2018 Mercyhealth Partner Benefits Book
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2018 Mercyhealth Partner Benefits Book
Table of Contents Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Health insurance benefits overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CHIP notification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 MercyCare EPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 EPO Summary of coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 MercyCare EPO HDHP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 EPO HDHP Summary of coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 MercyCare PPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 PPO Summary of coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 MercyCare PPO HDHP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 PPO HDHP Summary of coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Prescription drug coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Dental insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Vision appliance insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Life insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Mercy Health Corporation employees’ retirement plan . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Flex spending plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Voluntary benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Short-term disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Long-term disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Domestic partner coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Important contact information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Qualifying event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Mercyhealth Benefits
Welcome to our 2018 partner benefit book
Whether you are reviewing this at Open Enrollment or if you’re a new hire, this book is filled with
important information for you and your family.
Our partners are our most valuable resource. As such, Mercyhealth is committed to offering a
comprehensive partner benefit program with multiple options to meet the varied needs of our partners.
Health and dental premiums are paid with pre-tax dollars and we offer multiple ways for partners to set
aside other pre-tax dollars with flexible spending accounts and health savings accounts. Some benefits
are paid for completely by Mercyhealth, some the cost is shared, and for a few voluntary options, the
partner pays the entire cost but enjoys the benefit of group pricing.
We encourage you to review the materials thoroughly and make your decisions carefully. Please
contact your Human Resources representatives if you would like additional information or have any
questions about these benefits, policies or services.
Programs and policies can be modified, changed or discontinued at any time at the discretion of
Mercyhealth.
Coverage begins: For open enrollment, January 1, 2018.
For a new partner, or newly benefit eligible partner, under the following schedule:
First of the month following 30 days of First of the month following 90 days of
employment or eligibility employment or eligibility
• Health insurance • Life insurance
• Dental insurance • Universal life insurance
• Vision Insurance
• MetLife critical illness, accident, hospitalization and • Short-term disability
pet insurance • Long-term disability
• Flex spending accounts
Important Be sure to read
Please refer to summary plan this booklet carefully before making
descriptions or plan documents for your benefit selections.
additional information. If there is a This booklet is a summary of benefits
conflict between this material and the available.
plan documents, the plan documents
Contact Human Resources for
govern.
additional information.
1Health insurance benefits overview
Vendor: MercyCare
You and Mercyhealth share responsibility for the cost of the health care coverage for you, your spouse/
domestic partner, and qualified dependents. Under the Affordable Care Act, eligibility is determined by
the number of hours you work over a pre-determined eligibility period. Partners who work an average
of 30 hours per week or more are considered full-time for health insurance premium purposes.
Partners who work an average of 20-29 hours per week are considered part-time for health insurance
premium purposes. Your premium contribution also depends on who is covered and the type of plan
you choose.
Partners and their spouse/domestic partner enrolling in health insurance that are tobacco-free will be
eligible for a reduction in their health insurance premium. To receive the appropriate premium, partners
and their spouse/domestic partner must attest that they are tobacco-free when enrolling online.
Partners eligible for health insurance who choose not to elect coverage are required to waive coverage.
Partners who do not enroll or waive coverage will automatically be enrolled in the MercyCare
EPO HDHP plan.
Monthly Premium Contributions
Non-Tobacco User Tobacco User
MercyCare MercyCare MercyCare MercyCare MercyCare MercyCare MercyCare MercyCare
EPO EPO HDHP PPO PPO HDHP EPO EPO HDHP PPO PPO HDHP
Full-Time
Partner $109.20 $89.52 $153.28 $170.50 $159.20 $139.52 $203.28 $220.50
Partner + Spouse $270.02 $308.00 $374.34 $416.50 $320.02 $358.00 $424.34 $466.50
Partner + Child(ren) $218.40 $252.12 $306.54 $341.00 $268.40 $302.12 $356.54 $391.00
Partner + Family $420.67 $480.00 $583.44 $649.00 $470.67 $530.00 $633.44 $699.00
Part-Time
Partner $196.56 $217.74 $264.26 $294.50 $246.56 $267.74 $314.26 $344.50
Partner + Spouse $457.86 $505.12 $613.92 $683.06 $507.86 $555.12 $663.92 $733.06
Partner + Child(ren) $393.12 $435.48 $529.46 $589.00 $443.12 $485.48 $579.46 $639.00
Partner + Family $713.31 $787.20 $956.84 $1,064.36 $763.31 $837.20 $1,006.84 $1,114.36
Self-Employed Family Members: MercyCare insurance plans do not cover health care costs related
to injuries on the job. Mercyhealth partners with self-employed family members are advised to obtain
workers compensation coverage for those members who are on their MercyCare plan.
Domestic Partner Coverage: Health insurance coverage is an eligible domestic partner benefit. See
page 25 for details.
2Health insurance eligibility for adult child(ren)
Your adult child(ren) can be added to your MercyCare health insurance plan at the time of hire,
qualifying event or open enrollment if they are less than 26 years old (regardless of marital status).
Your adult child(ren) can choose to stay on your health plan until the end of the month in which they
turn age 26, even if they are eligible for their own employer-sponsored insurance plan.
Military dependent–requires individual consultation.
CHIP notification
Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from
Mercyhealth, the state you live in may have a premium assistance program that can help pay for
coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for
Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able
to buy individual insurance coverage through the Health Insurance Marketplace. For more information,
visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in Wisconsin, you can
contact the Wisconsin Medicaid office at (800) 362-3002, or view (https://www.dhs.wisconsin.gov/
publications/p1/p100095.pdf) to find out if premium assistance is available.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in Illinois, you can
contact the Illinois Comprehensive Health Insurance Plan at (800) 962-8384 or email infodesk.chip@
illinois.gov.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of
your dependents might be eligible for either of these programs, you can contact your state Medicaid or
CHIP office or dial (877) KIDS NOW or visit insurekidsnow.gov to find out how to apply. If you qualify,
you can ask your state if it has a program that might help you pay the premiums for an employer-
sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as
eligible under a MercyCare health insurance plan, Mercyhealth must allow you to enroll in a plan if
you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request
coverage within 60 days of being determined eligible for premium assistance. If you have questions
about enrolling in a health insurance plan contact the Department of Labor at askebsa.dol.gov or
(866) 444-EBSA (3272).
