STAY ON TRACK YOUR 2022 M-NCPPC - STAY ON TRACK - Maryland-National ...
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STAY ON
TRACK
YOUR
2022
M-NCPPC
BENEFITS
STAY ON TRACK
M-NCPPC
BENEFIT GUIDE 1
CLICK ON THE
NAVIGATION MENU Enrolling in Your Benefits
STAY ON Benefits for Active Employees
TRACK
and Retirees
Benefits for Active Employees Only
M-NCPPC PROVIDES YOU WITH
A COMPREHENSIVE BENEFIT
Your Cost for Coverage
PACKAGE FOR YOU AND YOUR
ELIGIBLE DEPENDENTS.
YOUR This guide gives you an overview of your Contacts for More Information
2022 benefit plans. Use this guide to determine
M-NCPPC how your benefits can help you stay on
BENEFITS track with your health and other aspects
of your life throughout the year.
Required Benefit Notices
Note: The information in this guide is a summary of the benefit plans offered to employees and retirees and their dependents. In the event of any discrepancies between the information in the guide
and official plan documents the plan documents supersede.The Commission reserves the right to make changes to its benefits program for all employees, retirees and beneficiaries. Benefits are subject Benefit Enrollment/Change Form
to the actual plan terms in effect as of a given time. In the event of a conflict between the terms of any benefit plan and this summary, the terms of the benefit plan will control.
Enrolling
in Your
Benefits
Benefits
for Active
Employees
and Retirees
Benefits
ENROLLING
for Active
Employees
Only
Your
IN YOUR
Cost for
Coverage
BENEFITS
Contacts
for More
Information
Required
Benefit
Notices
CONTINUED
Benefit
Enrollment/
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 3
Enrolling
in Your
Benefits YOUR ELIGIBLE DEPENDENTS
ENROLLING
INCLUDE YOUR:
Benefits
IN YOUR BENEFITS
for Active
Employees • Legal spouse (as recognized under Maryland law)
and Retirees
• Natural, step, or adopted child under age 26
Benefits
ELIGIBILITY
for Active • Unmarried child, not in a domestic partnership
Employees
Only or legal guardianship, age 26 or older who before
turning age 26 became totally and permanently
Employees are eligible to participate in the plans described in incapacitated due to mental or physical limitations;
Your
Cost for this guide if classified as one of the following employee types: if they meet certain criteria
Coverage
• Career FT/PT • Domestic partner (as certified by the Commission)
Contacts • Appointed and eligible child(ren)
for More
Information
• P/T Commissioners
• Merit Board
* Employees • A child for whom you or your covered dependent
spouse/partner has permanent (12 months or
and retirees
• Term Contract longer) legal guardianship before his/her 18th
Required may also
Benefit birthday (copy of court order required)
Notices choose to
Retirees are eligible to enroll in the healthcare plans if cover eligible
Benefit
they were enrolled in health coverage (either through the dependents,
Enrollment/
Change
* (Dependents of retirees must have been deemed
Commission or another source) for the 36 months immediately as applicable. eligible at the time of the retiree’s date of
Form
retirement. After you retire, new dependents
preceding their retirement date and began receiving their
are not eligible for coverage. You may not add
retirement annuity immediately following active employment. a new spouse, newborn child(ren), or any other
dependents who were not enrolled in coverage or
CONTINUED deemed eligible at the time of retirement.)
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 4
Enrolling
in Your
WHEN AND HOW TO ENROLL
Benefits
Benefits
for Active
Employees
and Retirees
EMPLOYEES RETIREES
Benefits When you first become eligible for benefits, you must enroll within 45 days If deemed eligible for healthcare
for Active
Employees of your date of hire or the date you become eligible for benefits. If you do benefits at the time of retirement
Only
not enroll within your 45-day enrollment window, you must wait until the next and you elected to receive an
open enrollment period to enroll, unless you experience a qualifying life event: immediate pension, retirees
Your
Cost for marriage, new born, adoption, loss of healthcare coverage, divorce, etc. can enroll as of their date of
Coverage
retirement or defer enrollment
If you have a qualifying life event, you must submit your enrollment and to a future date, including open
Contacts
for More
supporting documents to the Health & Benefits Office no later than 45 days enrollment by providing proof
Information
following the event. If later, you must wait until the next open enrollment of continuous coverage under a
period to make any changes in your benefits. comparable plan(s).
Required
Benefit
Notices Employees have two ways to enroll. Using the online Employee Self Service Retirees enroll in benefits
(ESS) platform, during Open Enrollment or completing a benefit enrollment/ by completing the benefit
Benefit
Enrollment/ change form. For help enrolling using ESS, refer to the ESS User Guide at enrollment/change form-
Change
Form www.mncppc.org/DocumentCenter/View/15775. included in this guide.
LET’S REVIEW YOUR BENEFIT OPTIONS CONTINUED
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 5Enrolling
in Your
LET’S REVIEW YOUR BENEFIT OPTIONS
Benefits
Benefits for
Employees ACTIVE EMPLOYEES AND RETIREES ACTIVE EMPLOYEES ONLY
and Retirees BENEFIT PLAN YOUR OPTIONS BENEFIT PLAN YOUR OPTIONS
• UnitedHealthcare Choice Plus POS Flexible Spending • Healthcare Flexible Spending Account
Benefits for • UnitedHealthcare Select EPO Accounts • Dependent Care Flexible Spending Account
Employees
Only • UnitedHealthcare Select EPO (Medicare Eligible)
• Automatic Basic Life and AD&D 2x base
Medical Plan • UnitedHealthcare Medicare Complement (Medicare Eligible) annual salary up to $200,000 (You can opt
out at any time)
Your • Kaiser Permanente HMO with Prescription Drug Coverage
Cost for • Supplemental Life: 1-5x base annual salary,
Coverage • Kaiser Permanente Medicare Advantage with Prescription up to $750,000
Drug Coverage (Medicare Eligible) Life and Accidental
Death & • Dependent Life:
Dismemberment
Contacts • CVS Caremark (if you are enrolled in a UHC medical plan) Insurance F Option 1: $10,000 spouse/$5,000
Prescription child(ren)
for More
Drug • Kaiser Permanente (automatically included when you enroll)
Information
F Option 2: $20,000 spouse/$10,000
child(ren)
• Delta Dental PPO
Required Dental Plan F Option 3: $30,000 spouse/$15,000
Benefit • DeltaCare HMO (Delta Dental HMO) child(ren)
Notices
• EyeMed – Low Option Sick Leave Bank • Employees make annual/sick leave
(Enhanced) contribution
Benefit Vision Plan • EyeMed – Moderate Option
Enrollment/
Change • EyeMed – High Option • Mandatory Basic Long-Term Disability
Form Long-Term
Disability • Supplemental Long-Term Disability (Base
Legal Plan • Legal Resources Salary more than $108,000)
CONTINUED
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 6Enrolling
in Your
Benefits
Benefits
for Active
Employees
and Retirees
MEDICAL PLAN
BENEFITS
PRESCRIPTION DRUG PLAN
DENTAL PLAN
VISION PLAN
LEGAL PLAN
FOR ACTIVE
Benefits
for Active
Employees
Only
EMPLOYEES
Your
Cost for
Coverage
AND RETIREES
Contacts
for More
Information
Required
Benefit
Notices
CONTINUED
Benefit
Enrollment/
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 7Enrolling
in Your
Benefits
Benefits
for Active
Employees
MEDICAL PLAN
and Retirees
MEDICAL PLAN STAY ON TRACK
PRESCRIPTION DRUG PLAN
DENTAL PLAN
Did you already have your yearly check-up?
