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City of Maple Heights

Table of Content

  1. Header
  2. Overview of Health Benefits
    1. 2024 Employee Benefits
    2. How To Enroll
    3. Eligibility and Qualifying Events
    4. Medical
    5. MMO My Health Plan and Mobile App
    6. Additional MMO Programs
    7. Prescription
    8. Prescription 2
    9. Smart90
    10. SaveOnSP (through Medical Mutual)
    11. ImpaxRX
    12. Health Savings Account (HSA)
    13. Medical Mutual HSA with WealthCare Saver Bank
    14. Dental
    15. Dental Cont.
    16. Dental Maximum Rollover Rewards
    17. Vision
    18. Basic & Voluntary Life
    19. Beneficiary Designation
    20. Virgin Pulse
    21. EASE@Work
    22. First Stop Health
    23. Carrier Contact Information
    24. Contact Us
    25. Benefits Compliance
  3. Footer

2024 Employee Benefits

Medical: Medical Mutual

  • HSA plan: $3200/$6400 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: Virgin Pulse

Benefit Guide

Benefit Guide

How To Enroll

open enrollment

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 2023 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 2024 Enrollment Form to HR.


After this deadline, you must wait until the 2025 Open Enrollment period or experience a Qualifying Life Event.

Eligibility and Qualifying Events

The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire plan year, January 1, 2024-December 31, 2024, 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?

What is a Qualifying Life Event?


When Does My Coverage Start?


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

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.


Medical

HSA Summary of Benefits & Coverage

HSA Summary of Benefits & Coverage

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.





MHP

My Health Plan is a secure website specifically for Medical Mutual members, My Health Plan makes it easy and convenient to manage your plan and your health online.

  • Search for in-network providers hospitals and facilities
  • Order new ID cards or access your temporary ID card
  • View your plan documents to see what is covered
  • Check the status of your deductible and coinsurance
  • View your Explanation of Benefits (EOB)
  • Access your HSA account


The MedMutual Mobile App gives you access to the vital health insurance information you need wherever you are.

  • Track claims and spending information
  • Find a provider, hospital or facility
  • Access your ID card

Additional MMO Programs

The City of Maple Heights is part of Medical Mutual's Chronic Care Management Program, which offers members a wide variety of services for various conditions at no cost.


  • Asthma
  • Heart Failure
  • Coronary Artery Disease (CAD)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes
  • Hypertension
  • Med Mutual Maternity App


New programs offered through MMO's Chronic Condition Management Program are,


  • SWORD Health: Virtual Physical Therapy
  • BLOOM: Through Sword, Virtual Pelvic Health Therapy


Please see attached Chronic Condition Management Flyer or reach out to HR for questions regarding these programs.

Chronic Care Management Flyer

Chronic Care Management Flyer

Prescription

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



RX

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 2024 list of Smart90 Network pharmacies.

Smart90 Flyer

Smart90 Flyer

SaveOnSP (through Medical Mutual)

SaveOnSP Flyer

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:

  1. Your doctor or health provider will continue to send your new prescription to Accredo or Gentry for filling.
  2. 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.
  3. The SaveOnSP representative will provide Accredo or Gentry your needed enrollment information.
  4. Accredo or Gentry will process the claim and you will pay $0 for your medication.
  5. 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

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 2024 limits)

  • $4,150 for Employee Only
  • $8,300 for a Two-Person or Family
Understanding an HSA

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

AccountLink Mobile

How to Transfer Funds

How to Transfer Funds

HSA Enrollment Instructions

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

Dental Summary

Guardian Maximum Rollover Oral Health Rewards strengthens savings by rewarding members with funds they can rollover and use as needed in the future simply by taking proactive care of their oral health. Guardian will roll over a portion of your unused annual maximum into your personal Maximum Rollover Account (MRA). If you reach your Plan Annual Maximum in future years, you can use money from your MRA. To qualify for an MRA, you must have a paid claim (not just a visit) and must not have exceeded the paid claims threshold during the benefit year.


Vision

Vision Benefit Summary

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

Guardian Life Insurance