You’re eligible for medical coverage if you’re a regularly scheduled full- or part-time colleague with 48 or more budgeted hours per pay period, and have satisfied the required waiting period.
2014 New Medical Plan Overview Video*
New for 2014!
Trinity Health and Saint Alphonsus Regional Medical Center are proud to offer you all new medical plan choices for 2014. Offering these three plan design structures supports our efforts to provide a common experience for all colleagues and to leverage the size of our System. All three plans are administered by Aetna and support our new clinically-integrated network structure. You have a choice between three all new medical plan options to protect you and your family from illness and injury: the Traditional PPO, the Health Savings PPO, and the Essential PPO. All three plans are preferred-provider organizations (PPO), which means you can receive care from any health care provider, but the amount you pay out of pocket will decrease when you receive care from network providers. Additionally, as part of the new medical plan designs for 2014, you will now share in the cost of services when you utilize Trinity Health facilities and Saint Alphonsus Health Alliance providers. Keep in mind, even with the new cost-sharing structure, you will still pay less when you use Trinity Health facilities and Saint Alphonsus Health Alliance providers.
- Tier 1, or the Saint Alphonsus Health Alliance network providers are facilities or physicians aligned with our organization that provide you with the most cost-effective care.
- Tier 2 includes select Aetna Providers not listed under Tier 1. Using Tier 2 providers can save you money, but not as much as using our Tier 1 network.
- Tier 3 providers are out-of-network providers and this Tier provides the lowest level of benefits. You can use these facilities and physicians for care, but you will pay the most out of your pocket when you do.
Locating a provider
Tier 1 (The Alliance) participating provider or a Tier 2 (In-Network) select Aetna participating provider.
Here’s how all of the Plans work:
- First. You pay the full cost of medical expenses until you reach the annual deductible (except when you receive preventive care services and fill preventive 90-day generic prescriptions).
- Second. Once you meet the deductible, you pay coinsurance. You pay 10% coinsurance for Tier 1 expenses until you reach the out-of-pocket maximum.
- Third. Once you reach the out-of-pocket maximum, Trinity Health and Saint Alphonsus Regional Medical Center pay 100% of all remaining eligible expenses during the year.
Use the plan comparison tool to estimate my plan costs*
*Plan comparison tool is based on use of Tier 1 providers
If you elect coverage under the Traditional PPO, you pay for a portion of the medical services you receive until you meet the annual deductible. Then, coinsurance begins up to the annual out-of-pocket maximum.
Traditional PPO Summary | Traditional PPO Summary of Benefits and Coverage
Traditional PPO SPD*Coming Soon
Rx Preventive Services List
Health Savings PPO
The Health Savings PPO gives you control and responsibility over how you pay for health care services. You pay much less per pay period for coverage than the Traditional PPO, leaving more money in your paycheck. In addition, the Health Savings PPO option features a Health Savings Account (HSA) to help pay for current and future medical expenses.
To log into your HSA account click here
For the Health Equity Member Education Site click here
HSA Reimbursement Form click here
HSA Contribution Change Form click here
Health Savings PPO Summary | Health Savings PPO Summary of Benefits and Coverage
Health Savings PPO SPD *Coming Soon
Preventive Therapy Generic Drug List (Health Savings PPO Only)
Rx Preventive Services List
If you enroll in the Health Savings PPO, you will automatically have an HSA. Trinity Health and Saint Alphonsus Regional Medical Center contribute to your HSA to help you pay for expenses toward your annual deductible and out-of-pocket maximum. You can also contribute to this account to build savings for current and future medical expenses.
Keep in mind...
In order to be eligible for the HSA, you must enroll in the Health Savings PPO. In addition, you cannot have coverage under any other medical plan, such as Medicare, TRICARE, or coverage through a spouse’s health plan.
The Health Savings PPO is called a consumer-driven health plan. The Health Savings PPO gives you the opportunity to participate in a plan where your health care costs are more closely determined by your decisions. Keep the following features of the Health Savings PPO in mind as you are considering which medical option to choose for your 2014 benefits:
- The Health Savings PPO lets you pay for medical services when you use medical care, instead of paying higher premium contributions throughout the year.
- The Health Savings PPO plan includes a combined deductible. This means, if one covered family member’s costs for health care services is more than the individual deductible amount, it will count toward meeting the family deductible.
- The Health Savings PPO offers a Health Savings Account (HSA) that allows you to save for and manage health care expenses.
