 2010 BENEFIT HOTLINE INFORMATION HERE IS WHO TO CALL WITH QUESTIONS DURING OPEN ENROLLMENT ORGANIZATION PHONE/WEBSITE MEDICAL MUTUAL OF OHIO 800/232‐7400 DESCRIPTION OF SERVICES Medical Mutual of Ohio (MMO) is the district’s medical and prescription provider for PPO benefits. Choosing providers and facilities that participate in the MMO network will save you time and money. To confirm the participating status of your provider and/or facility you can visit MMO’s website at www.medmutual.com or simply as your provider’s insurance/billing specialist if they participate in the SuperMed Plus network. If you choose services outside of the network on an elective basis, you will be responsible for higher out of pocket costs. KAISER PERMANENTE 216/686‐7100 Kaiser Permanente (KP) remains the district’s network only medical and prescription provider for HMO benefits. In this program, you must use a participating provider or facility to receive benefits. To confirm the participating status of your provider and/or facility you can visit Kaiser’s website at www.kaiserpermanente.org or simply as your provider’s insurance/billing specialist if they participate in the Kaiser HMO network. If you choose services outside of the network on an elective basis, you will not be eligible to receive benefits. KP.ORG YOUR OVERVIEW TO THE 2010 MAYFIELD SCHOOL DISTRICT BENEFIT PROGRAM YOUR 2010 BENEFIT GUIDE OASIS TRUST/CORESOURCE 800/282‐3920 CORESOURCE.COM The OASIS Trust, administered by CoreSource, is the district’s dental benefit administrator. Benefit levels and coverage limitations, allowances and exclusions remain identical to the current benefit program. On behalf of OASIS, CoreSource will be responsible for processing all claims and answering information regarding payment status of claims, coverage limitations and exclusions, benefit allowances and eligibility for coverage. BEHNKE & COMPANY 888/686‐8064 BEHNKEOHIO.COM Behnke & Company is the district’s benefits administration and consulting representative. Behnke’s staff is able to assist you with any benefit related inquiries that you may have regarding open‐enrollment, plan or carrier changes or coverage information. IMPORTANT NOTE CONCERNING THE CONTENTS OF THIS BROCHURE: Although every effort has been made to ensure the accuracy of the information contained herein, please note that should a discrepancy exist between this program and the benefits to which you are entitled by the rights of any and all insurance certificates, bargaining agreements or summary plan descriptions, the appropriate certificate or plan description shall take precedent. Nothing in this summary of coverage is a guarantee of benefits, eligibility, or employment with Mayfield City School District. Certain limitations and exclusions apply and could significantly impact the validity of your claim and/or coverage to which you are entitled. PPO MEDICAL/PRESCRIPTION COVERAGE MEDICAL MUTUAL OF OHIO HMO MEDICAL/PRESCRIPTION COVERAGE KAISER PERMANENTE DENTAL COVERAGE OASIS TRUST VISION COVERAGE MEDICAL MUTUAL OF OHIO LIFE AND AD&D COVERAGE GUARDIAN MEDICAL MUTUAL OF OHIO YOUR 2010 BENEFIT GUIDE VISION BENEFITS Medical Mutual of Ohio is the district’s vision benefit provider. Mayfield is contracted with MMO and their traditional vision program. MEDICAL MUTUAL OF OHIO MEDICAL PPO AND PRESCRIPTION COVERAGE Medical Mutual of Ohio is Mayfield’s PPO provider medical and prescription services. The district is contracted with MMO and their Supermed Plus program. Copayments and benefit options have been summarized below as part of your benefit agreement; however, please keep in mind this is intended as a brief summary. Consult the official Medical Mutual Benefit Summary for specific details. Key benefit changes have been highlighted below for your review. Please remember, your eligibility to qualify for deductible credits of up to $400/individual or $800/family will reduce your deductible amount. SUPERMED PLUS OUTSIDE OF THE NETWORK NETWORK PREVENTIVE CARE (ROUTINE EXAMINATIONS) NO COST DEDUCTIBLE+20% ADULT PHYSICALS WELL CHILD AND WELL BABY SERVICES ANNUAL OB/GYN EXAMINATION ROUTINE X‐RAY/LAB & MAMMOGRAM SERVICES ALL OTHER OFFICE VISITS (INJURY/ILLNESS) $15 COPAY DEDUCTIBLE+20% RELATED INDEPENDENT