Welcome to Open Enrollment Mount Carmel Health!

Transcription

Welcome to Open Enrollment Mount Carmel Health!
Trinity Health and Mount Carmel Health are pleased to provide you with the information you will need to enroll in benefits for next
year. Throughout the rest of this communication, you will see Trinity Health and Mount Carmel Health referred to as simply Trinity
Health. If you have more questions after reviewing this guide, refer to the “For More Information” section to learn where you can get
answers.
Your Top Three Tasks for Open Enrollment
What’s Inside
What’s New for 2017
2
Who is Eligible
3
About the Medical Plans
4
Medical Coverage
5
Medical Plan Highlights
6
More About the Health
Savings PPO
8
Live Your Whole Life
9
1
Review and make changes to your benefit elections by
Nov. 2, 2016.
2
Review and update your beneficiaries.
3
Submit your Personal Health Application for life insurance to
The Hartford by Jan. 9, 2017, if applicable.
It’s also a good time of year to:
Update your personal information through Self-Service (ESS).
More About the Medical
Plans
10
Dental Coverage
11
Vision Care Coverage
12
Review the Live Your Whole Life section of this Guide to learn about resources
that will help you maintain your health and incentives on your medical
contributions throughout the year.
Flexible Spending
Accounts
13
Print copies of your benefit elections for proof of enrollment.
Life Insurance
14
If you want to contribute to the Health Savings Account, the Health Care or
Dependent Care Flexible Spending Accounts or elect PTO cash-out, you must
make an election. Last year’s election will not carry forward.
Time Away from Work
15
Legal Plan and
Voluntary Benefits
16
How to Enroll
17
For More Information
18
Important Reminders
19
Check the eligibility rules if you, your spouse/eligible adult and/or dependent child
both work at Trinity Health at http://mybenefits.trinity-health.org.
If you want to participate in the Essential PPO Assist Plan for 2017, you must
apply each year and meet specific income and eligibility guidelines. For more
information on the Essential PPO Assist Plan, refer to page 7.
Additional Notices
Mount Carmel Health
1
What’s New for 2017
• You will have the opportunity to contribute $50 more
per year to your HSA, up to a maximum of $3,400 in
2017, if you have colleague only coverage. The IRS
contribution limit for all other coverage levels remains
$6,750. Trinity Health’s contribution amount to your
HSA will remain the same as in 2016.
• If you apply and qualify for the Essential PPO Assist
plan for 2017, the total amount Trinity Health
contributes to your employer sponsored Health
Reimbursement Account (HRA) increases from $750 to
$850 for colleague only coverage and increases from
$1,500 to $1,700 for all other coverage levels.
• Beginning January 1, 2017, your dental coverage will
cover ceramic and porcelain fillings for posterior teeth
and fluoride treatment up to age 19 (previously age 14).
• Beginning January 1, 2017, we will be offering an
improved well-being program to help you maintain a
lower contribution per pay period for your medical costs.
Updates to the Live Your Whole Life website allow for
easier navigation and a more user-friendly experience.
• If you have family coverage or have a spouse on your
plan, please note that there are now separate incentive
amounts for colleagues and spouses/eligible adults in
the Live Your Whole Life program with Traditional,
Health Savings or Essential PPO Plans. If both you
and your spouse/eligible adult complete the activities in
each period, you will maintain the Full Incentive
amounts. If only one of you completes the activities in
each period, you will start earning the 1-Person
Incentive amounts.
• While not mandatory, you are encouraged to take
advantage of the new opportunity to select a primary
care physician (PCP) online using the Aetna portal.
• Starting January 1, 2017, Nationwide Children’s
Hospital will be considered a Tier 1 provider.
Your Enrollment Requirements
If you don’t make benefit elections on or before Nov. 2, 2016, you will automatically receive a default package of
benefits, which includes the same elections you had last year for medical, dental, vision, life insurance, AD&D,
disability and legal benefits. Keep in mind:
• If you want to contribute to the Health Savings Account, the Health Care or Dependent Care Flexible Spending
Accounts or elect PTO cash-out you must make an election. Last year’s election will not carry forward.
• If you want to participate in the Essential PPO Assist Plan for 2017, you must apply each year and meet specific
income and eligibility guidelines. For more information on the Essential PPO Assist Plan, refer to page 7.
If you wish to participate in these programs next year you must complete your enrollment by Nov. 2, 2016 at 11:59
p.m. EST.
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Mount Carmel Health
Adding Family
Members
If you’re adding family members to
your benefit plan during this year’s
open enrollment, you’re required to
provide written documentation (for
example, marriage certificate or
birth certificate) verifying their
dependent status to Benefits and
Leave Team no later than Nov. 4,
2016. If you don’t submit the
required documentation by the
deadline, your dependents will
not be enrolled for coverage for
2017, and you’ll be required to
wait until next year’s open
enrollment period to add them to
the plan – provided they remain
eligible, and you provide written
documentation verifying their
dependent status at that time.
Who Is Eligible
Eligible Individual
Definition
Colleague
Regularly scheduled full- or part-time colleague with 32 or
more budgeted hours per pay period (32 or more
budgeted hours per pay period for short-term disability
and 32 or more budgeted hours per pay period for
long-term disability.)
Spouse/Eligible Adult
You may cover your spouse or Eligible Adult. An Eligible
Adult is an adult who resides and has financial
interdependence with the colleague, and is not a tax
qualified dependent or related by blood, adoption or
marriage to the colleague.
Dependent Children
Dependent children are eligible for coverage through the
end of the Plan Year in which they turn age 26, regardless
of marital status, student status, residency, financial
dependency or other requirements provided they meet all
of the following criteria:
They are:
You are required to provide a Social
Security number for each of your
dependents over the age of one in
order for them to be covered.
Please provide any missing
dependent Social Security numbers
to Benefits and Leave Team.
Please note, you have the option to
purchase coverage for your
spouse/eligible adult and
dependents. If you and your
spouse/eligible adult or
dependent(s) both work for Trinity
Health, and are benefits eligible, you
cannot elect dual coverage (enrolled
as a colleague and a dependent). In
addition, only one of you will be able
to elect coverage for your child(ren).
Mount Carmel Health
•
Your or your spouse/eligible adult’s natural children;
•
Your or your spouse/eligible adult’s legally adopted
children or children placed with you or your eligible adult
for adoption; or
•
Children for whom you or your spouse/eligible adult are
the court-appointed legal guardian.
•
Not otherwise covered under the Plan or any other
group health plan offered by the Employer.
Note: Children of eligible adults may be covered only if
their eligible adult is covered.
New Hires
New hires are eligible for benefits on the first day of the month following 30
days of employment.
To view the complete eligibility rules
and documentation requirements for
you and your family visit
http://mybenefits.trinity-health.org.
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More about the Clinically-Integrated Network
A Clinically-Integrated Network (CIN) joins local physicians and health care providers that have made a decision to partner with
a Regional Health Ministry (RHM) to deliver services focused on high quality and cost-efficient care designed to improve the
health of those we serve.
Seeking care within the CIN can help you and your physician make health care decisions that ensure that you are accessing the
right care, at the right time, in the right setting. In addition, by utilizing our CIN you will pay less out-of-pocket for the care you
receive, because all of the CIN providers are in our Tier 1 network.
Choose your Primary Care Physician (PCP)
Maintaining a relationship with your PCP is important because they are trained to recognize any health problems you may have.
A PCP is the doctor you see for most services, including annual check-ups. Your PCP can also help you identify and meet your
health goals and help you prevent serious, long-term health conditions. And, by following their preventive recommendations,
they can help keep your health care costs low. Trinity Health encourages you to select a PCP and develop a relationship with
them. To find an in-network physician or provider, visit http://mybenefits.trinity-health.org.
Trinity Health Offers Choice in Medical Benefits
You may be wondering how your benefits at Trinity Health compare with those offered through the Marketplace. On the
health insurance Marketplace, the value of each medical plan is categorized into a “Metal” rating – bronze, silver, gold
and platinum. The graphic shows where each of the choices at Trinity Health falls on the continuum of coverage
available on the Marketplace. Our plans range from covering benefits higher than the Silver Marketplace plan to just
below the Platinum plan.
Traditonal
PPO
4
Mount Carmel Health
Watch this Video
to Learn More
Medical Coverage
Trinity Health is offering you three medical plan choices for 2017 which support our
efforts to provide a common experience for all colleagues and provide meaningful
choices. All three plans are administered by Aetna and support our
clinically-integrated network structure.
The three medical plan options are the Traditional PPO, the Health Savings PPO,
and the Essential PPO. Each plan offers these three tiers so you can pay less by
receiving care from network providers.
Scan the tag with your
smartphone to download
and view a video about
your 2017 medical plan
choices. Get the free
mobile application at
http://www.scanlife.com/getthe-app. If you don’t have a
smartphone, visit your
benefits website to view the
video.
