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Plan/Group Number 443121
Billing Address P.O. Box 6018Cleveland, Ohio 44101
Member Service Number 1-888-213-2583 Carrier Website
Plan/Group Number: 677367
Billing Address P.O. Box 14611 Lexington, KY 40512-4611 Member Helpline Number 1-800-233-4013 Carrier Website
Dental/VisionLog in to Human.com > navigate to Coverage Claims & Spending > select Coverage & Benefits > choose Dental or Vision Carrier Website
IN NETWORKWhoever meets the $2,600 first will get their claims paid at 100 percent of our Allowed Amount. If the family combines to meet the $5,200, all covered services are paid at 100 percent of our Allowed Amount.
OUT OF NETWORKWhoever meets the $3,000 first will get their claims paid at 100 percent of our Allowed Amount. If the family combines to meet the $6,000, all covered services are paid at 100 percent of our Allowed Amount.
The city funds your HRA account as follows:Single $2,600Family $5,200
Whenever you incur medical or prescription expenses, the payment should be made from your HRA account using your TASC card. There are IRS guidelines that define eligible expenses. Dental claims are not covered. However, the medical plan may pay for certain oral care that it deems “medically necessary.” It is advisable to contact our insurance carrier to have that determination made before seeking treatment in non-emergency situations.
Your deductible is accumulated separately. Whoever meets the $2600 first will get their claims paid at 100 percent of our Allowed Amount. If the family combines to meet the $5,200 all covered services are paid at 100 percent of our Allowed Amount.
All fund balances are forfeited to the city after the close of the plan year. Contact TASC
The city funds your HSA account as follows:Single $2,340Family $4,680
Whenever you incur medical or prescription expenses, the payment should be made from your HSA account using your Avidia card. There are IRS guidelines that define eligible expenses. Dental claims are not covered. However, the medical plan may pay for certain oral care that it deems “medically necessary.” It is advisable to contact our insurance carrier to have that determination made before seeking treatment in non-emergency situations.
Your deductible is accumulated separately. Who ever meets the $2600 first will get their claims paid at 100 percent of our Allowed Amount. If the family combines to meet the $5,200, all covered services are paid at 100 percent of our Allowed Amount.
All fund balances are rolled over and remain the property of the employee after the close of the plan year. Contact Avidia
Through their diverse team of licensed, credentialed professionals, they offer:Short-term Counseling – for stress, relationships, family issues, depression, and moreChild Care – parenting support and assistance with locating reliable childcareClass Act – assistance with a wide variety of general and special education needs for school agersElder Care – caregiver support and assistance with locating resources for eldersLegal Resources – attorney consultations with 25% discount if retained, and downloadable documentsFinancial Resources – financial consultations for budgeting, savings, investment information and moreNutritional Coaching – in person sessions with a registered dietitian or holistic health coach for weight loss or other health concernsFitness Coaching – in person sessions with a certified fitness coach to develop a personalized fitness planMember Website – online, members-only resources and information for improving your life
They can assist in:Personal/Work Problems Smoking CessationAnxiety, Depression, & Stress Financial/Legal IssuesSubstance Abuse Fitness CoachingFamily Relationships Childcare NeedsNutritional Coaching Eldercare Issues
Toll free: 800-521-3273OnlineUser Name: MayfieldPassword: EASE Ease@Work Online
Non Emergency SituationsImmediately notify your supervisor of the injury.Seek medical treatment from the nearest medical facility.Preferred emergency medical center is Hillcrest Hospital (6780 Mayfield Road, 44124; 24/7) or UH Chagrin Highlands Health Center Urgent Care (3909 Orange Place, 44122 – Hours M-F 9am- 9pm; Sat/Sun 9am-5pm).Show the 888-OhioComp id card. 888 OhioComp is our Managed Care Organization (MCO).Complete the BWC First Report of Injury Form and accident reports required by the employer.
Dental/VisionLog in to Human.com > navigate to Coverage Claims & Spending > Select Find a Provider from the “I want to …” drop down list
The My Care Compare on-line tool allows you to see the difference for yourself. Shop and compare costs for a variety of doctors and medical services including office visits, blood tests/lab services, x-rays, MRIs, CT scans and physical therapy.
Log in to MyHealthPlan > navigate to Resources & Tools > select My Care Compare
HumanaLog in to Human.com > navigate to Coverage Claims & Spending > Select Find a Provider from the “I want to …” drop down list
Bypass inconvenient and costly visits to the emergency room and urgent care by using Cleveland Clinic Express Care On-line for benign issues such as and not limited to a sinus infection, allergies, earache, minor trauma (laceration or burn), should pain, bronchitis, urinary tract infection, cough/cold, or pink eye. The cost is only $49. This feature can be accessed 24/7 -- even while out of town. Doctors (in most states, including Ohio) are able to write prescriptions, if necessary.
Ages• Adults and Children 6 years old and up• Patients 17 years and under must be accompanied by a parent/guardian during the visit
***If you have chest pain, shortness of breath, dizziness, a severe headache, broken bone or other serious problems, please go to the nearest emergency department or 911.
Get started:Mobile devices: Download the Express Care Online app from either the "App Store" or "Google play".