X‐RAY/LAB SERVICES NO COST DEDUCTIBLE+20% URGENT AND EMERGENCY SERVICES (INJURY/ILLNESS) URGENT CARE CENTER $20 COPAY $20 COPAY $125 COPAY $125 COPAY EMERGENCY ROOM (WAIVED IF ADMITTED TO HOSPITAL) COPAY INCLUDES ALL SAME‐DAY ANCILLARY CHARGES Benefit levels, copayments and plan parameters of this option have been updated as part of your benefit agreement. Please consult the official Medical Mutual Benefit Summary for specific details. EXAMINATION (ONE PERMITTED PER BENEFIT PERIOD) FRAMES (ONE PERMITTED PER TWO BENEFIT PERIODS) LENSES (ONE ORDER PER BENEFIT PERIOD) CONTACT LENSES (IN LIEU OF LENSES ONE ORDER PER BENEFIT PERIOD) F.T.E. PREMIUM TO ENROLL SINGLE FAMILY YOU MAY USE ANY LICENSED PROVIDER* $7.50 COPAY $12.50 COPAY $12.50 COPAY $12.50 COPAY $0.82/MONTH $2.06/MONTH *ALTHOUGH ANY LICENSED PROVIDER MAY BE USED, ALL SERVICES WILL BE REIMBURSED TO THE LEVEL OF MEDICAL MUTUAL’S USUAL CUSTOMARY AND REASONABLE. IF YOU SELECT A PROVIDER OUTSIDE OF MMO’S NETWORK, YOU MAY BE RESPONSIBLE FOR ADDITIONAL AM0UNTS BILLED BY YOUR PROVIDER IN EXCESS OF THE USUAL, CUSTOMARY AND REASONABLE AMOUNT. BEFORE SECURING SERVICES, YOUR PROVIDER SHOULD MMO TO CONFIRM THE REIMBURSABLE AMOUNT AND ADVISE YOU OF ANY LIMITATIONS. FACILITY ORIGINATED SERVICES DEDUCTIBLE+0% DEDUCTIBLE+20% INPATIENT HOSPITAL OUTPATIENT HOSPITAL DIAGNOSTIC X‐RAY & LAB SERVICES (INCLUDING MRI/PET/CAT SCANS) PRENATAL AND DELIVERY SERVICES RELATED TO MATERNITY CARE MENTAL HEALTH/SUBSTANCE ABUSE 2010 DEDUCTIBLE PER PERSON/FAMILY MAX COINSURANCE AFTER DEDUCTIBLE 2010 MAX OUT OF POCKET PER PERSON/FAMILY MAX $500/$1000 100% $500/$1000 PRESCRIPTION COVERAGE (30 DAYS RETAIL OR 90 DAYS MAIL) GENERIC (REQUIRED UNLESS PRESCRIBED DAW) PREFERRED BRAND NON‐PREFERRED BRAND F.T.E. PREMIUM AS OF 01/10 TO ENROLL SINGLE FAMILY $5 COPAY $10 COPAY $20 COPAY $52.30/MONTH $143.84/MONTH DENTAL BENEFITS The district’s dental benefits are covered through the Oasis Trust dental benefit program. Oasis Trust is administered by CoreSource and provides you with the option to select a Dentemax provider. You are not required to use any specific network in this program. Benefit levels, copayments and plan parameters of this option are remaining the same; however, you should consult the official OASIS Benefit Summary and/or certificate of coverage for detailed information.. MEDICAL PROGRAM PARAMETERS OASIS TRUST $500/$1000 80% $1000/$2000 CLASS I PREVENTATIVE CARE (i.e., CLEANINGS, BITEWING X‐RAYS) CLASS II RESTORATIVE (i.e., RESTORATIONS, AMALGAMS) CLASS III MAJOR (i.e., CROWNS, BRIDGEWORK) CLASS IV ORTHODONTIC (i.e., BRACES, APPLIANCES) CLASS II/III/IV DEDUCTIBLE (PER PERSON/FAMILY MAX) MAXIMUM ANNUAL BENEFIT (PER PERSON) MAXIMUM ORTHODONTIC BENEFIT F.T.E. PREMIUM TO ENROLL SINGLE FAMILY YOU MAY USE ANY LICENSED PROVIDER* 100% COVERED DEDUCTIBLE+20% DEDUCTIBLE+20% DEDUCTIBLE+40% $25/$50 $3,000 $1,750 $4.36/MONTH $11.08/MONTH *ALTHOUGH ANY LICENSED PROVIDER MAY BE USED, ALL SERVICES WILL BE REIMBURSED TO THE 90TH PERCENTILE LEVEL OF USUAL CUSTOMARY AND REASONABLE. HIGHLIGHTS OF THE DEDUCTIBLE CREDIT PROGRAM FAQs AND RESOURCE INFORMATION FOR THE WELLNESS AND DEDUCTIBLE CREDIT INITIATIVES DID WE CHANGE INSURANCE PLANS? Not exactly. While the District’s coverage remains available through Medical Mutual of Ohio and Kaiser HMO, and your copayments and coinsurance amounts remain the same, the deductibles of our program did change on January 1, 2010 as part of the current bargaining agreements. The new deductibles go into effect for all services that you incur after January 1, 2010. WHAT ARE DEDUCTIBLE CREDITS? Each year, to help plan participants avoid the additional expense of the deductibles, Mayfield is providing all staff with the opportunity to earn deductible credits for improving or meeting healthy lifestyle targets. These credits are automatically applied against your medical program deductible. The credits can be earned for simple things like taking the Health Risk Assessment or being tobacco‐free. Additional credits can also be earned by achieving or improving toward target levels of BMI, cholesterol or blood pressure. WHAT IF I HAVE A MEDICAL CONDITION THAT IMPACTS MY SCORES? While the objective of the credit program is to help reward each employee for