• Tier 1, or the clinically-integrated Health Partners network providers, are
facilities or physicians aligned with our organization that provide you with the
most cost-effective care. For services unavailable through clinically-integrated
Health Partners network providers, Tier 2 providers are available.
• Tier 2 includes Health Partners physicians that do not participate in clinical
integration and select Aetna Providers (facilities and physicians) not listed
under Tier 1. Using Tier 2 providers can save you money, but not as much as
using our Tier 1 network.
• Tier 3 providers are out-of-network providers and this Tier provides the lowest
level of coverage. You can use these facilities and physicians for care, but you
will pay the most out of your pocket when you do.
How the medical plan works
Traditional PPO
If you elect coverage under the Traditional PPO, you pay for a portion of the medical services you receive
until you meet the annual deductible. Then, coinsurance begins up to the annual out-of-pocket maximum.
Health Savings PPO
With the Health Savings PPO, you pay less per pay period for coverage – leaving more money in your
paycheck – and you have access to a Health Savings Account (HSA) to help pay for current and future
medical expenses. Here’s how it works:
First
You pay the full cost of medical and prescription
expenses until you reach the annual deductible (Note:
preventive care services and certain preventive 90-day
generic prescriptions do not require you to meet the
deductible).
Second
Once you meet the deductible, you pay coinsurance until
you reach the out-of-pocket maximum.
Third
Once you reach the out-of-pocket maximum, Trinity
Health pays 100% of all remaining eligible expenses
during the year.
To learn more about the Health Savings PPO, see page 8 of this
enrollment guide.
If you enroll in the Health Savings
PPO, you will automatically have
an HSA. Trinity Health and Mount
Carmel Health contribute to your
HSA to help you pay for
expenses toward your annual
deductible and out-of-pocket
maximum. You can also
contribute to this account to build
savings for current and future
medical expenses. We
encourage you to consult with a
tax advisor for IRS rules and tax
implications related to HSAs.
Essential PPO
The Essential PPO works the same as the Traditional PPO where you pay for a portion of the medical
services you receive until you meet the annual deductible. Then, coinsurance begins. If you elect the
Essential PPO, you pay less in premium contributions than in the Traditional PPO, however, your
out-of-pocket costs are higher.
Mount Carmel Health
5
Medical Plan Highlights
For more information about your medical plan options or to find a provider, visit http://mybenefits.trinity-health.org.
Medical Plan
Highlights
Trinity Healthfunded account
(Individual / Family)
Annual deductible
Coinsurance
1
1
Network Tier
Traditional PPO
Health Savings PPO
Essential PPO
All Tiers
N/A
HSA: $650 / $1,300
HRA: $850 / $1,700
if you qualify
Tier 1
$250 / $500
$1,300 / $2,600
$1,000 / $2,000
Tier 2
$750 / $1,500
$2,500 / $5,000
$2,500 / $5,000
Tier 3
$1,500 / $3,000
$3,500 / $7,000
$4,000 / $8,000
Tier 1
10%*
10%*
20%*
Tier 2
20%*
20%*
30%*
Tier 3
40% R&C*
40% R&C*
40% R&C*
Tier 1
0% no deductible
0% no deductible
0% no deductible
Tier 2
0% no deductible
0% no deductible
0% no deductible
Tier 3
40% R&C*
40% R&C*
40% R&C*
Tier 1
$20 / $30
10%*
20%*
Office visit
(PCP / Specialist)
Tier 2
$30 / $40
20%*
30%*
Tier 3
40% R&C*
40% R&C*
40% R&C*
Urgent care visit
All Tiers
0% after $35 copay
10%*
20%*
Emergency room
All Tiers
0% after $100 copay
10%*
0% after $100 copay
Tier 1
None**
None **
None**
Tier 2
$500**
$500**
$750**
Tier 3
$1,000**
$1,000**
$1,000**
Tier 1
$50**
None**
$50**
Tier 2
$100**
$100**
$100**
Tier 3
$200**
$200**
$200**
Tier 1
$2,500 / $5,000
$2,600 / $5,200
$3,500 / $7,000
Tier 2
$4,750 / $9,500
$5,000 / $10,000
$5,500 / $11,000
Preventive care
Inpatient
admission
Outpatient
surgical services
Out-of-pocket
maximum
Tier 3
Prescription drug
34 day supply
90 day supply
$9,500 / $19,000
Trinity-Health
Owned Pharmacy
Retail
Pharmacy
Generic
Brand formulary
$8
16% ($24 min,
$64 max)
$10
20% ($30 min,
$80 max)
Brand
non-formulary
32% ($48 min,
$80 max)
40% ($60 min,
$100 max)
Trinity-Health
Owned Pharmacy
Mail
Order
Generic
Brand formulary
$24
16% ($72 min,
$192 max)
$25
20% ($75 min,
$200 max)
Brand
non-formulary
32% ($144 min,
$240 max)
40% ($150 min,
$250 max)
Out-of-pocket maximum based on
Tier 2
$7,000 / $14,000
Trinity-Health
Owned Pharmacy
Retail
Pharmacy
16% after
deductible†, 0%
after out-of-pocket
max
20% after
deductible†, 0%
after out-of-pocket
max
Trinity-Health
Owned Pharmacy
Mail
Order
16% after
deductible†, 0%
after out-of-pocket
max
20% after
deductible†, 0%
after out-of-pocket
max
Deductible and out-of-pocket
based on Tier 1
$9,000 / $18,000
Trinity-Health
Owned Pharmacy
Retail
Pharmacy
$8
20% ($24 min,
$64 max)
$10
25% ($30 min,
$80 max)
40% ($48 min,
$96 max)
50% ($60 min,
$120 max)
Trinity-Health
Owned Pharmacy
Mail
Order
$24
20% ($72 min,
$192 max)
$25
25% ($75 min,
$200 max)
40% ($144 min,
$288 max)
50% ($150 min,
$300 max)
Out-of-pocket maximum based on
Tier 2
The individual deductible only applies to those enrolled in colleague-only coverage for the Health Savings PPO and Essential PPO Assist Plans. For all
other coverage levels, the full family deductible must be met even if only one person in the family is receiving care.
*Subject to deductible.
1
**Subject to deductible and coinsurance.
†Select, generic preventive drugs are covered at 100% and are not subject to the annual deductible. See the MyBenefits website for the
complete list of eligible drugs.
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Mount Carmel Health
Paying for medical coverage
Contribution levels for the medical plans are based on the Social Security taxable wage base ($118,500 for 2016, indexed
annually) to ensure our benefit plan cost-sharing model is appropriately aligned with our colleagues’ income levels. The amount
you pay for medical coverage is based on your annual base salary (your base rate of pay times your budgeted hours) and your
participation in the Well-Being programs. If at any time during the 2017 plan year, you earn $118,500 or more, you will pay a
higher premium contribution per pay period for your medical insurance.
Full Time
Your per pay period cost
Traditional PPO
Full
Incentive
1 - Person
Incentive
Health Savings PPO
No
Incentive
Full
Incentive
1 - Person
Incentive
Essential PPO
No
Incentive
Full
Incentive
1 - Person
Incentive
No
Incentive
For colleagues earning less than the 2016 SSTWB‡ - Level 1
Colleague only
Colleague plus spouse/
eligible adult
$89.22
N/A
$104.22
$41.59
N/A
$56.59
$24.83
N/A
$39.83
$215.90
$230.90
$245.90
$122.00
$137.00
$152.00
$81.95
$96.95
$111.95
Colleague plus child(ren)
$152.11
N/A
$167.11
$85.96
N/A
$100.96
$57.74
N/A
$72.74
Colleague plus family
$269.88
$284.88
$299.88
$152.50
$167.50
$182.50
$102.44
$117.44
$132.44
For colleagues earning the 2016 SSTWB or more‡ - Level 2
Colleague only
$104.09
N/A
$119.09
$55.46
N/A
$70.46
$37.25
N/A
$52.25
eligible adult
$248.62
$263.62
$278.62
$152.50
$167.50
$182.50
$109.27
$124.27
$139.27
$175.16
N/A
$190.16
$107.44
N/A
$122.44
$76.98
N/A
$91.98
$310.77
$325.77
$340.77
$190.63
$205.63
$220.63
$136.59
$151.59
$166.59
Part Time
Traditional PPO
Full
Incentive
1 - Person
Incentive
Health Savings PPO
No
Incentive
Full
Incentive
1 - Person
Incentive
No
Incentive
Essential PPO
Full
Incentive
1 - Person
Incentive
No
Incentive
For colleagues earning less than the 2016 SSTWB‡ - Level 1
Colleague only
$113.01
N/A
$128.01
$83.18
N/A
$98.18
$69.53
N/A
$84.53
eligible adult
$281.33
$296.33
$311.33
$213.50
$228.50
$243.50
$180.29
$195.29
$210.29
$198.21
N/A
$213.21
$150.42
N/A
$165.42
$127.02
N/A
$142.02
$351.66
$366.66
$381.66
$266.88
$281.88
$296.88
$225.37
$240.37
$255.37
For colleagues earning the 2016 SSTWB or more‡ - Level 2
Colleague only
$127.88
N/A
$142.88
$97.05
N/A
$112.05
$81.95
N/A
$96.95
eligible adult
$314.04
$329.04
$344.04
$244.00
$259.00
$274.00
$207.61
$222.61
$237.61
$221.26
N/A
$236.26
$171.91
N/A
$186.91
$146.27
N/A
$161.27
$392.55
$407.55
$422.55
$305.00
$320.00
$335.00
$259.51
$274.51
$289.51
‡The 2016 Social Security taxable wage base (SSTWB) is $118,500.
