Benefits Effective January 1, 2027 - December 31, 2027

Open Enrollment: November 9 - November 23

2027 Benefits Overview

Welcome to your 2027 benefits overview for Lake County Development Authority!

NEW! Your prescription coverage will now be administered through MMO and Express Scripts Pharmacy (ESI).

Please see below for your current lines of coverage and carriers.

Medical: Medical Mutual

Prescription: Medical Mutual / Express Scripts Pharmacy

Specialty Prescription Assistance: ImpaxRx

Dental: MetLife

Vision: MMO

Accident and Critical Illness: Symetra

Telemedicine: First Stop Health

Employee Assistance Program: AllOne Health

Pet Insurance: Nationwide

Eligibility & Qualifying 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?

When Does My Coverage Start?

Employees make their benefit elections now for a January 1st effective date.

New Hires: Benefits begin first of the month following 30 days.

Who is Eligible for Benefits?

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

If you were hired 1/1/2018 or later, you are only eligible for the Lake Blue Plan.

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 Lake DA's Medical Coverage. To enroll your spouse, you must complete the below spousal waiver.

How to Enroll

All elections must be submitted by: November 23, 2026

BenXpress: Benefit Elections and changes for Medical/Prescription, Critical Illness and Accident Benefits must be completed in BenXpress.

Ancillary Coverage: Benefit Elections and changes for Dental elections need to be made on the Dental enrollment form and returned to Debbie Connor.

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)

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:

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.

Medical Mutual of Ohio - Login

Lake County Development Authority offers three (3) medical plan options through Medical Mutual.

EPO Plan: The EPO plan uses the Medical Mutual Medflex Network
500 Plan: The 500 plan uses the Medical Mutual Medflex Network
Lake Blue Plan: This is a 3-Tier Plan that utilizes the MMO SuperMedPlus Network.

Reminder:

Medical Mutual covers 1 annual vision exam. You must present your MMO Medical card at this visit.

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.

Check back later for your SBCs!

Member Welcome Flyer

MMO EOB Guide

Make the Most of Your Membership

EPO Plan

The EPO Plan utilizes the Medflex Network. This network does not include the Cleveland Clinic. This plan offers In Network benefits only. If you utilize a non-Network provider, your services will not be covered. It is important to confirm your providers are Network providers. The below packet can be downloaded and provides instructions on how you can find a MedFlex Network provider.

**Please refer to the Summary of Benefits/Certificate of Coverage from Medical Mutual for a full description of benefits and exclusions.

Find a Provider and Cost Estimate

500 Plan

The 500 Plan utilizes the Medflex Network. This network does not include the Cleveland Clinic. This plan offers In Network benefits only. If you utilize a non-Network provider, your services will not be covered. It is important to confirm your providers are Network providers. The below packet can be downloaded and provides instructions on how you can find a MedFlex Network provider.

**Please refer to the Summary of Benefits/Certificate of Coverage from Medical Mutual for a full description of benefits and exclusions.

Find a Provider and Cost Estimate

Lake Blue Plan

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 Facilities and Providers. 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.)

Find a Provider and Cost Estimate

MedMutual My Health Plan/Mobile App

My Health Plan is Medical Mutual's 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:

Check your deductible
Review your Explanation of Benefits (EOB)
Find in network doctors
Access your ID Card

To create your account:

Visit MedMutual.com/Member
Click on "Register for an Account"

My Health Plan Flyer

MMO Mobile App Flyer

Maternity Management and NICU Management

Maternity App Flyer

Maternity Management

Medical Mutual provides digital resources to help members prepare for their baby's arrival through age 2. During pregnancy members receive weekly updates and have access to tools to look up symptoms and issues.

Once the 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.

Transitional Care and Palliative Care

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.

Palliative Care Flyer

Digital and Telephonic Health Coaching

Medical Mutual's digit coaching is provided through LARK for members with Diabetes and Hypertension.

Digital 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

Diabetes Resource Guide

Pivot Breathe

Quit Tobacco on Your Timeline with Pivot Breathe

Whether you're ready to quit smoking or vaping today or simply want to start cutting back, Pivot Breathe can help. Available at no cost to eligible Medical Mutual plan participants age 18 and older, this personalized tobacco cessation program provides the tools, coaching, and support you need to make progress at your own pace.

Unlike traditional smoking cessation programs, Pivot Breathe doesn't begin with pressure to quit immediately. Instead, the program is designed around your individual goals and readiness. Whether you want to learn more about your tobacco use, reduce consumption, build healthier habits, or quit altogether, Pivot provides personalized support every step of the way.

When you enroll in Pivot Breathe, you'll receive access to:

A personalized mobile app with activities, lessons, and progress tracking
One-on-one support from a dedicated health coach
a 24/7 online community for encouragement and support
Tools and challenges to help manage cravings
Free nicotine replacement therapy (gum, patches, or lozenges) for eligible participants
The FDA-cleared SmartSensor, a handheld device that helps you see the impact of smoking in real time

What Makes Pivot Unique?