VISION PLAN
LEGAL PLAN
When you have regular check-ups, your doctor can detect health conditions and
diseases early. This increases your chance for treatment and cure.
Benefits
for Active
Employees
Only Are you up to date on your vaccines and preventive screenings?
Use the U.S. Department of Health and Human Services tool, MyHealthfinder at
Your https://health.gov/myhealthfinder to obtain a personalized list of vaccines and
Cost for
Coverage screenings just for you.
Contacts If you have not yet had your yearly check-up, schedule it as soon as possible.
for More
Information Don’t forget to take your personalized list of vaccines and screenings with you and
discuss them with your doctor to make sure you stay on track with your health.
Required
Benefit
Notices Remember, your health is your biggest asset, now and all year long.
Benefit CONTINUED
Enrollment/
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 8Enrolling
in Your
DOCUMENTS
YOUR MEDICAL
Benefits
REQUIRED IF
Benefits
for Active PLAN CHOICES ADDING ELIGIBLE
Employees
and Retirees DEPENDENTS
You can enroll in the following medical plans.
MEDICAL PLAN
If you are adding dependents to your coverage,
PRESCRIPTION DRUG PLAN Eligible dependents can be added as well. you must provide proof of relationship (copies
DENTAL PLAN
of marriage certificate, birth certificates,
VISION PLAN If you are not Medicare Eligible your choices are: adoption papers, etc. and a copy of the Social
LEGAL PLAN
Security card for each dependent).
• UnitedHealthcare (UHC) Select EPO
Benefits
You can submit these documents:
for Active • UnitedHealthcare (UHC) Choice Plus
Employees
Only
• Kaiser Permanente HMO with Prescription Drug Coverage
IN-PERSON
Health & Benefits Office - 6611 Kenilworth
Your
Cost for Avenue, Suite 404, Riverdale, MD 20737
Coverage *If you are not an active employee and eligible for Medicare • Call to make an appointment
due to age or disability-at any age, your choices are: 301-454-1694
Contacts • Secure Drop Box, in the lobby on the 1st
for More
• UnitedHealthcare Medicare Complement
Floor
Information
• Kaiser Permanente Medicare Advantage
BY U.S. MAIL
Required * Active employees who reach age 65 are not required to enroll in
Benefit
Notices Medicare. As an active employee, the non-Medicare medical plan BY EMAIL
remains primary for you and your eligible dependents. To benefits@mncppc.org
Encrypt your email when sending personal
Benefit
documents. If using Outlook, go to www.mncppc.
Enrollment/
Change CONTINUED org/DocumentCenter/View/18268 for guidance.
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 9Enrolling
in Your
UNITEDHEALTHCARE
Benefits
Benefits
for Active HEARING AID
ALLOWANCE
Employees
and Retirees
MEDICAL PLAN
PRESCRIPTION DRUG PLAN
DENTAL PLAN
The Hearing Loss • 48 million Americans
VISION PLAN Association of have a significant
LEGAL PLAN hearing loss
America (HLAA)
Benefits
Take a FREE hearing
for Active provides the • People with hearing
Employees test and find out how
Only
following statistics loss wait an average
you can optimize
of 7 years before
on hearing loss: your savings on
Your seeking help.
Cost for
Coverage
hearing aids at
www.UHCHearing.com.
Adults and children enrolled in the UnitedHealthcare
Contacts
for More Plans will receive a hearing aid benefit through You can also call
Information
UnitedHealthcare Hearing. The plan pays 80% and you 1-866-926-6632
pay 20% with a maximum allowance of $3,000 every 36 to set up an
Required months. UnitedHealthcare Hearing can save you 50%-
Benefit appointment to
Notices 80% off standard industry prices. explore your choices.
Benefit
CONTINUED
Enrollment/
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 10Enrolling
in Your
VIRTUAL CARE OPTIONS
Benefits
Benefits
24/7/365 CARE WHENEVER and WHEREVER
for Active
Employees
and Retirees
MEDICAL PLAN
If your doctor • Your toddler wakes up at 4:00 a.m. with a fever and there is a blizzard
PRESCRIPTION DRUG PLAN
outside
DENTAL PLAN is not in the
VISION PLAN
office, it is after • While hiking on the trail and you twisted your ankle. Now back at base camp,
LEGAL PLAN
your ankle is swollen and stiff, but you are nowhere near a healthcare facility
Benefits
hours, or you
for Active
Employees are on vacation • You are at the beach and your seasonal allergies start wreaking havoc on
Only your fun. Your eyes are itching and so red and puffy that you cannot see the
when:
sun and waves.
Your
Cost for
Coverage In these situations, how can you get immediate medical care without going to a doctor’s office?
In situations such as these and more, you can get help from a doctor using a virtual care option
Contacts
24/7/365, including weekends and holidays. Care is available by phone, mobile app, tablet or your
for More computer. Virtual Care medical professionals can not only diagnose and treat your condition, but
Information
also can prescribe medication and call it into a pharmacy.* Your copayment is $00.00 when you use
in-network providers.
Required
Benefit
Notices
* Go to the nearest Emergency Room if your condition is life-threatening or call 911.
Benefit
Enrollment/ CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 11Enrolling
in Your
MAKING A VIRTUAL APPOINTMENT
Benefits
Benefits
for Active
Employees
and Retirees
UnitedHealthcare Members, connect with:
MEDICAL PLAN
• Your own doctor if they provide this service, or
PRESCRIPTION DRUG PLAN
• One of UnitedHealthcare’s partner doctors at Optum Virtual
DENTAL PLAN
Care, Teladoc, Amwell or Doctors on Demand by phone,
VISION PLAN
LEGAL PLAN
mobile or video. Go to www.uhc.com/virtualvisits.
Benefits • For behavioral concerns such as stress and anxiety, set up a
for Active
Employees virtual appointment with a therapist. Follow the instructions
Only
at www.mncppc.org/DocumentCenter/View/18728.
Your
Cost for
Coverage
Kaiser Permanente HMO Members: :
Contacts
• Make a virtual appointment with a Medical Provider or
for More
Information
Behavioral Health Professional by signing into my.kp.org/
mncppc using a mobile app, computer or tablet or calling
1-800-777-7904 (1-800-700-4901, TTY). For more information
Required
Benefit go to www.mncppc.org/DocumentCenter/View/18279.