Need help with your health care costs?
You may be eligible for the Essential PPO Assist plan (“Assist Plan”) if you meet certain
income requirements. It is the same as the Essential PPO, but includes a Trinity
Health-funded Health Reimbursement Account (HRA) to help you pay for your health care
costs at the time of service. To participate in the Assist Plan, you must apply and meet
specific income and eligibility guidelines. To learn more, see the application form on the
MyBenefits website. Apply by submitting a completed application form with a copy of your
most recent Federal Income Tax Form 1040 or 1040EZ to Benefits and Leave Team by Nov.
4, 2016.
How do the
Incentives work?
For more information
on how to achieve Full
and 1-Person
incentives, see the Live
Your Whole Life section
on page 9.
NOTE: If you think you qualify for the Assist Plan, you should elect the medical plan you
think will be best for you – which could be the Traditional PPO, the Health Savings PPO, or
the Essential PPO. If you qualify for the Assist Plan, you will be moved to the Assist Plan.
Otherwise, you will remain in the plan you elected during open enrollment.
Mount Carmel Health
7
More about the
Health Savings
PPO
The Health Savings PPO
is a consumer-driven
health plan which gives
you the opportunity to
participate in a plan where
your health care costs are
more closely determined
by your decisions. Here
are some reasons to
consider choosing the
Health Savings PPO in
2017:
“
“
“
“
I liked that I saved
money in premium
contributions –
spending money
only when I used
medical care.
”
I can really save
for my health care
expenses when I
use the HSA.
”
It’s great that Trinity
Health makes its full
contribution to my HSA
in January.
”
For certain generic
preventive drugs and
diabetes and asthma
drug classes, I didn’t
have to pay my
deductible before the
plan started paying
those expenses.
”
How the
deductible works
The Health Savings
PPO Plan includes a
combined deductible.
A combined
deductible means the
full family deductible
must be met even if
only one person in
the family is receiving
care. Coinsurance
begins once the
combined deductible
has been met.
8
How the Health Savings Account (HSA) works
When you enroll in the Health Savings PPO plan, you automatically have a Health Savings
Account (HSA) through Health Equity to help you pay for current or future health care costs.
Trinity Health will make a full contribution to your account in January based on the coverage
level you elect. In addition, you can also contribute to this account up to IRS limits:
Coverage Level
Colleague only
All other coverage levels
Trinity Health
Contributions†
$650
$1,300
Your Voluntary
Contributions*†
$2,750
$5,450
Total IRS Allowed
HSA Contributions
$3,400
$6,750
*If you are 55 or older, you can contribute an additional $1,000 in catch-up contributions to your HSA.
†May be subject to state taxation.
Questions about the HSA
How do I get an HSA? To be eligible for the HSA, you must enroll in the Health Savings
PPO. In addition, you cannot have coverage under any other medical plan, such as Medicare,
TRICARE, or coverage through a spouse’s health plan.
Who can use funds in my HSA? You and your dependents can pay for medical, dental and
vision expenses with funds in your HSA. Dependents must be claimed on your tax return.
Why would I contribute to my HSA? Contributions to the HSA are a great way to save on
taxes. With the HSA, you do not pay taxes on the amount you contribute through payroll
deductions, the amount you withdraw for medical expenses, and the interest you earn in the
account (up to amounts set by federal law)†. Keep in mind that you can change the amount
you contribute to your HSA at any time during the plan year.
How can I use the money in my HSA? You may use the HSA to pay for qualified medical
expenses now and during retirement for you and your qualified dependents.
How do I pay for medical expenses with my HSA? When you receive eligible health care
services, you can pay for those services with your HSA debit card, or through several online
and smartphone app options. You’ll receive more information about your payment options if
you enroll in the Health Savings PPO with the HSA.
What happens if I don’t use all the money in my HSA each year? Any money you do
not use during the year is carried over, without any limits. Remember, you own the money in
your HSA and it is yours to keep – even when you change jobs or retire.
Can I enroll in the Health Care Flexible Spending Account (HCFSA) if I have an
HSA? When you enroll in the Health Savings PPO which includes the HSA, you will not have
access to the health care flexible spending account (HCFSA). However, the HSA may be seen
as having more advantages over the HCFSA including:
• The opportunity to carry over savings from year to year – you do not forfeit any amount in
your HSA at the end of the plan year (if you are currently enrolled in the HCFSA for 2016
and you elect the HSA for 2017, you must utilize your account funds by Dec. 31, 2016);
• Contributions of up to $6,750 in tax-free HSA dollars each year (the HCFSA maximum is
$2,550);
• Your HSA dollars are saved in a bank account that may earn interest.
How do I know if the Health Savings PPO, including an HSA, may be right for me?
Your medical plan choice depends on your personal situation. If you answer “yes” to some of
these questions, the Health Savings PPO plan may be right for you:
• Would you like to have lower per pay period contributions deducted from your paycheck?
• Do you want to save on taxes by contributing to the
HSA for your health care costs?
• Do you need a way to pay for future health care costs?
• Can you see your HSA balance growing as you keep
making contributions each year?
We encourage you to consult with a tax advisor for IRS
rules and tax implications related to an HSA.
†May be subject to state taxation.
For more information about the Health
Savings PPO, including the Health
Savings Account (HSA), visit
www.healthequity.com/ed/trinityhealth
or http://mybenefits.trinity-health.org.
Mount Carmel Health
Live Your Whole Life
Staying healthy all the way around - in body, mind, and spirit - makes us happier and more productive at home and on the job. At
Trinity Health, we believe that an annual Health Assessment, a Health Screening and healthy activities are essential steps in
understanding your well-being. It’s so important that we provide an incentive when you and your covered spouse or eligible adult
complete these steps.
To continue complying with the legal requirements for wellness
programs, Trinity Health made some changes to the incentives for
2017. Here’s how this year’s program will work:
1 All colleagues start with the Full Incentive amounts.
Note: See the box to the right to understand the new options
for Full and 1-Person Incentives.
2 There are two Periods where you can earn LifePoints to
maintain your Full Incentive amounts.
3 To maintain these incentives throughout the year, you
need to earn 100 LifePoints in each Period by completing
the required activities.
New Incentive Structure
There are now separate incentive amounts for
colleagues and spouses/eligible adults. If both you
and your spouse/eligible adult complete the activities
in each period, you will maintain the Full Incentive
amounts. If only one of you completes the activities
in each period, you will only maintain a 1-Person
Incentive amount. (See the section “Paying for
Medical Coverage” for contribution rates with Full
and 1-Person Incentives.)
Period 1 – Earn 100 LifePoints by March 31, 2017
Complete your Health Assessment
The Health Assessment is an online questionnaire about your health habits. Your answers are kept secure and confidential;
summary data is used to identify areas for future well-being and prevention programs.
Completing your Health Screening
Knowing your numbers – like blood pressure, cholesterol, glucose and more - will provide a more complete picture of your
health. There are several ways to submit your numbers:
• Get a health screening at scheduled on-site events,
• Visit your healthcare provider and submit the completed Health Screening Form (you may use results from
August 1, 2016 - March 31, 2017); or
• Visit a Live Your Whole Life community access lab location.
Note: To maintain your Full Incentive amount, the health assessment and health screening must be completed by you and
your covered spouse or eligible adult in Period 1 (Oct. 1, 2016 - March 31, 2017.) If you (and your spouse/eligible adult, if
applicable) do not complete your health assessment and health screening by March 31, 2017, you will not maintain the
incentive of a lower per pay period cost for medical coverage as of May 1, 2017.
Period 2 – Earn 100 LifePoints by June 30, 2017
To continue receiving the incentive throughout the year, you and your covered spouse or eligible adult need to earn 100
LifePoints by participating in a Meaningful Choice activity that interests you within Period 2. You can choose from a variety of
Meaningful Choice Activities that fit your lifestyle. Some examples include talking with a health coach, completing a stage of
an online journey module, tracking well-being items such as hours of sleep or time spent volunteering.
