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Welcome to Benefit Enrollment with MercyOne!Trinity Health and MercyOne are pleased to provide you with the information you will need to enroll in benefits. Throughout the restof this communication, you will see Trinity Health and Mercy Health Network referred to as simply Trinity Health. If you have morequestions after reviewing this guide, contact Amy Peters at amy.peters@mercyhealth.com or call 319-272-8434.H. .o. .wto Enroll.Step-by-step instructionsOpen a web browser to th or you can enroll by calling 855-342-0072. If youchoose to enroll online, please register as a new user. Your user name and password are not pre-determined.Who Is EligibleEligible IndividualDefinitionColleagueRegularly scheduled full- or part-time colleague with 40 or more budgeted hours per pay period.Spouse/Eligible AdultYou may cover your spouse or Eligible Adult. An Eligible Adult is an adult who resides and has financialinterdependence with the colleague, and is not a tax qualified dependent or related by blood, adoption ormarriage to the colleague.If an eligible adult qualifies as a tax dependent, you must complete the Non-Spouse Eligible Adult DependentCertification form posted on MyBenefits each year in order to receive pre-tax deductions.Dependent ChildrenDependent children are eligible for coverage through the end of the Plan Year in which they turn age 26,regardless of marital status, student status, residency, financial dependency or other requirements providedthey meet all of the following criteria.They are:Your or your spouse/eligible adult’s natural children;Your or your spouse/eligible adult’s legally adopted children or children placed with you or your eligible adultfor adoption; orChildren for whom you or your spouse/eligible adult are the court-appointed legal guardian.Not otherwise covered under the Plan or any other group health plan offered by the Employer.NOTE: Children of eligible adults may be covered only if their eligible adult is covered.Adding Family MembersIf you’re adding family members to your benefit plan, you’re required to provide written documentation (for example, marriagecertificate or birth certificate) verifying their dependent status to Human Resources. If you don’t submit the requireddocumentation within 30 days of enrolling, your dependents will not be enrolled in coverage, and you’ll be required towait until next year’s open enrollment period to add them to the plan – provided they remain eligible, and you providedocumentation verifying their dependent status at that time.You are required to provide a Social Security Number for each of your dependents over the age of one in order for them to becovered.Please note, you have the option to purchase coverage for your spouse/eligible adult and dependents. If you and yourspouse/eligible adult or dependent(s) both work for Trinity Health, and are benefits eligible, you cannot elect dual coverage(enrolled as a colleague and a dependent). In addition, only one of you will be able to elect coverage for your child(ren). If dualcoverage is elected or you both elect Trinity Health coverage for your child(ren), the coverage elected by one of you will notbecome effective and any premiums paid for that non-effective coverage are not refundable.
About the Medical PlansMore about the Clinically Integrated Network (CIN)A CIN joins local physicians and health care providers that have made a decision to partner with a Regional Health Ministry(RHM) to deliver services focused on high quality and cost-efficient care designed to improve the health of those we serve.Seeking care within the CIN can help you and your physician make health care decisions that ensure that you are accessing theright care, at the right time, in the right setting. In addition, by utilizing our CIN you will pay less out-of-pocket for the care youreceive, because all of the CIN providers are in our Tier 1 network.Access to CareTrinity Health’s goal with the Tier 1 network is to include adult/pediatric primary care, OB/GYN, hospital based physicians(radiologists, pathologists, hospitalists, etc.), and high volume specialties (cardiology, gastro, ENT, etc.). The majority ofservices should be available in Tier 1, however, some