MRCY_BRC-Open Enrollment Guide(final) - Mercy

MRCY_BRC-Open Enrollment Guide(final) - Mercy

Choosing the Right Benefits


Open Enrollment Guide

for Mercy Benefit Eligible Co-workers

Open Enrollment October 17-November 7

Mercy strives to offer a strong

benefits package that reflects our commitment

to you, while meeting the diverse needs of our many co-workers.

This guide contains important information about your benefits.

The most important thing to know is that you will need to

enroll to continue benefits coverage in 2012.

In 2012 the enrollment period is October 17 through November

7. You must complete enrollment even if there are no changes in

your elections for 2012. The benefits you elect during this period

are effective from January 1, 2012, through December 31, 2012.

You can’t change the benefits you elect after open enrollment

unless you have a change in family status event such as a

marriage, divorce or birth of a child. (See Change in Family

Status section for more information).

What’s New in 2012

• MyChoice will not be offered.

• Changes have been made to the Mercy Medical, Dental

and Vision Plans.

• MetLife will administer the Mercy Dental Plan.

• VSP will administer the Mercy Vision Plan.

• LDI, Inc. will administer the pharmacy benefit for all Mercy


• Some co-worker premiums have changed.

All 2012 Open Enrollment

information is found:


1. Go to:


2. Or, go to: Click on the My

Worklife tab, then select the My Benefits Home link.

You will find:

• 2012 Open Enrollment Guide

• 2012 Mercy Benefit Summary Booklet

• 2012 Mercy Medical Benefit Summary of Benefits

• Additional information about the Mercy Dental Plan with


• Additional information about the Mercy Vision Plan

with VSP

• Information about the Mercy prescription drug benefit

• And much more

Who Is Eligible

For Benefits?

• Full-time co-workers who regularly work at least 72

hours per pay period.

• Part-time co-workers who regularly work at least 32

hours per pay period.

• Your lawfully married spouse of the opposite sex.

• Your common law spouse (in the state of Oklahoma


• Your children, married or unmarried, up to age 26:

• Natural child

• Legally adopted child

• A child placed with you for adoption

• Your step-child

• A child who has been legally placed with you by an

authorized placement agency or by judgment,

decree or other order of any court of competent

jurisdiction, including a foster child.

You don’t have to cover the same dependents in each plan. For

example, you may cover your entire family for medical and only

yourself for dental.

Mercy requires co-workers to provide specific

documentation when covering their eligible dependents.

Without the required documents, co-workers will not be

allowed to add dependents.

Change In Family Status

The choices you make now remain in effect for 2012 unless

you experience a change in family status event. This applies to

medical, dental, vision, supplemental life, LTD and FSA

elections. A change in family status includes:

• Marriage or divorce.

• Birth, adoption or placement for adoption of a child.

• Death of a spouse and/or dependent.

• Loss or gain of coverage due to a change in your spouse’s

employment status, or open enrollment with their


• Change of employment status from eligible to ineligible

status, full-time to part-time, or vice versa.

• A dependent’s loss of eligibility because he/she has

reached age 26.

• Any other change that is permissible under IRS regulations

and rulings as determined by Mercy.

Mercy Medical Plan

Next year, Mercy will still offer the same three-tier plan design and the

same provider networks, but MyChoice will no longer be offered. This

means you won’t have to complete the three steps of participation.

Wellness continues to be a very important part of Mercy’s commitment

to co-workers. We believe in the value of preventive care and screenings

because the more you know about your health (and risk factors), the

healthier you can be.

Mercy currently offers wellness incentives through Healthification for

taking online courses and completing at least 600 minutes of physical

activity each month.

While these incentives are not the same as premium discounts, they help

us continue to reward healthy behaviors in a meaningful way. Additional

incentives through Healthification will be offered that reward

participation in disease management programs — asthma, depression

and diabetes — as well as participation in the Maternity Support Program

and/or a tobacco cessation program.

Managing the cost of health care remains a challenge, so some of the

co-pays and co-insurances have increased. They are bolded in the table


We’re committed to working together to ensure coverage is competitive,

affordable and focused on overall health.

For a list of medical benefits by tier, see the 2012 Mercy Medical Benefit

Summary. This can be found on, or on

Baggot Street (, click the My Worklife tab,

then the Benefits Home link.

