Are you a Hawaii Employee? If so, your benefits operate differently. Please click on our HAWAII BENEFITS page for more information.
Having Troubles?
If you are having troubles with accessing your individualized Open Enrollment form, or cannot find the information you need please contact MyHealthCare@mlrehab.com
Welcome to Your Online Resource for Benefits Enrollment 2012!
Please refer to your individual enrollment form or contact Human Resources for specific deadlines.
Important Information
Your enrollment forms have been sent to the email address we have on file, if you have not received them or are unable to open them – please contact Lina Buchanan immediately.
Each employee's benefit election effective date will vary and remain in effect for the entire year.
You cannot change your benefit selections until the next Open Enrollment, unless you experience a qualifying event.
All employees working 30 hours and above, regardless of class, are now benefits eligible.
All benefits eligible employees must complete an enrollment form, even if you are waiving coverage at this time.
What's New In 2012?
All Electronic Forms
No Co-Pays for Preventative Care Screenings
One eye exam is covered at 100% per year
Basic Life Insurance Coverage has changed to $25,000. This benefit is still provided to all benefits eligible employees at no cost.
$1,000 Deductible Plan has Increased to $1,500
Aetna is now both our Third Party Administrator and our Provider Network. Plan Name: Aetna Standard Pln/Open Choice PPO
Co-Pay Increase
Gym Membership Reimbursement Period runs January through March.
Dell Computers discounts are now available to all employees.
We have partnered with TicketsAtWork.com to bring you exclusive savings.
Well-Baby Care, Immunizations (recommended by US Preventive Task Force and Physicals are covered at 100%
Preventive Mammograms, Prostate Exams, Preventative Colonoscopies, Bones cans for Osteoporosis, Screening and counseling for diabetes and Obesity, Screening for Cervical Cancer, Screening for Cholesterol Abnormalities, and other screening as recommended by the U.S. Preventive Services Task Force. These services will be covered at 100%.
Specialists
A co-pay will be required depending on your deductible plan. Other services performed in a specialist office will have a 10% coinsurance.
Referrals are not required to see a specialist on our plan.
Prior Authorization
Certain medical procedures require prior authorization. All inpatient care (except maternity) requires prior authorization. Please have your physician contact the health plan to obtain prior authorization. The Prior authorization process reviews the procedure for medical necessity. It does not check if the provider being used is in-network and is not a guarantee of benefits.
Services for Physical Therapy, Occupational Therapy, or Speech Therapy a referral is not required. We recommend using Mountain Land or Brighton Rehabilitation as your provider for these services.
Laboratory and Pathology Services
If you should receive a bill for laboratory or pathology services, please contact the provider immediately to give them your billing information. Most lab companies bill the patients and do not submit the claim to the health plan.
The Affordable Care Act, which is part of the U.S. healthcare reform, allows young adults to stay on their parent’s health insurance plan up to the age of 26 if they are not eligible for their own coverage through their employer. Coverage will end at the end of the month in which the dependent child turns 26.
The law removes all previous and current eligibility requirements for coverage effective January 1, 2011. Your children, step children, or children you have legal custody of, can be enrolled, even if they are:
Not enrolled in school
Married
Not financially dependent on or residing with their parents
Proof of eligibility may be required.
Coordination of Benefits
If a dependent child is covered under more than one plan, the primary plan is the plan of the parent whose birthday (month and day) is earlier in the calendar year if: the parents are married or parents are living together or a court decree awards joint custody without specifying that one parent has the responsibility to provide health coverage.
Domestic Partnerships
The term “domestic partner” shall mean a person who is over the age of 18 and mentally competent to this declaration; not married to, or legally separated from, anyone else; not related by blood to the Covered Employee to a degree of closeness that would prohibit legal marriage in the Covered Employee’s state of legal residence; who has not had a different spouse or domestic partner within the last 6 months from the date of the execution of this declaration (this condition does not apply if you had a spouse or domestic partner who died); who resides with the Covered Employee and who intends to do so indefinitely; and who meets at least two of the following eligibility criteria continuously for the 12-month period prior to eligibility: a) lived with the Covered Employee continuously for 12 months; b) executed a domestic partnership agreement in a jurisdiction which authorizes such agreements; c) named as a beneficiary under the Covered Employee’s will; d) granted to the Covered Employee, or been granted by the Covered Employee, powers under a durable power of attorney; e) designated by the Covered Employee or designating the Covered Employee as a beneficiary under a life insurance policy; f) retain a joint bank account with the Covered Employee; g) cosigned a lease or deed with the Covered Employee; or h) named the Covered Employee on the same car insurance policy.
Additional Health Benefits
The following benefits are provided to all benefits eligible employees, regardless of whether or not you are enrolled in our Medical Plan, at no extra cost to you.
Become empowered and take control of your health. Your employer wants to help. Mountain Land and Brighton Rehabilitation and Aetna continually expand the benefits available to you and your family.
Smoking Cessation
Smoking is a serious and dangerous addiction that can be difficult to give up. Mountain Land and Brighton Rehabilitation would like to lend a hand in your effort to stop smoking. You can now be reimbursed up to $150.00, per year, for outpatient services and over the counter smoking remedies.