Laptop or Desktop users: Go to http://my.clevelandclinic.org/online-services/express-care-online. Get started by using the "See a Provider Now" button and enter your information on the Express Care Online website. Express Care Website
Disease ManagementMedical Mutual’s Disease Management Program offers additional support to those who are dealing with a chronic medical condition, like asthma or diabetes. Their trained Health Coaches provide education and assistance to increase understanding of the condition. Log on to My Health Plan > navigate to Healthy Living > select Disease Management Program
Maternity ProgramIf you’re pregnant, the Maternity Program can offer education and support to help you achieve your best overall health. The Maternity Program provides you with a specially trained Maternity Health Coach. Log on to My Health Plan > navigate to Healthy Living > select Maternity Program
QuitlineTake your first step to kick tobacco use by utilizing this free service provided by Medical Mutual. Log on to My Health Plan > navigate to Healthy Living > select Quit Smoking
*Weight WatchersTake a step toward better health and join Weight Watchers. Enrollment fee reimbursement up to $150 each calendar year when you meet all program rules.Log on to My Health Plan > navigate to Healthy Living > select Weight Watchers
*FitnessMedical Mutual has partnered with several health club chains to bring you valuable discounts and benefits. In addition, you have exclusive access to exercise tips and guides from Healthwise.Log on to My Health Plan > navigate to Healthy Living > select Fitness
*ShopDiscover a variety of member-only discounts, which include baby products, fitness club fees, hearing aids, drugstore items and other healthy products. Vendors include:• AmericanFitness.net• Beltone• Drugstore.com• Safe Beginnings• YOGAaccessories.com• VitaMix
Three companies are currently available to choose from: Mass Mutual Life Insurance Ohio Public Employees Deferred Plan Pacific Life
(Deductions are made every pay, 26 pays)
The maximum allowed per year is as follows (for 2016):
OverNormal Age 50 $18,000 $24,000
Withdrawal of money from the plan while still employed by the city is limited to extreme financial emergencies as defined by IRS code. (There is a loan option available from the Mass Mutual plan.)
Contact Lisa Benedetti at 440-442-2626 x204 for contact information for any of the above listed companies.
Accidental death and dismemberment insuranceOffered by the Ohio Municipal League (OML).(Deducted second pay of the month)
Cancer, intensive care, accident, life, short term disability, disease specific insurances Offered through Washington National and AFLAC. This is in addition to the coverage offered through our health insurance with Medical Mutual. (Deducted twice a month)
Contact Lisa Benedetti at 440-442-2626 x204 for supplemental benefit details.
TO ACCESS YOUR VOICEMAIL FROM INSIDE THE OFFICE WHEN YOU DON’T HAVE AN ASSIGNED DESK PHONE (PHANTOM MAILBOX USERS)1. Dial 6052. Press * & enter your extension when you hear the main city hall greeting3. Enter your password
Coinsurance• Coinsurance is your share of the costs of a health care service. It's usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you've paid your plan's deductible.Here's how it works. Joan has allergies, so she sees a doctor regularly. She just paid her $2,600 deductible. Now her plan will cover 70 percent of the cost of her allergy shots. Joan pays the other 30 percent; that's her coinsurance. If her treatment costs $150, her plan will pay $105 and she'll pay $45.If Joan has a PPO plan, she has the option to see any doctor she wants. If she goes to an out-of-network doctor, her plan will still share the cost, but her percentage of coinsurance will be higher. And, if the medical service she gets is more than what her plan would pay for an in-network doctor, she'll have to pay the difference. Our plan has no co-insurance for covered, in-network services once the deductible is met. The out of network deductibles are higher and there is an out of pocket maximum. What you pay goes toward your deductible first. Once you’ve met that amount for the year, further out of network payments accumulate on top of that deductible amount until you meet your out-of-pocket max. The amount you pay for covered services with an out of network provider is 40%. That 40% is your coinsurance.
Copay• A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled.For example, a doctor’s office visit might have a copay of $30. The copay for an emergency room visit will usually cost more, such as $250. For some services, you may have both a copay and coinsurance. Our plan does not have a copay.
Out of Pocket Maximum• The most you will have to pay for covered medical expenses in a plan year through deductible and coinsurance before your insurance plan begins to pay 100 percent of covered medical expenses.Your deductible is $3,000 for out of network services. You will pay that first $3,000 of your bill as your deductible. Then, your coinsurance kicks in. Insurance company pays 60% of your covered medical expenses. You'll be responsible for 40% of those expenses—until the remaining $2,000 of your $5,000 out-of-pocket maximum is met. Then, our plan covers 100% of your remaining qualified medical expenses for that calendar year. The out of pocket maximum for in-network services matches our in network deductibles.
When the insurance company pays your doctor, it will send you a report called an Explanation of Benefits, or EOB, that shows you what it did. You need to be able to read and understand the EOB to know what your insurance company is paying for, what it's not paying for, and why. An EOB is not a bill.
Your doctor's office might send you a statement. A statement will show you how much you owe the doctor. If you receive a statement before your insurance company pays your doctor, do not need pay the amounts listed at that time. After your insurance company pays your doctor, you will need to pay the doctor any balance due.
Here are some things to look for:• If the dates of service and description of services on your EOB and billing statement aren't the same, or if they don't match other records you may have of the visit, contact your doctor's office first.• If you have questions about why the insurance company did not cover something or about the amount you have to pay, contact the insurance company.• If more than 60 days have passed and the insurance company still hasn't paid your doctor, contact the insurance company.
Finally, keep your EOBs and statements organized (e.g., filed by date) so that you can access them easily should questions arise. When payments are made, note the date and amount paid on the EOB and statement.