Notices
Benefit
Enrollment/
Change
Here are the summaries of the benefits under each medical plan. CONTINUED
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 12Enrolling
in Your HERE ARE THE SUMMARIES
Benefits
OF THE BENEFITS UNDER
EACH MEDICAL PLAN-
Benefits
for Active If You are Not UNITEDHEALTHCARE UNITEDHEALTHCARE KAISER PERMANENTE HMO WITH
Employees
and Retirees Eligible for Medicare CHOICE PLUS POS SELECT EPO PRESCRIPTION DRUG COVERAGE
IN-NETWORK OUT-OF-NETWORK IN-NETWORK ONLY IN-NETWORK ONLY
MEDICAL PLAN $250 individual
PRESCRIPTION DRUG PLAN Annual Deductible None $500 2-member None None
$600 family
DENTAL PLAN
$600 individual $1,100 individual
$1,100 individual
VISION PLAN $1,200 2-member $3,600 family
Annual Out-of-Pocket Limit $3,600 family
$1,800 family Does not include
LEGAL PLAN Includes copays
Does include copays; Does not include deductible copays
Benefits Preventive Care $0 copay Covered 80% after deductible $0 copay $0 copay
for Active Office Visits $10 copay Covered 80% $10 copay $10 copay
Employees
Only Emergency Room $50 copay, waived if admitted $50 copay, waived if admitted $50 copay, waived if admitted $50 copay, waived if admitted
Urgent Care Center $10 copay Covered 80% after deductible $15 copay $15 copay
Virtual Visit $0 copay Covered 80% after deductible $0 copay $0 copay
Your
Cost for Covered 80% after
Coverage Inpatient Surgery $0 copay deductible, plus $0 copay $0 copay
$100 inpatient deductible
$10 copay in office Covered 80% after $0 copay in office
Outpatient Surgery $25 copay
$0 copay at facility deductible $25 copay at facility
Contacts
for More Mental Health & Substance Abuse
Information Covered 100% Covered 80% after deductibles Covered 100% Covered 100%
• Inpatient
Mental Health & Substance Abuse $5 copay, group therapy
$10 copay Covered 80% after deductibles $10 copay
• Out-Patient Services $10 copay, individual therapy
Required
Out-of the-Country Bona fide emergencies are covered Bona fide emergencies are covered Bona fide emergencies are covered Bona fide emergencies are covered
Benefit
Notices 80% covered, after deductible,
80% covered every 36 months, up 80% covered every 36 months, up 1 hearing aid every 6 months covered
Hearing Aids every 36 months, up to $3,000
to $3,000 maximum to $3,000 maximum up to $1,000
maximum
Benefit
Enrollment/
Change CONTINUED
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 13Enrolling
in Your Active employees are not required to enroll in Medicare when they reach age 65; your If you are a retiree, when
Benefits
medical plan remains primary for you and your eligible dependents. you or your eligible
COMPARISON OF
dependents become
Benefits MEDICAL PLANS
for Active
Medicare eligible due
Employees If You are Eligible
and Retirees to reaching age 65 or
for Medicare due
MEDICAL PLAN to Age or Disability UNITEDHEALTHCARE UNITEDHEALTHCARE
KAISER PERMANENTE disability at any age you
MEDICARE ADVANTAGE
MEDICARE SELECT EPO
PRESCRIPTION DRUG PLAN at any Age. COMPLEMENT MEDICARE ELIGIBLE
WITH PRESCRIPTION must enroll in Medicare
DRUG COVERAGE
DENTAL PLAN Part A and Part B.
None; the plan pays Part A and Part B None; but you must pay Part A
VISION PLAN Annual Deductible None
deductibles and Part B deductible
LEGAL PLAN • Medicare becomes your
$1,100 individual $3,400
primary medical plan and
Annual Out-of-Pocket Limit N/A $3,600 family Includes copay and
Benefits Does not include copays coinsurance your Commission sponsored
for Active medical plan becomes
Employees Preventive Care Remaining 20% of Medicare approved amount $0 copay $0 copay
secondary.
Only Office Visits Remaining 20% of Medicare approved amount $10 copay $10 copay
Emergency Room $50 copay, waived if
Remaining 20% of Medicare approved amount $50 copay, waived if admitted • Provide a copy of your
(medical emergency only) admitted
Your Medicare card confirming
Cost for Urgent Care Center Remaining 20% of Medicare approved amount $15 copay $15 copay
Coverage your enrollment to the
Virtual Visit Remaining 20% of Medicare approved amount $0 copay $0 copay Health & Benefits Office
Inpatient Surgery Covered in full by Medicare $0 copay $0 copay (benefits@mncppc.org or
$0 copay in office Fax: 301-454-1687). If you
Contacts Outpatient Surgery Remaining 20% of Medicare approved amount $25 copay
$25 copay at facility submit your Medicare card by
for More
Information Mental Health & Substance Abuse email, you are encouraged
Remaining 20% of Medicare approved amount Covered 100% Covered 100%
• Inpatient to use encryption. If you are
$5 copay, group therapy
using Outlook, you can refer
Mental Health & Substance Abuse to the guide at www.mncppc.
Required Remaining 20% of Medicare approved amount $10 copay $10 copay, individual
• Out-Patient Services
Benefit therapy org/DocumentCenter/
Notices Bona fide emergencies are Bona fide emergencies are View/18268 for assistance to
Out-of the-Country Bona fide emergencies are covered
covered covered encrypt your email.
80% covered every 36 months, up to $3,000 80% covered every 36 months, 1 hearing aid up to $1,000
Benefit Hearing Aids
maximum up to $3,000 maximum per ear every 36 months
Enrollment/
CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 14Enrolling
in Your
Benefits
Benefits
for Active
Employees
PRESCRIPTION DRUG PLAN
and Retirees
MEDICAL PLAN STAY ON 1. Take your medication at the same time every day.
PRESCRIPTION DRUG PLAN
DENTAL PLAN TRACK 2. Try taking your medications with a daily routine like brushing your
teeth or getting ready for bed. Before choosing a mealtime for your
VISION PLAN routine, check if your medication should be taken on a full or empty
LEGAL PLAN
The Federal Drug Administration stomach.
(FDA) advises that taking your
Benefits 3. Keep a “medicine calendar” with your pill bottles and note each time
for Active medication as prescribed-in the you take a dose.
Employees
Only right dose, at the right time, and
4. Use a pill container. Some types have sections for multiple doses at
in the right way is important for different times, such as morning, lunch, evening, and night.
Your controlling chronic health conditions
Cost for 5. When using a pill container, refill it at the same time each week. For
Coverage and your overall long-term health example, every Sunday morning after breakfast.
and well-being. If you do not take 6. Purchase timer caps for your pill bottles and set them to go off when
Contacts your medication as prescribed, your your next dose is due. Some pill boxes also have timer functions.
for More
Information health condition could get worse 7. When travelling, be certain to bring enough of your medication, plus a
and result in hospitalization. Here few days extra, in case your return is delayed.
Required are 8 tips from the FDA to help 8. If you’re flying, keep your medication in your carry-on bag to avoid
Benefit
Notices you stay on track and take your lost luggage. Temperatures inside the cargo hold could damage your
medication as prescribed. medication.
Benefit
Enrollment/ For more information and resources, read the entire article at https://www.fda.gov/drugs/special-
CONTINUED features/why-you-need-take-your-medications-prescribed-or-instructed.
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 15Enrolling
STAY ON TRACK WITH YOUR MEDICATIONS
in Your
Benefits
Benefits
as prescribed to maintain and improve your health.
for Active
Employees
and Retirees
The prescription plan available to you depends on the medical plan you enroll in:
MEDICAL PLAN
PRESCRIPTION DRUG PLAN
If you enroll in a UnitedHealthcare medical plan, you can
DENTAL PLAN
enroll separately in the CVS Caremark prescription drug plan at
VISION PLAN
LEGAL PLAN an additional cost.
