2026 Benefits Overview

NEW! Accident, Critical Illness, and Hospital Indemnity are now being offered through Symetra!

NEW! GLP-1 Weight Loss Program through WellnessIQ!

Medical: Medical Mutual

Prescription: CVS Caremark/RxBenefits

Specialty Prescription Assistance: ImpaxRx

Dental: Guardian

Vision: Guardian

Basic and Voluntary Life: Guardian

Telemedicine: First Stop Health

Employee Assistance Program: AllOneHealth

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

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What is a Qualifying Life Event?

What is a Qualifying Life Event?

When Does My Coverage Start?

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

Who is Eligible for Benefits?

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

Who are my legal dependents?

Your children (up to age 26) including natural children, stepchildren, legally adopted children, children placed for adoption, children for whom you serve as legal guardian.

Disabled dependent child(ren) of any age. Coverage ends the end of the month of the 26th birthday.

Your legal spouse: If your spouse has coverage through his/her employer, they are not eligible for LMHA's Medical Coverage. To enroll your spouse, you must complete the below spousal waiver.

How to Enroll

Action Required!

All elections must be submitted by 11/21

This is an ACTIVE enrollment.

This means that you must complete an election form to enroll yourself and your dependents for benefits. After this deadline you must wait until the next open enrollment period or experience a qualifying event.

During Open Enrollment you can:

• Elect the same coverage with the same dependents.
• Add or remove coverage for dependents.
  • If adding a dependent, please provide a marriage certificate for spouse and birth certificate for children.
• Decline benefits.
• Enroll if you are not currently enrolled in 2025 plans.
• Update Life Insurance beneficiaries.
• Enroll in additional Voluntary Life Insurnace through Guardian (at your expense)

**Please note your Guardian dental, vision and life benefits are not elected in BenXpress. Please see Diana Dilisio to make changes to these benefits**

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)

Go to: BenXpress

NEW! Accident, Critical Illness, and Hospital Indemnity

Lake Metropolitan Housing Authority now offers Accident, Critical Illness, and Hospital Indemnity 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
• Hosptial 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

HOSPITAL INDEMNITY INSURANCE

Hospital indemnity complements your health insurance to help you pay for costs associated with a hospital stay. The funds can be used to help pay for the out-of-pocket expenses that your medical plan may not cover, such as deductible and coinsurance. When you have a covered inpatient admission, your health insurance company pays your doctor or hospital, but your hospital indemnity insurance company pays you.

For more information on your Symetra products visit the employee resource center using the link below or download the attached benefit brochures.

Go to: Brite

Brite Flyer

Brite Flyer

Symetra Accident Flyer

Symetra Accident Flyer

Symetra Critical Illness Flyer

Symetra Critical Illness Flyer

Symetra Hospital Indemnity Flyer

Symetra Hospital Indemnity Flyer

NEW! GLP-1 Weight Loss Program

Lake Metropolitan Housing Authority has partnered with WellnessIQ to offer GLP-1 Medications to employees and spouses at a discounted price.

You do not need to be enrolled on the medical plan to have access to this program.

Register in 2 simple steps:

1. Complete the online intake form
2. Select your Program

All plans include:

• Enforced by FDA - Pharmacies adhere to all State Board, USP-797, and PCAB standards
• GLP-1 prescribed by a clinician, customized for you, with ongoing monitoring and on-demand support
• No hidden costs, undisclosed charges, or bait and switch
• Free, overnight, temperature-controlled shipping
• Tips, tricks and maintenance plans to keep the weight off for life
• Group virtual lifestyle medicine coaching
• Change programs or cancel anytime

Along with medication, all plans include Wellness Coaching to help you develop sustainable habits for long-term health.

• Goal Setting
• Behavior Change
• Emotional Health and Stress Management
• Healthy Sleep and Nutrition Strategies
• Exercise

All employees and spouses have access to the Wellness Coaching - you do not need to register for GLP-1 medication.

Click the link below to register!

Go to: LMHA GLP-1 portal

GLP-1 Flyer

GLP-1 Flyer

Lake Metropolitan Housing Authority offers 1 medical plan option through Medical Mutual.

1. 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.

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

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.)

Go to: Find a SuperMed Provider

Lake Blue Plan

MedMutual My Health Plan/Mobile App

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"

Go to: MyHealthPlan

MMO Mobile App Flyer

MMO Mobile App Flyer

Medical Mutual Total Health

Lake Metropolitan Housing Authority 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

24/7 Nurse Line and Care Navigation

24/7 Nurse Line and Care Navigation

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 Management and NICU Management

Maternity Management and NICU Management

Maternity App Flyer

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

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.