If you live in a state other than Wisconsin and you would like to see if a premium assistance program is
available or you would like more information on special enrollment rights, you can contact either:
U.S. Department of Labor U.S. Department of Health
Employee Benefits Security Administration and Human Services
www.dol.gov/ebsa Centers for Medicare & Medicaid Services
(866) 444-EBSA (3272) www.cms.hhs.gov
(877) 267-2323, ext. 61565
3MercyCare EPO
Monthly premium contribution
Non-Tobacco User Tobacco User
MercyCare EPO MercyCare EPO
Full-Time
Partner $109.20 $159.20
Partner + Spouse $270.02 $320.02
Partner + Child(ren) $218.40 $268.40
Partner + Family $420.67 $470.67
Part-Time
Partner $196.56 $246.56
Partner + Spouse $457.86 $507.86
Partner + Child(ren) $393.12 $443.12
Partner + Family $713.31 $763.31
MercyCare EPO summary of benefits
The foundation of MercyCare Health Plans is to have each MercyCare member develop a caring,
professional relationship with a Primary Care Physician (PCP) who will coordinate and manage their
medical care. All MercyCare plans require members to use the provider network established except in
the case of emergency care.
Provider network
This is a group of providers contracted with the plan to provide services for members within a specific
geographic location as specified in MercyCare’s Provider Directory. A participating provider is a specific
provider who is listed in the MercyCare Provider Directory as a participating provider in the specific
network.
Choosing a primary care physician (PCP)
A PCP is a doctor who practices in one or more of these fields: Family Medicine, Internal Medicine
and Pediatrics. Each family member must select a doctor in one of these fields. Women may select an
OB/GYN for routine gynecologic and obstetrical care, yet must still select a PCP for all other services.
Please refer to our Provider Directory for a complete list of network PCPs.
Specialist providers
MercyCare Health Plans has a comprehensive list of specialists to meet the health care needs of
its members. You do not need a referral from your PCP to see any network specialists, but you are
encouraged to coordinate specialist care with your PCP.
Emergency care
Members who have a medical emergency within the MercyCare service area should, if possible,
seek immediate attention at the nearest network provider. Members who have a medical emergency
outside the MercyCare network should seek care at the nearest emergency facility. MercyCare should
be notified within 48 hours, or as soon as possible.
4EPO Network Providers Non-Network Providers
Summary of coverage You Pay You Pay
Deductible $0 single, $0 family N/A
Coinsurance 10% coinsurance N/A
Office visit charge-Primary Care Provider $30 copay N/A
Office visit charge-Specialist $40 copay N/A
Medical maximum out of pocket $3,000 single, $6,000 family N/A
RX maximum out of pocket $3,600 single, $7,200 family N/A
Preventive services $0 Not covered
Diagnostic services (lab and x-ray) includes 10% coinsurance Not covered
office location
Hospital inpatient services** $750 copay per hospital admission Not covered
per stay per member. 10% coinsurance
Hospital outpatient services** 10% coinsurance Not covered
Emergency room charge (waived upon admission) $100 copay $100 copay
Ambulance $0 $0
Urgent and immediate care charge $50 copay $60 copay
Mental health inpatient** $750 copay per hospital admission per Not covered
stay per member. 10% coinsurance
Mental health day treatment** 10% coinsurance Not covered
Mental health outpatient $30 copay Not covered
Durable medical equipment & prosthetics 20% coinsurance Not covered
Physical, speech and occupational therapy 10% coinsurance Not covered
Stay Healthy Benefit $200 maximum benefit per year per N/A
adult / $400 maximum per family
**Prior authorization required for these services
Prescription Drug Coverage
Tier 1 $15 copay
Tier 2 $30 copay or 20% coinsurance
up to max $50
Tier 3 $100 copay or 50% coinsurance
up to max $150
Tier 4 25% coinsurance
These benefits are a partial outline of health services under the Policy. Refer to your Schedule of
Benefits for applicable limits to these health services. If differences exist between this Summary and
the Summary Plan Description (SPD), the SPD governs.
5MercyCare EPO High deductible health plan (HDHP)
Monthly premium contribution
Non-Tobacco User Tobacco User
MercyCare EPO HDHP MercyCare EPO HDHP
Full-Time
Partner $89.52 $139.52
Partner + Spouse $308.00 $358.00
Partner + Child(ren) $252.12 $302.12
Partner + Family $480.00 $530.00
Part-Time
Partner $217.74 $267.74
Partner + Spouse $505.12 $555.12
Partner + Child(ren) $435.48 $485.48
Partner + Family $787.20 $837.20
MercyCare EPO HDHP summary of benefits
The foundation of MercyCare Health Plans is to have each MercyCare member develop a caring,
professional relationship with a Primary Care Physician (PCP) who will coordinate and manage their
medical care. All MercyCare plans require members to use the provider network established except in
the case of emergency care.
Provider network
This is a group of providers contracted with the plan to provide services for members within a specific
geographic location as specified in MercyCare’s Provider Directory. A participating provider is a specific
provider who is listed in the MercyCare Provider Directory as a participating provider in the specific
network.
Choosing a primary care physician (PCP)
A PCP is a doctor who practices in one or more of these fields: Family Medicine, Internal Medicine
and Pediatrics. Each family member must select a doctor in one of these fields. Women may select an
OB/GYN for routine gynecologic and obstetrical care, yet must still select a PCP for all other services.
Please refer to our Provider Directory for a complete list of network PCPs.
Specialist providers
MercyCare Health Plans has a comprehensive list of specialists to meet the health care needs of
its members. You do not need a referral from your PCP to see any network specialists, but you are
encouraged to coordinate specialist care with your PCP.
Emergency care
Members who have a medical emergency within the MercyCare service area should, if possible,
seek immediate attention at the nearest network provider. Members who have a medical emergency
outside the MercyCare network should seek care at the nearest emergency facility. MercyCare should
be notified within 48 hours, or as soon as possible.