If you (and your spouse/eligible adult, if applicable) do not earn 100 LifePoints by June 30, 2017, you will not maintain the
incentive of a lower per pay period cost for medical coverage as of August 1, 2017.
Need another chance to earn your Full Incentives?
If you did not complete the required activities by the Period 1 deadline, you still have one more
chance to regain your Full Incentive amounts. If you complete both the Period 1 and Period 2
activities by June 30, 2017, you will regain the Incentive (Full or 1-Person, depending on if your
spouse/eligible adult completes the activities) starting August 1, 2017.
If you feel that you are unable to complete the Live Your Whole Life incentive activities by the
deadline due to extenuating circumstances (e.g. medical hardship, military deployment), you
may request an exception. For your exception request to be reviewed, the form must be
completed and returned prior to the end of each Period. Exception forms can be found at
www.mybenefits.trinity-health/lywl or by calling 1.855.491.8781.
Mount Carmel Health
For more information
on dates and activities,
please visit the Live
Your Whole Life
website at mybenefits.
trinity-health.org/lywl
or call 1-855-491-8781.
9
Be a smart health care consumer
As you know, the cost of high-quality health care continues to increase each year. Being a smart consumer means
getting the best price on something you need, whether it’s a new car or health care.
Being a smart health care consumer doesn’t mean you should avoid trips to the doctor – it means making the best
decisions about when to go to the doctor. Regular checkups can improve your health and extend your life. By getting
the recommended exams and tests, you increase your chances of discovering problems before an illness significantly
affects your health. Plus, preventive care is beneficial not only to your physical well-being, it also makes sense for your
financial health because generally, it’s covered by your medical plan. For more information on preventive care benefits,
visit http://mybenefits.trinity-health.org.
An easy way to be a smart health care consumer is to choose a Trinity Health Tier 1 provider when you or a family
member needs medical care. Besides receiving excellent care at our own facilities, you receive the highest level of
benefits while paying the lowest available copayment and coinsurance amounts.
How do I know which tier my provider is considered?
Mount Carmel Health System facilities and clinically-integrated Health Partners physicians are part of the Tier 1
network. Understanding which tier your provider falls in is important to help you make healthcare decisions.
In order to assist you in choosing Tier 1 physicians, go to Trinity Health’s customized Aetna DocFind. To verify whether
if a physician is part of the Tier 1 or Tier 2 network, select Tier 1 or Tier 2 in the search criteria under “Select a Plan”.
This link is available on MyBenefits or InSight online.
Maintenance Choice program for your maintenance medications
Our prescription drug plan requires that you receive your maintenance medications* in 90-day supplies through a
nearby Trinity Health onsite pharmacy, a local CVS pharmacy or the CVS Caremark Mail Service Pharmacy. Once
you reach your plan limit (initial fill and 2 refills) for filling 30-day supplies at a retail pharmacy, you will pay the full cost
of your medications if you do not move your prescription to one of the long-term options listed here.
*A maintenance medication is a long-term medication taken regularly for chronic conditions or long-term therapy.
10
Mount Carmel Health
Dental Coverage
You have a choice between two Delta Dental of Michigan plan options: the High plan and the Standard plan. Our plans utilize
the Delta Premier and PPO networks. Visit www.deltadentalmi.com for providers in your area.
Dental Plan Highlights
High Plan
Participating Dentist
Standard Plan
Nonparticipating Dentist
Participating Dentist
Nonparticipating Dentist
Annual deductible
Individual/Family
Class I - Preventive services
$25/$50
$50/$100
$50/$100
$100/$150
100% covered
100% covered
100% covered
100% covered
($0 colleague cost)
(Usual and Customary
($0 colleague cost)
(Usual and Customary
rates apply)
rates apply)
Class II - Basic services
20% after deductible
Class III - Major restorative services
Class IV - Orthodontics
Not covered
Maximums
Per person annual (non-orthodontics)
$1,750
$1,250
$1,500
$1,000
Per person lifetime (orthodontics)
$1,500
$1,500
Not applicable
Not applicable
Part-time
Full-time
Part-time
Full-time
Colleague only
$7.83
$9.57
$5.02
$6.27
Colleague plus spouse/eligible adult
$17.39
$20.87
$11.29
$13.80
$19.57
$23.48
$12.70
$15.53
$28.27
$33.92
$18.35
$22.43
NOTES: When you receive services from a non-participating dentist, you will be responsible for the difference between what
your dentist charges and the Delta Dental non-participating dentist fee. Fluoride treatments are covered once every 12 months
up to age 19. Bitewing x-rays are covered once every 12 months.
For more information about your
dental plan options or about
Delta Dental, visit
Mount Carmel Health
11
Vision Care Coverage
You have a choice between two United Health Care vision plan options: the High plan and the Standard plan. Visit
www.myuhcvision.com for providers in your area.
UHC Vision Plan Highlights
High Plan
Standard Plan
In-network
Out-of-network
(reimbursement schedule)
In-network
Out-of-network
(reimbursement schedule)
Benefit frequency
Calendar year
Vision exam
Covered in full
Calendar year
Calendar year
Calendar year
Up to $40
$10 copayment
Up to $40
Pair of lenses
Single vision
Bifocal
Up to $40
$0 copayment
Up to $60
Up to $40
$0 copayment
Up to $60
Trifocal
Up to $80
Up to $80
Lenticular
Up to $80
Up to $80
Frames
Covered frame
$150 retail allowance
Up to $45
at retail locations
$150 retail allowance
Up to $45
at retail locations
Non-covered frame
Contact lenses
(in lieu of eyeglasses)
Elective
Necessary
Additional pair of eyeglasses
or contact lenses
Additional lens options
Contact lens coverage is provided under the plan and may vary dependent on the type of contact lenses
prescribed. Please see the benefit summary on My Benefits for additional information.
20% discount
20% discount
The following lens
20% discount
20% discount
The following lens options
options are covered in
are covered in full:
full: standard scratch-
standard scratch-resistant
resistant coating, standard
coating, standard
basic and high-end
polycarbonate lenses
progressive lenses,
standard polycarbonate
lenses, standard antireflective coating, UV,
tints, photochromic,
Transitions®, edge coating
Colleague only
Colleague plus
spouse/eligible adult
$5.29
$3.17
$10.98
$5.81
$11.52
$6.11
$16.22
$8.43
vision care plan options, visit
12
Mount Carmel Health
Health Care and Dependent Care Flexible Spending Accounts
You have the opportunity to set aside before-tax money to offset eligible health care or dependent care expenses. There are
two different types of Flexible Spending Accounts – a Health Care Flexible Spending Account (HCFSA) and a Dependent Care
Flexible Spending Account (DCFSA).
Health Care Flexible Spending Account (HCFSA)
Dependent Care Flexible Spending Account (DCFSA)
How much can I contribute?
Before-tax dollars in any amount between $130 and
$2,550
Before-tax dollars in any amount between $130 and
$5,000
What expenses will it cover?
Eligible health care products and services used by you
and/or your eligible dependents. Examples include:
Expenses for the care of your eligible dependents (child
under age 13 or qualifying adult incapable of self-care)
while you work:
• Vision care, including eyeglasses, contact lenses and
saline solution
• Babysitting or au pair services
• Dental care, both preventive and restorative
• Before and after-school programs
• Orthodontia
• Day care and nursery school
• Physical therapy, counseling, or psychological
• Pre-school programs
services
• Chiropractic care and acupuncture
• Elder care services
• Copayments, coinsurance and deductibles
• Prescribed Over-the-Counter (OTC) medications
For a list of expenses that are eligible for HCFSA reimbursement, visit http://mybenefits.trinity-health.org.
When do I have to spend the
money?
Contributions made to the HCFSA during the 2017
calendar year can be used for claims with dates of
service between Jan. 1, 2017 and Mar. 15, 2018.
Contributions made to the DCFSA during the 2017
calendar year can be used for claims with dates of
services between Jan. 1 and Dec. 31, 2017.
How do I access my FSA
savings?
You can use a variety of payment options to access your
FSA savings. These include the WageWorks Health
Card, Pay my Provider, Pay me Back, or by using the
Mobile application.
You can use a variety of payment options to access your
FSA savings. These include the Pay my Provider, Pay
me Back, or by using the Mobile application.
Reminders:
• If you choose to enroll in the Health Savings PPO medical plan option, you cannot enroll in the HCFSA. The Health
Savings Account works just like the HCFSA but offers additional benefits, such as the opportunity to carry over unused
funds, contribute up to $2,750/individual ($5,450/family), plus an additional $1,000 in catch-up contributions if you are age 55
or over, and earn interest on your savings.