Benefits
for Active • If you are not an active employee and are Medicare eligible (enrolled
Employees
Only in Medicare Part A and Part B) you will be enrolled in the SilverScript
Prescription Drug Plan, a Medicare Part D plan approved by the Centers
Your for Medicare and Medicare (CMS) that is administered by CVS Caremark.
Cost for
Coverage
If you enroll in a Kaiser Permanente plan, you are covered
Contacts automatically in the Kaiser Permanente prescription drug plan
for More
Information at no extra cost.
Required
Benefit Each prescription drug plan covers generic, preferred (on the
Notices
formulary) and non-preferred (not on the formulary) drugs. CVS
CONTINUED
Benefit
Caremark also covers lifestyle drugs that treat such conditions
Enrollment/ as baldness, wrinkles, erectile dysfunction and acne.
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 16Enrolling
THE PRUDENTRx
in Your
Benefits USE AUTOMATIC REFILLS
Benefits
COPAY PROGRAM TO STAY ON TRACK WITH
for Active PRESCRIPTIONS
Employees
and Retirees The PrudentRx Copay Program will be added to the Caremark prescription
MEDICAL PLAN drug plan. You will be enrolled if you use a specialty drug. When you fill With Automatic Refills, your prescriptions are refilled
PRESCRIPTION DRUG PLAN at a CVS Specialty Pharmacy and are enrolled in the PrudentRx Copay automatically at the right time. You do not have to
DENTAL PLAN Program, your copayment will be $0 for specialty medications such as worry about contacting the pharmacy each month
VISION PLAN
those for Hepatitis C, Autoimmune Conditions, Oncology and Multiple to refill your prescription or call your doctor’s office
LEGAL PLAN
Sclerosis. If you opt out or do not complete additional steps to enroll you to renew your prescription. When your prescription
Benefits
for Active will pay 30% of the drug cost. DO NOT OPT OUT! is down to the last refill or is about to expire, the
Employees
Only pharmacy will contact your doctor to renew. You do
• Enrollment in PrudentRx is FREE not have to worry.
• Call PrudentRx today at 1-800-578-4403 to make sure they have your member information
Your
Cost for on file and register for any copay assistance available from drug manufacturers.
Coverage
• If you are eligible, more information will be mailed to your home from Prudent Rx
Use the links below to request Automatic Refills to
• Call CVS Specialty Pharmacy at 1-866-387-2573 if you have any questions about your
help you stay on track with your prescriptions.
Contacts
for More
specialty drugs.
Information
• CVS Caremark – Go to www.caremark.com/
Get the PrudentRx facts at manage-prescriptions/refill
Required
Benefit www.mncppc.org/DocumentCenter/View/18210
Notices • Kaiser Permanente HMO – Register at my.kp.org/
mncppc and go to the Pharmacy Tab to manage
You can find the PrudentRx Specialty drug list at
Benefit
Enrollment/ CONTINUED
your prescription services or use the kp.org app.
Change
www.mncppc.org/DocumentCenter/View/18209
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 17Enrolling
in Your
PRESCRIPTION PLANS SUMMARY
Benefits
Benefits
for Active Here is a summary of your
Employees
and Retirees Prescription Plans.
MEDICAL PLAN CVS CAREMARK PRESCRIPTION PLAN KAISER PERMANENTE PRESCRIPTION PLAN
PRESCRIPTION DRUG PLAN DRUG TYPE Participating Retail Pharmacy/Network Mail Order Pharmacy/
CVS Mail Order or CVS Pharmacy
Pharmacy Pharmacy Network Pharmacy
DENTAL PLAN (up to 90-day supply)
(up to 34-day supply)* (up to 30-day supply) (up to 90-day supply)
VISION PLAN
Generic Drugs $8 copay $16 copay $7/$10 copay $14/$20 copay
LEGAL PLAN
Preferred Brand Name Drugs $16 copay $32 copay $15/$20 copay $30/$40 copay
Benefits Non-Preferred Brand Name Drugs $25 copay $40 copay $30/$35 copay $60/$70 copay
for Active
Employees $0 copay if enrolled in PrudentRx; otherwise,
Only Specialty Drugs N/A N/A N/A
you pay 30% of the cost of the drug
Lifestyle Drugs 50% copay 50% copay N/A N/A
Your *Participating retail pharmacies other than CVS accept the CVS Caremark card to fill short-term medications, up to 34-day supply. Other Participating retail pharmacies include Costco, Giant, Harris Teeter,
Cost for Kmart, Sam’s Club, Target, Wal-Mart, Walgreens, and Wegmans.
Coverage
Use these resources to determine if your drug is on the formulary and how much you will pay out-of-pocket:
Contacts
for More
Information Is your drug on the formulary?
CVS Caremark
• www.mncppc.org/DocumentCenter/View/216
Required
Benefit Kaiser Permanente
Notices
• Kaiser Permanente HMO - www.mncppc.org/DocumentCenter/View/18267
• Kaiser Permanente Medicare Advantage - www.mncppc.org/DocumentCenter/View/18283
Benefit
Enrollment/
Change CONTINUED
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 18Enrolling
in Your
Benefits
Benefits
for Active
Employees
DENTAL PLAN
and Retirees
MEDICAL PLAN STAY ON TRACK
PRESCRIPTION DRUG PLAN
DENTAL PLAN The American Dental Association recommends that you
VISION PLAN get a dental exam every 6 months. Dental exams, are
LEGAL PLAN
important to your overall health. During a dental exam,
Benefits your dentist or dental hygienist not only checks your teeth
for Active
Employees and gums, but also looks for signs and symptoms of other
Only
health conditions including diabetes, cancer, heart disease,
Your
osteoporosis and premature birth. Early detection and
Cost for follow-up treatment with a doctor or specialist for these
Coverage
conditions can result in a favorable outcome.
Contacts
for More For more information on the connection between your oral
Information
health and your overall health go to www.mncppc.org/
DocumentCenter/View/18197
Required
Benefit
Notices
Smile throughout the year. Get your dental exams.
Benefit
Enrollment/ CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 19Enrolling
in Your
DENTAL PLANS
Benefits
Benefits
for Active
Employees
and Retirees You have two dental plans to choose from:
MEDICAL PLAN • DeltaCare USA HMO
PRESCRIPTION DRUG PLAN • Delta Dental PPO
DENTAL PLAN
VISION PLAN
LEGAL PLAN
The DeltaCare USA HMO features: Delta Dental PPO features:
Benefits
for Active
Employees • Plan does not cover services from providers • Flexibility – You can obtain services from a
Only
outside of the nationwide DeltaCare provider in the Delta Dental PPO network, Delta
network, unless an emergency (up to Dental Premier network, or go out-of-network
Your
Cost for $100 for emergency dental expenses per to a non-Delta Dental provider. All networks are
Coverage
emergency) nationwide
• You must select a Primary Care dentist or • No need to choose a Primary Care dentist
Contacts
for More one will be selected for you • No referrals required
Information
• Primary Care dentist refers you to specialists • Your out-of-pocket costs will be lowest if you see a
Required • You pay a preset fee provider in the Delta Dental PPO network, slightly
Benefit
Notices • No deductibles higher if you see a provider in the Delta Dental
Premier network, and highest if you see a non-
• No annual dollar maximums
Benefit Delta Dental provider.