6EPO HDHP Network Providers Non-Network Providers
Summary of coverage You Pay You Pay
Deductible $2,700 single, $7,000 family N/A
Coinsurance 0% coinsurance after deductible N/A
Office visit charge-Primary Care Provider 0% coinsurance after deductible N/A
Office visit charge-Specialist 0% coinsurance after deductible
Medical and RX maximum out of pocket $2,700 single, $7,000 family N/A
Preventive services $0 Not covered
Diagnostic services (lab and x-ray) 0% coinsurance after deductible Not covered
Hospital inpatient services** 0% coinsurance after deductible Not covered
Hospital outpatient services** 0% coinsurance after deductible Not covered
Emergency room charge (waived upon admission) 0% coinsurance after deductible 0% coinsurance after
deductible
Ambulance 0% coinsurance after deductible 0% coinsurance after
deductible
Urgent and immediate care charge 0% coinsurance after deductible 0% coinsurance after
deductible
Mental Health inpatient** 0% coinsurance after deductible Not covered
Mental Health day treatment** 0% coinsurance after deductible Not covered
Mental Health outpatient 0% coinsurance after deductible Not covered
Durable medical equipment and prosthetics 0% coinsurance after deductible Not covered
Physical, speech and occupational therapy 0% coinsurance after deductible Not covered
Stay Healthy Benefit $200 maximum benefit per adult / $400
maximum per family
**Prior authorization required for these services
Prescription Drug Coverage
Tier 1-4 0% coinsurance after deductible
These benefits are a partial outline of health services under the Policy. Refer to your Schedule of Benefits for
applicable limits to these health services. If differences exist between this Summary and the Summary Plan
Description (SPD), the SPD governs.
Health Savings Account (HSA). Partners choosing this plan have the option to participate and make
contributions to a Health Savings Account. The money that contribute to your HSA is portable, meaning
that it is not subject to the “use it or lose it” rules that Flex Spending Accounts (FSA) have and can be
carried over from year to year. Partners who choose to participate in this plan and also participate in the
Mercyhealth Flex Spending Account will be required to participate in a limited purpose Flex Spending
Account.
7MercyCare PPO
Monthly premium contribution
Non-Tobacco User Tobacco User
MercyCare PPO MercyCare PPO
Full-Time
Partner $153.28 $203.28
Partner + Spouse $374.34 $424.34
Partner + Child(ren) $306.54 $356.54
Partner + Family $583.44 $633.44
Part-Time
Partner $264.26 $314.26
Partner + Spouse $613.92 $663.92
Partner + Child(ren) $529.46 $579.46
Partner + Family $956.84 $1,006.84
MercyCare PPO coverage levels and providers
Tier 1: MercyCare PPO provides the highest level of benefits whenever you obtain health care services
from a Mercyhealth provider. Tier 1 providers are listed in the Provider Directory. The highest level of
benefit is described in the Tier 1 Benefits column of the Schedule of Benefits. 1. On the web, go to
mercycarehealthplans.com. 2. Click on find a doctor/facility. 3. Select MercyCare PPO and then
follow the instructions.
Tier 2: Tier 2 providers are those who are not Tier 1 providers but are found in the First Health complementary
network of providers. When you use this level of benefits, you pay a greater share of the cost of health care
services you receive. This level of benefit is described in the Tier 2 Benefits column of the Schedule of Benefits.
On the web go to firsthealthcomplementary.com to find the providers who are participating at this level.
Please be aware that even though the following providers/hospital groups may be found on the First
Health complementary website, they are not available to you as a Tier 2 provider: Aurora Health Care,
Beloit Health System, SSM Health – formerly Dean Health System/St. Mary’s Hospital, OSF HealthCare
System, Swedish American Health System.
Tier 3: A Tier 3 provider is any provider who is not listed in the MercyCare Provider Directory or on the First
Health complementary website (excluding those providers listed above). When you use this level of benefits,
you pay the greatest share of the cost of health care services you receive. Tier 3 benefits are subject to usual
and customary charge limitations. This tier of benefit is described in the Tier 3 benefits column of the Schedule
of Benefits.
8PPO Summary of coverage Tier 1 Tier 2 Tier 3
Deductible $0 single, $0 family $0 single, $0 family $0 single, $0 samily
Coinsurance 15 % coinsurance 25 % coinsurance 50 % coinsurance
Office visit charge-Primary $30 copay $50 copay $60 copay
Care Provider
Office visit charge-specialist $40 copay $60 copay $70 copay
Medical maximum out of pocket $3,250 single, $6,500 family $8,000 Single, $16,000 Family
(Level 1 and Level 2 combined)
RX maximum out of pocket $3,600 single, $7,200 family
Preventive Services $0 $0 50% coinsurance
Diagnostic Services (lab and 15% coinsurance 25% coinsurance 50% coinsurance
x-ray), includes office location
Hospital inpatient services** $800 copay per hospital $1,600 copay per hospital $3,500 copay per hospital
admission per stay per admission per stay per admission per stay per
member. 15% coinsurance member. 25% coinsurance member. 50% coinsurance
Hospital outpatient services** 15% coinsurance 25% coinsurance 50% coinsurance
Emergency room charge $100 copay $100 copay $100 copay
(waived upon admission)
Ambulance $0 $0 $0
Urgent care charge $50 copay $75 copay $75 copay
Mental health inpatient** $800 copay per hospital $1,600 copay per hospital $3,500 copay per hospital
admission per stay per admission per stay per admission per stay per
member. 15% coinsurance member. 25% coinsurance member. 50% coinsurance
Mental health day treatment** 15% coinsurance 25% coinsurance 50% coinsurance
Mental health outpatient $30 copay $50 copay $60 copay
Durable medical equipment 20% coinsurance 25% coinsurance 50% coinsurance
and prosthetics
Physical, speech and 15% coinsurance 25% coinsurance 50% coinsurance
occupational therapy
Stay Healthy Benefit $200 maximum benefit per N/A N/A
adult / $400 maximum per
family
**Prior authorization required for these services
Prescription Drug Coverage
Tier 1 $15 copay
Tier 2 $30 copay or 20% coinsurance up to max $50
Tier 3 $100 copay or 50% coinsurance up to max $150
Tier 4 25% coinsurance
These benefits are a partial outline of health services under the Policy. Refer to your Schedule of Benefits for
applicable limits to these health services. If differences exist between this Summary and the Summary Plan
Description (SPD), the SPD governs.
