Saint Mary's Health Care, Grand Rapids
NOTE: Acrobat
Reader is required to view Plan Summaries. Click to download
for free.
> My
Health & Welfare | >
My Discounts
PTO Cash-out | Medical
Discount | Medical | Dental
| Vision
Life Insurance | Short
Term Disability | Long Term Disability
Flexible Spending | Legal
New overage dependent child definition for 2010:
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 during annual enrollment, you must submit
dependent verification information to Human Resources November
18, 2009. 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
2010
Open Enrollment Booklet and Plan Highlights
PTO Cash-out
Non-exempt (hourly) associates can cash out between 1 and
80 hours, provided you maintain a minimum PTO bank of one
hour. You willl receive your payout with the paycheck that
coincides with November 1, 2010, which is the pay check dated
November 19, 2010. Your PTO cash-out election for 2010 may
only be made during open enrollment to avoid taxation on the
value of your PTO bank, including the hours that you do not
intend to cash out. Your election is irrevocable and cannot
be changed. You may only cash out hours that you will accrue
during the calendar year in which you plan to receive payment.
Consequently, you may not cash out PTO hours carried over
from previous years. For example, Jane has a PTO balance of
100 hours as of December 31, 2009. During open enrollment,
she elects to cash out 40 hours in 2010. Jane cannot cash
out any of the 100 hours she earned in 2009 or earlier. She
must plan her 2010 cash-out amount on only the hours she will
accrue in 2010.
REMINDER: You may cash-out PTO if you are
a non-exempt (hourly) associate. If you want to cash out PTO
in 2010, you must make a new PTO cash-out election. Your prior
year election will NOT carry forward.
Medical Discount
Our Mission as Trinity Health calls us to treat the entire
well-being of those in our care – and that includes
our associates. In order to increase access to health care
and treatment for all of our associates, Trinity Health has
developed a medical plan discount program. This program makes
medical benefits more affordable for eligible associates enrolled
in a Trinity Health medical benefit plan. The program does
this by reducing the eligible associates’s medical plan
contribution. For more information, please refer to the brochure
below.
Medical
Discount Brochure
Medical
You have the choice of two medical plans - Personal Care
Account (PCA) PPO and Healthy Blue Solutions Plan B PPO.
Find a Blue
Cross Blue Shield MI Participating Provider
Use the plan comparison tools to Estimate
My Plan Costs
PCA
PPO and Heathy Blue Solutions Plan B PPO Preventive Care Overview
Personal Care Account (PCA) PPO
Is 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 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.
PCA PPO Summary
PCA PPO Summary Plan Description
Healthy Blue Solutions PPO
Healthy Blue Solutions Plan B rewards your decision to
actively adopt a healthier lifestyle by reducing your copayments
and deductibles. It combines quality PPO health care benefits
with effective wellness and care management features. You
will automatically enjoy the plan’s enhanced benefit
level.
Healthy
Blue Solutions Enhanced PPO Summary | Healthy
Blue Solutions Standard PPO Summary
Complete Health
Appraisal
Healthy
Blue Solutions Member Guide
Healthy Blue Solutions PPO SPD
Prescription
Drug Changes Effective 11/01/2009
Fill your prescription at Saint Mary's Health Care
pharmacies for an additional 20% discount. Ninety day prescriptions
can also be filled at Saint Mary's Pharmacies.
If you take prescription medication on an ongoing basis, your
prescription drug plan may allow you, for chronic conditions,
to order prescriptions from Medco By Mail. Please visit Medco
Health - Rx for more information.
Medco By Mail Claim Form
Medco Fax Cover Sheet
> Looking for a
Saint Mary's Health Care Doctor? Visit the Saint Mary's
Health Care website and search our Find
a Physician directory!
Dental
You have a choice of two dental plan options - Delta Dental
Premier Standard option and Delta Dental Premier High option.
Delta Dental Premier
Standard Option Summary
Delta Dental Premier High
Option Summary
Delta Dental 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 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.
| 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. It is your responsibility to complete and return
your Statement of Health form.
Life Insurance Certificate
Life
Insurance EOI and Maximum Amendments
Statement of Health 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 2010 calendar year will be eligible
for reimbursement on services incurred from January 1, 2010
through March 15, 2011. 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 2010 elections. The claim submission
deadline is March 31, 2011.
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
2010 calendar year will be eligible for reimbursement on services
incurred from January 1, 2010 through December 31, 2010. The
claim submission deadline is March 31, 2011.
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/DCSA participants can track
HCSA and DCSA 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 or DCSA, review your HCSA or DCSA
balance, sign up for Direct Deposit, print claim forms, and
much more. Once you enroll in an HCSA or DCSA,, 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
My Discounts
In addition to the Trinity Health system-wide discounts,
Saint Mary's Health Care associates are eligible to receive
various local discounts. For a listing, please go to the Saint
Mary's Intranet in the Organization & Talent Effectiveness
Folder.
|