St. Mary Mercy Hospital, Livonia
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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 within
31 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.
Required Documents
Medical
NEW!!!!
Effective July 1, 2010 Trinity Health and its Ministry
Organizations transitioned from Medco, our previous pharmacy
benefit manager (PBM), to CVS Caremark. This change
applied only to associates who are covered under a self-insured
medical plan (that is, Blue Cross Blue Shield of Michigan,
or Aetna). It does NOT apply to fully insured plans (Blue
Care Network (BCN), Priority Health HMO, etc.).
Visit www.caremark.com
for more information.
Medical Plans
You have a choice of three medical plan options - Priority
Health Healthby Choice HMO, Healthy Blue Solutions PPO, Personal
Care Account (PCA) PPO
Use the plan comparison tool to Estimate
My Plan Costs
Personal Care Account 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.
Personal
Care Account PPO SPD |
Personal Care Account PPO Summary
Preventive
Care Overview
Caremark
Summary of Material Modification - Effective 7/1/2010
Summary
of Material Modification - Transplants
Healthy Blue Solutions PPO
Healthy Blue Solutions 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. The Healthy Blue Solutions
plan offers two levels of benefits:
- Enhanced offers lower co-payments and deductibles to members
who adopt a healthy lifestyle.
- Standard has higher co-payments and deductibles for members
who choose not to participate in designated wellness and
disease management interventions.
You will automatically enjoy the plan’s enhanced benefit
level for the first 120 days of coverage if you and your spouse:
- Go online to bcbsm.com and complete a BlueHealthConnection®
health appraisal by 1/31/2010, and
- Based on your HA results, attend the first of four appointments
with a BCBSM health coach by 4/15/2010.
If you and your spouse do not commit to the above, you will
be dropped to the standard benefit level on your 121st day
of coverage.
Healthy
Blue Solutions Enhanced PPO Summary | Healthy
Blue Solutions Standard PPO Summary Complete
Health Appraisal
Healthy Blue
Solutions PPO SPD
Healthy
Blue Solutions Member Guide
Preventive
Care Overview
Caremark
Summary of Material Modification - Effective 7/1/2010
Summary
of Material Modification - Transplants
Find a BCBSM
Participating Provider.
HealthybyChoice HMO
Priority Health - HealthbyChoice HMO is a health plan combined
with a wellness program encouraging members to make healthier
choices. The HealthbyChoice plan has two levels of benefits:
- Choice offers lower co-payments and deductibles to participants
who adopt a healthy lifestyle.
- Standard has higher co-payments and deductibles for participants
who choose not to participate in designated wellness and
disease management interventions.
You automatically will enjoy the Choice benefit level of
for the first 90 days of coverage if you and your spouse:
- Complete a Health Risk Appraisal
- Meet with your primary care physician(s) to complete
a Qualification form, and
- Adopt a healthy lifestyle
If you and your spouse do not commit to the above within
your first 90 days of coverage, you will be dropped to the
standard benefit level.
HealthbyChoice
HMO Summary
HealthbyChioce FAQ
HealthbyChoice
Brochure
HealthbyChoice
Qualifications Form
Complete
Health Risk Appraisal
> Looking for a
St. Mary Mercy Doctor? Visit the St. Mary Mercy website
and search our Find
a Doctor directory!
Dental
You have a choice of two dental plan options - Delta Dental
Premier Standard and Delta Dental Premier High Option.
Premier Standard Summary
Premier High Summary
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 continue to have Basic
Life Insurance provided at 2x annual salary with the option
to "buy down" to 1x annual salary.
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. It is your responsibility to complete and return your
Statement of Health during the Enrollment Period.
Life Insurance Certificate
Statement of Health Form
Beneficiary Designation
Form
Short Term Disability
SMMH provides Full-time associates with Short Term Disability
coverage at 66 2/3% of your base pay for a maximum period
of 26 weeks. This income replacement benefit begins after
you have exhausted your fourteen day elimination period.
Short Term Disabililty
Certificate
Long Term Disability
Full-time and Part-time associates are provided with LTD
coverage at 60% of your base pay not to exceed a monthly benefit
of $10,000. This income replacement benefit begins after you
have exhausted your Short Term Disability benefits.
You have the option to "buy up" your LTD coverage
to 66 2/3% of base pay, or "buy down" to 50% of
base pay.
If you currently have a 50% benefit and elect up to a 66
2/3% benefit, you must complete an Evidence of Insurability
Form.
Long Term Disability
Certificate
Evidence of Insurability Form
Flexible Spending Accounts
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.
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.
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 for yourself and your family.
Hyatt Legal Brochure
Hyatt Legal SPD
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