City of Fairview Park

Table of Content

  1. Header
  2. Your 2025 City of Fairview Park Benefits
    1. How to Enroll
    2. Forms
    3. Eligibility
    4. Eligibility
    5. Medical
    6. Summary of Benefits and Coverage (SBC)
    7. MedMutual My Health Plan/Mobile App
    8. NEW! Medical Mutual Total Health
    9. 24/7 Nurse Line and Care Navigation
    10. Maternity Management and NICU Management
    11. Transitional Care and Palliative Care
    12. Virtual Physical Therapy
    13. Digital and Telephonic Health Coaching
    14. Preventive Care Covered 100%
    15. HSA
    16. Health Equity
    17. FSA
    18. Prescriptions
    19. SaveOnSP (through Medical Mutual)
    20. Smart90 (through Medical Mutual)
    21. ImpaxRX
    22. Dental
    23. Dental Summaries
    24. Vision
    25. Vision Summaries
    26. Life Insurance
    27. Voluntary Life Insurance
    28. Beneficiary Designation
    29. Personify Health
    30. First Stop Health
    31. Ease@Work
    32. Contact Information
    33. Compliance
  3. Footer

Your 2025 City of Fairview Park Benefits

Medical: Medical Mutual

Pharmacy: Express Scripts and Smart90

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

Dental: Guardian

Vision: Guardian

Basic and Voluntary Life: Guardian

HSA Bank: Health Equity

Health, Dependent Care, and Limited Purpose FSA: BASIC

Wellness - Personify Health (previously called Virgin Pulse)

Telemedicine: First Stop Health

Employee Assistance Program: Ease@Work

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How to Enroll

If you need a printed election form, please contact the Finance Department. Signed enrollment forms must be returned to the Finance Department.

During Initial Enrollment, you may:

  • Elect the same coverage with the same dependents.
  • Add or remove coverage for your dependents.
    • If adding a dependent, please provide a marriage certificate for spouse and birth certificate for children.
  • Enroll, if you are not currently enrolled in 2024 plans.
  • Decline/waive benefits.
  • Update Life Insurance beneficiaries.
  • Enroll in Voluntary Life Insurance with Guardian.

Attached are the 2025 Election Forms. Click to download the form that applies to you.

Admin Election Form

Admin Election Form

Police and Fire Election Form

Police and Fire Election Form

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 the Finance Department 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 be effective on 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 or domestic partner.

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

The City of Fairview Park offers two medical plans through Medical Mutual.

A PPO option offers the freedom to see any provider when you need care. When you use providers from within the PPO network, you receive benefits at the discounted network cost. Most expenses, such as office visits, emergency room and prescription drugs are covered by a copay. Other expenses are subject to a deductible and coinsurance.

The HSA is similar to the PPO Plan in that you have the option to choose any provider when you need care. However, in exchange for a lower per-paycheck cost, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs. ​ All expenses are your responsibility until the deductible is reached, with the exception of preventive care, which is covered at 100% when you visit a physician in the network.

Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept Medical Mutual contract rate as the final charge and the member is not balance billed*. Your medical network with MMO is SuperMed Plus.

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

Medical Summary

Summary of Benefits and Coverage (SBC)

Looking for more details about how items are covered? Please refer to the formal Summary of Benefits and Coverage (SBC) below.

HSA Plan Summary of Benefits and Coverage

HSA Plan Summary of Benefits and Coverage

PPO Plan Summary of Benefits and Coverage

PPO Plan Summary of Benefits and Coverage

MedMutual My Health Plan/Mobile App

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:

  • 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"
MMO My Health Plan

NEW! Medical Mutual Total Health

City of Fairview Park 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 Health Coaching through LARK for diabetes and hypertension
  • 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

24/7 Nurse Line

Maternity App Flyer

Maternity App Flyer

Maternity Management

Medical Mutual provides digital resources to help members prepare for baby's arrival 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 Fairview Park Health Plan.

Transitional Care

Transitional Care

Palliative 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

BLOOM

Sword

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

Diabetes Prevention

Diabetes Prevention

Diabetes Management

Diabetes Management

Hypertension Management

Hypertension Management

Preventive Care Covered 100%

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
Preventive Care

HSA

Health Savings Account

A Health Savings Account (HSA) is a tax-free savings account that is owned by you, it 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 be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP).

UNDERSTANDING YOUR HSA

  • Pre-tax contributions are deducted through payroll and deposited into your HSA account.
  • You can use your HSA available funds to pay for qualified medical expenses tax-free.
  • HSA funds can be used for non-eligible expenses but will be subject to regular income taxes and a 20% excise tax penalty.
  • Unused funds remain in your account for future use and roll over each calendar year.
  • HSAs remain with you even if you change health plans or companies. If you open an HSA and later become ineligible to make contributions, you can still use your remaining funds.
  • You can change your HSA contribution at any time during the plan year for any reason.

You may contribute as follows: (IRS Update for 2025)

$4,300 for Employee Only

$8,550 for a Two-person or Family

MAINTAINING RECORDS

To protect yourself in the event that you are audited by the IRS, keep records of all HSA documentation and itemized receipts for at least as long as your income tax return is considered open (subject to an audit), or as long as you maintain the account, whichever is longer.

HSA funds may be used for non-eligible expenses but will be subject to regular income taxes and a 20% excise tax penalty.

HSA Overview

HSA Overview

Your Health Savings Account is through Health Equity.


Fairview Park contributes 50% of your deductible to your HSA account, on a quarterly basis. You have the option to contribute to your HSA account by payroll deduction. To do this, please download, complete and return the attached document.


This form must be completed each year.