9MercyCare PPO HDHP
Monthly premium contribution
Non-Tobacco User Tobacco User
MercyCare PPO HDHP MercyCare PPO HDHP
Full-Time
Partner $170.50 $220.50
Partner + Spouse $416.50 $466.50
Partner + Child(ren) $341.00 $391.00
Partner + Family $649.00 $699.00
Part-Time
Partner $294.50 $344.50
Partner + Spouse $683.06 $733.06
Partner + Child(ren) $589.00 $639.00
Partner + Family $1,064.26 $1,114.36
MercyCare PPO HDHP coverage levels and providers
Tier 1: MercyCare PPO provides the highest level of benefits whenever you obtain health care services
from a Mercyhealth provider. Tier 1 providers are listed in the Provider Directory. The highest level of
benefit is described in the Tier 1 Benefits column of the Schedule of Benefits. 1. On the web, go to
mercycarehealthplans.com. 2. Click on find a doctor/facility. 3. Select MercyCare PPO and then
follow the instructions.
Tier 2: Tier 2 providers are those who are not Tier 1 providers but are found in the First Health complementary
network of providers. When you use this level of benefits, you pay a greater share of the cost of health care
services you receive. This level of benefit is described in the Tier 2 Benefits column of the Schedule of Benefits.
On the web go to firsthealthcomplementary.com to find the providers who are participating at this level.
Please be aware that even though the following providers/hospital groups may be found on the First
Health complementary website, they are not available to you as a Tier 2 provider: Aurora Health Care,
Beloit Health System, SSM Health – formerly Dean Health System/St. Mary’s Hospital, OSF HealthCare
System, Swedish American Health System.
Tier 3: A Tier 3 provider is any provider who is not listed in the MercyCare Provider Directory or on the First
Health complementary website (excluding those providers listed above). When you use this level of benefits,
you pay the greatest share of the cost of health care services you receive. Tier 3 benefits are subject to usual
and customary charge limitations. This tier of benefit is described in the Tier 3 benefits column of the Schedule
of Benefits.
10PPO HDHP Summary of coverage Tier 1 Tier 2 Tier 3
Deductible $2,700 single, $3,500 family $3,500 single, $7,000 family $7,000 single, $14,000 family
Coinsurance 0% coinsurance 0% coinsurance 0% coinsurance
Office visit charge-Primary 0 after deductible 0 after deductible 0 after deductible
Care Provider
Office visit charge-specialist 0 after deductible 0 after deductible 0 after deductible
Medical and RX maximum $2,700 single, $3,500 family $3,500 single, $7,000 family $7,000 single, $14,000 family
out of pocket (Integrated)
Stay Healthy Benefit $200 maximum benefit per year per adult / $400 maximum benefit per family
Preventive Services 100% coverage 100% coverage 100% coverage
Diagnostic services (lab and 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
x-ray), includes office location
Hospital inpatient services** 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
Hospital outpatient services** 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
Emergency room charge 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
(waived upon admission)
Ambulance 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
Urgent and immedicate care charge 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
Mental health inpatient** 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
Mental health day treatment** 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
Mental health outpatient 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
Durable medical equipment 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
and prosthetics
Physical, speech and 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible
occupational therapy
** Prior authorization required for these services
Prescription Drug Coverage
Tier 1-4 0% coinsurance after deductible
These benefits are a partial outline of health services under the Policy. Refer to your Schedule of Benefits for
applicable limits to these health services. If differences exist between this Summary and the Summary Plan
Description (SPD), the SPD governs.
Health Savings Account (HSA). Partners choosing this plan have the option to participate and make
contributions to a health savings account. The money you contribute to your HSA is portable, meaning
that it is not subject to the “use it or lose it” rules that Flex Spending Accounts (FSA) have and can be
carried over from year to year. Partners who choose to participate in this plan and also participate in the
Mercyhealth Flex Spending Account, will be required to participate in a limited purpose Flex Spending
Account.
11Prescription drug coverage
Four-tier drug plan for MercyCare EPO and PPO plans
What is a four-tiered drug plan?
It incorporates four levels of benefits.
• Tier 1 is for preferred generic drugs. It has the lowest copay.
• Tier 2 covers our preferred brand name drugs and some select generics. It has the second lowest copay.
• Tier 3 represents all non-preferred brand and generic drugs.
• Tier 4 represents specialty drugs and will have coinsurance.
This drug plan uses a defined formulary, that lists covered drugs and tier placement. All drugs listed are
available to our members unless otherwise determined to be excluded. Our designated Pharmacy Benefit
Manager and/or MercyCare determine the placement of drugs within each tier of this formulary.
Other changes may occur to this formulary as determined by MercyCare or our designated Pharmacy Benefit
Manager. A current formulary is available online at mercycarehealthplans.com.
Paying for your prescription
Participating Pharmacy Benefits:
Tier 1: Preferred Generic Drugs:
• $15 copay per prescription drug order (30-day supply)
Tier 2: Preferred Brand Name and Select Generic Drugs:
• $30 minimum copay or 20% of total cost up to a maximum of $50 copay per prescription drug order
(30-day supply)
Tier 3: Non-preferred Brand and Non-preferred Generic Drugs:
• $100 minimum copay or 50% of total cost up to a maximum $150 copay per prescription drug order
(30-day supply)
If the price of your prescription drug is less than your copay, you will pay the lower amount.
Tier 4: Specialty Drugs:
• 25% of total cost. They do not typically qualify for mail order
The maximum out-of-pocket expense for this plan is $3,600 (single)/$7,200 (family). After reaching the
maximum out-of-pocket, prescriptions drugs are covered at 100%. If the price of your prescription drug is
less than your copay, you will pay the lower amount.
Prior approval
Certain formulary drugs require prior approval from MercyCare before coverage is provided. If you are
on a medication and would like to know if it requires a prior approval, please call Customer Service at
(800) 895-2421.
Non-covered drugs
• Fertility drugs.
