Mercy Medical Center MMS, Sioux City
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My Health & Welfare | Enroll
Now
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 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
2010
Open Enrollment Booklet and Plan Highlights
Medical
Coming Soon!!!
Effective July 1, 2010 Trinity Health and its Ministry
Organizations will transition from Medco, our existing pharmacy
benefit manager (PBM), to CVS Caremark. This change
applies only to associates and retirees who are covered under
a self-insured medical plan (that is, Blue Cross Blue Shield
of Michigan, Aetna, Priority Health and NGS American). It
does NOT apply to fully insured plans (Blue Care Network (BCN),
Priority Health HMO, etc.).
In preparation for this change, over the coming weeks
you’ll receive more information about the transition
to CVS Caremark. In addition, shortly before the July 1 effective
date you’ll receive new medical and pharmacy ID cards.
Be sure to watch your home mail for these important materials.
Visit www.caremark.com/trinityhealth
for more information.
Medical Plans
You have the choice of two medical plan options - the PPO
Standard Option and PCA PPO.
Find an Aetna
Participating Provider
Use the plan comparison tool to Estimate
My Plan Costs
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 electing the Delta Dental Premier Standard
Option Plan.
Delta Premier Standard
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:
| 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 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.
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
- Mercy Medical Services
Long Term Disability Certificate
- Mercy Home Care
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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