Mercy Advantage Comprehensive Out-of-Network My Notes

(Tier 1) (Tier 2) (Tier 3)


Co-worker only $200 $500 $3,000 If I have a claim, I pay the

Co-worker + 1 $400 $1,000 $6,000 deductible first, then the plan

Co-worker + 2 or more $600 $1,500 $9,000 pays a co-insurance.

Co-insurance 15% 30% 50% This is the amount I pay after

(after deductible)

the deductible. The plan pays the

most when I go to a Mercy


Out-of-Pocket Max

Co-worker only $1,450 $3,500 Unlimited Once I’ve met my out-of-pocket

Co-worker + 1 $2,900 $7,000 max for the year, the plan pays 100%

Co-worker + 2 or more $4,350 $10,500 except for co-pays and prescriptions.

Lifetime Max Unlimited Unlimited Unlimited

Primary Care Co-pay $20 $35 50% When I go to a network doctor in

Tier 1 or 2, I only pay a co-pay.

Specialist Co-pay $35 $50 50%

Preventive Care $0 $0 Not covered Mercy pays for certain preventive

care when I stay in-network.

Emergency Room $125/$250 $125/$250 $125/$250 If I call Nurse-on-Call before


going to the ER, I may eliminate

an unnecessary visit.

Urgent Care $50 $50 $50

Maternity One time $100 One time $200 50% One time co-pay includes two

co-pay for all co-pay for all ultrasounds .

office visits associated office visits associated

with prenatal care with prenatal care

during a single

during a single



Lab and x-ray 15% 30% 50%

High cost diagnostics 25% after 40% after 50%

(MRI and PET scans) deductible deductible

Chiropractic Services $25 co-pay per visit $25 co-pay per visit In-network only

up to $500 up to $500

annual max

annual max

Page 3

Prescription Drug Benefit

On January 1, LDI, Inc. will be the pharmacy benefit manager for all Mercy

co-workers and their dependents. This will result in some changes to the

current formulary and the requirements of some prescription drugs on

the formulary, such as prior authorization, quantity limits or step therapy.

You and your provider will receive a letter before January 1 if a

prescription medication you are currently taking is affected by this


First Fills at any Pharmacy,

Refills at a

Refills at a Preferred Pharmacy Non-Preferred Pharmacy My Notes

Tier 1 $4 $20 Using generics and buying them from a


Preferred pharmacy saves me money.

Tier 2 $35 $50


Tier 3 $55 $75 Includes specialty

(Non-preferred Brand)

90-Day Supply 2½ times co-pay Mail order is a good choice for maintenance

Mail Order for a 90-day supply drugs. Specialty drugs, 30-day supply only.

* Mercy pharmacies and LDI are the only mail order options. Wal-Mart is not an option for mail order.

• Co-workers who don’t have access to a Mercy pharmacy can use Wal-Mart as their preferred pharmacy for 30-day fills and pay the lower co-pay.

• If you are employed by one of the following facilities, your preferred pharmacy is Mercy: Ft. Smith, Kansas, Aurora, Cassville, Lebanon, Springfield,

Mountain View, Ministry Office, St. Louis and Washington.

If you are a retiree or you are employed by one of the following facilities your preferred pharmacy is Walmart or Mercy: Oklahoma City, Ardmore,

Maude Norton, Joplin, Hot Springs, NW Arkansas, Springfield (living in Arkansas), Berryville, and out-of-area Mercy.

Mercy Dental Plans

On January 1, Mercy’s new dental plan administrator will be MetLife. You will have access to their website where you can review the plan details, look

up your claims, print ID cards and even receive an email when your claim has been processed.

Some Important Dental Plan Details

• The new Mercy dental plan includes a network of dentists. When you

use a network dentist, you don’t need an ID card and there are no

claim forms or paperwork to complete. Just tell your dentist you have


• You can still choose any dentist you want. But if you go out of network,

you could pay more out-of-pocket and you may need to show an ID

card or file your own claim with MetLife for reimbursement.

• You can find a participating dentist by going to and

clicking on Find A Dentist on the right side of the screen, or calling


• Additional materials can be found on, or on Baggot Street

( Click the My Worklife tab, then

the Benefits Home link.

• Some co-insurances have changed. Changes are bolded in the

table below.