•A ny drug or medicine that is taken by or administered to you while you are a patient in a licensed hospital,
rest home or sanitarium, extended care facility, convalescent hospital, skilled nursing facility or similar
institution.
•A nti-obesity and anorexients.
•P rescription drugs, that the eligible person is entitled to receive without charge from any Worker’s
Compensation laws or any municipal state or federal program.
12• Any drug when used for a cosmetic treatment or for the treatment of the aging process.
• Any drug when used for treatment of hair loss or excessive hair growth.
• Any medication used to obtain, treat or enhance sexual performance and/or function. This includes
dysfunction caused by organic diseases.
• Special formulations of covered drugs such as sustained release intended primarily for convenience of the
patient, as deemed by MercyCare, are not covered.
• Special packaging of covered drugs intended primarily for convenience of the patient, as deemed by
MercyCare, are not covered.
• Retin-A, for members age 40 and older.
Definitions
Generic: A generic equivalent means a prescription drug available from more than one drug manufacturer
that has the same active therapeutic ingredient as the brand or trade name prescription drug prescribed
to you.
Preferred drug: Branded and generic drugs on our preferred drug list as determined by our designated
Pharmacy Benefit Manager and MercyCare.
Non-preferred drug: All branded and generic drugs not on our preferred drug list.
Specialty drug: Drugs that typically require special storage, handling, or administration. Medications
included in this designation are required to be dispensed by a specialty pharmacy as noted in the formulary.
This is a Summary of Benefits only, and does not outline all the benefits and exclusions.
Mercyhealth pharmacy extended supply program
All Mercyhealth pharmacies offer the three-month supply for the price of two months. Partners have the
option to pick up their 90-day prescription at any Mercyhealth retail pharmacy. If they choose to have their
90-day supply mailed, the Mercyhealth Mall Pharmacy will continue to be the mail order pharmacy.
Not all medications are good candidates for extended supply. Examples are antibiotics, medications that are
taken on an “as needed” basis and medications that require special handling like refrigeration. This includes
the specialty drugs listed on Tier 4, which are only covered as a 30-day supply.
Extended supply copay reductions cannot be combined and are not additive with other copay reduction
programs, such as pill splitting. Partners can benefit from the incentive that reduces their copays the
greatest, but unfortunately cannot combine programs. For more information or to sign up call
(608) 755-8700 or (877) 597-6627.
Information is also available on the MercyCare website at mercycarehealthplans.com.
13Dental insurance
Vendor: Delta Dental IL
Your dental benefit plan provides a comprehensive program to ensure your dental health. Coverage is
included for important preventive care and also for treatment needed as a result of dental disease or
accidental injury. Partners hired to work 20 to 29 hours per week (.5 - .74 FTE) are considered part-time for
premium purposes. Partners hired to work 30 hours per week or more (.75 – 1.0 FTE) are considered full-
time for premium purposes.
The following summary does not cover all plan details. Further information can be found in the Summary Plan
description. That document provides a thorough explanation of your dental plan, including any limitations or
exclusions that might apply. If there are any discrepancies between information found here and the group
contract, the group contract shall govern.
Monthly Premium Contribution
Partner Partner + Partner +
Work Status Partner
+ Spouse Child(ren) Family
Full-Time $16.00 $34.00 $41.00 $59.00
Part-Time $22.00 $44.00 $55.00 $78.00
Dental insurance eligibility for adult child(ren)
Your adult child(ren) can be added to your Mercyhealth dental insurance plan at the time of hire, qualifying
event or open enrollment if they are less than 26 years old (regardless of marital status).
Your adult child(ren) can choose to stay on their parents dental plan until the end of the month in which they
turn age 26, even if they are eligible for their own employer-sponsored insurance plan.
Domestic partner coverage
Dental insurance coverage is eligible as a domestic partner benefit. See page 25 for details.
With Delta Dental PPO and Premier Networks:
• You can go to any licensed general or specialty dentist.
• You will maximize your benefits by receiving care from a Delta Dental PPO or Delta Dental Premier network
dentist.
• Delta Dental’s network dentists have agreed to reduced fees as payment in full, which means you will likely
save money by going to a Delta Dental PPO or Delta Dental Premier network dentist. Non-network dentists
have not agreed to accept our reduced fees as payment in full, which means they may bill you for any
charges over our allowed fees.
• You are charged only the patient’s share at the time of treatment. Delta Dental pays its portion directly to
network dentists.
• Enhanced Benefit Program offers additional coverage for individuals who have specific health conditions
(including pregnancy, diabetes, high-risk cardiac conditions, and suppressed immune systems) that can be
positively affected by additional oral health care.
Member Connection
You may register on Delta Dental of Illinois’ website, deltadentalil.com. Once registered, you can get
real time benefit information, check claim status, sign up for electronic Explanation of Benefits and print a
temporary ID card.
14Finding a dentist
Visit our website, deltadentalil.com and click on Provider Search.
Example of Your Copayment with Delta Dental Network Dentists and Non-Network Dentists
• Delta Dental PPO: Lowest out-of-pocket costs and network protection.
• Delta Dental Premier: Higher out-of-pocket costs than PPO, but may be lower than non-network and
network protection.
• Non-network: You may have the highest out-of- pocket costs.
Customer Service
Call (800) 323-1743 to access our automated phone system or speak to a Customer Service Representative
from 7 am to 7 pm, Monday through Thursday and 7 am to 6 pm, Friday, Central Time. Our automated phone
system is available 24 hours a day, seven days a week, and offers dentist listings and claim information.
You can also connect with us through our mobile app, Facebook, Twitter, our blog and more.
Learn more
You can learn more about your Delta Dental of Illinois dental plan by reading the information included in your
enrollment kit.
The information on the following page is a brief summary of your dental plan and the services it
covers. There are some limitations on the expenses for which your dental plan pays. If you have
specific questions regarding benefit coverage, limitations, exclusions, or non-covered services, please
refer to your Certificate of Coverage/Dental Benefit Booklet or contact Delta Dental of Illinois.
The patient’s share is the coinsurance/copayment, any remaining deductible any amount over the
annual maximum and any services your plan does not cover.