HSA Payroll Deduction Form (Click to Download)

HSA Payroll Deduction Form (Click to Download)

FSA

Flexible Spending Accounts (FSA) allow you to reduce your taxable income by setting aside pre-tax dollars from each paycheck to pay for eligible out-of-pocket health care and dependent 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 qualifying event. 

Employees have the option to enroll in a Health Care, Dependent Care (DCFSA) or Limited Purpose FSA (LPFSA).

With a Health Care FSA all eligible health care expenses – such as deductibles, medical and prescription copays, dental expenses, and vision expenses – can be reimbursed from your FSA account. With the Health Care FSA, you can spend up to the full amount of your annual election as soon as your account has been set up.

Maximum Annual Contribution: $3,300

The Dependent Care FSA allows you to pay for eligible dependent care expenses with tax-free dollars. 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 may set aside up to $5,000 annually in pre-tax dollars, or $2,500 if you are married and file taxes separately from your spouse.
  • If you participate in a Dependent Care FSA, you cannot apply the same expenses for a dependent care tax credit when you file your income taxes.

Limited Purpose FSAs are designed to work in conjunction with your Health Savings Account (HSA). Members who elect a LPFSA can pay for dental and vision expenses with pre-tax funds. This plan helps members save money while retaining their HSA eligibility.

BASIC FSA Enrollment Form (Click to Download)

BASIC FSA Enrollment Form (Click to Download)

Prescriptions

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 | Low copay: This category includes non-preferred and low-cost generic drugs.


TIER 3 | 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.


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.

RX Summary

SaveOnSP (through Medical Mutual)

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. 

SaveOnSP Flyer

SaveOnSP Flyer

Smart90 (through Medical Mutual)

Smart90 Flyer

Smart90 Flyer

Smart90 is a feature to your Medical Mutual 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.

ImpaxRX

ImpaxRX Info Flyer

ImpaxRX Info Flyer

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 Fairview Park 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 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. As in previous years, you have the option to choose between the Guardian Value and NAP Plans.


NETWORK: The Value and NAP plan utilize the DentalGuard Preferred Network.


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 Insurance Overview Video

Dental Insurance Overview Video

Dental Summary

Vision

The City of Fairview Park 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. Please note: Members may choose between prescription glasses (lenses and frame) and contact lenses, not both.

NETWORK: Your vision plan network is Davis Vision.

Did You Know?

Eyes can give doctors a clear picture of overall wellness. That’s why vision care—and vision benefits—can help employees stay healthy. A comprehensive eye exam can detect early signs of serious health problems, such as:

    • Diabetes
    • Heart disease
    • High blood pressure
    • High cholesterol
    • Glaucoma and cataracts

To find out if your provider is in-network, please visit the website below.

Vision Benefit Summary

Vision Insurance Overview

Vision Insurance Overview

Life Insurance

Life/AD&D

Life/AD&D

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 Life - Employer Paid $50,000 Benefit through Guardian

A sudden accident or death can leave you or your loved ones in a vulnerable position. Employees are given Term Life and Accidental Death & Dismemberment insurance which will supplement lost income in the event of an accident or death.


Basic Life Insurance is provided to all Active Full-Time employees in the amount of $50,000.


If You Are Age 65 Or Older benefits are reduced at the below percentage,

  • Reduced by 35% at age 65
  • Reduced by 50% at age 70

Voluntary Life - Employee Paid Benefit through Guardian

Voluntary Life Insurance is provided to all Active Full-Time employees.

  • Employee Benefit: $10,000 increments up to a maximum of $300,000.
  • Spouse Benefit: $5,000 increments up to a maximum of $150,000
  • Child Benefit: Ages 14 days to 26 years. $1,000 increments up to a maximum of $10,000.

Guaranteed Issue: When you are first eligible at hire for Voluntary Life and ADD, you may purchase up to the Guaranteed Issue (GI) for yourself and your dependents without providing proof of good health (EOI). Any amount over the GI will require EOI.

  • Employee: $100,000
  • Spouse: $25,000
  • Child: $10,000

If You Are Age 65 Or Older benefits are reduced at the below percentage,

  • Reduced by 35% at age 65
  • Reduced by 50% at age 70
Life Insurance Enrollment Form (Click to Download)

Life Insurance Enrollment Form (Click to Download)

Life Insurance Packet

Life Insurance Packet

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 Finance Department.

Personify Health

The City of Fairview Park offers the Personify Health Wellness Platform. (previously called 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 $200 in Rewards Cash that can be turned in for gift cards or used in the Personify Health store!

First Stop Health

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

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.
fsh

Ease@Work

All employees and their covered dependents have access to 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
  • Life Coaching
  • Parenting
  • Stress
  • Wellness
  • Financial and Legal Consultation

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

Company Code: fairviewpk

1-800.521.3273

Contact Information

City of Fairview Park Contacts

Carlene Hayes

Finance Specialist

carlene.hayes@fairviewpark.com

440-356-4400

Jennifer Pae

Director of Finance

jennifer.pae@fairviewpark.com

Carrier Contact Information

Medical Mutual

Customer Service: 877-730-2221

Website: www.medmutual.com/member

Express Scripts

Customer Service: 800-282-2881

Website: www.express-scripts.com

ImpaxRX

Customer Service: 844-467-2979, option 1

Guardian

Customer Service: 1-888-482-7342

Website: www.guardianlife.com

Health Equity (HSA)

Customer Service: 866-346-5800

Website: www.healthequity.com

BASIC (FSA)

Customer Service: 800-444-1922

Website: www.basiconline.com

First Stop Health

Customer Service: 888-691-7867

Website: www.fshealth.com

Ease@Work

Customer Service: 800-521-3272

Website: www.easeatwork.com

contact

Compliance

Medicare Part D

Medicare Part D

Market Exchange Notice

Market Exchange Notice

2025 Annual Notices

2025 Annual Notices

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