Provision Basic Dental Plan Premium Dental Plan My Notes

Deductible (single/family) $50/$150 $50/$150 Family is considered 3 or more

Preventive Care 100% of Reasonable 100% of Reasonable Exams & cleanings twice a year

and Customary (R&C)

and Customary (R&C)

Basic Restorative 70% of R&C following 80% of R&C following Includes fillings, wisdom teeth



Major Restorative 40% of R&C 50% of R&C Includes crowns, bridges & dentures

following deductible

following deductible

Orthodontia No Coverage 50% to $2,000 lifetime The difference between the Basic

limit per participant & Premium plans are orthodontia

& annual maximums.

Annual Benefit Maximum $1,000 per $2,000 per



Mercy Vision Plan

On January 1, Mercy’s new vision administrator will be VSP. You will have access to their full-featured website where you can view

plan benefits and claim activity, locate a provider, print an ID card and much more.

Important Vision Plan Details

• The new Mercy vision plan includes a network of providers. When

you choose a VSP network provider, your cost is lower, you don’t

need an ID card and there are no claim forms or paperwork to

complete. Just let your doctor know you have VSP.

• You can still choose any provider you want. But if you go out of

network, you could pay more out-of-pocket and you may need to

show an ID card or file your own claim with VSP for reimbursement.

• To find an in-network provider, visit or call


• Additional materials can be found on, or on Baggot Street

( Click the My Worklife tab, then the

Benefits Home link.

• The Mercy Vision Plan has changed. See table below.

Provision In-Network Out-of-Network My Notes

Eye Exam $10 co-pay $45 allowance

Contacts $25 co-pay $105 allowance Plan covers one pair of glasses OR

($140 allowance) 12 months of contacts annually.

Lenses $0 $40 allowance If I stay in network, lenses are

Single Vision $0 $30 allowance included in the $25 co-pay, for

Bifocal Vision $0 $50 allowance frames/contacts (not including

Trifocal Vision $0 $65 allowance add-ons, such as tinting).

Lenticular Vision $0 $100 allowance

Frames $25 co-pay $70 frame Plan covers one pair of glasses OR

($140 allowance) allowance 12 months of contacts annually.

A note about “Allowance” — The allowance is the amount you are ‘allowed’ to spend on the particular product or service. Amounts

that exceed the allowance are your responsibility.

Supplemental &

Dependent Life Insurance

Supplemental and

Dependent Life My Notes

Co-worker 1-4 times salary Can only increase by one

up to $2.5 million when times salary. EOI is

combined with basic life required for any increase.

Spouse $10,000 increments EOI is required for any

up to $100,000 increase.

Child(ren) $10,000 for each child No EOI required

Accidental Death &

Dismemberment (AD&D)


My Notes

Co-worker $50,000 increments Any amount over $150,000

up to 10x annual salary cannot exceed 10x annual

or $750,000 salary.

Spouse 50% or 100% of

co-worker’s AD&D

up to $500,000

Child(ren) 10% of co-worker This is per child.

amount up to $50,000

Mercy provides full-time benefit eligible co-workers two times annual salary in basic life and AD&D, at no cost to them.

• Part-time benefit eligible co-workers receive one times annual salary in basic life and AD&D, at no cost to them.

• Full and part-time benefit eligible co-workers can elect supplemental life and AD&D for themselves and their eligible dependents at their expense.

• You may increase your supplemental life insurance by one times your salary during annual enrollment. Increases are subject to Evidence of

Insurability (EOI). See online enrollment site for more information.

Long Term Disability (LTD)



60% of monthly pay up to $10,000 per month

66⅔% of monthly pay up to $10,000 per month

• LTD replaces a portion of your income if you become disabled and can’t work for an

extended period of time.

Mercy provides full-time co-workers with one or more years of continuous full-time

service with basic LTD coverage at no cost.

• Full-time benefit eligible co-workers can elect to buy-up additional LTD. Part-time

benefit eligible co-workers may purchase the basic LTD (60% plan) only (where


Flexible Spending Accounts (FSA)

Annual Minimum

Annual Maximum

Health Care $130 $5,000

Dependent Care $480 $5, 000

(total combined limit if married or if

single with eligible dependent)


(if you and your spouse file separate

income tax returns)

• You don’t have to be enrolled in Mercy’s other benefits to enroll in an FSA.