Note: Delta Dental imposes no restrictions on the method of diagnosis or treatment by a treating
dentist. A benefit determination relates only to the level of payment that your group dental plan is
required to make.
The American Dental Association recommends that a child’s first dental visit be by age one or the
first tooth – whichever is sooner. It is suggested to add the newborn at time of birth or next open
enrollment. If you would like more information on this recommendation, visit ada.org.
15Delta Dental insurance
Summary of benefits and covered services
Tier 1 Tier 2 Tier 3
Prescription drug coverage
Annual Maximum $1,500/person $1,500/person $1,500/person
Annual Deductible $50/person $50/person $100/person
(applies to Basic/Major only) $100/family $100/family $300/family
Dependents eligible to age 26 Delta Dental PPO Network Delta Dental Premier Network Out-of-Network
Preventive/diagnostic 100% of reduced fee* 100% of MPA** 100% of MPA***
•O
ral evaluations (two
per calendar year)
•X
-rays (bitewings – once per
calendar year; full mouth series
- once every three years)
•P
rophylaxis (cleaning;
two per calendar year)
•F
luoride treatment (twice
per calendar year for children
under age 19)
• Space maintainers
• Sealants
Basic 80% of reduced fee* 80% of MPA** 80% of MPA***
• Fillings
• Posterior composites
• Panoramic x-ray
• Oral surgery
• Periodontics
• Endodontics
•C
rowns, jackets, cast
restorations
•G
eneral anesthesia (in
conjunction with oral surgery)
• Non-surgical TMJ
Major 50% of reduced 50% of MPA** 50% of MPA***
• Fixed/removable bridges
• Partial/full dentures
• Implants
Orthodontia
•L
ifetime Ortho. Maximum $1,000/per dependent $1,000/per dependent $1,000/per dependent
(for dependents under age
19 only)
Billing 50% of reduced fee* subject 50% of dentist’s usual fee 50% of dentist’s usual fee
to lifetime maximum subject to lifetime maximum subject to lifetime maximum
*You will not be “balance **You will not be “balance ***You are responsible for
billed” for charges exceeding billed” for charges exceeding charges exceeding Delta
Delta Dental’s allowed PPO Delta Dental’s maximum plan Dental’s maximum plan
fees allowances (MPAs) allowances (MPAs)
16Vision appliance insurance
Vendor: Delta Dental IL
Mercyhealth partners who work a minimum of 20 hours per week (0.5 FTE) are eligible to enroll in a voluntary vision
appliance plan. This plan is for appliances only (for example, glasses, contacts). Vision exams are covered under your
MercyCare health plan.
Monthly premium contribution
Partner + Partner + Partner +
Partner
Spouse Child(ren) Family
$4.34 $8.48 $9.51 $13.72
DeltaVision® is provided by ProTec Insurance Company, a wholly owned subsidiary of Delta Dental of Illinois, in
association with EyeMed Vision Care networks. DeltaVision offers members vision appliance benefits that combine
choice, value and wellness. Your DeltaVision program provides vision appliance insurance to you (and your family, if
applicable) according to the following information.
Prescription drug coverage
Vision Care Services Select Network Member Cost Out-of-Network Allowance
Frames: $130 allowance, 20% off balance $65
Any available frame at provider location over allowanc
Standard plastic lenses:
Single vision $25 copay $25
Bifocal $25 copay $40
Trifocal $25 copay $55
Standard progressive (in addition to lens) $65 copay $40
Premium Progressive (in addition to lens) $65, 20% off retail price, then apply $40
$120 allowance
Lens options:
UV coating $15 N/A
Tint (solid and gradient) $15 N/A
Standard plastic scratch coating $15 N/A
Standard polycarbonate $40 N/A
Standard anti-reflective coating $45 N/A
Other add-ons and services 20% discount off retail price N/A
Contact lenses:
(Contact lens allowance covers materials only)
Conventional $0 copay, $100 allowance, $80
15% off balance over $100
Disposable $0 copay, $100 allowance, $80
15% off balance over $100
Visually required $210
$0 copay, paid-in-full
Frequency:
Examination N/A
Lenses or contact lenses Once every 12 months
Frames Once every 24 months
17Additional discounts
Member receive a 20% discount at in-network providers on items not covered by the program. This discount
may not be combined with any other discounts or promotional offers and the discount does not apply to
contact lenses or an in-network provider’s professional services. Retail prices may vary by location.
Members also receive a 40% discount on complete pair eyeglass purchases and a 15% discount on
conventional contact lenses at in-network providers once the funded benefit has been used.
After initial purchase, replacement contact lenses may be obtained via the Internet at substantial savings
and mailed directly to the member. Details are available at deltadentalil.com/deltavision. The contact lens
benefit allowance is not applicable to this service.
Network information
You may choose to go to any licensed optometrist, ophthalmologist and/or dispensing optician whenever you
need vision care. However, there may be significant cost advantages when you receive treatment from an
in-network provider.
We offer two easy ways to locate an in-network provider 7 days a week, 24 hours a day. You can either:
• Search our online provider directory at deltadentalil.com/deltavision; or
• Use the automated phone system by calling (866) 723-0513
Using your vision appliance program
1. An in- network provider participates in the EyeMed Vision Care Provider network. You will only receive in-
network benefits from Select network providers. Please note: the network provider will need the primary
enrollee’s name and date of birth to verify eligibility.
2. Pay your copayment and any other charges not covered at the time of service. No paperwork is required.
You continue to save on additional eyewear purchases any time you present your card to an in-network
provider.
If you select a provider who is not in the network, you do not receive preferred pricing and you may be
asked to provide full payment to your out-of-network provider at the time of service. To receive benefit
reimbursement, submit a completed claim form (available at deltadentalil.com/deltavision, along with
itemized receipts from your provider and your prescription to:
DeltaVision Claims Processing c/o
EyeMed Vision Care
P.O. Box 8504 Mason, OH 45040-7111
Exclusions
In no event will coverage exceed the lesser of:
1. The actual cost of covered services or materials or
2. The limits of the policy, shown in the schedule.
Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next benefit
period.
Benefits may not be combined with any discount, promotional offering or other group benefit programs.
