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Saint Mary's Health Care, Grand Rapids

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Medical Dental | Vision | Life Insurance | Short Term Disability
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 covering any family members, you must submit dependent verification information to Organization and Talent Effectiveness within 31 days. If you do not submit the required paperwork by the deadline, your dependents will not be enrolled in coverage and you will be required to wait until the next annual enrollment period to enroll dependents in the plan.

Required Documents

Medical

You have the choice of three medical plans:

Personal Care Account (PCA) PPO: a high deductible (PPO) plan using Blue Cross and Blue Shield Community Blue Network, with a personal care account funded by Trinity Health. The Personal Care Account (which is funded by Trinity Health) is used to fund a portion of the deductible. Once the PCA is exhausted, the remaining amount of the deductible must be met before the regular co-insurances and co-pays apply. Preventative services are 100% covered. Unused PCA funds may be carried over from year to year. Flexibility to see any physician, in or out of network.

Traditional PPO: a Preferred Provider Organization (PPO) plan using Blue Cross and Blue Shield Community Blue Network. Deductibles and co-insurances apply. Flexibility to see any physician, in or out of network.

Blue Care Network HMO: A Health Maintenance Organization (HMO) offered through Blue Care Network where a primary care physician coordinates your care within the HMO. Low out of pocket costs, no out of network benefits. No annual deductibles. Co-insurance for inpatient or outpatient surgery applies.

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> Looking for a Saint Mary's Health Care Doctor? Visit the Saint Mary's Health Care website and search our Find a Physician directory!

Medical Comparison

PCA PPO Summary Plan Description - coming 2008
Traditional PPO High Option Summary Plan Description - coming 2008
BCN HMO Summary Plan Description

PCA PPO Summary
Traditional PPO High High Option Summary
BCN HMO Summary

PCA PPO Blue Cross Blue Shield MI Handbook
Traditional PPO Blue Cross Blue Shield MI Handbook

PCA PPO and Traditional PPO Preventive Care Overview

Dental

You have a choice of two dental plan options - Delta Dental Premier Standard option and Delta Dental Premier High option.

Dental Comparison
Delta Dental Premier Standard Option Summary
Delta Dental Premier High Option Summary
Delta Dental Premier Certificate

Vision

You have the option of electing vision coverage through Spectera Vision.

Spectera Vision Summary
Spectera Vision Summary Plan Description

Life Insurance

Full-time and Part-time associates have Basic Life coverage provided at 1x Annual Salary.

In addition, you have the option to purchase additional coverage for yourself and your dependents in the increments provided below.

Please Note: Some elections may require a Statement of Health. It is your responsibility to complete and return your Statement of Health form.

Life Insurance Certificate
Statement of Health Form
Beneficiary Designation Form

Short Term Disability

Saint Mary's Health Care provides full-time associates(budgeted 72 hours or more per pay period) with STD coverage at 60% of your base pay. This income replacement benefit begins after you have exhausted your 40 hour elimination period.

Short Term Disability Certificate

Long Term Disability

Saint Mary's Health care provides full and part-time associates (budgeted 40 hours or more per pay period) with LTD coverage at 60% of your base pay (not to exceed a monthly benefit of $10,000). This income replacement benefit begins on the 181st day of disability.

To provide choice and flexibility, there are two additional coverage levels from which you may choose. You have the option to "buy-up" your LTD coverage to 66 2/3% of base pay, or "buy-down" your LTD coverage to 50% of base pay.

If you currently have a 50% benefit and elect up to a 66 2/3% benefit, you must complete a Unum Evidence of Insurability Form.

Long Term Disability Certificate
Evidence of Insurability Form

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. Contributions made to the DCSA during the 2008 calendar year will be eligible for reimbursement on services incurred from January 1, 2008 through December 31, 2008. The claim submission deadline is March 31, 2009.

Click here for additional information regarding HCSAs and DCSAs.

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
Direct Deposit Authorization Form
Flexible Spending Accounts Summary Plan Description

Legal

You have the choice of electing legal coverage through Hyatt Legal.

Hyatt Legal Brochure
Hyat Legal Brochure - Spanish Version
Hyatt Legal Summary Plan Description

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My Discounts

In addition to the Trinity Health system-wide discounts, Saint Mary's Health Care associates are eligible to receive various local discounts as described in the attached document.

Saint Mary's Health Care Discounts