Enrollment/
CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 20Enrolling
FEATURES SUMMARY
in Your
Benefits DELTA DENTAL
PPO PLAN MEMBERS
Benefits DELTACARE USA
for Active
Employees
HMO
DELTA DENTAL PPO
Virtual Screenings and
and Retirees
In-Network In-Network
Non-Delta Urgent Care
Dental Provider
MEDICAL PLAN
Annual $50/person $50/person
PRESCRIPTION DRUG PLAN None
Deductible $150/family $150/family
DENTAL PLAN Annual Benefit $2,000/person each $2,000/person each
Toothpic offers virtual dental screenings for non-
None
VISION PLAN Maximum calendar year calendar year urgent/non-emergencies. Use your smartphone to
LEGAL PLAN Diagnostic
& Preventive
upload photos of your teeth, gums or other areas
Benefits Services- Exams, Refer to fee of concern and receive a detailed assessment from
Covered at 100% Covered at 100%**
for Active cleanings, schedule*
Employees x-rays and a Delta Dental provider with recommendations
Only sealants
and next steps within 24 hours. No appointments
Basic Services
Your
– Fillings, root
Refer to fee Covered at 80% after Covered at 80%** necessary. To schedule your screening go to https://
canals, gum
schedule* deductible after deductible
Cost for treatments, oral member.toothpic.com/create-account.
Coverage surgery
Major Services –
Crowns, inlays, Refer to fee Covered at 60% after Covered at 60%**
Contacts onlays and cast schedule* deductible after deductible Virtual Consult available for urgent care (pain,
for More restorations
Information chipped teeth, swollen gums). Schedule a real-time
Orthodontics
– Adults and Refer to fee
Covered at 60% Covered at 60%** video visit with a participating Delta Dental provider.
$2,000 lifetime $2,000 lifetime
dependent schedule*
Required children
maximum maximum Go to www.deltadentalvirtualconsult.com.
Benefit
Notices * View the fee schedule and plan summary at www.mncppc.org/DocumentCenter/View/6355
** Non-Delta Dental providers can bill you for charges that exceed their reimbursement from Delta Dental.
Note: You will be responsible for charges when Toothpic/virtual
consults/in-office oral evaluations-combined, exceed 2 visits per
Benefit
Enrollment/ CONTINUED year. Toothpic fee is fixed at $35/visit. Virtual Consult fees vary.
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 21Enrolling
in Your
Benefits
Benefits
for Active
Employees
VISION PLAN
and Retirees
MEDICAL PLAN STAY ON TRACK
PRESCRIPTION DRUG PLAN
DENTAL PLAN Even if you do not wear eyeglasses or contact lenses, the American Optometric
VISION PLAN Association advises that those age 18-64 should get a vision exam every two (2) years
LEGAL PLAN
and those age 65 and older annually.
Benefits
for Active
Employees Your eye doctor not only looks for common conditions that affect your eyesight but
Only
also those that affect your overall health. Eye doctors may be the first to detect signs
Your
of conditions such as diabetes, high blood pressure, high cholesterol, skin cancer and
Cost for rheumatoid arthritis so you can seek treatment and early intervention.
Coverage
Some of the common conditions that your eye doctor looks for include dry eyes,
Contacts
for More glaucoma, cataracts and astigmatism. Use EyeMed’s Eye Condition Simulator, at www.
Information
eyesiteonwellness.com/eye-diseases/, to see how 12 common eye conditions may be
affecting your eyesight and your need to get an eye exam as soon as possible.
Required
Benefit
Notices
If you are overdue for an annual vision exam, schedule it as soon
as possible. Stay on track with your vision exams. Your vision is
Benefit
Enrollment/ important- 80% of what we learn is through our eyesight. CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 22Enrolling
in Your
YOUR VISION PLAN
Benefits
HERE’S HOW THE EYEMED PLAN OPTIONS COMPARE:
Benefits
for Active EyeMed Vision Plan’s national network PLAN LOW MODERATE HIGH
Employees
FEATURE PLAN* PLAN* PLAN*
and Retirees provides you with over 100,000 vision care
FREQUENCY OF VISION CARE SERVICES
MEDICAL PLAN providers to choose from that include both
Every Every Every
PRESCRIPTION DRUG PLAN independent providers and major retail Exam
plan year plan year plan year
DENTAL PLAN chains: LensCrafters, Pearle Vision and Target Every other plan Every other plan Every
Frame
VISION PLAN year year plan year
Optical, America’s Best, For Eyes Optical and
LEGAL PLAN Every other plan Every Every
Lenses
more. You can also purchase brand-name year plan year plan year
Benefits Every other plan Every Every
for Active frames, eyeglasses and contact lenses online Contact Lenses
year plan year plan year
Employees
Only through participating providers: Ray-Ban, IN-NETWORK PROVIDER MEMBER COST*
Glasses.com and ContactsDirect. $0 copay; $150 $0 copay; $150 $0 copay; $250
Frames allowance; 20% off allowance; 20% off allowance; 20% off
Your balance over $150 balance over $150 balance over $250
Cost for
Coverage EyeMed helps pay for routine periodic eye $0 copay; $130 $0 copay; $130 $0 copay: $200
Conventional Contact Lenses allowance; 15% off allowance; 15% off allowance; 15% off
exams, eyeglasses and contacts, and related balance over $130 balance over $130 balance over $200
Standard Plastic Lenses –(Single/
Contacts supplies. When you use an in-network Bifocal/Trifocal/Lenticular)
$0 copay $0 copay $0 copay
for More
Information provider you receive discounted services Up to Up to
Standard Anti-Reflective Coating $0 copay
$45 copay $45 copay
and the plan pays a percentage of your cost.
Standard Progressive $55 copay $55 copay $0 copay
Required
There are three vision plan options: low, Up to Up to
Standard Tint (Solid/Gradient) $0 copay
Benefit $15 copay $15 copay
moderate and high.
Notices Standard Photochromic/
$75 copay $75 copay $0 copay
Transition
Benefit CONTINUED
Enrollment/
Change
* *If you use an out-of-network provider, you will need to pay at time of service and submit a claim for any applicable
reimbursements. If the provider charges more than EyeMed’s allowance, you may have to pay the difference.
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 23Enrolling
in Your
Benefits
Benefits LEGAL
PLAN
for Active
Employees
and Retirees
LEGAL
MEDICAL PLAN
RESOURCES
PRESCRIPTION DRUG PLAN
DENTAL PLAN
STAY ON TRACK Legal Resources advises that
VISION PLAN You never know when you will need the help of a lawyer- 70% of employees have a
LEGAL PLAN
traffic accident, divorce, marriage, prenuptial agreement, legal need each year and if
Benefits
adoption, eviction, landlord disputes, bankruptcy, identity they hire an attorney on their
for Active
Employees own, the cost could be $300
Only
theft, elder care, etc.*
or more per hour.
Your Experiencing these events, can derail your life, causing you to • If you enroll in Legal
Cost for
Coverage worry, take time off from work, and affect your physical health Resources you pay $17.00/
as well. With Legal Resources, you have a local law firm on month or $204/year for
retainer to help you stay on track with your legal matters so unlimited advice and
Contacts
for More you can get on with your life. consultation for covered
Information
services.
View a short video to discover what Legal • You must remain in the
Required
Benefit Resources has to offer to help you stay plan for 12 months before
Notices
on track with your legal matters at
you can cancel coverage
https://www.legalresources.com/members/videos.