• You must make HCFSA and/or DCFSA elections for 2017 during open enrollment. Your
prior year elections will NOT carry forward.
• HCFSA and DCFSA claims for the 2017 plan year must be postmarked on or before Mar.
FSA benefits and to obtain a list
of eligible expenses, visit
31, 2018.
http://mybenefits.trinity• If you choose to contribute to the HCFSA for the first time in 2017, a new WageWorks
health.org.
Health Card will be mailed to your home. Otherwise, you will only receive a new
WageWorks Health Card when your current card expires.
Take advantage of WageWorks mobile site
As the nation’s largest independent provider of consumer-directed benefit solutions, WageWorks offers
FSA participants the latest technology to make it easier to manage your savings. Their mobile site and
new EZ Receipts app offer the following features:
• Check your current HCFSA and DCFSA account balances
• Submit HCFSA and DCFSA claims
• Submit WageWorks Health Care card receipts
Learn more at www.wageworks.com or contact your Benefits and Leave Team representative.
Mount Carmel Health
13
Life Insurance
Colleague life insurance options
If eligible, you receive employer-provided basic life/AD&D insurance at one times your
annual base salary.
In addition, you have the option to purchase supplemental coverage for yourself in the
increments shown in the table below. If you purchase colleague supplemental life
insurance and you’re approved, the premium contributions will be deducted from your
paycheck on an after-tax basis.
You will be eligible for will preparation services through The Hartford’s EstateGuidance
Will Services at no charge. To get started, access The Hartford’s EstateGuidance Will
Services online at www.estateguidance.com/wills and enter the Trinity Health Web ID
“WILLHLF” in the Promotional Code box.
Colleague Life Insurance
Plan Highlights (full- and part-time)
Basic life/AD&D
(employer-paid)
One times annual base salary
Supplemental life
One to eight times annual base salary
Supplemental AD&D
One to eight times annual base salary
Maximum amounts
Basic life: $1.5 million
Supplemental life: $1.5 million
(Combined: $3 million)
Personal Health
Applications
Any increase in colleague Supplemental life coverage will require you to
complete a Personal Health Application form. For more information about
your life insurance benefits or to obtain a Personal Health Application form,
visit http://mybenefits.trinity-health.org. NOTE: Personal Health Application
forms should be sent to The Hartford by Jan. 9, 2017.
Costs for colleague supplemental life insurance coverage are based on your age as of Jan. 1, 2017, and will
be available when you enroll online.
Are your
beneficiaries
up-to-date?
You may want to take a
moment to review the
beneficiary(ies) you have
on file for your life
coverage. If you haven’t
yet designated
beneficiary(ies), your life
insurance benefits will
be paid according to the
plan provisions as
outlined in the Summary
Plan Description.
You may change your
beneficiary(ies) during
the Open Enrollment
process or anytime
throughout the year.
Beneficiary(ies)
designated for Basic Life
Insurance apply to any
Employee Supplemental
Life Insurance elections.
Dependent life insurance options
You have the option to purchase coverage for your dependents (including your spouse,
eligible adult or eligible children). You may elect coverage for your dependents without
electing coverage for yourself. If you and your spouse or eligible adult both work for
Trinity Health and are benefit eligible, you cannot elect Spouse/Eligible Adult
coverage for that individual. Also, only one of you will be able to elect coverage for
your child(ren). If your dependent child also works at Trinity Health and is benefit
eligible, you cannot elect child life coverage for that individual.
Dependent Life Insurance
Plan Highlights (full- and part-time)
Personal
Health
Application
Spouse/Eligible Adult life1
Child(ren) life2
Coverage amount
Coverage amount*
$10,000
$20,000
$50,000
$80,000
$100,000
$5,000
$10,000
$20,000
Any increase in spouse/eligible adult supplemental life coverage will require you to
complete a Personal Health Application form. NOTE: Personal Health Application
forms should be sent to The Hartford by Jan. 9, 2017.
1
Costs for spouse/eligible adult life insurance coverage are
based on your age as of Jan. 1, 2017, and will be available
when you enroll online.
2
Child(ren) life insurance costs cover all of your eligible
children, and will be available when you enroll online.
14
For more information about your life
insurance benefits or to obtain a
Personal Health
Application form, visit
http://mybenefits.trinity-health.org
Mount Carmel Health
Time Away From Work
PLT cash-out
At Trinity Health, we are working to harmonize time off
benefits across our Ministry. Our goal is to help strengthen
and enhance our people-centered health system and provide
our colleagues with meaningful benefits that are competitive
and sustainable. Here are some of the benefits you receive as
you need time away from work.
Under the PLT program, hourly colleagues earn PLT based
on your “hours worked.” You are able to cash out a certain
amount of your unused PLT each year.
How much time can
you cash out
You can cash out up to 40 hours.
Electing to cash out
Election for 2017 may only be made during
open enrollment to avoid taxation on the value
of your PLT bank. Your election is irrevocable
and cannot be changed.
Payment date for
cash-out
You will receive your cash-out in pay period 23
of 2017.
Other notes
A separate form through InSight online is no
longer necessary. Make sure you choose to
cash-out PLT while electing medical, dental
and vision coverage if you want it.
Short-term disability
Short-term disability (STD) pays a benefit if you are unable to
work because of a qualified injury or illness. NOTE: this is an
employer provided benefit. No election is required to receive
this benefit.
Amount of benefit
60% of base pay
When benefits
begin
After a 7 calendar day elimination period following
an injury or illness
How long benefits
continue
Up to 180 days
Use of PLT time
Full- or part-time colleagues are required to
use PLT for days scheduled to work during
the first 7 calendar days.
Long-term disability
Long-term disability (LTD) pays a benefit if you are unable to
work for a long period of time because of a qualified injury or
illness. You have the option to elect more LTD coverage
through a “buy-up” election during open enrollment.
You may cash out only hours you will accrue during the
calendar year in which you plan to receive payment.
Consequently, you may not cash out PLT hours carried over
from previous years. For example, Jane has a PLT balance
of 100 hours as of Dec. 31, 2016. During open enrollment,
she elects to cash out 40 hours in 2017. Jane cannot cash
out any of the 100 hours she earned in 2016 or earlier. She
must plan her 2017 cash-out amount on only the hours she
will accrue in 2017.
REMINDER: If you want to cash out PLT in 2017, you must
make a new PLT cash-out election. Your prior year election
will NOT carry forward.
Amount of
60% of base pay, not to exceed $10,000 per month
employer-provided
benefit
Amount of
available ”buy-up”
coverage
66 2/3% of base pay
Cost for “buy-up”
coverage
• Based on your income level
When benefits
may begin
After 180 days of disability
How long benefits
continue
Benefits continue until you are able to return
to work, are deemed no longer disabled, or
until age 65 or older, depending on when the
disability begins.
For more information about
the program, visit
• Available when you enroll online
For more information about your disability benefits, visit
disability benefits, visit
Mount Carmel Health
15
Legal Plan
You’re eligible for the legal plan if you are a regularly scheduled full- or part-time colleague with 32 or more budgeted hours per
pay period, and you have satisfied the required waiting period. You have the option of electing legal coverage through Hyatt
Legal.
Hyatt Legal
Plan Highlights
In-network
Out-of-network
All covered services are paid in full
No waiting periods
No deductibles or copayments
No claim forms
You may choose a non-plan attorney
and be reimbursed according to a set fee schedule
Following is a brief outline of personal legal services provided:
•
Office consultation and telephone advice
•
Incompetency defense
•
Consumer protection
•
•
Wills and codicils
Document preparation – affidavits, deeds, demand letters, mortgages,
notes, powers of attorney
•
Living wills
•
Document review
•
Living trusts
•
Uncontested divorce
•
Sale, purchase or refinancing of home
•
Premarital agreement
•
Debt collection defense
•
Uncontested adoption, guardianship or conservatorship
•
Personal bankruptcy
•
Name change
•
Tax audits
•
Protection from domestic violence
•
Administrative hearing representation
•
Property tax assessment
•
Juvenile court defense
•
Traffic ticket defense (no DUI)
•
Eviction defense (tenant only)
•
Identity theft defense
•
Tenant negotiation (tenant only)
•
Immigration assistance
•
Civil litigation defense
Colleague only:
$5.12
Colleague plus family:
$6.97
For more information about
the legal plan, visit
www.legalplans.com.
Voluntary Benefits
In addition to your group benefits, Trinity Health has partnered with The Farmington Company to provide eligible colleagues the
opportunity to elect personal insurance plans. Individual policy options include :
• Life insurance
• Accidental Death and Dismemberment (AD&D) Insurance
• Cancer insurance
• Critical illness insurance
• Auto/home insurance
• Pet insurance
• Identity theft insurance
• Hospital Indemnity
• Accident insurance
For more information, call 1-866-251-9529. Be sure to tell the representative that you are a member of Trinity Health and Mount
Carmel Health.
