MRCY_BRC-Open Enrollment Guide(final) - Mercy

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 www.VSP.com or call
1-800-877-7195.
• Additional materials can be found on
https://2012benefits.mercy.net, or on Baggot Street
(http://baggotstreet.mercy.net). 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)
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.