Benefit
Enrollment/
CONTINUED
Change *Does not cover Commission related lawsuits.
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 24Enrolling
in Your
Benefits
LEGAL RESOURCES SUMMARY
Benefits Here is a summary of the services provided by Legal Resources:
for Active
Employees
CONTINUED
and Retirees
PLAN FEATURE LEGAL RESOURCES
MEDICAL PLAN Who is Covered You, your spouse, and your dependent children up to age 19 or up to age 23, if a full-time student
PRESCRIPTION DRUG PLAN
Other Family Member Your parents can get 25% discount off legal needs
DENTAL PLAN
VISION PLAN Legal Consultation Unlimited in-person or telephone advice and consultation for fully covered services
LEGAL PLAN Cost of
Covered Services Unlimited in-person or telephone advice and consultation for fully covered services
Services
Benefits
Identity Theft
Not Covered
for Active
Civil Actions Under
Employees • Prevention and identity recovery assistance
• Representation as defendant the Plan:
Only
• Representation as plaintiff 25% discount
Family Law
• Insurance matters
• Uncontested domestic adoption
• Initial administrative hearing
Your
• Uncontested divorce
• Small Claims Court advice
Cost for • Uncontested name change
Coverage Real Estate
Wills and Estate Planning
• Purchase, sale, or refinance of primary residence
• Will preparation and periodic updates
• Tenant-Landlord matters:
• Advance medical directive
o Eviction
Contacts • Financial powers of attorney
o Interruption of utilities
for More o Habitability
Information Traffic Violations
• Speeding
Consumer Relations and Credit Protection
• Reckless driving
• Warranty disputes
• Driving under the influence (1st Offense/Criminal)
Required • Billing disputes For more information on
Benefit • Collection agency harassment
Preparation and Review of Routine Legal Documents these services go to
Notices • Purchase and Sale of Your Home
www.LegalResources.com
Attorney Assignment You must select one participating firm for all your legal needs
Benefit or call l 1-800-728-5768.
Enrollment/ Monthly Premium $17.00/month
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 25Enrolling
in Your
Benefits
Benefits for
Employees
and Retirees
Benefits for
Employees
Only
Your
Cost for
Coverage
Contacts
for More
Information
BENEFITS
Required
Benefit
FOR ACTIVE
EMPLOYEES ONLY
Notices
Benefit
Enrollment/
Change
Form
CONTINUED
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 26Enrolling
in Your
Benefits
FSA DEADLINES
Benefits for
FSA FLEXIBLE STAY ON TRACK
SPENDING
Employees
and Retirees
Stay on track with your FSA deadlines to
ACCOUNTS
ensure that you use your funds and file your
Benefits for
Employees claims before the deadlines. Don’t lose your
Only
FSA funds, use them.
FLEXIBLE SPENDING ACCOUNTS
STAY ON TRACK
LIFE AND AD&D INSURANCE
SICK LEAVE BANK Flexible Spending Accounts (FSAs) allow you to set Incur Eligible File Forfeiture
PLAN YEAR
Expenses Claims (Loss)
aside money from your paycheck, before taxes, to pay Includes
LONG-TERM DISABILITY on or no later of Unused
Grace Period
eligible out-of-pocket expenses incurred by you and your before ……... than ……... Funds
Your
Cost for dependents. You can also use a debit card for immediate January 1, 2021 –
Coverage
access to your funds. With a debit card you do not need December 31, 2022
12-month
to pay for the eligible expense up front and file a claim 12/31/2022 1/31/2023 2/1/2023
grace period
Contacts per relaxation
for More
for reimbursement. You have the option of enrolling in
of IRS rules
Information the Healthcare FSA or the Dependent Care FSA.
January 1, 2022 –
March 15, 2023
Required When you enroll in an FSA you have to keep track of the 3/15/2023 3/31/2023 4/1/2023
Benefit 2.5-month
Notices deadlines. If you miss these deadlines, you could lose grace period
some or all of your funds at the end of the year; you will
Benefit
Enrollment/
not be reimbursed.
CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 27Enrolling
in Your
FLEXIBLE SPENDING
Benefits
There are two Flexible Spending Accounts that you can participate in:
Benefits for
Employees
and Retirees
ACCOUNTS HEALTHCARE FSA | DEPENDENT CARE FSA
Benefits for
HEALTHCARE FSA DEPENDENT CARE FSA
Employees
Only
The Health Care FSA can be used to reimburse If you have dependents, you may have to pay a caregiver to look after
eligible expenses that are not covered under your them while you work or attend school. Eligible dependents can be
FLEXIBLE SPENDING ACCOUNTS medical, dental, or vision plan. NEW: For 2022, children under age 13 or adults that are elderly or disabled and rely on
LIFE AND AD&D INSURANCE you can set aside up to $2,750 and expenses are you for support. For 2022, you can set aside up to $5,000 if married
SICK LEAVE BANK reimbursed as you receive the services. and filing jointly or single as head of household or $2,500 if married
LONG-TERM DISABILITY and filing separately. Expenses are reimbursed to you when you have
Eligible expenses are set by the IRS and include: adequate funds in your account.
Your
Cost for • Deductibles (for medical, dental and vision)
Coverage
Examples of eligible dependent care expenses include:
• Copayments
• Child or adult daycare center fees
Contacts • Coinsurance
for More • Before-school/afterschool care
Information • Hearing Aids (not including tuition expenses)
• Orthodontia For a list of eligible For a list of eligible
• Day Camp
Required
expenses, visit expenses, visit
Benefit
• Chiropractor costs, • Nursery School
Notices
www.benstrat.com. www.benstrat.com.
and more
• and more
Benefit
Enrollment/ CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 28Enrolling
in Your
Benefits
Benefits for
THE FSA TAX ADVANTAGE
Employees When you participate in the FSAs, you can reduce your
and Retirees
taxable income and increase your spendable income.
Benefits for In the illustration below, you could increase your
Employees
Only spendable income by $1,417.38/year
FLEXIBLE SPENDING ACCOUNTS FSA ELECTIONS
WITHOUT WITH
LIFE AND AD&D INSURANCE DO NOT ROLL FSA FSA
SICK LEAVE BANK OVER TO THE NEXT
Gross Annual Salary $45,000 $45,000
LONG-TERM DISABILITY
CALENDAR YEAR
Healthcare FSA Contribution $0 $2,750
Your
Cost for
Dependent Care FSA Contribution $0 $3,000
Coverage Unlike other
benefits, you Total FSA Contributions $0 $5,750
Contacts must enroll in the
for More
Information Healthcare FSA and Tax Savings on Total FSA Contribution $0 $1,417.38
Dependent Care
State (5% x $5,750) $287.50
Required FSA annually during
Benefit Federal (12% x $5,750) $690.00
Notices Open Enrollment.
Social Security (7.65% x $5,750) $439.88
Benefit
Enrollment/
Change CONTINUED
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 29Enrolling
in Your
Benefits
Benefits for
LIFE AND AD&D FOP members
receive
INSURANCE
Employees
and Retirees
FREE $50,000
AUTOMATIC BASIC AD&D coverage
Benefits for LIFE INSURANCE
Employees
Only STAY ON TRACK (You may opt-out at any time.)
FLEXIBLE SPENDING ACCOUNTS Life happens. You get married, divorced, have children,
Click here for the Opt-Out form www.mncppc.org/
LIFE AND AD&D INSURAANCE get an increase in your pay, etc. These are times when you
DocumentCenter/View/18507.