16
Mount Carmel Health
How to Enroll
Annual enrollment is conducted
using our web-based tool which
you access through your benefits
website. It takes only about 10
minutes to make your benefit
elections online, and you may not
need to fill out any forms. If you
don’t have a computer with
Internet access in your workplace
or your home, you can enroll at
computer stations provided by
your Human Resources
department or at your local public
library. You can enroll any time
that’s convenient to you during
the open enrollment period – 24
hours a day, seven days a week.
Step-by-step instructions
1.
Access the MyBenefits website through the Internet at
2.
Click on the section titled “My Health & Welfare.”
3.
Click on the “State” and “Name/Location” of your Trinity Health Regional
Health Ministry.
4.
Select “2017 Open Enrollment.”
5.
Click on “Enroll Now.”
6.
Enter your user ID, password and the unique code shown on the screen:
• User ID: Your employee ID (if you don’t remember your employee ID
number, refer to your pay advice).
• Password: Enter your existing password. If you forgot your password
and have set up your two security questions, click the “Forgot Password”
link for a new password to be generated. If this is your first time logging
in, your password will be your first initial of both your first and last name
as it appears on your pay statement in capital letters, followed by your
employee ID. For example: Jane Doe, employee ID#123456 = User ID of
123456 and password of JD123456.
During the two-week open
enrollment period, you can make
as many changes to your benefit
elections as you wish. The last
day to modify your choices is
Nov. 2, 2016.
Be sure that your personal
information is secure on the
enrollment website. Trinity Health
has taken extra precautions to
ensure the integrity of all
confidential records.
When you enroll online
The Employee Self
Service webpages are
compatible with web
browser Internet Explorer
(IE). Page layout can be
distorted with browsers
such as Safari, Chrome or
Firefox.
• Unique Code: Enter the combination of random letters and numbers
shown on the screen.
Click on “Sign In.” You may be prompted to change your password.
For problems logging in, contact Trinity Resolution Center at Trinity
Resolution Center 1.888.667.3003 and select option 2.
7.
Under Benefits, click “Benefits Home TH.” The e-benefits home page is the
starting point for enrolling in your benefits. You may choose from the
following options/links:
• Benefits Summary: Review your current coverage.
• Benefits Enrollment: Review detailed information on coverage and
dependents and make any open enrollment changes for 2017 by Nov. 2,
2016 at 11:59 p.m. EST. Remember, if you enroll in the Health Savings
PPO, you cannot enroll in the Health Care Spending Account (HCFSA).
8.
Follow the instructions on the online enrollment system.
9.
Be sure to print the enrollment page for your records by clicking on the
printer icon located at the top of the screen.
Review your confirmation statement.
If you do not change or correct your benefit elections by Nov. 2, 2016 at 11:59
p.m. EST, IRS regulations require you to remain in your elections throughout
2017 or until you experience a qualified status change. For more information on
qualified status changes, visit http://mybenefits.trinity-health.org.
Review your confirmation statement
If the confirmation statement that you receive in your home mail does not
match the benefits that you elected, contact your Benefits and Leave
Team representative immediately to make the necessary corrections to
your benefit enrollment record.
Mount Carmel Health
17
For More Information
We hope this enrollment guide has provided you and your family with all of the information you need to make your benefit
elections for 2017. In addition to Open Enrollment, please remember to review and update your personal information, such as
your address, phone number, and emergency contacts as necessary. You may update your personal information at any time
throughout the year. If you still have questions about your options or the open enrollment process:
• Review all information available about the benefit changes including any materials sent to your home, emailed to you at work
or posted online. Use the tools and resources made available to help you understand your benefit options for 2017.
• Visit the Benefits section of InSight Online. There are numerous tools and resources available to assist you and your family in
making benefit decisions, such as enrollment instructions, videos, toolkits, plan scenarios and comparisons and more.
• Watch the videos available on Insight online or the MyBenefits website http://mybenefits.trinity-health.org.
• Contact the Benefits and Leave Team. Benefits and Leave Team will be available before, during, and after open enrollment to
help with questions and how to enroll. Contact us at 614-234-6274, option 3, or email us at benefits@mchs.com. NOTE: The
Benefits and Leave Team will be extremely busy during open enrollment and appreciate your patience. Please listen closely
to the prompts as the menu may have changed since the last time you called.
• Virtual and in-person benefit forums have been scheduled to provide an overview of the medical plans and answer questions.
Visit InSight Online for an updated schedule and conference information (search: Benefit Forums).
Day
Friday, Oct. 7
Tuesday Oct. 11
Wednesday Oct. 12
Thursday, Oct. 13
Friday, Oct. 14
Monday, Oct. 17
Tuesday, Oct. 18
Tuesday, Oct. 18
Wednesday, Oct. 19
Campus
CSC Forum
MCSA Forum
MCW Forum
MCGC Forum
MCE Forum
MCNA Forum
Location
Virtual Forum (Webex)
Auditorium
Conference Room
Cafeteria Auditorium
Conference Room
Siegel Center West
Boardroom
Time
3:00 p.m. – 4:00 p.m.
8:00 a.m. – 9:00 a.m.
12:00 p.m. – 1:00 p.m.
2:00 p.m. – 3:00 p.m.
3:00 p.m. – 4:00 p.m.
9:00 a.m. – 10:00 a.m.
7:00 a.m. – 8:00 a.m.
11:00 a.m. – 12:00 p.m.
11:00 a.m. – 12:00 p.m.
• Attend a Live Your Whole Life (LYWL) event during October or November at your care site. LWYL events provide health
screenings and information about other wellness and prevention resources available to colleagues. Representatives from the
Benefits and Leave Team will also be available to answer any questions you may have about open enrollment and benefit
options. You will earn 500 LYWL Rewards Points for attending a LYWL event!
• The Health Screenings available at the LYWL Events will complete your health screening requirement to maintain your Full
Incentive amount. Additional onsite health screening events will be offered throughout November, December and January.
Visit www.LYWLRewards.com for a full, updated list of onsite health screening opportunities. Appointments are strongly
recommended. Call HealthCALL at 614.234.LIFE to schedule. Spouses/eligible adults on the health plan may also schedule
for the events.
• During open enrollment, the Benefits and Leave Team will be available via phone and email. If you need assistance in using
the online enrollment tool, use a computer that is on the Mount Carmel network (in your unit or workstation or even in the
cafeterias) and call us at 614-234-6274, option 3, and we can remotely connect to your computer and help more colleagues.
Day
Monday, Oct. 3
Thursday, Oct. 6
Tuesday, Oct. 18
Thursday, Oct. 20
Friday, Nov. 4
Wednesday, Nov. 16
Campus
Mount Carmel St. Ann’s
Corporate Service Center
Mount Carmel West Hospital
Mount Carmel East Hospital
Mount Carmel New Albany
Mount Carmel Grove City
Location
Conference Room A & B
Auditorium
Healthy Living Center
Siegel Center
Boardroom
Conference Room
Time
7:00 a.m. – 12:00 p.m.
7:00 a.m. – 12:00 p.m.
7:00 a.m. – 12:00 p.m.
7:00 a.m. – 12:00 p.m.
7:00 a.m. – 10:00 a.m.
6:00 a.m. – 9:00 a.m.
• Please note that enrollment and Benefits support is only available by calling or emailing the Benefits and Leave
Team. If you are having a difficult time enrolling in your benefits, call us while on a Mount Carmel-network computer
and we can remote in and help you virtually.
• Check out Mount Carmel Health’s HSA Informational Video by visiting http://youtu.be/2btDy4DT5MQ.
18
Mount Carmel Health
Important Reminders
Benefit elections are final for 2017
Remember, the benefits you elect during open enrollment will be in effect from
Jan. 1 through Dec. 31, 2017. The choices you make now are final for 2017,
because open enrollment is your only opportunity during the year to switch
medical, dental or vision plan coverage.
If you experience a qualified family
For more information on qualified
status change or certain employfamily status changes, visit
ment status changes and provide
any required documentation to your
Benefits and Leave Team representative within 30 days of the event, you will be
allowed to make certain benefit changes that are consistent with the status
change. For example, if you get married during the plan year, you’ll be able to
add your spouse to your coverage within 30 days of the marriage. For more
information on qualified family status changes, visit
HIPAA privacy notice is available online
Trinity Health takes the security of its colleagues’ and family members’ Personal
Health Information (PHI) very seriously. To access a copy of the Health
Information Portability and Accountability Act (HIPAA) Privacy Notification, visit
http://mybenefits.trinity-health.org. If you are unable to access the HIPAA notice
online, contact your Benefits and Leave Team representative to request a paper
copy by mail.
