliative Care

Medical Mutual virtual physical therapy provides guided physical therapy at home with real-time feedback, which can help members avoid injury and surgery, reduce pain, and decrease reliance on medication.

There programs are offered through THRIVE-SWORD and BLOOM.

BLOOM

Sword

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

Asthma
Heart Disease
Type 1 diabetes
COPD

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

Lark Diabetes Prevention

Lark Diabetes Management

Lark Hypertension Management

Preventive Care

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 fall 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

Prescription

Your prescription drug coverage through Express Scripts is illustrated in the table shown below.

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.

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.

Smart90

The City of Maple Heights is enrolled in Smart90 with Medical Mutual. This is a feature to your prescription plan, managed through Express Scripts. With it, you have 2 ways to get up to a 90-day supply of your long-term medications (medications that you take regularly for ongoing conditions). You can conveniently fill these prescriptions either though home delivery from an Express Script Pharmacy or at a retail pharmacy in the Smart90 Network.

By getting up to a 90-day supply of your long-term medication, you’ll make fewer trips to the pharmacy, and you’ll only need to make one payment every three months. Also, there’s usually a savings for getting one 90-day supply vs. three 30-day supplies at retail. You will pay the same copayment for your 90-day supply whether you fill through home delivery from Express Scripts Pharmacy or at a Smart90 network pharmacy.

Please see attached 2025 list of Smart90 Network pharmacies.

Smart90 Flyer

SaveOnSP (through Medical Mutual)

SaveOnSP Flyer

Medical Mutual members can join the SaveOnSP program that helps you pay $0 for your specialty medications.

How do I enroll?

For any new eligible medications:

Your doctor or health provider will continue to send your new prescription to Accredo or Gentry for filling.
An Accredo/Gentry representative will call you and transfer you to a SaveOnSP customer service representative. The SaveOnSP representative will assist you with the enrollment in the new manufacturer’s assistance program.
The SaveOnSP representative will provide Accredo or Gentry your needed enrollment information.
Accredo or Gentry will process the claim and you will pay $0 for your medication.
After initial enrollment, SaveOnSP will only contact you once a year to ensure you are properly re-enrolled in the manufacturer’s program if needed.

The SaveOnSP service representative will ensure you are enrolled in the appropriate manufacturer program for each SaveOnSP medication you take.

The City of Maple Heights' participation in the ImpaxRX Medications Under Management Program helps deliver NO-COST medications for you.

If you or other family members have been prescribed a High-Cost medication an ImpaxRX program advocate will reach out to you to determine if you qualify to receive your High-Cost medication at NO-COST to you.

If you are contacted by an ImpaxRX advocate, please be ready to answer a few simple questions to determine if your drug qualifies for program savings. Once enrolled in the program you will start receiving your medications uninterrupted directly delivered to your home or local pharmacy.

If you miss a call from ImpaxRX, please call them back at 844-467-2979, option 1.

ImpaxRX Info Flyer

Health Savings Account (HSA)

A Health Savings Account (HSA) is a tax-free savings account that is owned by you, is 100% vested from day one, and lets you build up savings for future needs. The funds may be used to pay for qualifying healthcare expenses not covered by insurance or any other plan for yourself, your spouse, or tax dependents. You decide how much you would like to contribute, when and how to spend the money on eligible expenses, and how to invest the balance.

To have an HSA and make contributions to the account you must meet several basic qualifications.

You must have coverage under a qualified High Deductible Health Plan (HDHP)
Participants cannot be covered by any other health insurance plan (this exclusion does not apply to dental, vision, disability or long-term care coverage)
Participants cannot participate in a Healthcare FSA or spouse/domestic partner's Healthcare FSA or Health Reimbursement Account (HRA)
Participant cannot be enrolled in Medicare or Medicaid
You cannot be eligible to be claimed as a dependent on someone else's tax return
You have not received Department of Veterans Affairs Medical benefits in the past 90 days.

You may contribute as follows: (new 2025 limits)

$4,300 for Employee Only
$8,550 for a Two-Person or Family

Understanding an HSA

Full Access 24/7

Once enrolled, you will have 24/7 online access to your HSA and health benefits through My Health Plan.

