Saint Joseph's Regional Medical Center, Indiana
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> My Health
& Welfare | >
My Voluntary Options
Medical | Dental
| Vision | Life Insurance
| 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 a choice of three medical plan options -Traditional
PPO High Option A plan, Standard PPO Option B, and the Advantage
HMO plan.
Find an in-network physician using Aetna
Doc Find
Find a Sagamore
Provider
Use the plan comparison tool to Estimate
My Plan Costs
Choose which coverage level you want - Associate Only, Associate/Spouse,
Associate/Child(ren), or Family. Full-time associates may
"opt-out" of medical coverage with proof of other
coverage and receive $500 annually.
Medical
Comparison
Traditional
PPO High Option PPO SPD | Traditional
PPO High Option A Summary
Standard
PPO Option B SPD | Standard
PPO Option B Summary
Standard PPO and Traditional
PPO Preventive Overview
Preventative
Care Summary Modification
Advantage
Health HMO Plan Summary
Advantage
Health HMO Provider Listing
Dental
You have a choice of two dental plans - Delta Premier Standard
Option and Delta Premier High Option.
Dental
Comparison
Delta Premier Standard
Summary
Delta Premier High Summary
Delta Premier Certificate
Delta Dental ID Card
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. Your employer pays the cost
of your Basic Life Insurance..
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 Insurance Company during the
Enrollment Period.
Life Insurance Certificate
Plymouth Statement of Health
Form
South Bend Statement of Health
Form
OLP Statement of Health
Form
SJRMC, Inc. Statement of Health
Form
Long Term Disability
SJRMC provides Full-time associates with LTD coverage at
60% of your base pay not to exceed a monthly benefit of $10,000.
This cost is provided in the flexible credits you receive.
This income replacement benefit begins after you have exhausted
your Short Term Disability benefits.
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.
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.
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
_____________________________________
My Voluntary Options
In addition to your group benefits, Trinity Health has partnered
with The Farmington Company to provide eligible associates
the opportunity to elect personal insurance plans from a portfolio
of products. Individual policy options include:
Universal Life Insurance
Long Term Care Insurance
Cancer Insurance
Critical Illness Insurance
Accidental Death and Dismemberment (AD&D)
Insurance
Auto/Home Insurance
Pet Insurance
Enroll
Now in My Voluntary Options
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