Medical plan election notification
When you enroll in a Trinity Health medical plan, the medical plan coverage
provides benefits through a clinically integrated network (CIN) of hospitals,
physicians, and other health care providers and professionals, including care
coordinators and case managers that monitor and coordinate all aspects of your
medical care. Trinity Health and Mount Carmel Health participate in the CIN.
When you and your covered dependents receive health care services at facilities
or by the colleagues of your employer or a health care provider or professional
affiliated with your employer, colleagues of your employer or a health care
provider or professional affiliated with your employer will have access to and may
use and disclose your and your covered dependents’ personal health information
to manage and coordinate your care. Any access to and use and disclosure of
protected health information will comply with the privacy and security regulations
under HIPAA and any applicable state privacy and security laws.
Plan documents and Summary of Benefits and
Coverage (SBC) are available online
Health Care Reform legislation requires all employers to provide an easy-to-read
summary of their medical plan options called the Summary of Benefits and
Coverage (SBC). The SBC provides basic information about your medical plan
options, comparison examples, and a glossary of terms. To access a copy of the
SBC, visit http://mybenefits.trinity-health.org. If you are unable to access the
SBC online, contact your Benefits and Leave Team representative to request a
paper copy by mail.
Mount Carmel Health
Notice: Women’s Health and
Cancer Rights Act of 1998
The Women’s Health and Cancer Rights
Act of 1998 requires all employers who
provide a medical benefit plan to its
employees to communicate the coverage
provisions established under the Act.
Trinity Health’s medical benefit plan
provisions are as follows:
• The Trinity Health medical benefit plan
will not restrict benefits if you or your
eligible dependent receives benefits
for a mastectomy and elects breast
reconstruction in connection with the
mastectomy.
• Benefits will not be restricted provided
that the breast reconstruction is
performed in a manner determined in
consultation with your (or your eligible
dependent’s) physician, and may
include:
– Reconstruction of the breast on
which the mastectomy was
performed;
– Surgery and reconstruction of the
other breast to produce a
symmetrical appearance; and
– Prostheses and treatment of
physical complications of all stages
of mastectomy, including
lymphedemas.
Benefits for breast reconstruction may be
subject to appropriate plan coverage
provisions and limitations, including
annual deductible, copayment and
coinsurance provisions that are
consistent with those established for
other benefits under the plan.
If you have any questions about your
medical plan provisions relating to the
Women’s Health and Cancer Rights Act
of 1998, contact your Benefits and Leave
Team representative.
19
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 your
employer, your state 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 a State listed below, contact
your State Medicaid or CHIP office to find out if premium assistance is available.
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, contact your State Medicaid or CHIP office or dial
1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, 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
your employer plan, your employer must allow you to enroll in your employer 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 your employer plan,
contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health
plan premiums. The following list of states is current as of July 31, 2016. Contact your State for more
information on eligibility –
ALABAMA – Medicaid
Website: http://myalhipp.com/
Phone: 1-855-692-5447
FLORIDA – Medicaid
Website: http://flmedicaidtplrecovery.com/hipp/
Phone: 1-877-357-3268
ALASKA – Medicaid
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com/
Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com Medicaid
Eligibility:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS – Medicaid
Website: http://myarhipp.com/
Phone: 1-855-MyARHIPP (855-692-7447)
COLORADO – Medicaid
Medicaid Website: http://www.colorado.gov/hcpf
Medicaid Customer Contact Center: 1-800-221-3943
GEORGIA – Medicaid
Website:
on
Phone:
Payment (HIPP)
INDIANA – Medicaid
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.hip.in.gov
Phone: 1-877-438-4479
All other Medicaid
Website: http://www.indianamedicaid.com
Phone 1-800-403-0864
IOWA – Medicaid
Website: http://www.dhs.state.ia.us/hipp/
Phone: 1-888-346-9562
– Medicaid
– Medicaid
Website:
Phone: 1-
Website:
– Medicaid
Medicaid
d
Medicaid Website:
Website:
Phone: 1-
/
/
Medicaid Phone: 609 -631-2392
Website:
– Medicaid
– Medicaid
Website:
Website:
Phone: 1-800-541-2831
/
Phone: 1-
– Medicaid
– Medicaid
Website:
Phone: 919-855-4100
Website:
a
Phone: 1-800-442-6003
Maine
– Medicaid
Website:
Phone: 1-800-462-1120
d
– Medicaid
Website:http://www.nd.gov/dhs/services/medicalserv/
medicaid
Phone: 1-844-854-4825
OTA – Medicaid
Website:
Phone: 1-
– Medicaid
d
Website:
Medicaid
– Medicaid
Website:
Website:
Phone: 1-
MONTANA – Medicaid
Website:
– Medicaid
Website: http://www.dhs.pa.gov/hipp
Phone: 1-
Phone: 1-800-694-3084
Medicaid
Website:
– Medicaid
Website: http://www.eohhs.ri.gov/
Phone: 401-462-5300
ska/Pages/accessnebraska_index.as px
Phone: 1-855-632-7633
– Medicaid
Medicaid Website: http://dwss.nv.gov/
Medicaid Phone: 1 -800-992- 0900
– Medicaid
Website: http://www.scdhhs.gov
Phone: 1-888-549-0820
Website: http://dss.sd.gov
Phone: 1-888-828-0059
Website: http://www.hca.wa.gov/free-or
Phone: 1-800-5
Website:
Website:
Phone: 1-800-440-0493
e
Phone: 1-8
Website:
Medicaid:
CHIP:
Phone: 1-877-543-7669
Website:
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-84
Website:
Phone:
Phone: 1-800
-598
002
531
icaid
Medicaid Website:
http://www.coverva.org/programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
CHIP Website:
http://www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282
see if
other states have added a
31
www.dol.gov/ebsa
1-8
-444
1-8
Centers for Medicare
www.cms.hhs.gov
-2
Menu
Medicaid
15 5
Paperwork Reduction Act Statement
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no person
be
of information if the
of information does not
a
reporting burden for this
of information is estimated to average
seven minutes per respondent.
other aspect of this
of
Interested parties are encouraged to send comments regarding the burden estimate or
suggestions for reducing this
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of
and
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20210 or
and reference the
1210-0
.
NOTICE REGARDING WELLNESS PROGRAM
The Live Your Whole Life Colleague Health Plan Well-Being Incentive Program (the “Well-Being Program”) is a voluntary
wellness program available to all colleagues and their spouses/eligible adult dependents, if applicable, who are enrolled in a
participating medical and prescription drug program (a “group health plan”) offered by the colleagues’ Trinity Health employer.
The Live Your Whole Life Well-Being Program is administered according to federal rules permitting employer-sponsored wellness
programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the
Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable,
among others. If you choose to participate in the Live Your Whole Life Well-Being Program you will be asked to complete a
voluntary health risk assessment or “HRA” that asks a series of questions about your health-related activities and behaviors and
whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You will also be asked to complete
a biometric screening, which will include measuring blood pressure, measuring Body Mass Index (BMI) through height and weight
measurements, a waist circumference measurement and a blood test for total cholesterol, high density lipoproteins (HDL), low
density lipoproteins (LDL), triglycerides, and blood glucose. In addition, certain other activities that are intended to help
colleagues improve their health or prevent disease (referred to as “meaningful choice activities”) are offered under the Live Your
Whole Life Well-Being Program. You are not required to complete the HRA, biometric screening or participate in any of
meaningful choice activities.
However, colleagues who are enrolled in a group health plan offered by their Trinity Health employer and who choose to
complete a voluntary HRA, biometric screening and meaningful choice activities will receive an incentive of a lower per pay cost
for the group health plan coverage. If a colleague’s spouse/eligible adult dependent, is also enrolled in the Trinity Health group
health plan, the colleague will receive an additional incentive of lower per pay cost for the coverage if the spouse/eligible adult
completes an HRA, biometric screening and meaningful choice activities. Although you are not required to complete the HRA,
biometric screening or the meaningful choice activities, only colleagues (and their spouses/eligible adult dependents, if
applicable) who do so will receive the incentive of a lower per pay cost for group health plan coverage throughout the plan year.
Additional incentives of up to $500 may be available for colleagues and their spouses/eligible adult dependents, if applicable, who
submit a claim for non-surgical weight loss reimbursement.
If you (or your spouse/eligible adult dependent, if applicable) are unable to participate in any of the health-related activities
required to earn an incentive, you (or your spouse/eligible adult dependent, if applicable) may be entitled to a reasonable
accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by
contacting the Live Your Whole Life consumer support line (powered by RedBrick Health) at 855-491-8781.
The information from your HRA and the results from your biometric screening will be used to provide you with information to help
you understand your current health and potential risks, and may also be used to offer you services through the Live Your Whole
Life Well-Being Program, such as condition management, medical management, case management and health and well-being
coaching. You also are encouraged to share your results or concerns with your own doctor.