services may only be available at the Tier 2 level. Our intent is to ensureaccess to all services within Tier 1 or Tier 2 networks.Choose your Primary Care Physician (PCP)Maintaining a relationship with your PCP is important because they are trained to recognize any health problems you may have.A PCP is the doctor you see for most services, including annual check-ups. Your PCP can also help you identify and meet yourhealth goals and help you prevent serious, long-term health conditions. And, by following their preventive recommendations,they can help keep your health care costs low. Trinity Health encourages you to select a PCP and develop a relationship withthem. You and your covered dependents will be required to select a PCP. Be sure to indicate your PCP through themedical vendor’s online portal. If no PCP is indicated, the Plan will auto-assign based on claim history, Tier 1 physician withina 10 mile radius of your home, or Tier 2 physician within a 10 mile radius of your home. To find an in-network physician orprovider, visit http://mybenefits.trinity-health.org, and select the “My Service Providers” tab.Understanding your out-of-pocket medical costsYou may be wondering how Trinity Health and you share medical and pharmacy costs each year. The graphic belowshows how costs are shared for both premiums and coverage. Keep in mind, your costs will vary depending on the planand the network you access at the time of service.How Trinity Health & You Share Medical & Pharmacy CostsHealthYourMercyOne Northeast IowaSharedPlanCost5
Medical CoverageTrinity Health is offering you three medical plan options during open enrollment: the Traditional Plan, the Health Savings Plan,and the Essential Plan. All three plans are administered by BlueCross BlueShield of Michigan and support our clinicallyintegrated network structure.Each plan offers these three tiers so you can pay less by receiving care from network providers. Tier 1, or the Mercy ACO network providers, are facilities or physiciansaligned with our organization that provide you with the lowest deductibles,coinsurance and copays. The Clinically Integrated Network (CIN) includesthese Tier 1 physicians who work to improve the health of our colleaguesand the communities in which they live and work. For services unavailablethrough Mercy ACO network providers, select BlueCross BlueShield ofMichigan providers will be available at the Tier 2 benefit level. Tier 2 includes select BlueCross BlueShield of Michigan providers (facilitiesand physicians) not listed under Tier 1. Tier 2 providers can save youmoney, but not as much as using our Tier 1 network. Tier 3 providers are out-of-network (for example, Mayo Rochester) and thisTier provides the lowest level of coverage. You can use these facilities andphysicians for care, but you will pay the most out of your pocket when you do.Did you Know?On average, 85% of TrinityHealth colleagues have accessto at least two Tier 1 primarycare providers within thefollowing distance from theirhome address: Five miles if they reside inurban areas 10 miles if they reside inBy using Tier 1 providers, you’re not only reducing your out-of-pocket expenses, you’re supporting Trinity Health as anorganization. Since the cost of medical premiums are shared by you and Trinity Health, using Tier 1 providers helps to minimizethe rising cost of health care for all of us.Selecting the Plan that’s right for you. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Review your medical plan options below to find the one that fits your needs.Traditional PlanHealth Savings Plan(HDHP with HSA) Pay more each Pay less each paycheck, butpaycheck, but less atmore at the time of servicethe time of service(100% of costs) until you Choose this plan if youare interested in lowermeet your deductible Receive annual employercosts at the time you usecontribution in an HSA basedinsuranceon enrollment tier Choose this plan toEssential Plan(Assist plan with HRA if qualify) Pay the least amounteach paycheck, but moreat the time of service Essential Assist plan,including HRA withannual employercontribution based onenrollment tier, available forcontribute to the HSA, andcolleagues who meet certainmaximize your taxincome requirementsadvantage as you save forcurrent and future healthcare expenses Choose this plan ifyou are interested inlower payrollcontributionsMercyOne Northeast Iowa6