healthy lifestyle decisions, there are provisions in place to handle cases of pre‐existing medical conditions which prevent participants from hitting the targets. If you are under the care of a physician for a medical condition which prevents you from reaching the target scores, your physician is able to certify your treatment so you may still qualify for the credit. HOW DOES THIS WORK? Deductibles operate at Mayfield on a calendar year basis (from January 1st through December 31st). Facility based expenses for services incurred after January 1, 2010 will be subject to a deductible of $400/single or $800/family in network. BY TAKING THE BIOMETRICS & HRA IN 2008/2009 You had the opportunity to establish a baseline and qualify for a $20/month premium discount. The baseline was used to develop your 5% improvement score. The $240/year premium discount by participating was to help offset the increased deductible in 2010. BY TAKING THE BIOMETRICS & HRA IN 2009/2010 You again qualify for the $20/month premium discount. Premium discounts just for “showing up” now total $240 from 2009 and $240 for 2010, or $480 in total. Your HRA participation qualifies you for an additional $80/single or $160/family deductible credit. In addition, if you are a non‐smoker, or complete the smoking cessation program in 2010, you qualify for an additional $80/single or $160/family deductible credit. Additional deductible credits of $80/individual or $160/family are also available if you meet or exceed the target scores in each category of BMI, Cholesterol and Blood Pressure. In total, participants can qualify for $480 in premium discounts from 2008/2009 and 2009/2010 and $400/individual or $800/family in deductible credits to help offset the increased deductible amounts that are in effect for all services incurred after January 1, 2010. WHAT IF I AM DISSATISFIED WITH THE ONSITE TESTING RESULTS? If you do NOT qualify for a deductible credit and believe it is the result of an existing medical condition for which you are seeking treatment, or you believe that your physician has a more accurate test method, you are permitted to appeal your scores. Information on the appeal process is available when scores are reported at the beginning of each plan year or during the year (applicable to mid‐year entrants) by contacting our healthcare consultants at Behnke at 888/686‐8064. KAISER PERMANENTE MEDICAL HMO AND PRESCRIPTION COVERAGE Kaiser will remain Mayfield’s alternative HMO option for all medical and prescription services. While copayments and coverage levels remain the same for 2010, this program’s deductibles are increasing for all services incurred after January 1, 2010. Please consult the official Kaiser Benefit Summary or certificate of coverage for specific coverage limitations, allowances and exclusions and keep in mind participants can qualify for deductible credits of $500/individual or $800/family by participating in the Mayfield Wellness Initiative. ADULT PHYSICALS WELL CHILD AND WELL BABY SERVICES ANNUAL OB/GYN EXAMINATION ROUTINE X‐RAY/LAB & MAMMOGRAM SERVICES PREVENTATIVE CARE (ROUTINE EXAMINATIONS) ALL OTHER OFFICE VISITS (INJURY/ILLNESS) KAISER HMO NETWORK OUTSIDE OF THE NETWORK $10 COPAY NOT COVERED $10 COPAY NOT COVERED NO COST NOT COVERED $10 COPAY $10 COPAY DEDUCTIBLE+0% NOT COVERED $500/1000 100% $500/1000 NOT COVERED NOT COVERED NOT COVERED RELATED INDEPENDENT X‐RAY/LAB SERVICES URGENT AND EMERGENCY SERVICES (INJURY/ILLNESS) EMERGENCY ROOM (WAIVED IF ADMITTED TO HOSPITAL) COPAY INCLUDES ALL SAME‐DAY ANCILLARY CHARGES NON‐NETWORK ER REQUIRES APPROVAL FROM KAISER FACILITY ORIGINATED SERVICES INPATIENT HOSPITAL OUTPATIENT HOSPITAL DIAGNOSTIC X‐RAY & LAB SERVICES (INCLUDING MRI/PET/CAT SCANS) PRENATAL AND DELIVERY SERVICES RELATED TO MATERNITY CARE MENTAL HEALTH/SUBSTANCE ABUSE MEDICAL PROGRAM PARAMETERS DEDUCTIBLE PER PERSON/FAMILY MAX COINSURANCE AFTER DEDUCTIBLE MAX OUT OF POCKET PER PERSON/FAMILY MAX PRESCRIPTION COVERAGE (30 DAYS RETAIL OR 62 DAYS MAIL) KAISER FORMULARY (REQUIRED UNLESS PRESCRIBED DAW) NON‐PREFERRED BRAND PREMIUM TO ENROLL SINGLE FAMILY $10 COPAY NOT COVERED $47.42/MONTH $1.58/MONTH DON’T FORGET! YOU HAVE 30 DAYS FROM WHEN A QUALIFIED EVENT OCCURS TO NOTIFY HR OF A STATUS CHANGE.