Mercy Medical Center - North Iowa, Mason City
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Health & Welfare | >
Medical | Dental
| Vision | Life Insurance
| Short Term Disability | Long
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 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.
Please note - Providers/facilities
in Rochester, MN or associated with the Mayo Clinc and the
University of Iowa Hospitals and Clinics are paid at the non-network
level, unless an approved referral has been obtained through
Aetna prior to having services at one of these facilities/providers.
FOR MORE INFORMATION.
You have a choice of two medical plan options - Personal
Care Account PPO and Standard Option PPO.
Aetna Participating Provider
Use the plan comparison tool to Estimate
My Plan Costs
Drug Benefit Changes Effective 8/1/2009
Care Account PPO SPD | Personal
Care Account PPO Summary
Option PPO SPD |
Standard Option PPO Summary
Care Summary Modification
You have a choice of two dental plan options - Delta Dental
Standard and Delta Dental High Option.
Delta Premier Certificate
You have the option of electing two vision benefits through
United Healthcare(UHC) Vision.
High Vision Summary
Standard Vision Summary
Vision Benefit Booklet
UHC High Vision
Full-time and Part-time associates 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:
|1x annual salary
2x annual salary
3x annual salary
4x annual salary
5x annual salary
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
Short Term Disability
Full and part-time associates are required to use PTO the
first week off work to cover the days you were normally scheduled
to work. Full-time associates are covered the second week
of disability on their regular paycheck at 66 2/3% coverage.
After two weeks (starting with the 15th day of disablity),
full-time associates are covered through UNUM. UNUM pays at
66 2/3% coverage to a weekly maximum of $2,500.
Long Term Disability
Associates budgeted 32 or more hours per pay are provided
LTD coverage at at 60% of your base pay not to exceed a monthly
benefit of $10,000. This income replacement benefit begins
after being off of work for six months.
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 an Evidence of Insurability
Long Term Disability
Evidence of Insurability Form
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.
to help estimate your health care and / or dependent care
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 2009 calendar year will be eligible
for reimbursement on services incurred from January 1, 2009
through March 15, 2010. 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 2009 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
Dependent Care Spending - you may contribute pre-tax
dollars in any amount between $130 and
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
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
Account Claim Form
Account Claim Form
Over-The-Counter Drug Claim Form
Direct Deposit Authorization
Flexible Spending Accounts
Summary Plan Description
You continue to have the choice of electing legal coverage
through Hyatt Legal for yourself and your family.
Hyatt Legal Brochure
Hyatt Legal SPD
In addition to the Trinity Health system-wide discounts,
Mercy Medical Center associates are eligible to receive various
local discounts as described in the attached document.
Center Discounts - Mercy Club