Medical and Pharmacy Plan HighlightsFor more information about your medical and pharmacy plan options, visit http://mybenefits.trinity-health.org.Medical PlanHighlightsTrinity Healthfunded account(Individual / Family)Annual deductible(Individual / Family)CoinsurancePreventive careOffice visit(PCP / Specialist)Network TierTraditional PlanHealth Savings Plan1Essential PlanAll TiersN/AHSA: 650 / 1,300HRA: 850 / 1,700(Essential Assist Plan Only)Tier 1 250 / 500 1,500 / 3,000 1,000 / 2,000Tier 2 750 / 1,500 2,500 / 5,000 2,500 / 5,000Tier 3 1,500 / 3,000 3,500 / 7,000 4,000 / 8,000Tier 110%*10%*20%*Tier 220%*20%*30%*Tier 340% R&C*40% R&C*40% R&C*Tier 10% no deductible0% no deductible0% no deductibleTier 20% no deductible0% no deductible0% no deductibleTier 340% R&C*40% R&C*40% R&C*Tier 1 20 / 3010%*20%*Tier 2 30 / 4020%*30%*Tier 340% R&C*40% R&C*40% R&C*Urgent care visitAll Tiers0% after 35 copay10%*20%*Emergency roomAll Tiers0% after 100 copay(waived if admitted)10%*Subject to Tier 1 deductible0% after 100 copay(waived if admitted)Tier 1None**None**None**Tier 2 500** 500** 750**Tier 3 1,000** 1,000** 1,000**All Tiers10%Subject to Tier 1 deductible10%Subject to Tier 1 deductible20%Subject to Tier 1 deductibleTier 1 50**None** 50**Tier 2 100** 100** 100**InpatientadmissionInpatientadmission(thru EmergencyRoom)Outpatientsurgical servicesOut-of-pocketmaximum(Individual / Family)Tier 3 200** 200** 200**Tier 1 2,500 / 5,000 2,600 / 5,200 3,500 / 7,000Tier 2 4,750 / 9,500 5,000 / 10,000 5,500 / 11,000Tier 3Prescription drug34 day supplyRetailPharmacy 1020% ( 30 min, 80 max)32% ( 48 min, 80 max)Trinity HealthOwned Pharmacy40% ( 60 min, 100 max)MailOrderGenericBrand formulary 2416% ( 72 min, 192 max) 2520% ( 75 min, 200 max)Brandnon-formulary32% ( 144 min, 240 max)40% ( 150 min, 250 max)GenericBrand formularyBrandnon-formulary90 day supply 9,500 / 19,000Trinity HealthOwned Pharmacy 816% ( 24 min, 64 max)Out-of-pocket maximum based onTier 2 7,000 / 14,000Trinity HealthOwned PharmacyRetailPharmacy16% after20% afterdeductible†, 0%deductible†, 0%after out-of-pocket after out-of-pocketmaxmaxTrinity HealthOwned PharmacyMailOrder16% after20% afterdeductible†, 0%deductible†, 0%after out-of-pocket after out-of-pocketmaxmaxDeductible and out-of-pocketbased on Tier 1 9,000 / 18,000Trinity HealthOwned Pharmacy 820% ( 24 min, 64 max)RetailPharmacy 1025% ( 30 min, 80 max)40% ( 48 min, 96 max)Trinity HealthOwned Pharmacy50% ( 60 min, 120 max)MailOrder 2420% ( 72 min, 192 max) 2525% ( 75 min, 200 max)40% ( 144 min, 288 max)50% ( 150 min, 300 max)Out-of-pocket maximum based onTier 2The individual deductible and individual out-of-pocket maximum only apply to those enrolled in colleague-only coverage for the Health Savings Plan.For all other coverage levels, the full family deductible and family out-of-pocket maximum must be met even if only oneperson in the family is receiving care.*Reasonable and Customary (R&C), subject to deductible.**Subject to deductible and coinsurance.†Select, generic preventive drugs are covered at 100% and are not subject to the annual deductible. See the MyBenefits website for the complete list ofeligible drugs.1MercyOne Northeast Iowa7
Paying for Medical and Pharmacy CoverageContribution levels for the medical and pharmacy plans are based on the Social Security taxable wage base ( 128,400 for2018, indexed annually) to ensure our benefit plan cost-sharing model is appropriately aligned with our colleagues’ incomelevels. The amount you pay for medical and pharmacy coverage is based on your annual base salary (your base rate of paytimes your budgeted hours) and your participation in the Well-Being programs. If at any time during the 2019 plan year, youearn 128,400 or more, you will pay a higher premium contribution per pay period for your medical insurance.Full TimeYour per pay period costFullIncentiveTraditional Plan1- PersonNoIncentiveIncentiveHealth Savings PlanFull1 - sential Plan1 - PersonNoIncentiveIncentiveFor colleagues earning les s than the 2018 SSTWB‡ - Level 1 88.39N/A 103.39 56.95N/A 71.95 41.55N/A 56.55Colleague plus spouse/eligible adult 219.82 234.82 249.82 148.79 163.79 