After logging in, you’ll be able to:

▪ Track HSA and investment balances

▪ Pay for qualified medical expenses

▪ Invest in mutual fund options

▪ Report and reissue a lost or stolen debit card

▪ Use all the health benefits resources on My Health Plan, including My Care Compare and Find a Provider

AccountLink Mobile App

Access your Medical Mutual HSA on the go with Medical Mutual’s AccountLink mobile app. AccountLink lets you manage your Medical Mutual HSA, view your account balance and profile information; submit a claim; and much more from your mobile device. Download the app today for free from the Apple App Store® or Google Play™ by searching for AccountLink.

Medical Mutual Debit Card

Your HSA comes with a Medical Mutual debit card that can be used to pay for qualified medical expenses, including doctor’s visits, prescriptions and more

For more information, please reach out to the Finance Department.

AccountLink Mobile

How to Transfer Funds

HSA Enrollment Instructions

Dental

Your dental coverage is through Guardian. Dental Benefits through Guardian provides 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.

Employees who receive care from Out of Network providers may be responsible for higher costs and may be balanced billed.

*Balance Billing: Some Out of Network Providers bill a patient the difference between the total cost of services and the amount insurance pays.

What's Covered?

Preventive: Nearly all dental plans emphasize preventive care. Dental insurance is designed to make it easier for you to prevent serious oral health conditions. Your dental insurance allows 2 preventive cleanings per year. In addition to cleanings your plan offers:

Exams, cleanings, fluoride treatments, sealants and X-rays covered at 80%

Basic Care:

Fillings, root canal, scaling and root planing (per quadrant), simple extractions, surgical extractions covered at 80%

Major Care:

Anesthesia, bridges, dentures, dental implants, inlays, onlays, veneers, repair of bridges, crowns and dentures covered at 80%

Orthodontia:

Child(ren) covered at 50%

** Please refer to below Dental Summary for more plan details and exclusions.

** Click the tab below for an overview of you Dental Max Rollover Rewards program with Guardian.

Dental Summary

Vision

Vision Benefit Summary

Vision insurance plans help provide coverage for routine exams and provides discounts on glasses and contacts. Your vision coverage is through Guardian. Your vision network is Davis Vision.

You may use the eye doctor of your choice, however those that are In Network will be more cost effective. Employees who receive care from Out of Network providers may be responsible for higher costs and be balanced billed*.

*Balance Billing: Some Out of Network Providers bill a patient the difference between the total cost of services and the amount insurance pays.

How often can I obtain services?

Exams: once every 24 months (Note: an annual vision exam is also included in your Medical Mutual medical plan)

Frames: once every 24 months

Lenses: once every 24 months

**Please see attached Vision Benefit Summary for more plan details and exclusions.

Basic & Voluntary Life

Life insurance is an important part of your financial security. All life insurance will provide a payout to your beneficiaries if you pass away.

The City of Maple Heights offers both Basic and Voluntary Life Insurance to employees through Guardian.

Your Basic Life Benefit:

100% employer paid.
Benefit amount dependent on employee class.
Benefits reduced at ages 70 and 75.
Convertible: When coverage ends with your plan you can convert your benefit to an individual permanent life policy.
Portable: Allows you to take coverage with you if you terminate employment.

Your Voluntary Life Benefit

100% employee paid.
Coverage for spouse and children is available.
Benefits reduced at ages 70 and 75.
Convertible: When coverage ends with your plan you can convert your benefit to an individual permanent life policy.
Portable: Allows you to take coverage with you if you terminate employment.

Guardian Life Insurance

Beneficiary Designation

It is important to designate your beneficiaries to ensure that your assets will be distributed according to your direction.

Primary Beneficiary(ies) receive your life insurance benefits in the event of your death. Contingent Beneficiary(ies) receive your life insurance benefits if the primary beneficiary(ies) cannot. You can change your beneficiaries at any time.

Please make sure your beneficiary designations are up to date with the HR office.

Personify Health

The City of Maple Heights offers the Personify Health wellness platform (previously known as Virgin Pulse).

Effective January 1, 2025, Virgin Pulse will be revealing a brand-new look and feel for their new name: Personify Health. All of your historical account information and on-platform rewards will migrate over with the brand change, along with the mobile app. Action items on your end? You will just need to simply update your mobile app and become familiar with the new look and feel of the rebranding.

Whether you’re just starting to consider making healthy changes or trying to add new challenges to your wellness routines, you’ll have access to the same great tools and support you need to reach your goals.