- Trinity Health and Saint Alphonsus Regional Medical Center will automatically make the full contribution to your Health Savings Account (HSA) based on your elected coverage level on Jan. 1, 2014. The amount Trinity Health and Saint Alphonsus Regional Medical Center contribute to your HSA covers up to half of your annual deductible amount when you use Tier 1 health care providers.
- The Health Savings PPO plan includes 100% coverage for generic, preventive drugs – and you don’t have to meet your deductible first. For a complete list of 100% covered generic, preventive drugs under the Health Savings PPO, visit MyBenefits.
How the Health Savings Account (HSA) Works
When you enroll in the Health Savings PPO plan, you automatically have a Health Savings Account (HSA) through Health Equity to help you pay for current or future health care costs. Trinity Health and Saint Alphonsus Regional Medical Center make contributions to your account based on the coverage level you elect. In addition, you can also contribute to this account up to IRS limits:
Total IRS Allowed HSA Contributions*
All other coverage levels
*If you are 55 or older, you can contribute an additional $1,000 in catch-up contributions to your HSA.
Here are some additional highlights of the HSA:
- You may use the HSA to pay for qualified medical expenses now and during retirement for you and your qualified dependents.
- With the HSA you do not pay taxes on the amount you contribute, the amount you withdraw for medical expenses, and the interest you earn in the account (up to amounts set by federal law).
- You can change the amount you contribute to your HSA at any time during the plan year.
- When you receive health care eligible health care services, you can pay for those services with your HSA debit card, or through several online and smartphone app options. You’ll receive more information about your payment options if you enroll in the Health Savings PPO with the HSA.
- Any money you do not use during the year is carried over, without any limits.
- You own the money in your HSA and it is yours to keep – even when you change jobs or retire.
- Because the HSA pays for eligible health care expenses, when you enroll in the Health Savings PPO, you will not have access to the health care spending account (HCSA). The HSA works just like the HCSA to help pay for eligible medical, dental, and vision expenses, plus, it includes additional benefits such as:
- The opportunity to carry over savings from year to year. In other words, you do not forfeit any amount in your HSA at the end of the plan year;
- You may contribute up to $6,550 in tax-free HSA dollars each year (the HCSA maximum is $2,500);
- Your HSA dollars are saved in a bank account that may earn interest.
How do I know if the Health Savings PPO, including an HSA is right for me?
- Your medical plan choice depends on your personal situation. Here are some questions to ask yourself to determine if the Health Savings PPO plan is right for you:
- Would you like to have lower per pay period contributions deducted from your paycheck?
- Do you want to save on taxes by contributing to the HSA for your health care costs?
- Do you need a way to pay for future health care costs?
- Can you see your HSA balance growing as you keep making contributions each year?
If you answered “yes” to some of these questions, the Health Savings PPO withthe HSA may be right for you.
The Essential PPO works the same as the Traditional PPO where you pay a portion of the medical services you receive until you meet the annual deductible. Then, coinsurance begins. If you elect the Essential PPO, you pay less in premium contributions than in the Traditional PPO, however, your out-of-pocket cost are higher.
Essential PPO Summary | Essential PPO Summary of Benefits and Coverage
Essential PPO SPD*Coming Soon
Rx Preventive Services List
Assistance with your health care costs
If you qualify as a low-income individual, you may be eligible for the Essential PPO Assist plan. It is the same as the Essential PPO, but includes a Trinity Health and Saint Alphonsus Regional Medical Center-funded Health Reimbursement Account (HRA), to help you pay for your health care costs at the time of service. You do not make contributions to the HRA under the Essential PPO Assist plan. To participate in the Essential PPO Assist, you must apply for and meet specific income and eligibility guidelines. You can apply for the Essential PPO Assist by completing an application form and submitting it with a copy of your most recent Federal Income Tax Form 1040 or 1040EZ to Human Resources by Nov. 20, 2013. NOTE: Even if you think you qualify for the Essential PPO Assist, you should elect the medical plan you think will be best for you and your family, which could be the Traditional PPO, the Health Savings PPO, or the Essential PPO. If you qualify for the Essential PPO Assist plan, you will be moved from the plan you elect during open enrollment to the Essential PPO Assist plan. Otherwise, you will remain in the plan you elected during open enrollment.
Essential PPO Assist application form
Essential PPO Assist Summary
* Please note: colleagues who are logged onto the Trinity Health network remotely through Network Connect will not be able to view this video or access social media. Please utilize the Windows Secure Manager setting or view from your home network or another secure Internet connection.