178.79 112.51 127.51 142.51Colleague plus child(ren) 154.87N/A 169.87 104.83N/A 119.83 79.27N/A 94.27Colleague plus family 274.77 289.77 304.77 185.99 200.99 215.99 140.64 155.64 170.64Colleague onlyFor colleagues earning the 2018 SSTWB or more‡ - Level 2Colleague only 105.15N/A 120.15 72.37N/A 87.37 55.66N/A 70.66Colleague plus spouse/eligible adult 256.69 271.69 286.69 182.71 197.71 212.71 143.55 158.55 173.55Colleague plus child(ren) 180.85N/A 195.85 128.73N/A 143.73 101.14N/A 116.14Colleague plus family 320.87 335.87 350.87 228.39 243.39 258.39 179.44 194.44 209.44NoIncentiveFullIncentiveTraditional PlanPart TimeYour per pay period costFullIncentive1- PersonIncentiveHealth Savings Plan1 - PersonIncentiveNoIncentiveEssential PlanFullIncentive1 - PersonIncentiveNoIncentiveFor colleagues earning less than the 2018 SSTWB‡ - Level 1Colleague only 149.87N/A 164.87 110.35N/A 125.35 79.91N/A 94.91Colleague plus spouse/eligible adult 346.63 361.63 376.63 258.43 273.43 288.43 189.86 204.86 219.86Colleague plus child(ren) 244.22N/A 259.22 182.08N/A 197.08 133.76N/A 148.76Colleague plus family 433.29 448.29 463.29 323.04 338.04 353.04 237.32 252.32 267.32For colleagues earning the 2018 SSTWB or more‡ - Level 2Colleague only 166.64N/A 181.64 125.77N/A 140.77 94.02N/A 109.02Colleague plus spouse/eligible adult 383.51 398.51 413.51 292.35 307.35 322.35 220.90 235.90 250.90Colleague plus child(ren) 270.20N/A 285.20 205.97N/A 220.97 155.63N/A 170.63Colleague plus family 479.39 494.39 509.39 365.43 380.43 395.43 276.13 291.13 306.13‡The 2018 Social Security taxable wage base (SSTWB) is 128,400.Need help with your health care costs?You may be eligible for the Essential Assist Plan (“Assist Plan”) if you meet certain incomerequirements. It is the same as the Essential Plan, but includes a Trinity Health-fundedHealth Reimbursement Account (HRA) to help you pay for your health care costs at the timeof service. To participate in the Assist Plan, you must apply and meet specific income andeligibility guidelines. To learn more, see the application form on the MyBenefits website.Apply by submitting a completed application form with a copy of your most recent FederalIncome Tax Form 1040 or 1040EZ to Human Resources.How do theIncentives work?For more informationon how to achieve Fulland 1-Personincentives, see the LiveYour Whole Life sectionfor more details.NOTE: If you think you qualify for the Assist Plan, you should elect the medical plan youthink will be best for you – which could be the Traditional Plan, the Health Savings Plan, orthe Essential Plan. If you qualify for the Assist Plan, you will be moved to the Assist Plan.Otherwise, you will remain in the plan you elected.MercyOne Northeast Iowa8
More about the HealthSavings PlanThe Health Savings Plan is aconsumer-driven health plan whichgives you the opportunity to participatein a plan where your health care costsare more closely determined by yourdecisions.How the Health Savingsplan works:FirstSecondThirdYou pay the full cost ofmedical and prescriptionexpenses until you reachthe annual deductible.(Note: preventive careservices and certainpreventive 90-daygeneric prescriptions donot require you to meetthe deductible).Once you meet thedeductible, you paycoinsurance until youreach the out-of-pocketmaximum. A combineddeductible means the fullfamily deductible must bemet even if only oneperson in the family isreceiving care.Coinsurance begins oncethe combined deductiblehas been met.Once you reach theout-of-pocket maximum,Trinity Health pays 100%of all remaining eligibleexpenses during the year.How the Health Savings Account (HSA) worksWhen you enroll in the Health Savings Plan, you automatically have a HealthSavings Account (HSA) through Health Equity to help you pay for current orfuture health care costs. Trinity Health will make a full contribution to youraccount in January based on the coverage level you elect. In addition, youcan also contribute to this account up to IRS limits:Coverage LevelColleague onlyAll other coverage levelsTrinity HealthContributions† 650Your VoluntaryContributions*† 2,850Total IRS AllowedHSA Contributions 3,500 1,300 5,700 7,000*If you are 55 or older, you can contribute an additional 1,000 in catch-up contributions to your HSA.