SICK LEAVE BANK should reevaluate your life insurance coverage. Do you have
LONG-TERM DISABILITY enough life insurance coverage at this stage in your life? The Basic plan coverage is 2 times your base annual
salary up to a maximum of $200,000. You pay 20%
Your
Cost for of the premium. In addition to the Basic Coverage,
Coverage To determine how much life insurance you need at
this stage in your life and the cost, use Securian’s Life you automatically receive Accidental Death &
Insurance Needs Calculator at: Dismemberment coverage at 2 times your base annual
Contacts
for More salary up to a maximum of $200,000. The maximum
Information https://www.securian.com/insights-tools/life-insurance-
deduction from your pay check ($200,000 coverage) will
needs-calculator.html
be $2.14 bi-weekly. AD&D insurance provides payment
Required
Benefit to you if you lose a limb and to your beneficiaries if you
Notices Revisit your life insurance on a regular basis to make die in an accident.
sure your coverage stays on track with your needs while
Benefit
Enrollment/ providing financial security for you and your family. CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 30Enrolling
in Your
Benefits
You also have the option of purchasing supplemental life insurance for yourself
Benefits for and coverage for your spouse/dependents. You pay 100% of the premium.
Employees
and Retirees
Benefits for
Employees
SUPPLEMENTAL SPOUSE/DEPENDENT LIFE INSURANCE
Only
LIFE INSURANCE You may purchase life insurance for your
spouse/dependent(s). There are three options.
FLEXIBLE SPENDING ACCOUNTS
You may purchase one to five If you want to apply
LIFE AND AD&D INSURAANCE
times your annual base pay, up to OPTION 1 for Supplemental or
SICK LEAVE BANK Spouse/Dependent
a $750,000. You are guaranteed $10,000 spouse/$5,000 child(ren)
coverage, contact the
LONG-TERM DISABILITY
coverage up to 3 x base annual OPTION 2 Health & Benefits Office
Your
salary not to exceed $300,000, $20,000 spouse/$10,000 child(ren)
• benefits@mncppc.org
Cost for
without Evidence of Insurability, OPTION 3 • 301-454-1694
Coverage
if you enroll within 45 days of $30,000 spouse/$15,000 child(ren)
eligibility. Coverage in excess of that (Your spouse must provide Evidence of Insurability)
Contacts
for More guaranteed coverage ($300,000) or
Information Use Securian’s online benefits decision tool, Benefit Scout™ to learn more about
4 x or 5 x base annual salary requires your life insurance options and to determine your cost for basic, supplemental
Evidence of Insurability. and spouse/dependent life insurance. Visit www.LifeBenefits.com/MNCPPC.
Required
Benefit
Notices
IMPORTANT THINGS • All Life Insurance is term-Life Insurance. There is no cash or surrender value.
TO KNOW ABOUT YOUR • If you leave the Commission, you may port or convert all or part of your coverage to an individual CONTINUED
Benefit
Enrollment/ GROUP LIFE INSURANCE life insurance policy. Premiums may be higher than those paid as an active employee.
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 31Enrolling
in Your
Benefits
THE SICK LEAVE BANK
Benefits for SICK LEAVE ENHANCEMENTS
BANK
Employees *The Sick Leave Bank has been
and Retirees
enhanced as follows:
Benefits for
Employees
Only
STAY ON TRACK YOU HAVE
TWO
• No waiting periods before or after enrollment
• When first becoming benefit eligible, you now have 60 days
CHANCES
The Sick Leave Bank is a voluntary short-term, income- instead of 45 days to enroll
FLEXIBLE SPENDING ACCOUNTS TO ENROLL
replacement disability program that enables members • You do not have to exhaust all accrued leave; you may retain
IN THE SICK
LIFE AND AD&D INSURAANCE LEAVE BANK. up to 80 hours of annual leave
who exhaust their accrued leave to access a source of
SICK LEAVE BANK • Parental leave for birth, adoptions and foster care up to 12
paid leave when they unable to work for an extended 1. Within 60 weeks. Applies to men and women
LONG-TERM DISABILITY
period of time and need it most; in the event of their days of hire • Leave to care for a family member who is ill has been
own serious illness (including pregnancy), the illness or eligibility extended from 2 weeks to 4 weeks
Your
Cost for • If you are caring for a child, the age of the child has been
Coverage of a family member or parental responsibilities. 2. Open increased from age 19 to age 25
Participants may be required to donate up to 8 hours Enrollment
• And more ………………………
of their sick/annual leave each year.
Contacts
for More
Information
For the complete details of the enhanced Sick Leave Bank Program,
When you participate in the Sick Leave Bank you can
view the policy at www.mncppc.org/DocumentCenter/View/222.
count on a source of income-replacement to help you
Required
Benefit stay on track with your financial obligations while you
Notices CONTINUED
are unable to work.
Benefit
Enrollment/
Change If you continue to be disabled and are unable to work for 120 days, you may apply for benefits under the Long-Term Disability Plan.
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 32Enrolling
in Your
Benefits
Benefits for LONG-TERM LONG-TERM DISABILITY (LTD)
DISABILITY
You are automatically enrolled in the Basic Long-Term
Employees
and Retirees Disability plan. You pay a portion of the premium. If
you become disabled more than 120 days, your LTD plan
STAY ON TRACK
Benefits for pays 66 2/3% of your basic monthly earnings up to a
Employees maximum of $6,000 per month. (Note: Park Police may
Only
have different benefit levels; refer to your collective
If you are unable to work for a period
FLEXIBLE SPENDING ACCOUNTS bargaining agreement.)
exceeding 120 days, how will you pay
LIFE AND AD&D INSURAANCE
your bills and support your family? Not
SICK LEAVE BANK
to worry. The Commission helps you SUPPLEMENTAL LONG-TERM
LONG-TERM DISABILITY
stay on track with your living expenses DISABILITY
by providing you with a basic Long-Term If you earn more than $108,000 annually, you may enroll
Your
Cost for in the Supplemental Long-Term Disability Plan. Coverage
Coverage Disability plan.
provides you with 66 2/3% of your base salary between
$108,000 to $216,000. This benefit is in addition to any
This plan provides you with partial
Contacts
benefit received under the basic LTD plan. The maximum
for More income replacement if you are unable to
Information benefit for supplemental coverage is $6,000 per month.
work due to a non-occupational injury or
You pay 100% of the premium.
illness. You can also pay for supplemental
Required
Benefit long-term disability coverage if your base You can enroll in the Supplemental LTD plan when you first
Notices
salary exceeds $108,000/year. become eligible or during Open Enrollment each Fall. If
Benefit you enroll more than 45 days after your initial eligibility
Enrollment/ CONTINUED period, you must provide Evidence of Insurability.
