Lake Metropolitan Housing Authority

Table of Content

  1. Header
  2. Overview of Health Benefits
    1. Your Lake Metropolitan Housing Authority Employee Benefits
    2. 2024 Benefits Overview
    3. Eligibility & Qualifying Events
    4. Eligibility & Qualifying Events
    5. How to Enroll
    6. BenXpress
    7. Medical
    8. EPO Plan
    9. Lake Blue Plan
    10. MedMutual My Health Plan/Mobile App
    11. Preventive Care
    12. Prescriptions
    13. ImpaxRX
    14. Guardian
    15. Dental
    16. Vision
    17. Basic Life
    18. Beneficiary Designation
    19. First Stop Health
    20. FSH
    21. Ease@Work
    22. EASE@Work
    23. Employee Contributions
    24. Contact Information
  3. Footer

Your Lake Metropolitan Housing Authority Employee Benefits

To Our Employees: 


We have made a conscious decision to offer you benefits because we care about you and your families, and we want to do everything we can to make sure you are taken care of. 


Once again this year, we conducted a thorough review of options available to us and we think we’ve come up with the best possible package. But the process doesn’t stop here—we need you to take an active role in understanding and selecting your benefit options. 


To help you gain that strong understanding, please read this kit carefully and consult with our partners at LMHA with any questions. 


Thank you for all that you do for us!


2024 Benefits Overview

Medical: Medical Mutual

  • 2024 updates!
  • Your basic vision exam will be covered under your Medical Mutual plan.
  • All UH Facilities and Providers will be added to Tier 1 on the Lake Blue Plan effective January 1, 2024.
  • Hearing Aid benefits have been added the medical plan effective January 1, 2024.


Prescription: CVS Caremark

  • All members will be receiving new prescription ID cards for 2024.


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

OE

Action Required!

All elections must be submitted by:<____>


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).

Medical Mutual of Ohio - Login


The 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.


2024 updates!

  • Your basic vision exam will be covered under your Medical Mutual plan.
  • All UH Facilities and Providers will be 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"


Preventive Care

All health plans recognize routine preventive services at 100%, no coinsurance, no deductible if the claim is submitted as routine or preventive abd the services performed falls 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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cvs-caremark-logo | RxBenefits


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.

Lake Blue RX 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

The City of Kirtland 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 Summary of Benefits 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*

Ask A Doctor Online | Telemedicine Companies | First Stop Health




First Stop Health and the Virtual Primary Care feature will continue to be offered in 2024.


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.


fsh

Employee Assistance Programs | ERC

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




Employee Contributions

Medical Employee Contributions

Dental Employee Contributions

Vision Employee Contributions

Contact Information

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



Medical Mutual

Customer Service: 1-844-583-3072

Website: www.medmutual.com


CVS Caremark

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

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