†May be subject to state taxation.Questions about the HSAHow do I get an HSA? To be eligible for the HSA, you must enroll in theHealth Savings Plan. In addition, you cannot have coverage under anothernon-high deductible health plan, such as Medicare, TRICARE, or coveragethrough a spouse’s health plan.Who can use funds in my HSA? You and your dependents can pay formedical, dental, vision and pharmacy expenses with funds in your HSA.Dependents must be claimed on your tax return.Why would I contribute to my HSA? Contributions to the HSA are a greatway to save on taxes. With the HSA, you do not pay taxes on the amount youcontribute through payroll deductions, the amount you withdraw for medicalexpenses, and the interest you earn in the account (up to amounts set byfederal law)†. We encourage you to consult with a tax advisor for IRS rulesand tax implications related to an HSA. Keep in mind that you can change theamount you contribute to your HSA at any time during the plan year.How can I use the money in my HSA? You may use the HSA to pay forqualified medical, dental, vision and pharmacy expenses now and duringretirement for you and your qualified dependents.How do I pay for medical expenses with my HSA? When you receiveeligible health care services, you can pay for those services with your HSAdebit card, or through several online and smartphone app options. You’llreceive more information about your payment options if you enroll in theHealth Savings Plan with the HSA.What happens if I don’t use all the money in my HSA each year? Anymoney you do not use during the year is carried over, without any limits.Remember, you own the money in your HSA and it is yours to keep – evenwhen you change jobs or retire.Can I enroll in the Health Care Flexible Spending Account (HCFSA) ifI have an HSA? When you enroll in the Health Savings Plan which includesKeep in mind, the plan pays 100% forcertain generic prescription drugs,diabetes and asthma drugs before yourdeductible is met.For more information about the HealthSavings Plan, including the HealthSavings Account (HSA), visitwww.healthequity.com/ed/trinityhealthor http://mybenefits.trinity-health.org.MercyOne Northeast Iowathe HSA, you will not have access to the health care flexible spendingaccount (HCFSA). However, the HSA may be seen as having moreadvantages over the HCFSA including: The opportunity to carry over savings from year to year – you do not forfeitany amount in your HSA at the end of the plan year (if you are currentlyenrolled in the HCFSA for 2018 and you elect the HSA for 2019, you mustutilize your HCFSA funds by Dec. 31, 2018); Contributions of up to 7,000 in tax-free HSA dollars each year (theHCFSA maximum is 2,650); Your HSA dollars are saved in a bank account that may earn interest.†May be subject to state taxation.9
Live Your Whole LifeStaying healthy all the way around - in body, mind, and spirit - makes us happier and more productive at home and on the job. AtTrinity Health, we believe that an annual Health Assessment and healthy activities are essential steps in understanding yourwell-being. It’s so important that we provide an incentive when you and your covered spouse or eligible adult complete these steps.Here’s how this year’s program will work:All colleagues start with the Full Incentive amounts andwill get the full incentive for the first calendar year. Nextyear you will need to complete the incentives in order tomaintain the lowest possible premiums.Incentive StructureThere are separate incentive amounts for colleaguesand spouses/eligible adults. If both you and yourspouse/eligible adult complete the activities in eachperiod, you will maintain the Full Incentive amounts.If only one of you completes the activities in eachperiod, you will only maintain a 1-Person Incentiveamount. (See the section “Paying for MedicalCoverage” for contribution rates with Full and1-Person Incentives.)More About the Medical and Pharmacy PlansBe a smart health care consumerAs you know, the cost of high-quality health care continues to increase each year. Being a smart consumer meansgetting the best price on something you need, whether it’s a new car or health care.Being a smart health care consumer doesn’t mean you should avoid trips to the doctor – it means