Benefit allowances provide no remaining balance for future use within the same benefit period.
18Life insurance
Vendor: The Standard
Group Term Life
Mercyhealth provides Term Life Insurance benefits to partners hired to work 20 hours or more a week (.5
FTE). Eligibility begins the first of the month following 90 days of employment. Term life is equal to one times
annual salary up to $150,000* with Accidental Death and Dismemberment (ADD). Further information can be
found in the summary Plan Description.
*Physician maximum $350,000
Supplemental Life
You may purchase your own supplemental life insurance coverage up to four times your annual earnings
up to a maximum of $1,000,000. Eligibility begins the first of the month following 90 days of employment
for partners that are hired to work 20 hours or more a week (.5 FTE). You may increase the coverage during
each open enrollment by one times your annual earnings without proof of insurability. Evidence of insurability
is required if you want to request more than $600,000 worth of coverage, enroll or increase your coverage
during the plan year. However, you may discontinue your coverage any time.
Your premium is based on your age bracket and the amount of coverage chosen. The table below shows the
monthly rates per $1,000 of coverage based on age:
•Y ou can choose to purchase additional term life insurance in increments of one, two, three or four times
your benefit pay.
•P remium contributions are made with after-tax dollars; premiums adjust the month following a salary
increase and/or a birthday if your age ends in 5 or 0, beginning at age 35 (for example; 35, 40, 45, etc.)
•Y ou can choose supplemental life insurance if you want a greater level of coverage. Remember–you may
not increase your life insurance by more than one level of Benefit Pay from year to year, unless you submit
evidence of insurability.
Monthly Monthly Monthly Monthly
Age Age Age Age
rate rate rate rate
Under 30 $0.08 40 - 44 $0.15 55 - 59 $0.46 70 - 74 $3.18
30 - 34 $0.10 45 - 49 $0.24 60 - 64 $0.69 75+ $6.37
35 - 39 $0.11 50 - 54 $0.40 65 - 69 $1.38
Dependent Term Life
You may purchase life insurance at two levels of coverage for eligible dependents. Eligibility begins the first
of the month following 90 days of employment for partners hired to work 20 hours or more a week (.5 FTE).
Dependent child means:
1. Your unmarried child from live birth through the end of the calendar month in which your child reaches age
26 or
2. Your unmarried child who meets either of the following requirements
a. The child is insured under the group policy and, on and after the date on which insurance would
otherwise end because of the child’s age, is continuously disabled.
b. The child was insured under the prior plan on the day before the effective date of your employer’s
coverage under the group policy and was disabled on that day, and is continuously disabled thereafter.
3. The date dependent life insurance ends is the date the dependent ceases to be a dependent.
4. The monthly premium covers all eligible children and spouce.
19Premium
Level of Coverage
Per Month
Option 1: $10,000 coverage for spouse, $5,000 per child $3.00
Option 2: $25,000 coverage for spouse, $10,000 per child $6.50
For both supplemental and dependent term life you may increase the coverage by one level during each
open enrollment without proof of insurability. During the plan year, you may enroll if there is a change in your
family status, or increase the level of coverage with approved evidence of insurability. However, you may
discontinue the coverage anytime during the plan year.
Note: A partner may not be insured as both a partner and a dependent. A child may not be insured by more
than one partner.
Mercy Health Corporation employees’ retirement plan
Vendor: VOYA
403(b)
Mercyhealth partners are offered a 403(b) plan that allows the option to contribute on a pre-tax basis a portion
of your earnings to an account, up to the annual federal maximum. There are over 30 investment options
to choose from. You can enroll anytime by contacting Rohlik Financial Services at (800) 236-2608. You may
also change your investment options, beneficiaries, and deferral electives at any time by contacting Rohlik
Financial Group or going online at voyaretirementplans.com.
Auto-enrollment
Mercyhealth believes that all partners should take an active approach in contributing towards their retirement;
therefore, Mercyhealth will automatically enroll partners into a VOYA retirement plan at 3%. If you do not
want to contribute to your plan, you have the option to opt out but your account will remain open for any
qualifying discretionary contributions.
Auto-escalation
For partners who want to contribute to a 403(b) account but do not want to be actively involved will be eligible
for an automatic contribution increase of 1% each calendar year up to a maximum contribution of 6%.
Matching contribution
If you work a minimum of 1,000 hours by your first anniversary you will be eligible for a matching
contribution. Otherwise, matching eligibility will begin after the calendar year in which you complete 1,000
hours of service. Mercyhealth will contribute up to 100% of the first 4% of your earnings that you contribute
up to the federal compensation limit. The matching contribution will be deposited into your VOYA account
at the same time your contribution is deposited. When you have two years of service with Mercyhealth, as
defined by the Plan, you are vested (gain ownership) in this benefit.
Discretionary contribution
For each year in which you work a minimum of 1,000 hours, Mercyhealth will contribute a discretionary
contribution of up to 2% based on your W-2 earnings from the previous calendar year to your VOYA
account. When you have one year of service with Mercyhealth, as defined by the Plan, you are vested (gain
ownership) in this benefit. The discretionary contribution is deposited into your VOYA account in October
each year and is based on the successful completion of system-wide performance and financial goals.
Partners do not have to contribute their own earnings to be eligible for the discretionary contribution.
20Roth contribution
Mercyhealth partners may also make Roth contributions to their VOYA 403(b) account. Roth contributions
are eligible for the matching contribution.
457(b)
In addition to contributing to the Mercyhealth Corporation Employees’ Retirement Plan, all highly
compensated partners have the option to increase their tax-deferred contributions by contributing to a
457(b) account through VOYA. The 457(b) account is not eligible for any matching contributions. Federal
contribution maximums apply. Partners can enroll at any time through Rohlik Financial Services and have the
same investment options as the 403(b).
All accounts are accessible online at voyaretirementplans.com or contact a representative at Rohlik
Financial Group at (800) 236-2608.
