Mount Carmel Health System
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Medical | Dental
| Vision
Life Insurance | Long Term
Disability
Flexible Spending | Legal
Dependent child definition:
Your dependent child may be eligible to be on your health
coverage through the end of the year they turn 26. Please
click
here for more information.
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 you must submit dependent verification
information to Human Resources within 30 days of your
new hire or status change date. 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. Click here
for a listing of required documents.
Social Security Numbers Required When Adding Dependents
To remain compliant with federal regulations, all associates
must provide Social Security numbers for any dependent age
one year and over enrolled in any health or welfare plan offered
by Trinity Health. This mandate is outlined in the Medicare,
Medicaid and State Children's Health Insurance Program Extension
Act of 2007. Social Security numbers are used to coordinate
Medicare payments with other insurance and workers' compensation
benefits. For more information on the collection
of Social Security Numbers for dependents, click
here.
Medical
Medical Plans
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
Standard Option - Summary of Coverage | EPO
High Option - Summary of Coverage
EPO Summary
Plan Description
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 two vision benefits through
United Healthcare(UHC) Vision.
UHC
High Vision Summary
UHC
Standard Vision Summary
UHC
Vision Benefit Booklet
UHC High Vision
SPD
UHC Standard
Vision SPD
Life Insurance
Full-time and Part-time associates 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
Life
Insurance Enrollment Brochure
Guaranty
Association Notices (To be delivered to residents of the
applicable states) – Certain state guaranty association
laws require that a notice be provided to their residents.
The notice explains the protections, subject to limitations
and exclusions, available to residents in the event that the
insurer becomes financially impaired or insolvent. If the
client covers residents in any of the following states, the
client must provide the applicable state notice when distributing
certificates: Alaska, Arkansas, California, Colorado, District
of Columbia, Hawaii, Illinois, Indiana, Kansas, Louisiana,
Maryland, Minnesota, Missouri, Mississippi, Montana, North
Carolina, North Dakota, New Hampshire, New Jersey, Nevada,
Ohio, Oklahoma, Rhode Island, South Dakota, Tennessee, Texas,
Utah, Washington, West Virginia, and Wyoming.
Will Preparation Information - If you elect supplemental
life insurance you qualify for free will preparation through
Prudential.
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.
Medical
Group - Long Term Disability Certificate
Health
Partners - 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.
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 2012 calendar year will be eligible for reimbursement
on services incurred from January 1, 2012 through March 15,
2013. 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 2012 elections.
Dependent Care Spending:
You may contribute pre-tax dollars in any amount between $130
and $5,000 annually.
Direct Deposit:
You can elect to have your reimbursements automatically deposited
into your checking or savings account by signing up for direct
deposit. This can be done by going on www.wageworks.com or
by calling WageWorks customer service at 1-877-WageWorks (1-877-924-3967).
Health Care Debit Card:
Associates enrolled the HCSA will receive a debit card that
can be used for many health care purchases including prescription
co-pays, dental and vision expenses.
Wageworks.com:
HCSA/DCSA participants can track HCSA/DCSA account statuses
through www.wageworks.com. This is available 24 hours a day,
7 days a week. With wageworks.com, you can check the status
of your HCSA/DCSA, review your HCSA/A balance, sign up for
Direct Deposit, print claim forms, and much more. Once you
enroll in an HCSA/DCSA, you can register to use www.wageworks.com.
Additional Flexible
Spending Account Information
Healthcare
Spending Account Claim Form
Dependent
Spending Account Claim Form
Flexible Spending Accounts Summary Plan Description-Coming
Soon!
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
Identity Theft Protection
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