making the bestdecisions about when to go to the doctor. Regular checkups can improve your health and extend your life. By gettingthe recommended exams and tests, you increase your chances of discovering problems before an illness significantlyaffects your health. Plus, preventive care is beneficial not only to your physical well-being, it also makes sense for yourfinancial health because generally, it’s covered by your medical plan. For more information on preventive care benefits,visit http://mybenefits.trinity-health.org.An easy way to be a smart health care consumer is to choose a Trinity Health Tier 1 provider when you or a familymember needs medical care. Besides receiving excellent care at our own facilities, you receive the highest level ofbenefits while paying the lowest available copayment and coinsurance amounts.Discounted prescriptions available at your MercyOne Waterloo Pharmacy, MercyOne JesupPharmacy and MercyOne LaPorte City PharmacyRemember, purchasing your medications at your MercyOne Waterloo Pharmacy, MercyOne Jesup Pharmacy andMercyOne LaPorte City Pharmacy may save you money. Also, you can fill prescriptions for up to a 90-day supply ofyour medications at our own pharmacy. See your MercyOne Waterloo, MercyOne Jesup or MercyOne Laporte Citypharmacist for more information.Maintenance Choice program for your maintenance medicationsOur prescription drug plan requires that you receive your maintenance medications* in 90-day supplies through yourTrinity Health owned pharmacy or through the CVS Caremark Mail Service Pharmacy. Once you reach your plan limit(initial fill and 2 refills) for filling 30-day supplies at a retail pharmacy, you will pay the full cost of your medications if youdo not move your prescription to one of the long-term options listed above.*A maintenance medication is a long-term medication taken regularly for chronic conditions or long-term therapy.MercyOne Northeast Iowa11
Dental CoverageYou have a choice between two Delta Dental of Michigan plan options: the High plan and the Standard plan. Our plans utilizethe Delta Premier and PPO networks. Visit www.deltadentalmi.com for providers in your area.Dental Plan HighlightsHigh PlanParticipating DentistNonparticipating DentistStandard PlanParticipating DentistNonparticipating DentistAnnual deductibleIndividual/FamilyClass I - Preventive services 25/ 50 50/ 100 50/ 100 100/ 150100% covered100% covered100% covered100% covered( 0 colleague cost)(Usual and Customary( 0 colleague cost)(Usual and Customaryrates apply)rates apply)Class II - Basic services20% after deductible20% after deductible40% after deductible40% after deductibleClass III - Major restorative services40% after deductible40% after deductible50% after deductible50% after deductibleClass IV - Orthodontics50% after deductible50% after deductiblePer person annual (non-orthodontics) 1,750 1,250 1,500 1,000Per person lifetime (orthodontics) 1,500 1,500Not applicableNot applicableFull-timePart-timeFull-timePart-timeNot coveredMaximumsYour per pay period costColleague only 9.13 9.90 6.45 6.99Colleague plus spouse/eligible adult 18.27 19.79 12.90 13.97Colleague plus child(ren) 20.55 22.26 14.51 15.72Colleague plus family 29.69 32.16 20.96 22.70NOTE: When you receive services from a non-participating dentist, you will be responsible for the difference between what yourdentist charges and the Delta Dental non-participating dentist fee. Fluoride treatments are covered once every 12 months up toage 19. Bitewing x-rays are covered once every 12 months.For more information about yourdental plan options or aboutDelta Dental, visithttp://mybenefits.trinity-health.org.MercyOne Northeast Iowa12
