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Mercy Hospital, Port Huron

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My Health & Welfare | Enrollment Forms

Medical | Dental | Vision | Life Insurance
Short Term Disability | Long Term Disability | 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.

Required Documents

Medical

You have the option of choosing from two medical plan options - Healthy Blue Solutions PPO and Priority Health Healthby Choice HMO.

Medical Comparison

Use the plan comparison tool to Estimate My Plan Costs:
Full Time Associate Cost Advisor
Part Time Associate Cost Advisor

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 hcbo.com and complete a BlueHealthConnection® health risk appraisal by 1/31/2009, and
• Based on your HRA results, attend the first of four appointments with a BCBSM health coach by 4/15/2009.

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.

Prescription Drug Changes Effective 8/1/2009 - Healthy Blue Solutions

Healthy Blue Solutions Enhanced PPO Summary | Healthy Blue Solutions Standard PPO Summary
Healthy Blue Solutions Plan Requirements
Complete Health Risk Appraisal
Healthy Blue Solutions PPO SPD
Preventive Care Overview
Preventative Care Summary Modification

Find a BCBSM Participating Provider.

Healthyby Choice HMO

Priority Health - Health By Choice HMO is a health plan combined with a wellness program encouraging members to make healthier choices. The Health By Choice 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.

Prescription Drug Benefit Changes Effective 8/1/2009 - Healthyby Choice HMO

Healthby Choice HMO Summary
Healthby Choice Summary of Requirements
Healthby Chioce FAQ
Healthby Choice Brochure
Healthby Choice Qualifications Form
Complete Health Risk Appraisal

Find a BCBSM Community Blue Participating Provider.

> Looking for a Mercy Hospital Doctor? Visit the Mercy Hospital website and search our Find a Physician directory!

Dental

You have the option of electing dental coverage provided by Delta Dental.

Dental Comparison
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 associates have Basic Life Insurance provided at 1x annual salary.

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

Short Term Disability

Full-time associates are provided Short Term Disability coverage at 66 2/3% base annual salary. This income replacement benefit begins after you have exhausted your 7 calendar day elimination period.

Short Term Disability Certificate

Long Term Disability

Full-time and Part-time associates are provided Long Term Disability coverage at 66 2/3% base annual salary not to exceed a monthly benefit of $10,000. This income replacement benefit begins after being off of work for six months.

Long Term Disability Certificate

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 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 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