Pivot is the only quit-smoking program that includes the FDA-cleared SmartSensor. The device measures carbon monoxide levels, helping users see how changes in their smoking habits affect their health. By providing real-time feedback, the SmartSensor has been shown to help increase motivation to quit and reduce cigarette use.

Earn Credit Through Program Engagement

To satisfy your program goal, participants must complete at least six activities per week for a total of six weeks (weeks do not need to be consecutive). Examples of engagement include:

Completing lessons or activities in the app
Interacting with a health coach
Using the SmartSensor
Participating in the online community
Ordering nicotine replacement theory
Setting a quit date
Progressing through the program stages of Learn, Reduce, Quit, or Maintain

Pivot Brochure

Pivot FAQ

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

Prescriptions

Your prescription benefits are moving to MMO/Express Scripts! Please make sure to read the important information related to your current scrips below!

Existing prior authorizations will not transfer automatically. Beginning in January, a member whose medication requires authorization can receive limited retail fills. However, your doctor must submit the new authorization. This needs to occur after receiving one fill at a retail pharmacy for 30-day prescriptions or one fill for 90-day prescriptions.

Members using CVS mail-order autofill must stop the autofill by the end of December and obtain a new prescription for Express Scripts mail-order for maintenance medications. Specialty medications will move from CVS to designated MMO/ESI channels - Accredo, Gentry, or UH.

If a medication is on the SaveOnSP list and members elect not to use the program, then members will pay 30% copay on the medication every time, and that amount will not go towards the maximum out-of-pocket.

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.

TIER 4 | Specialty Drugs: This category includes specialty medications used to treat complex or chronic health conditions. These drugs typically have the highest cost and may require special handling, monitoring, or administration, resulting in the highest member cost share.

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.

Click the link below to log in to your ESI portal to find a provider. Please also see the lists of in-network pharmacies below.

Prescription Summary For All Plans

Preferred Plus Prescription Drug Formulary

MMO National Plus Pharmacy Network Directory

MMO CVS Advantage Pharmacy Network Directory

Smart90 (through Medical Mutual)

MMO Smart90 Flyer

Smart90 Prescription Program

Save time and money on your long-term prescription medications with the Smart90 program. Employees who take maintenance medications can receive up to a 90-day supply through Express Scripts Pharmacy home delivery or a participating CVS retail pharmacy. This means fewer trips for refills, convenient home delivery options, and potential savings on prescription costs.

After your first three 30-days fills, eligible maintenance medications must be filled as a 90-day supply through Express Scripts Pharmacy or CVS to remain covered under the plan. Employees can continue using their preferred network pharmacy for short-term medications, such as antibiotics.

Benefits of Smart90 include:

Up to a 90-day supply of maintenance medications
Fewer pharmacy visits and refills each year
Convenient home delivery through Express Scripts Pharmacy
Free standard shipping on home delivery prescriptions
Potential prescription cost savings compared to traditional 30-day fills

SaveOnSP (through Medical Mutual)

If you take specialty medications for complex or chronic health conditions, the SaveOnSP program can help lower your prescription costs. Available through your Medical Mutual prescription drug plan, SaveOnSP works with manufacturer copay assistance programs to reduce eligible specialty medication costs, with many participants paying as little as $0 out of pocket for covered medications. More than 200 specialty drugs are included in the program.

The program is easy to enroll in and allows you to continue filling prescriptions through participating specialty pharmacies, including Accredo, University Hospitals of Cleveland Specialty Pharmacy, and Gentry Health Services. Employees currently using eligible specialty medications may be contacted by a SaveOnSP representative or can enroll directly by calling SaveOnSP.

Key Benefits

Reduce out-of-pocket costs for eligible specialty medications
Access manufacturer copay assistance programs
Continue using participating specialty pharmacies
Potentially pay as little as $0 for covered specialty prescriptions

SaveOnSP Flyer

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 Lake County 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.

Dental

Dental Benefits through MetLife 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: PDP Plus

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 Summary - Low Plan

Dental Summary - High Plan

Dental Benefit Summary

Dental Enrollment Form

Vision

Covered through Medical Mutual: Lake County Development Authority pays 100% for your basic vision exam when you elect medical coverage and visit a provider in the EyeMed network. Vision exams are allowed once every 12 months at a $0 copay if the exam is provided by an EyeMed Vision Network Provider.

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.

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

HOW OFTEN CAN I OBTAIN SERVICES?

Exams: Once a year
Lenses: Once a year
Frames: Once every 2 years

Vision Benefit Summary

Accident and Critical Illness

Lake County Development Authority now offers Accident and Critical Illness coverage through Symetra on a voluntary basis.

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?

Breaking a limb
Loss of a digit or limb
Paralysis
Burns
Lacerations
Accidental Death

Accident insurance can help you pay for things like:

Emergency helicopter transportation
Hospital admissions
Intensive Care and Rehab Unit Care
Diagnostic Exams
Follow - Up Treatments
Physical Therapy

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 is your choice how to spend it.

What is Covered?