Vision Care CoverageYou have a choice between two United Health Care vision plan options: the High plan and the Standard plan. Visitwww.myuhcvision.com for providers in your area.UHC Vision Plan HighlightsHigh PlanStandard PlanIn-networkOut-of-network(reimbursement schedule)In-networkOut-of-network(reimbursement schedule)Benefit frequencyCalendar yearVision examCovered in fullCalendar yearCalendar yearCalendar yearUp to 40 10 copaymentUp to 40Pair of lensesSingle visionBifocalUp to 40 0 copaymentUp to 60TrifocalUp to 80LenticularUp to 80FramesCovered frame 150 retail allowanceUp to 45at retail locationsUp to 40 0 copaymentUp to 60Up to 80Up to 80 150 retail allowanceUp to 45at retail locationsNon-covered frameContact lenses(in lieu of eyeglasses)ElectiveNecessaryContact lens coverage is provided under the plan and may vary dependent on the type of contact lensesprescribed. Please see the benefit summary on My Benefits for additional information.Additional pair of eyeglassesor contact lensesAdditional lens options20% discount20% discountThe following lens20% discount20% discountThe following lens optionsoptions are covered inare covered in full:full: standard scratch-standard scratch-resistantresistant coating, standardcoating, standardbasic and high-endpolycarbonate lensesprogressive lenses,standard polycarbonatelenses, standard antireflective coating, UV,tints, photochromic,Transitions , edge coatingYour per pay period costColleague only 5.29 3.17Colleague plusspouse/eligible adult 10.98 5.81Colleague plus child(ren) 11.52 6.11Colleague plus family 16.22 8.43Children’s Eye Care ProgramBeginning in Jan. 2019, the Vision Plan is adding additional benefits for covered dependent children under age 13.Dependent children will be able to receive a second eye exam each calendar year. If a covered child experiences aprescription change of .5 diopter or greater, the enhanced benefit also provides for an additional pair of glasses. Copaysfor the exam and glasses still apply. This benefit ends on the covered child’s 13th birthday.For more information about yourvision care plan options, visithttp://mybenefits.trinity-health.org.MercyOne Northeast Iowa13
Health Care and Dependent Care Flexible Spending AccountsYou have the opportunity to set aside before-tax money to offset eligible health care or dependent care expenses. There aretwo different types of Flexible Spending Accounts – a Health Care Flexible Spending Account (HCFSA) and a Dependent CareFlexible Spending Account (DCFSA).Health Care Flexible Spending Account (HCFSA)Dependent Care Flexible Spending Account (DCFSA)How much can I contribute?Before-tax dollars in any amount between 130 and 2,650Before-tax dollars in any amount between 130 and 5,000What expenses will it cover?Eligible health care products and services used by youand/or your eligible dependents. Examples include:Expenses for the care of your eligible dependents (childunder age 13 or qualifying adult incapable of self-care)while you work: Vision care, including eyeglasses, contact lenses andsaline solution Babysitting or au pair services Dental care, both preventive and restorative Before and after-school programs Orthodontia Day care and nursery school Physical therapy, counseling, or psychological Pre-school programsservices Chiropractic care and acupuncture Elder care services Copayments, coinsurance and deductibles Prescribed Over-the-Counter (OTC) medicationsFor a list of expenses that are eligible for HCFSA reimbursement, visit http://mybenefits.trinity-health.org.When do I have to spend themoney?Contributions made to the HCFSA during the 2019calendar year can be used for claims with dates ofservice between Jan. 1, 2019 and Mar. 15, 2020.Contributions made to the DCFSA during the 2019calendar year can be used for claims with dates ofservices between Jan. 1 and Dec. 31, 2019.How do I access my FSAsavings?You can use a variety of payment options to access yourFSA savings. These include the WageWorks HealthCard, Pay my Provider, Pay me Back, or by using theMobile application.You can use a variety of payment options to access yourFSA savings. These include the Pay my Provider, Payme Back, or by using the Mobile application.Reminders: If you choose to enroll in the Health Savings Plan medical plan option, you cannot enroll in the HCFSA. The HealthSavings Account (HSA) works just like the HCFSA but offers additional benefits, such as the opportunity to carry overunused funds, contribute up to 2,850/individual ( 5,700/family), plus an additional 1,000
Trinity Health encourages you to select a PCP and develop a relationship with them. You and your covered dependents will be required to select a PCP. Be sure to indicate your PCP through the medical vendor's online portal. If no PCP is indicated, the Plan will auto-assign based on claim history, Tier 1 physician within