Transitional Care

Transitional Care

Palliative Care

Palliative Care

Virtual Physical Therapy

Virtual Physical Therapy

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.

Go to: SWORD & BLOOM portal

BLOOM

BLOOM

THRIVE-SWORD

THRIVE-SWORD

Digital and Telephonic Health Coaching

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

Go to: LARK portal

Diabetes Prevention

Diabetes Prevention

Diabetes Management

Diabetes Management

Hypertension Management

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

U.S. Preventive Services

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.

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.

Prescription Summary

ImpaxRX

ImpaxRX

About ImpaxRX

About 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.

Go to: ImpaxRX

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.

NETWORK: DentalGuard Preferred

PREVENTION FIRST!

Your dental health is an important part of your overall health. Make sure you take advantage of your preventive dental visits.

Preventive care services are covered at 100% if you visit an In-Network provider. They are also not subject to the annual deductible.





Go to: Find a Network Dentist

Dental Summary

Dental Benefits Coverage

Dental Benefits Coverage

Vision

Lake Metropolitan Housing Authority 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.

NETWORK: Avesis Network

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

Find a Vision provider

Vision Benefit Summary

Vision Benefits Coverage

Vision Benefits Coverage

Basic Life

Life insurance is an important part of your financial security. Life insurance helps protect your family from financial risk and sudden loss of income in the event of your death. Accidental Death & Dismemberment (AD&D) insurance is equal to your Life benefit in the event of your death being a result of an accident and may also pay benefits for certain injuries sustained.

Basic - Employer Paid $15,000 Benefit through Guardian

A sudden accident or death can leave you or your loved ones in a vulnerable position. Lake Metro Housing Authority provides a $15,000 Basic Life and AD&D benefit to all full-time employees.

**Please see attached Guardian Enrollment Kit for more plan details and exclusions**

Life/AD&D Coverage

Life/AD&D Coverage

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Life/AD&D

Life/AD&D

Beneficiary Designation

Beneficiary Designation

Who's Your Beneficiary?

Naming a beneficiary is a crucial part of electing life insurance. Also, don't forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.

Primary Beneficiary: Your primary beneficiary receives your benefits in the event of your death.

Contingent Beneficiary: Your contingent beneficiary receives your benefit, in the event that your primary beneficiary cannot.

*Please make sure your beneficiary information is up to date with your HR office*

Short Term Disability

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 $1,000.
• Benefits begin on the 8th day of an accident, and the 8th day of a sickness.
• Duration of benefits: 12 weeks

Premiums for this coverage is 100% employer paid.

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Understanding Short Term Disability

Understanding Short Term Disability

STD Coverage

STD Coverage

Pet Insurance

Lake MHA 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.

Go to: Nationwide

Enrollment Kit

Enrollment Kit

First Stop Health

First Stop Health and the Virtual Primary Care feature will continue to be offered in 2026.

Members have access to convenient and affordable high-quality primary care with First Stop Health's nationwide network of doctors. Using the app, website or phone call you have access to:

• 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.

Go to: First Stop Health

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

Go to: AllOne Health

AllOne Health Member Portal Flyer

AllOne Health Member Portal Flyer

Contact Information

Diana Dilisio: ddilisio@lakemetrohousing.org. 440-354-3347 (x33)

Medical Mutual

Customer Service: 1-844-583-3072

Website: www.medmutual.com

CVS/RxBenefits

Customer Service: Call the Customer Care number on your ID card. If you do not have an ID card, call 1-800-552-8159

Website: www.caremark.com

Guardian

Customer Service: 1-888-482-7342

Website: www.guardianlife.com

Symetra

Customer Service: 1-800-796-3872

Website: www.symetra.com

First Stop Health

Customer Service: 888-691-7867

Website: www.fshealth.com

AllOneHealth

Customer Service: 800-521-3273

Website: www.ease.mylifeexpert.com

ImpaxRx

Customer Service: 844-467-2979 option 1

Website: www.impaxRX.com

Client Contacts

DD

Diana Dilisio

ddilisio@lakemetrohousing.org

(440) 354-3347

Compliance

2026 Annual Notices

2026 Annual Notices

2025 Medicare Part D

2025 Medicare Part D

Marketplace Exchange Notice

Marketplace Exchange Notice