Mercy Medical Center - North Iowa, Mason City
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Medical | Dental
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Life Insurance | Short
Term Disability | Long Term Disability
Flexible Spending | Legal
Dependent child definition for 2011:
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 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
Medical Plans
IMPORTANT! Referral process
for University of Iowa and Mayo Clinic
Mercy Medical Center – North Iowa participants need
to obtain an approved out-of network referral before receiving
services at the University of Iowa Hospitals and Clinics in
Iowa City, any hospital/clinic associated with Rochester/Mayo
Clinic or other non-network provider. A referral is required
for services provided at these facilities, as well as for
any physician or professional services. If you do not obtain
an approved referral before receiving care, your claims will
be paid at the out-of-network level. If you’re referred
to an out-of-network provider for services, the referring
physician will need to call Aetna at 1.888.632.3862 before
you receive care. Aetna will review referrals for emergency
situations upon receipt (except for weekends or non-business
hours), and will review non-emergency referrals within 15
days of receipt. For additional information on the referral
process, contact Aetna at 800.544.5108.
CLICK HERE
FOR MORE INFORMATION.
You have a choice of two medical plan options - Personal
Care Account PPO and Standard Option PPO.
Find an
Aetna Participating Provider
Use the plan comparison tool to Estimate
My Plan Costs
Personal
Care Account PPO SPD | Personal
Care Account PPO Summary
2010 Standard
Option PPO SPD | Standard
Option PPO Summary
2011 PPO SPD - Coming Soon!
Preventive
Care Overview
Dental
You have a choice of two dental plan options - Delta Dental
Standard and Delta Dental High Option.
Delta Standard Summary
Delta 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 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
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.
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 The Hartford. The
Hartford pays at 66 2/3% coverage to a weekly maximum of $2,500.
Pleas click here
for directions on how to file your short term disability claim.
Short
Term Disability Certificate
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 overage 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
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.
Important 2011 Change! Over-the-counter drugs purchased on
or after January 1, 2011 will no longer be reimbursable through
the health care spending account (HCSA).
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 2011 calendar year will be eligible for reimbursement
on services incurred from January 1, 2011 through March 15,
2012. 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 2011 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
Legal
You continue to have the choice of electing legal coverage
through Hyatt Legal for yourself and your family.
Hyatt
Legal Brochure
Hyatt Legal SPD
My Discounts
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.
Mercy
Medical Center Discounts - Mercy Club
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