Mercy’s FSA vendor is WageWorks. When you enroll in an FSA, WageWorks will send you a kit

with information about filing claims, eligible expenses, customer service, online support and

how to open and access your account.

• A Visa® “Take Care” debit card can be used to pay for expenses. Money is instantly deducted

from your FSA account. Save all receipts for items purchased with the “Take Care” card. You will

receive this card from WageWorks.

• Eligible expenses you incur between January 1, 2012 and March 15, 2013 must be submitted

for reimbursement by June 15, 2013, or you will lose these dollars.

• Your annual election is withdrawn from your paycheck in equal installments each pay period.

• Upon termination or loss of eligibility, you have only 90 days to submit claims for


Important Facts About the Dependent Care FSA

• Your total contribution cannot be greater than your earned income or your spouse’s, whichever

is lower.

• You are not eligible for reimbursement if your spouse has no earned income unless your spouse

is a full-time student or is disabled.

How To Enroll in Benefits for 2012

Co-workers hired before October 10 must enroll online at between October 17 and

November 7. Co-workers hired after October 10 must

complete a paper enrollment form by December 31 to enroll

in benefits with an effective date of January 1, 2012.

Using the Online Enrollment System

Before you start

The online enrollment system is available from work or home

during open enrollment (October 17 — November 7). Your

computer must have Internet Explorer 5.0 or greater

ºinstalled to access the system.

Logging On

1 Go to https://2012 This is where

you log on to make your 2012 elections.

2 All enrollment documents are to the right of the screen

under the header Open Enrollment Materials.

3 Log on by entering your co-worker ID (also called

Lawson ID) and password. If you need to set up a

password, click Forgot Your Password or call 866-440-


Finding my co-worker (Lawson) ID:

1 Look on the top of your pay stub to the right of

your name.

2 Look in Kronos if you have the Kronos software on

your PC. See directions below.

3 Ask your Kronos editor or leader.

To Find Your ID in Kronos:

1 Click on Start > All Programs > Kronos > Kronos

2 Log On to Kronos

Contact the MTS Service Center at x3399

(2‐3399 in Springfield) or 1‐866‐440‐3399 with

any log-on issues or questions.

3 Once logged into Kronos:

• Click on the My Information tab

• Click on My Timecard

• Your name and Lawson ID are at the top of

the page

Completing Your Enrollment

All benefits will show as “no coverage.” You must make an

election for your benefits. (The exceptions are life insurance

and retirement. See step 3 and step 7 below.)

You must verify and save each step. You can proceed to the

next step when you receive the green check mark.

Step 1 | Personal Data

Step 2 | Health, Dental and Vision: The dependent grid at the

bottom of this screen will be populated with all of your

dependents currently in the Lawson Payroll System. You

must select which coverage you want each dependent to

have, if any.

Step 3 | Life Insurance: This is a “read only” screen. Follow

the instructions if you want to make changes to your

current voluntary life elections. Otherwise, your current

elections will rollover to 2012.

Step 4 | Long-Term Disability (LTD)

Step 5 | Flexible Spending Accounts: A link to the

Wageworks website will be available so you can see what

you elected in 2011 and/or use the Wageworks calculator

to determine how much to elect in 2012.

Step 6 | Authorization

Step 7 | Retirement Program: Your current election will show

on the screen, along with a link to the Retirement website.

If you want to change your current election you must

complete the change form on the retirement site.

Step 8 | Final Review: Print your confirmation statement of

your successful enrollment for your records, or email it to


Key Contact Information

Benefit Enrollment Site . . . . . . . . . . . . . . . . . . . . .

Coventry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855-96-Mercy (6-3729)

Nurse on Call . . . . . . . . . . . . . . . . . . . . . . . . . . 855-530-5300 or 417-820-5662

MetLife Dental . . . . . . . . . . . . . . . . . . . . . . . . . or 1-800-942-0854

VSP Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . or 800-877-7195

Flexible Spending Accounts . . . . . . . . . . . . . . . . . . or 877-423-7125

My Retirement Program . . . . . . . . . . . . . . . . . . . . or 866-341-5681

Prior Authorization for Mental Health and . . . . . . . . . 314-729-4600 or 800-413-8008

Chemical Dependency Benefits

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