You can check out daily wellbeing tips, track Healthy Habits, take small steps with digital coaching, join your friends and coworkers in fun challenges, and so much more. And it’s all available in the easy-to-use app so you always have what you need on the go. Connect devices, apps and activity trackers you already use to sync and automatically track health data like steps, sleep and mindful minutes.

What to know about transitioning to Personify Health

The app will change to Personify Health 1/1/25
The new web URL will be https://app.personifyhealth.com (link button below)
Members will not lose any historical data, and activity will remain as is

You can earn up to $100 Rewards Cash for your Biometric Screening and Health Risk Assessment. This can be traded in for gift cards or you can shop the Personify Health store!

EASE@Work

All employees and their covered dependents have access to this free Employee Assistance Program through EASE@Work.

Get support for you and your family from licensed counselors 24/7.

Get help with

Family Conflict
Work/Life Balance
Couples/Relationships
Depression
Anxiety
Parenting
Stress

EASE@Work counseling can be done via phone, web portal, mobile app, chat, or video.

Scan the QR code below to access Ease@Work on your mobile phone.

Your employee code: maplehts

1-800.521.3273

Ease@Work Flyer

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

What is a non-emergency condition?

Bladder infection
Bronchitis
Diarrhea
Fever
Rash
Seasonal flu
Allergies
Sore throat

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.

Carrier Contact Information

Medical Plan - Medical Mutual

Medical Plan Customer Service: 877-730-2221

Website: www.medmutual.com/member

Group Number: 153094

Express Scripts

Customer Service: 800-282-2881

Website: www.express-scripts.com

ImpaxRX

Customer Service: 844-467-2979, option 1

Dental, Vision, Life, Accident, Disability - Guardian

Customer Service: 1-888-482-7342

Website: www.guardianlife.com

Group Number: 00043524

Telemedicine - First Stop Health

Customer Service: 888-691-7867

Website: www.fshealth.com

Group Number: 1020304255

Employee Assistance - Ease@Work

Customer Service: 800-521-3272

Website: www.easeatwork.com

Pet Insurance - ASPCA

Customer Service:1-866-204-6764

Website: www.aspcapetinsurance.com/?prioritycode=EB24MapleHeights

Client Contacts

AP

April Perkins

aperkins@mapleheightsohio.com

+1 216-662-6000

LL

Letitia Linker

llinker@mapleheightsohio.com

+1 216-662-6000

TT

Tinita Tillman

ttillman@mapleheightsohio.com

+1 216-662-6000

City of Maple Heights

Table of Content

2025 Employee Benefits

Open Enrollment Meetings

How To Enroll

Eligibility

What is a Qualifying Life Event?

What is a Qualifying Life Event?

NEW - Guardian Benefits

Short Term Disability

Short Term Disability

Long Term Disability

Long Term Disability

Accident Protection

Accident Protection

NEW - ASPCA Pet Insurance

ASPCA Flyer

ASPCA Flyer

ASPCA Flyer

ASPCA Flyer

Medical

NEW! Medical Mutual Total Health

24/7 Nurse Line

24/7 Nurse Line

Maternity Management

Maternity Management

Transitional Care

Transitional Care

Palliative Care

Palliative Care

BLOOM

BLOOM

Sword

Sword

Lark Diabetes Prevention

Lark Diabetes Prevention

Lark Diabetes Management

Lark Diabetes Management

Lark Hypertension Management

Lark Hypertension Management

Preventive Care

Prescription

RX

Smart90

Smart90 Flyer

Smart90 Flyer

SaveOnSP (through Medical Mutual)

SaveOnSP Flyer

SaveOnSP Flyer

ImpaxRX Info Flyer

ImpaxRX Info Flyer

Health Savings Account (HSA)

Understanding an HSA

Understanding an HSA

AccountLink Mobile

AccountLink Mobile

How to Transfer Funds

How to Transfer Funds

HSA Enrollment Instructions

HSA Enrollment Instructions

Dental

Dental Summary

Dental Summary

Vision

Vision Benefit Summary

Vision Benefit Summary

Basic & Voluntary Life

Guardian Life Insurance

Guardian Life Insurance

Beneficiary Designation

Personify Health

EASE@Work

Ease@Work Flyer

Ease@Work Flyer

First Stop Health

Carrier Contact Information

Client Contacts

Benefits Compliance

Medicare Part D

Medicare Part D