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Mercy Health Partners Union

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> My Health & Welfare

My Health & Welfare | Enrollment Forms

Medical | Dental | Vision | Life Insurance
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

You have a choice of two medical plan options - High Option A PPO and Blue Care Network Healthy Blue Living.

BCBSM PPO

Find a BCBSM Community Blue Participating Provider

High Option A PPO SPD | High Option A PPO Summary
Preventive Care Overview
Caremark Summary of Material Modification - Effective 7/1/2010

BCN
Healthy Blue Living is an innovative health plan that rewards members with lower costs for pursuing their health goals. The Healthy Blue Living plan has two levels of benefits:

• Enhanced 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 enhanced 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
• If you’re a smoker, join Quit the Nic smoking cessation program within your first 120 days of enrollment, 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.

Healthy Blue Living Summary
Healthy Blue Living HRA Insturctions
Healthy Blue Living Member Checklist
Healthy Blue Living Member Guide
Healthy Blue Living Qualifications Form

Dental

You have the option of electing dental coverge through Delta Dental.

Delta Premier 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 employees have Basic Life Insurance provided as described in your "Benefits at a Glance."

In addition, you have the option to purchase additional coverage for yourself and your dependents in the following increments:

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

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. 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