Lake Metropolitan Housing Authority

Table of Content

  1. Header
  2. LMHA
    1. 2025 Benefits Overview
    2. Eligibility & Qualifying Events
    3. Eligibility & Qualifying Events
    4. How to Enroll
    5. BenXpress
    6. Medical
    7. EPO Plan
    8. Lake Blue Plan
    9. MedMutual My Health Plan/Mobile App
    10. NEW! Medical Mutual Total Health
    11. 24/7 Nurse Line and Care Navigation
    12. Maternity Management and NICU Management
    13. Transitional Care and Palliative Care
    14. Virtual Physical Therapy
    15. Digital and Telephonic Health Coaching
    16. Preventive Care
    17. Prescriptions
    18. ImpaxRX
    19. Guardian
    20. Dental
    21. Vision
    22. Basic Life
    23. Beneficiary Designation
    24. Short Term Disability
    25. NEW! Pet Insurance
    26. NEW! Accident Protection and Critical Illness
    27. First Stop Health
    28. First Stop Health
    29. Ease@Work
    30. EASE@Work
    31. Employee Contributions
    32. Contact Information
    33. Compliance
  3. Footer

2025 Benefits Overview

NEW! Pet Insurance through Nationwide

NEW! Accident and Critical Illness through AFLAC

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: Ease@work

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?

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

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Action Required!

All elections must be submitted by 11/18

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 2023 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)

Medical Mutual of Ohio - Login

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.
  • All UH Facilities and Providers have been added to Tier 1 on the Lake Blue Plan effective January 1, 2024.
  • Hearing Aid benefits have been added to the medical plan effective January 1, 2024.

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)

Lake Blue Plan

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"

NEW! 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

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 App Flyer

Maternity App Flyer

Maternity Management


Medical Mutual provides digital resources to help members prepare for babys arival through age 2. During pregnancy members receive weekly updates and have access to tools to look up symptoms and issues.


Once baby arrives members can track feeding, diaper changes, and milestones through age 2.


You can find the app by searching MedMutual Maternity.


There is no cost associated with the app or its tools for members enrolled on the health plan.



NICU Management with Progeny Health


Medical Mutual has partnered with Progeny Health to increase the level of NICU support. Progeny will reach out to members who may need this support to offer care management to babies and their families through the baby's first birthday.

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

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

Digital and Telephonic Health Coaching

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

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
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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

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.

Guardian_Insurance_logo - Wireless Warehouse

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.







Dental Summary

LMHA

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
Vision Benefit Summary

Basic Life

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 - 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**

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

Lake MHA offers Short Term Disability on a voluntary basis. Premiums for this coverage is 100% employee paid.

Understanding Short Term Disability

Understanding Short Term Disability

NEW! Pet Insurance

Lake MHA now 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.

Enrollment Kit

Enrollment Kit

NEW! Accident Protection and Critical Illness

Lake MHA now offers Accident and Critical Illness coverage through Aflac.

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

Critical Illness: A serious illness can affect you physically and emotionally - what's not so obvious is the effect on your personal finances. Major medical plans may pay for a good portion of the cost associated with a critical illness, however there are a lot of expenses that may not be covered. With critical illness coverage you receive a cash benefit directly, giving you the flexibility to help pay for bills for treatment or everyday expenses.

Please see attached benefit summaries for a full list of covered accidents and illness.

**These coverages are elected in BenXpress**

Accident Summary

Accident Summary

Critical Illness Summary

Critical Illness Summary

First Stop Health

First Stop Health and the Virtual Primary Care feature will continue to be offered in 2025.

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.
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Ease@Work

Ease@Work 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: easeatwork.com & select Member Portal & App

Portal Code: lakecounty



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

First Stop Health

Customer Service: 888-691-7867

Website: www.fshealth.com

Ease@Work

Customer Service: 800-521-3273

Website: www.easeatwork.com

ImpaxRX

Customer Service: 844-467-2979 option 1

Website: www.impaxRX.com

contact

Compliance

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