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To Our Employees:
Our medical insurance renewal date is November 1st. The initial renewal with United Healthcare resulted in a very large increase. In order to maintain a good plan at a reasonable cost, we will be changing our plan to Medical Mutual of Ohio. MMO is accepted at Cleveland Clinic and University Hospitals as well as most other medical providers.
Thank you for all that you do for us!
Helping you and your family reach and maintain good health is very important to Mariana Enterprises. We are pleased to offer a selection of benefits designed with your health and financial wellbeing in mind. We review our benefit programs each year to ensure we consider the best combination of benefit coverage, network access and affordability for employees.
Please see HR for help in electing benefits or making any changes.
The benefit choice you make during your initial enrollment or annual open enrollment remain in effect for the entire year.
EMPLOYEE ELIGIBILITY
You are eligible to participate if you are full-time and work a minimum of 30 hours per week.
***Reminder:
You have up to 30 after your benefit effective date to make your elections. If you wait until the 31st day, you will need to wait until Open enrollment or a qualifying event.
DEPENDENT ELIGIBILITY
You may also enroll eligible dependents for benefits coverage. A ‘dependent’ is defined as the legal spouse and/or ‘dependent child(ren)’ of the plan participant or the spouse.
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
Ready to Enroll?
Creekside offers a medical plan option through Medical Mutual of Ohio.
This is a PPO option which 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.
Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept Medical Mutual of Ohio contract rate as the final charge and the member is not balanced billed.
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.
On a maintenance medication, you take each month?
Use home delivery from Express Scripts PharmacySM. Your Rx is delivered to your door about eight days after your Rx is received. Delivery is free!
The differences in prescription drug costs are summarized here:
WHEN CAN I USE A VIRTUAL VISIT?
When you have a non-emergency condition and:
*Your covered children may also use Virtual Visits when a parent or legal guardian is present for the visit.
Examples of Non-Emergency Conditions:
HOW DOES IT WORK?
HOW DO I GET ACCESS?
Learn more about Virtual Visits and access direct links by downloading the Medical Mutual app on your phone.
The resources below are provided by Creekside Restaurant to all eligible, full-time employees at no additional cost.
Click below for the MedMutual Member portal
Medical Mutual of Ohio | 1(866) 925-2542
Nurseline 1(888) 912-0636
As you consider your benefit options, please be sure to review all available information. If you don't understand your benefits or need any assistance, please contact Human Resources.
Matt Harper
mharper@creeksiderestaurant.com
440-546-0555
Shirley Harper
sharper@creeksiderestaurant.com
440-546-0555
David Leszcz
Producer / Sales Consultant
dave.leszcz@nfp.com
216-264-2725
Lyndsay Shones
Account Manager
lyndsay.shones@nfp.com
216-264-2707
Naomi Butze
Account Executive
naomi.butze@nfp.com
216-816-0026