Protections from Disclosure of Medical Information
We are required by law to maintain the privacy and security of your personally identifiable health information. Although the WellBeing Program and Trinity Health may use aggregate information they collect to design a wellness program based on identified
health risks in the workplace, the Live Your Whole Life program will never disclose any of your personal information either
publicly or to your employer, except as described in the paragraph below, as necessary to respond to a request from you for a
reasonable accommodation needed to participate in the Well-Being Program, or as expressly permitted by law. Medical
LYWL 2
information that personally identifies you that is provided in connection with the Well-Being Program will not be provided to your
supervisors or managers and may never be used to make decisions regarding your employment.
All Trinity Health group health plans provide care coordination, care management, utilization review and referral services to help
manage the healthcare provided to covered members. By enrolling in a Trinity Health group health plan you understand that the
plan will provide services to manage each covered member’s care. These services may be provided through independent thirdparty administrators, a clinically integrated network of hospital, physicians and other health care providers and professionals
(“CIN”) and other healthcare providers. Your participation in a Trinity Health group health plan means that the persons contracted
to provide these services will have access to your personal health information, including health information you disclose through
an HRA, biometric screening or other Well-Being Program activities. Trinity Health facilities and healthcare providers and
professionals affiliated with Trinity Health facilities participate in certain CINs. Information about your medical treatment at any
facility and from any healthcare provider or professional may be accessed and used by individuals who work at a Trinity Health
facility or provider (including your employer) participating in a CIN or the group health plan not only for treatment but also to
manage and coordinate your healthcare.
Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to
carry out specific activities related to the Well-Being Program, and you will not be asked or required to waive the confidentiality of
your health information as a condition of participating in the Well-Being Program or receiving an incentive. Anyone who receives
your information for purposes of providing you services as part of the Well-Being Program will abide by the same confidentiality
requirements. The only individual(s) who will receive your personally identifiable health information is (are) third-party
administrators, members of a CIN and other healthcare providers and professionals such as registered nurses, doctors, case
managers, medical managers, health coaches, condition managers and the Well-Being Program administrator in order to provide
you with services under the Well-Being Program.
In addition, all medical information obtained through the Well-Being Program will be maintained separate from your personnel
records, information stored electronically will be encrypted, and no information you provide as part of the Well-Being Program will
be used in making any employment decision. Any access to, use or disclosure of your medical information obtained through the
Well-Being Program will comply with the privacy and security regulations under the Health Insurance Portability and
Accountability Act and any applicable state privacy and security laws. Appropriate precautions will be taken to avoid any data
breach, and in the event a data breach occurs involving information you provide in connection with the Well-Being Program, we
will notify you as soon as possible.
You may not be discriminated against in employment because of the medical information you provide as part of participating in
the Well-Being Program, nor may you be subjected to retaliation if you choose not to participate.
If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact
the Live Your Whole Life consumer support line (powered by RedBrick Health) at 855-491-8781.
LYWL 2
Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and
Sample Nondiscrimination Statement: Discrimination is Against the Law
The Trinity Health Corporation Welfare Benefit Plan (“Plan”) complies with applicable Federal civil rights laws and does not discriminate
on the basis of race, color, national origin, age, disability, or sex. The Plan does not exclude people or treat them differently because of
race, color, national origin, age, disability, or sex.
The Plan, through Trinity Health Corporation and the other participating employers in the Plan:
•
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
o
•
Qualified sign language interpreters
o
Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as:
o
Qualified interpreters
o
Information written in other languages
If you need these services, contact Jodi Weiner. If you believe that the Plan has failed to provide these services or discriminated in
another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Jodi Weiner, Trinity Health
Corporation Vice President, Benefits & Well-Being, 20555 Victor Parkway, Livonia, MI 48152, 855-812-1297 (telephone), (248) 347-5437
(fax), ACAsection1557@trinity-health.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance,
Jodi Weiner is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically
through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S.
Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 855-812-1297.
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 855-812-1297
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 855-812-1297.
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 855-812-1297 번으로 전화해 주십시오.
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag
sa 855-812-1297.
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните
855-812-1297.
.(855-812-1297 :‫ )رﻗﻢ ھﺎﺗﻒ اﻟﺼﻢ واﻟﺒﻜﻢ‬xxx-xxx-xxxx-1 ‫ اﺗﺼﻞ ﺑﺮﻗﻢ‬.‫ ﻓﺈن ﺧﺪﻣﺎت اﻟﻤﺴﺎﻋﺪة اﻟﻠﻐﻮﯾﺔ ﺗﺘﻮاﻓﺮ ﻟﻚ ﺑﺎﻟﻤﺠﺎن‬،‫ إذا ﻛﻨﺖ ﺗﺘﺤﺪث اذﻛﺮ اﻟﻠﻐﺔ‬:‫ﻣﻠﺤﻮظﺔ‬
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 855-812-1297.
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 855-812-1297.
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 855-812-1297.
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 855-812-1297.
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero
855-812-1297.
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer:
855-812-1297.
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-734-343-0884まで、お電話にてご連絡ください。
ध्यान द�: य�द आप िहं दी बोलते ह� तो आपके िलए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह�। 855-812-1297 पर कॉल कर�।
ACA
Ո Ւ Շ Ա Դ Ր Ո Ւ ԹՅ Ո Ւ Ն ՝
Ե թ ե խո ս ո ւ մ ե ք հ այ ե ր ե ն , ապա ձ ե զ ան վ ճ ար կ ար ո ղ ե ն տր ամ ադ ր վ ե լ լ ե զ վ ակ ան
աջ ակ ց ո ւ թ յ ան ծ առ այ ո ւ թ յ ո ւ ն ն ե ր : Զանգահ ար ե ք 855-812-1297
ુ ના: જો તમે
ચ
ુ રાતી બોલતા હો, તો િન: ુ ક ભાષા સહાય
જ
સેવાઓ તમારા માટ ઉપલ ધ છે . ફોન કરો 855-812-1297.
LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 855-812-1297.
855-812-1297. ‫ تو آپ کو زبان کی مدد کی خدمات مفت ميں دستياب ہيں ۔ کال کريں‬،‫ اگر آپ اردو بولتے ہيں‬:‫خبردار‬
របយ័តន៖ េបើសិនជាអនកនិយាយ ភាសាែខមរ, េសវាជំនួយែផនកភាសា េដាយមិនគិតឈនួល គឺអាចមានសំរាប់បំេរីអនក។ ចូរ ទូរស័ពទ 855-812-1297 ។
ਿਧਆਨ ਿਦਓ: ਜੇ ਤੁਸ ਪੰ ਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਿਵੱ ਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 855-812-1297 'ਤੇ ਕਾਲ ਕਰੋ।
লkয্ ক নঃ যিদ আপিন বাংলা, কথা বলেত পােরন, তাহেল িনঃখরচায় ভাষা সহায়তা পিরেষবা uপলb আেছ। েফান ক ন 1-855-812-1297
.855-812-1297 ‫ רופט‬.‫ זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון אפצאל‬,‫ אויב איר רעדט אידיש‬:‫אויפמערקזאם‬
ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ
855-812-1297.
เรี ยน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริ การช่วยเหลือทางภาษาได้ฟรี โทร 855-812-1297.
ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້
ທ່ານ. ໂທຣ 855-812-1297.
KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në
855-812-1297.
OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 855-812-1297.
УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки.
Телефонуйте за номером 855-812-1297.
यान िदनह
ु ोस ्: तपाइर्ंले नेपाली बो नुहु छ भने तपाइर्ंको िनि त भाषा सहायता सेवाह िनःशु क पमा उपल ध छ । फोन गनह
ुर् ोस ् 855-812-1297
AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 855-812-1297.
ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 855-812-1297.
KUMBUKA: Ikiwa unazungumza Kiswahili, unaweza kupata, huduma za lugha, bila malipo. Piga simu 855-812-1297.
శర్దధ్ ెటట్ం ి: ఒక ేళ
రు ెలుగు ాష మాటాల్డుతునన్టల్
ే,
కొరకు ెలుగు ా ా స యక ేవలు ఉ తం ా ల
త్ ా
. 855-812-1297 కు కాల్ ేయం ి.
ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε
855-812-1297.
Ige nti: O buru na asu Ibo asusu, enyemaka diri gi site na call 855-812-1297.
AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 855-812-1297.
Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch
Schprooch. Ruf selli Nummer uff: Call 855-812-1297.
PIŊ KENE: Na ye jam në Thuɔŋjaŋ, ke kuɔny yenë kɔc waar thook atɔ̈ kuka lëu yök abac ke cïn wënh cuatë piny. Yuɔpë 855-812-1297
ACA
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Welcome to Open Enrollment Mount Carmel Health!

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