Mount Carmel Health System
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Medical | Dental
| Vision | Life Insurance
| Long Term Disability
Flexible Spending | Legal
Planning to add dependents?
In order for new family members to be eligible for coverage
under any Trinity Health benefit plan, you are required to
provide proof of their dependent status. If you are planning
to add family members during annual enrollment, you must submit
dependent verification information to Human Resources within
31 days. If you do not submit the required paperwork by
the deadline, your newly added dependents will not be enrolled
in coverage and you will be required to wait until the next
annual enrollment period to enroll new dependents in the plan.
Required Documents
Medical
You have a choice of two medical plans - EPO Standard Option
and EPO High Option.
Find a Mt.
Carmel Participating Provider
Use the plan comparison tool to Estimate
My Plan Costs.
EPO Summary
Plan Description
EPO Standard Option
- Summary of Coverage
EPO High Option -
Summary of Coverage
Preventive
Care Overview
Dental
You have the choice of two dental plan options - Premier
High plan and Premier Standard plan.
Premier High Summary
- Group Number - 9557-9100
Premier Standard Summary
- Group Number - 9557-9101
Delta Premier Certificate
Vision
You have the option of electing vision coverage through Spectera
Vision. If you do not enroll you will be defaulted to your
current election.
Spectera Vision Summary
Spectera Vision SPD
Life Insurance
Full-time employees have Basic Life Insurance provided at
1x annual salary (employer-paid).
In addition, you have the option to purchase additional coverage
for yourself and your dependents in the following increments:
| For
Yourself |
For
Your Spouse |
For
Your Child(ren) |
1x annual salary
2x annual salary
3x annual salary
4x annual salary
5x annual salary
|
$10,000
$20,000
$50,000
$100,000 |
$2,000
$5,000
$10,000
$20,000 |
Please Note: some elections may require a Statement of
Health.
Life Insurance Certificate
Statement of Health Form
Beneficiary Designation
Form
Long Term Disability
Full-time associates are provided Long Term Disability coverage
at 60% base annual salary not to exceed a monthly benefit
of $15,000. This income replacement benefit begins after you
have completed your elimination period.
Long Term Disability
Certificate
Flexible Spending
A Flexible Spending Account (FSA) gives you a way to pay
for your out-of-pocket health care and / or dependent care
expenses with before-tax dollars.
Click here
to help estimate your health care and / or dependent care
expenses.
Health Care Spending - you may contribute pre-tax
dollars in any amount between $130 and $5,000 annually. Contributions
made to the HCSA during the 2008 calendar year will be eligible
for reimbursement on services incurred from January 1, 2008
through March 15, 2009. The claim submission deadline will
continue to be March 31st. This 2-½ month extension
is allowed under new IRS guidelines. Please consider this
extension when making your 2008 elections.
Over-the-counter Medications (OTC) - Certain
OTC items qualify as "medical care" and are eligible
for reimbursement through an HCSA. Examples of such items
include asprin, allergy and sinus medications, antacids and
more.
Dependent Care Spending - you may contribute pre-tax
dollars in any amount between $130 and
$5,000 annually.
Click here
for additional information regarding HCSAs and DCSAs.
Streamline Enrollment -If you participate in a medical
plan administered by Aetna, you may utilize the streamline
enrollment process for any out-of-pocket costs related to
your medical claims. Streamline enrollment allows you to receive
reimbursement from your Health Care Spending account without
submitting a paper claim. To initiate the streamline enrollment
process please complete and return the streamline
enrollment form to Aetna or sign up through Aenta Navigator.
Direct Deposit - You can elect to have your reimbursements
automatically depositied into your checking or savings account
by signing up for direct deposit. Simply complete a Direct
Deposit Authorization Form and submit your completed form
to Aetna.
Aetna Navigator - HCSA participants can track HCSA
account statuses through Aetna Navigator, Aetna's member self-service
website. Navigator is available 24 hours a day, 7 days a week.
Through Aetna Navigator, you can check the status of your
HCSA, review your HCSA balance, sign up for Direct Deposit,
print claim forms, and much more. Once you enroll in an HCSA,
you can register to use Aetna
Navigator.
Healthcare Spending
Account Claim Form
Dependent Spending
Account Claim Form
Over-The-Counter Drug Claim Form
Streamline Enrollment
Form
Direct Deposit Authorization
Form
Flexible Spending Accounts
Summary Plan Description
Legal
You have the choice of electing legal coverage through Hyatt
Legal for yourself and your family. If you do not enroll you
will be defaulted to your current election.
Hyatt Legal Brochure
Hyatt Legal SPD
My Voluntary Options | Enroll
Now or Call 1 (866) 251-9529
In addition to your group benefits, Trinity Health has partnered
with The Farmington Company to provide eligible employees
the opportunity to elect personal insurance plans from a portfolio
of products. Individual policy options include:
Short Term Disability
Universal Life Insurance
Long Term Care Insurance
Cancer Insurance
Critical Illness Insurance
Accidental Death and Dismemberment (AD&D)
Insurance
Auto/Home Insurance
Pet Insurance
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