Cancer
Heart Attack
Blindness
Loss of Speech
End-Stage Renal Failure
Deafness
Severe Burns
Stroke
Coma
Major Organ Transplant

Brite Flyer

Accident Benefit Summary

Critical Illness Benefit Summary

How to File an Accident Claim

How to File a Critical Illness Claim

First Stop Health

First Stop Health and the Virtual Primary Care feature will continue to be offered in 2027.

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:

Urgent Care: 24/7 access to doctors who connect to patients within minutes.
Preventive Care: Schedule virtual doctor visits for routine screenings with coordinated care for lab, imaging and procedure orders.
Chronic Care: Schedule virtual doctor visits for the management of ongoing health issues and care follow-up.

AllOne Health

AllOne 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.

Mental Health Sessions Manage stress, anxiety, and depression, resolve conflict, improve relationships, overcome substance abuse, and address any personal issues.
Life Coaching Reach personal and professional goals, strengthen relationships, and build balance.
Financial Consultation Build financial wellness related to budgeting, buying a home, paying off debt, managing taxes, preventing identity theft, and saving for retirement or tuition.
Legal Consultation Get help with personal legal matters including estate planning, wills, real estate, bankruptcy.
Work-Life Resources and Referrals Obtain information and referrals when seeking childcare, adoption, special needs support, eldercare, housing, transportation, education, and pet care.
Personal Assistant Save time with referrals for travel and entertainment, seeking professional services, cleaning services, home food delivery, and managing everyday tasks.
Medical Advocacy Get help navigating insurance, obtaining doctor referrals, securing medical equipment or transportation, and planning for transitional care and discharge.
Wellness Build holistic well-being with wellness coaching.
Member Portal and App These digital tools enable you to access your benefits 24/7/365 with online requests and chat options.

Call: 800-521-3273

Visit: ease.mylifeexpert.com & select Member Portal & App

Portal Code: lakecounty

Pet Insurance

Lake County Development Authority 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.

Employee Contributions

Employee Monthly Contributions - Medical

Employee Monthly Contributions - Dental

Contact Information

Medical Mutual

Customer Service: 1-844-583-3072

Website: www.medmutual.com

Express Scripts

Customer Service: 1-800-282-2881

Website: www.express-scripts.com

MetLife

Customer Service: 1-800-638-5433

Website: www.metlife.com

Symetra

Customer Service: 1-800-796-3872

Website: www.symetra.com

First Stop Health

Customer Service: 888-691-7867

Website: www.fshealth.com

AllOne Health

Customer Service: 800-521-3273

Website: www.portal.allonehealth.com

ImpaxRx

Customer Service: 844-467-2979 option 1

Website: www.impaxRX.com

Lake County Development Authority

Table of Content

2027 Benefits Overview

Eligibility & Qualifying Events

What is a Qualifying Life Event?

What is a Qualifying Life Event?

How to Enroll

Member Welcome Flyer

Member Welcome Flyer

MMO EOB Guide

MMO EOB Guide

Make the Most of Your Membership

Make the Most of Your Membership

EPO Plan

Find a Provider and Cost Estimate

Find a Provider and Cost Estimate

EPO Plan - Medical Summary

EPO Plan - Hearing Summary

500 Plan

Find a Provider and Cost Estimate

Find a Provider and Cost Estimate

500 Plan - Medical Summary

500 Plan - Hearing Summary

Lake Blue Plan

Lake Blue Plan - Medical Summary

Lake Blue Plan - Hearing Summary

Find a Provider and Cost Estimate

Find a Provider and Cost Estimate

MedMutual My Health Plan/Mobile App

My Health Plan Flyer

My Health Plan Flyer

MMO Mobile App Flyer

MMO Mobile App Flyer

Medical Mutual Total Health

24/7 Nurse Line and Care Navigation

Maternity Management and NICU Management

Maternity App Flyer

Maternity App Flyer

Transitional Care and Palliative Care

Palliative Care Flyer

Palliative Care Flyer

Virtual Physical Therapy

Digital and Telephonic Health Coaching

Diabetes Resource Guide

Diabetes Resource Guide

Pivot Breathe

Pivot Brochure

Pivot Brochure

Pivot FAQ

Pivot FAQ

Preventive Care

Prescriptions

Prescription Summary For All Plans

Preferred Plus Prescription Drug Formulary

Preferred Plus Prescription Drug Formulary

MMO National Plus Pharmacy Network Directory

MMO National Plus Pharmacy Network Directory

MMO CVS Advantage Pharmacy Network Directory

MMO CVS Advantage Pharmacy Network Directory

Smart90 (through Medical Mutual)

MMO Smart90 Flyer

MMO Smart90 Flyer

SaveOnSP (through Medical Mutual)

SaveOnSP Flyer

SaveOnSP Flyer

ImpaxRX

Dental

Dental Summary - Low Plan

Dental Summary - High Plan

Dental Benefit Summary

Dental Benefit Summary

Dental Enrollment Form

Dental Enrollment Form

Vision

Vision Benefit Summary

Accident and Critical Illness

Brite Flyer

Brite Flyer

Accident Benefit Summary

Accident Benefit Summary