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 33Enrolling
in Your
Benefits
Benefits for
Employees
and Retirees
Benefits for
Employees
Only
Your
Cost for
Coverage
YOUR
Contacts
for More
Information COST FOR
Required
Benefit
Notices COVERAGE
Benefit
Enrollment/ CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 34Enrolling
in Your
Benefits
Benefits for
YOUR RATES
COST FOR
Employees
and Retirees
Benefits for
Employees
Only
COVERAGE RATES FRATERNAL ORDER OF POLICE (FOP)
This guide provides you with details about
Your your benefit plans to assist you in making
Cost for
Coverage your elections for 2022. While the details
of each plan are important, you also need RATES
CONTRACT EMPLOYEES
Contacts to consider the cost to ensure that your
for More
Information elections not only fit the needs of you and
your family, but also your budget. Click on
Required the link to view the 2022 premium rates for
Benefit
the medical, prescription, dental, vision and RATES MCGEO, NON-UNION REPRESENTED EMPLOYEES
Notices
group prepaid legal plans.
Benefit
Enrollment/
Change Employees will also find the premium rates
Form
for the long-term disability, basic life and
accidental death and dismemberment plans. RATES
RETIREE AND SURVIVORS MONTHLY
CONTINUED
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 35Enrolling
in Your
Benefits
Benefits for
Employees
and Retirees
Benefits for
Employees
Only
Your
Cost for
Coverage
CONTACTS
Contacts
for More
Information FOR MORE
Required
Benefit
Notices INFORMATION
Benefit
Enrollment/ CONTINUED
Change
Form
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 36Enrolling
in Your
Benefits If you have questions about the benefits described in this guide, you can
Benefits for
Employees
CONTACTS contact the Health & Benefits Office at benefits@mncppc.org or 301-454-1694.
You may also contact the benefit providers as listed below.
and Retirees
BENEFITS PROVIDER PHONE NUMBER WEBSITE
MEDICAL
Benefits for
Employees UnitedHealthcare (All Plans) 1-800-603-4190 (M-F, 8 a.m. to 8 p.m.) www.myuhc.com
Only
Kaiser Permanente HMO with Prescription Drug Coverage 1-800-777-7902 (24 hours a day/7 days a week) my.kp.org/mncppc/
PRESCRIPTION DRUG
Your
Cost for -CVS Caremark 1-800-421-5501, 1-800-231-4403 (TTD)
www.caremark.com
Coverage -SilverScript (Medicare Eligible) 1-800-270-3759, 771 (TTD)
DENTAL
1-800-422-4234 DeltaCare HMO)
Contacts DeltaCare USA HMO and Delta Dental PPO 1-800-932-0783 (Delta Dental PPO) www.deltadentalins.com
for More
(Monday-Friday, 8:00 a.m. to 9:00 p.m.)
Information
VISION
1-866-800-5457
Required EyeMed Vision (Monday-Friday, 7:30 a.m. to 11:00 p.m.) www.eyemed.com
Benefit (Saturday-Sunday, 11:00 a.m. to 8:00 p.m.)
Notices
FLEXIBLE SPENDING ACCOUNTS
1-888-401-FLEX
Benefit Benefit Strategies (Monday-Thursday, 8:00 a.m. to 6:00 p.m.) www.benstrat.com
Enrollment/ (Friday 8:00 a.m. to 5:00 p.m.)
Change
Form LIFE AND AD&D INSURANCE
1-866-293-6047
Securian Financial www.LifeBenefits.com
(Monday-Friday, 6:00 a.m. to 5:00 p.m.)
LEGAL PLAN
1-800-728-5768
Legal Resources www.legalresources.com
(Monday-Friday, 8:30 a.m. to 5:30 p.m.)
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 37Enrolling
in Your
Benefits
Benefits for
Employees
and Retirees
Benefits for
Employees
Only
Your
Cost for
Coverage
Contacts
for More
Information
REQUIRED
Required
Benefit
Notices
BENEFIT
NOTICES
Benefit
Enrollment/
Change
Form
CONTINUED
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 38Enrolling
in Your
Benefits enrollment within 30 days after you or your dependents’ In addition, continuation of coverage may be available to your
REQUIRED
other coverage ends (or after the employer stops contributing eligible dependents if:
toward the other coverage);
• You die
Benefits for • If you or your dependents lose Medicaid or Children’s Health
BENEFIT
Employees Insurance Program (“CHIP”) coverage as a result of a loss • You and your spouse divorce or separate
and Retirees of eligibility for such coverage. However, you must request
enrollment within 60 days after the loss of such coverage; or • A covered child ceases to be an eligible dependent
NOTICES • If you or your dependents become eligible for a premium • You become entitled to Medicare
Benefits for assistance subsidy under Medicaid or CHIP. However, you
To apply for COBRA coverage, you or a dependent must contact
Employees must request enrollment within 60 days after you or your
the Health & Benefits Office at 301-454-1694 within 60 days
Only dependents become eligible for such assistance.
HEALTH INSURANCE PORTABILITY AND of a qualifying life event. You and/or your dependents must
pay the full cost of COBRA coverage, i.e., 100% of the monthly
ACCOUNTABILITY ACT (HIPAA)
In addition, if you have a new dependent as a result of marriage, premium plus 2% for administrative costs.
Your birth, adoption or placement for adoption, you may be able to
An Important Notice About Your Privacy
Cost for Under the law, COBRA must be offered to eligible individuals at
enroll yourself and your dependents. However, you must request
Coverage group rates. These rates are subject to change annually, based
The Health Insurance Portability and Accountability Act of 1996 enrollment within 30 days after the marriage, birth, adoption
or placement for adoption. on plan experience.
(HIPAA) requires that health plans protect the confidentiality of
your private health information. The Plan uses health information
about you and your covered dependents only for the purposes To request special enrollment or obtain more information, WOMEN’S HEALTH AND CANCER RIGHTS
Contacts
for More of providing treatment, paying claims, and related functions. To contact the Health & Benefits Office at 301-454-1694 ACT OF 1998
Information protect the privacy of health information, access to your health
information is limited to such purposes. In addition, effective COBRA - CONTINUING COVERAGE FOR This law requires group health plans that provide coverage for
April 14, 2003, the Plan complies with the applicable health HEALTH BENEFITS medically necessary mastectomies to also provide coverage for:
information privacy requirements of federal regulations issued
Required by the Department of Health and Human Services. The Plan’s Under certain circumstances, you and your enrolled dependents • Reconstruction of the breast on which the mastectomy has
Benefit privacy policies are described in more detail in the Plan’s privacy been performed;
have the right to continue coverage under the medical and
Notices
notice. You may contact the Commission’s Health & Benefits dental plans, as well as the health care flex account, beyond the
• Surgery and reconstruction of the other breast to provide a
Office if you would like to receive a copy of the HIPAA notice. time that coverage would have ordinarily ended. You may elect
symmetrical appearance; and
continuation of coverage for yourself and your dependents if
Benefit HIPAA Special Enrollment you lose coverage under the plan due to one of the following • Prostheses and the treatment of physical complications during
Enrollment/
qualifying events: all stages of the mastectomy.
Change
If you are declining enrollment for yourself or your dependents
Form
(including your spouse) because of other health insurance or • Termination (for reasons other than gross conduct) The Commission’s plans cover mastectomies and the benefits
group health plan coverage, you may be able to enroll yourself required by this act. If you would like more information on WHCRA
and your dependents in this plan in the following circumstances: • Reduction in employment hours benefits, call the Health & Benefits Office at 301-454-1694.
• Retirement
• If you or your dependents lose eligibility for that other coverage
(or if the employer stops contributing towards you or your • You become entitled to Medicare CONTINUED
dependents’ other coverage). However, you must request
STAY ON TRACK M-NCPPC
BENEFIT GUIDE 39You can also read
