2025 Benefits Overview

NEW! Pet Insurance through Nationwide

Medical: Medical Mutual

Prescription: CVS Caremark/RXBenefits

Specialty Prescription Assistance: ImpaxRX

Vision: Guardian

Dental: Guardian

Basic and Voluntary Life: Guardian

Telemedicine: First Stop Health

Employee Assistance Program: Ease@work

Eligibility

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?

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

New Hire: Benefits are effective first of the month, following 30 days.

Qualifying Life Event: Benefits are updated effective date of event.

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 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 Madison Library'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: November 18

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.

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)

**Please note your Vision, Dental, Life and Voluntary Life benefits are not elected on BenXpress. Please contact Shawna Goostree to make or change these elections for January 1, 2025.**

Go to: BenXpress

NEW! Pet Insurance

Madison Library 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.

Go to: Nationwide

Enrollment Kit

Enrollment Kit

Madison Library offers 2 medical plan options through Medical Mutual.

1. Medical Mutual EPO Plan: Effective 1/1/23 the EPO plan uses the Meical Mutual Medflex Network.
2. Lake Blue Plan: This is a 3 Ties Plan that utilizes the MMO SuperMed Plus Network

Reminder:

• Your Medical Mutual plan covers 1 annual vision exam. You must present your MMO ID card for this visit.
• All UH Facilities and Providers are Tier 1 on the Lake Blue Plan effective January 1, 2024.
• Hearing Aid benefits have been added to both medical plans effective January 1, 2024.

Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept MMOs 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.

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.

Go to: Find a MedFlex Provider

EPO Plan

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 System in Lake County. 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)

Reminder:

• All UH Facilities and Providers are Tier 1 on the Lake Blue Plan effective January 1, 2024.

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

Medical Mutual Total Health

Madison Library 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 Management

Maternity Management

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

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 Madison Library Health Plan.

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.

Digital and Telephonic Health Coaching

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

Lark Diabetes Prevention

Lark Diabetes Prevention

Lark Diabetes Management

Lark Diabetes Management

Lark Hypertension Management

Lark 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 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

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.

SPECIALTY DRUGS

TIER 4  | Lowest Specialty Drug copay: Tier 4 specialty drugs are generally more effective and less expensive than nonpreferred specialty drugs in tier 5.

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

EPO 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.

Go to: ImpaxRX

Vision

Madison Library offers vision coverage through Guardian to help pay for eye exams and materials. This is a voluntary, employee paid benefit.

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

Go to: Find a Vision Provider

Vision Plan Summary

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.

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 Dentist

Dental Summary

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 through Guardian - Flat $10,000 amount

A sudden accident or death can leave you or your loved ones in a vulnerable position. Madison Library provides Basic Life and AD&D benefit to employees working 20 hours or more per week.

• Benefit Reduction Schedule: Your Life Benefit will be reduced by a certain percentage as you age.
  • 35% at age 65
  • 50% at age70
  • 60% at age 75
  • 75% at age 80

Voluntary - Employee Paid Benefit through Guardian

Coverage is also available for your spouse and/or child dependents, but only after you've elected coverage for yourself. A sudden accident or death can leave you or your loved ones in a vulnerable position. Employees have the opportunity to enroll in Term Life and Accidental Death & Dismemberment insurance which will supplement lost income in the event of an accident or death. If you choose to enroll in employee coverage, this will be in addition to your employer provided Basic Life coverage. Review the attached full benefit summary below for details on reductions, portability and conversion options.

Employee: $10,000 increments up to $300,000

Spouse: $5,000 increments up to $150,000

Children: $2,000 increments up to $10,000

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

Guardian Enrollment Kit

Guardian Enrollment Kit



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.

Go to: First Stop Health

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First Stop Health Telemedicine

First Stop Health Telemedicine

EASE@Work

EASE@WORK Member Portal Flyer

EASE@WORK Member Portal Flyer

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



Go to: EASE@WORK

Employee Contributions

Monthly employee contributions below.

Medical Employee Contributions

Dental Contributions

Vision Rates

Contact Information

Shawna Goostree: shawna.goostree@madison-library.info, 440-428-2189 ext 5203

Medical Mutual

Customer Service: 1-844-583-3072

Website: www.medmutual.com

RX Benefits

Customer Service: 800-334-8134

Email: customercare@rxbenefits.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

Compliance