Flex spending plans
Health savings account/Medical/Dependent care
Vendor: Health Equity
Mercyhealth partners hired to work 20 or more hours per week (.5 FTE) are eligible to participate in the
flexible spending plan. The flexible spending plan allows you to set aside pre-tax dollars from your paycheck
to pay for qualified medical and dependent care expenses. Consequently, you pay less income tax and
increase your take home pay. Eligible medical expenses include out-of-pocket health, dental and vision
related expenses. The appropriate amount will be deducted bi-weekly from your paycheck on a pre-tax basis.
Please evaluate your situation carefully and conservatively before determining how much, if any, you want
to set aside for the various expenses in a flexible spending plan as restrictions apply. You may change the
benefits elected during the plan year only if there is a major family status change (qualifying event). Call
Human Resources or Health Equity at (866) 346-5800 with any questions.
Health Savings Accounts (HSA)
Participants in the MercyCare EPO HDHP or PPO HDHP may elect to contribute to a Health Savings Account
(HSA). The dollars are set aside on a pre-tax basis to pay for medical expenses. Partners can contribute up to
$3,450 with a single plan or $6,900 with a family plan to the Health Savings Account. Partners 55 or older are
eligible to contribute an additional $1,000.
If you participate in a Health Savings Account, you can also enroll in a limited purpose medical account for
planned dental and vision expenses. You may also use it for medical expenses after you have satisfied your
annual deductible.
Flexible Spending Medical
You can choose to set aside money from each paycheck to pay for those expenses not covered by insurance
such as your deductible, your coinsurance, and your copays. This is a pre- tax deduction, which means that
you don’t pay any federal, state, or Social Security taxes on the dollars you set aside.
The maximum amount you can set aside is $2,650. The money can be used to reimburse you for any
expenses incurred between January 1, 2018 or when you become eligible (whichever is later) and December
31, 2018, or when you are no longer eligible (whichever is first). Your reimbursement claim must be
submitted by March 31, 2019. Under federal law, the medical plan allows for a carryover of $500 for the next
plan year; however, any remaining amount over $500 will be forfeited.
21Dependent care:
You can choose to set aside up to $5,000 annually from your paycheck to pay for eligible dependent care
expenses that allow you (and your spouse if you’re married) to work, look for work, or attend school full-
time. Expenses must be related to:
• Dependent children under age 13
• A person of any age you claim as a dependent on your federal income tax return, and who is mentally or
physically incapable of self-care. This would include an elder or other adult dependent.
Under federal law, any unused dollars remaining at the end of the plan year in a dependent care plan will be
forfeited.
Note: You cannot change the amount of a flexible spending account deduction, except at open enrollment,
unless you have a change in family status.
Voluntary benefits
Long-term care insurance (Legacy Services)
All partners and family members are eligible to purchase long-term care insurance at any time through
Legacy Services. Long-term care insurance is a benefit that goes beyond medical care and nursing care to
include assistance you could need if you ever have a chronic illness or disability that leaves you unable to care
for yourself for an extended period of time. You can receive long-term care in a nursing home or in your own
home, in the form of help with such activities as dressing or bathing, etc. Long-term care can be of help to a
young or middle-aged person who has been in an accident or suffered a debilitating illness, but older people
use most long-term care services. Your premium is based on your age and the type of coverage you select.
For further information, contact Legacy Services at (800) 230-3398.
Universal Life Insurance (VOYA)
If you are hired to work 20 or more hours per week (.5 FTE), you are eligible to purchase universal life
insurance coverage underwritten by VOYA. This program allows you to apply for an individual life insurance
policy. You can also apply for individual life insurance policies for your spouse, dependent children and, in
most cases, grandchildren, even if you choose not to apply for your own policy. The premium you pay is
based on the death benefit you select. For more information or to enroll contact Rohlik Financial Group
at (800) 236-2608.
529 college savings programs
All Mercyhealth partners are eligible at any time to participate in 529 college savings programs through payroll
deduction. These programs allow partners to set aside dollars specific to college education costs and interest
earned is tax-free. For more information or to enroll, contact Rohlik Financial Group at (800) 236-2608.
Auto and home insurance (Travelers)
If you are hired to work 20 or more hours per week (.5 FTE), you are eligible to receive special program rates
through Travelers Insurance on your auto, home, and other personal insurance. Periodically, eligible partners
receive information packets sent directly to their home from Travelers. This benefit is available to partners
throughout the year. For more information, please call Travelers at (800) 842-5075.
22Voluntary benefits continued
MetLife Plans
If you are hired to work 20 or more hours per week (0.5 FTE), you are eligible to purchase the following
benefits. Contact Williams-Manny Insurance Group at (815) 227-8923.
• Accident insurance
Accident insurance will cover your family for a wide variety of accidental injuries including broken bones,
cuts, concussions, dislocations and second or third degree burns. It provides a lump sum payment when
a person has medical services and treatments related to accidental injuries, such as certain doctor visits,
ambulance transportation, medical testing and physical therapy. It can be a valuable complement to your
medical insurance.
This type of insurance can help protect your savings from unexpected expenses and provides payment
directly to you, that you can use any way you see fit.
• Critical illness
A serious illness such as cancer, heart attack or stroke will bring unexpected expenses that are not
covered by your health insurance. At the same time, a critical illness may affect your ability to earn an
income, which may cause you to dip into your savings. This plan can help you pay for expenses such
as essential living expenses if you’re not able to work, pay for medical co-pays and deductibles, or for
additional care while you recover.
• Hospitalization insurance
Will allow you to receive a lump-sum payment when you first go into the hospital, then receive daily
amounts paid for each day in the hospital. Payments will be paid directly to you to use as you see fit.
Nationwide/Williams-Manny
If you are hired to work 20 or more hours per week (0.5 FTE), you are eligible to purchase the following
benefits. Contact Williams-Manny Insurance Group at (815) 227-8923.
• Pet insurance
Pets play an important role in a family’s life however when an accident or illness occurs it can set you
back $1,000’s. This plan will allow you to be reimbursed for eligible veterinary expenses for medical
problems and conditions such as accidental injuries, poisonings and illness-even cancer. Office
procedures include diagnostic tests, x-rays, lab fees surgeries and hospitalization. Your pet’s prescriptions
are even covered. There are plans for dogs and cats starting at 6 weeks of age and plans also available
for birds, ferrets, reptiles and other exotic pets.
23You can also read
