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Mercy Medical Center, Sioux City

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My Health & Welfare | Enroll Now

PTO Cash-out | Medical Discount | 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 November 18, 2009. 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

2010 Open Enrollment Booklet and Plan Highlights

PTO Cash-out

You can cash out between 8 and 80 hours, provided you maintain a minimum PTO bank of 80 hours. You may elect one of two cash-out dates: August 6 or November 12, 2010. Your PTO cash-out election for 2010 may only be made during open enrollment to avoid taxation on the value of your PTO bank, including the hours that you do not intend to cash out. Your election is irrevocable and cannot be changed. You may only cash out hours that you will accrue during the calendar year in which you plan to receive payment. Consequently, you may not cash out PTO hours carried over from previous years. For example, Jane has a PTO balance of 100 hours as of December 31, 2009. During open enrollment, she elects to cash out 40 hours in 2010. Jane cannot cash out any of the 100 hours she earned in 2009 or earlier. She must plan her 2010 cash-out amount on only the hours she will accrue in 2010.

REMINDER: If you want to cash out PTO in 2010, you must make a new PTO cash-out election. Your prior year election will NOT carry forward.

Medical Discount

Our Mission as Trinity Health calls us to treat the entire well-being of those in our care – and that includes our associates. In order to increase access to health care and treatment for all of our associates, Trinity Health has developed a medical plan discount program. This program makes medical benefits more affordable for eligible associates enrolled in a Trinity Health medical benefit plan. The program does this by reducing the eligible associates’s medical plan contribution. For more information, please refer to the brochure below.

Medical Discount Brochure

Medical

You have the choice of two medical plan options - the PPO Standard Option and PCA PPO.

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PPO Standard Option SPD | PPO Standard Option Summary
PCA PPO SPD | PCA PPO Summary
Preventive Care Overview

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

Dental

You have a choice of two dental plan options - Delta Dental Premier Standard Option and Delta Dental Premier High Option.

Delta Premier Standard Option Summary
Delta Premier High Option 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 to MetLife during the Enrollment Period.

Life Insurance Certificate
Statement of Health Form

Short Term Disability

You have short-term disability benefits provided at 66 2/3% of your base annual salary. The length of your benefit is dependent upon your status and length of service with Mercy Medical Center.

Short Term Disability Certificate

Long Term Disability

Full Time Associates
Mercy Medical Center provides you with Long Term Disability (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.

To provide choice and flexibility, there are two additional coverage levels from which you may choose. 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. Your personalized enrollment worksheet will reflect the cost or credit associated with this "buy-up" or "buy-down."

If you currently have a 50% benefit and elect up to a 66 2/3% benefit, you must complete Evidence of Insurability Form. If you have been treated for the same illness or injury within the 3 months just prior to your effective date of coverage, you will be subject to the pre-existing conditions clause. Please refer to certificate for additional information.

Long Term Disability Certificate
Evidence of Insurability Form

Physicians
Please refer to your contract for details of the Physician LTD plan options.

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. 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.

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 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
Streamline Enrollment 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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