Weight Management and Gym Reimbursement
Mountain Land and Brighton also understands that correct weight management is vital to a healthy way of life. Consulting a nutritionist is a great way to learn about healthy eating and weight loss. As an added bonus, you can be reimbursed up to $200.00, per year, for weight loss programs and an additional $100 per year, for health club memberships.
Talk to your Human Resources Department to find out how you can take advantage of these great programs.
There is no network for dental. You can use any provider for dental services.
Calendar Year Maximum is $1,200 per person
Fluoride treatment is covered for dependent children under age 19
Preventative Services: 2 visits per year covered at 100%
Panoramic X-ray: Covered every 24 months
Oral Surgery: If oral surgery is necessary on teeth that have already erupted through the skin, this benefit will fall under dental and you can use any dentist.
If the oral surgery is for impacted teeth, this benefit will fall under the medical benefits.
There are no in-network Oral Surgeons so you and use any provider.
Calendar Year Deductible: Per Person $50.00 / Per Family Unit $150.00
Vision services and frames/contacts are available through our VSP Plan.
VSP offers several programs and services for you and your family: Laser Vision Care, Contact Lens Care, and VSP's Eye Health Management Program, to name a few.
You are also eligible under our Medical Plan for one preventative exam per year, if you use an in-network provider.
Pharmacy Benefits
Due to the market fluctuations prescription costs can vary greatly, shopping around can be very beneficial to you and your family.
Ask your doctor about generic medicines. Research shows that you can save an average of 30% to 80% when you fill your prescription with a generic instead of a brand–name medicine.
If you go to www.caremark.com you can explore the lowest cost options before you order, or see where you can save on your existing prescriptions. With your prescription benefits information on line, you can find ways to maximize your healthcare investment.
The CVS/Caremark Mail Order program is another great way to save money. You can receive an extended supply of medicine; enjoy convenient delivery to the location of your choice, with free shipping. You have an opportunity to speak to a registered pharmacist 24 hours a day, seven days a week. Another great option might be ordering prescription refills online or by phone any time, day or night. The mail services are fast, convenient, and worry free.
Flex Spending
The Flexible Benefits Plan lets you set aside money for your out-of-pocket medical and/or dependent care expenses directly from your paycheck – before taxes! When you incur an eligible expense, for out-of-pocket health care expenses and/or dependent care expenses, you get reimbursed with tax-free money.
In the Health Care Reimbursement Account, you can set aside up to $4,000 per plan year. Here are a few examples of some of the types of expenses that would be eligible for reimbursement.
Acupuncture
Alcoholism Treatment
Braces/Orthodontia
Chiropractor
Contact Lenses/Eyeglasses
Insulin
Lasik or Laser Eye Surgery
Wigs to cover baldness due to medical reasons
Obstetrician/Midwife
Office Visit Co-pays
Ophthalmologist
Optometrist
Oxygen Equipment
Podiatrist
Psychiatrist
Psychologist
Rental of Medical equipment
Prescription Co-pay
Smoking Cessation Treatment
Weight Loss Programs due to specific diseases diagnosed, such as obesity, heart disease, etc.
Mileage Expense to obtain medical care (2006 – $0.15/mile)
Effective January 1, 2011 the purchase of over the counter items will not be eligible.
Dependent Care Reimbursement Account
This account may be used to reimburse yourself for eligible Dependent Care expenses incurred to allow you (and your spouse) to work or look for work. You can set aside up to $5,000 per tax year from your paycheck for reimbursement of child care/elder care expenses ($2,500 if you are married and file a separate return).
Day care center expenses
Preschool expenses
Before and after school day care
Summer Day Camp
Services of a housekeeper, maid or cook if performed in connection with the care of a qualifying dependent.
For Dependent Care Expenses, you must provide the tax ID number of your provider: social security number if the provider is an individual; or, a business license or taxpayer ID if the provider is a day care center or preschool.
Streamlining
Aetna's Streamlining Feature allows you to be reimbursed for qualifying expenses automatically. Review their flyer below for more information.
All full-time active employees working 30 or more hours per week in an eligible class are eligible for coverage.
Maximum Monthly Benefit
60% of salary up to $5,000 per month
Maximum Benefit Duration
To Age 65/Reduced Benefit Duration
Own Occupation Period
24 Months
Elimination Period
90 days The number of days you must be disabled prior to collecting disability benefits.
Accumulation of Elimination Days
You can satisfy the days of your elimination period with either total (off work entirely) or partial (working some hours at your current job) disability. If you are working on a partial basis, you will have 2x the elimination period days to satisfy the total of 90 days.
Pre-Existing Condition
You may not be eligible for benefits if you have received treatment for a condition within the past 12 months until you have been covered under this plan for 12 months, or if you remain treatment free for a period of 12 consecutive months.
Enrollment (Newly Eligible)
You are able to take advantage of this coverage now without a health examination. You may not be offered this opportunity again, or may be responsible for the cost of required examinations.
Waiver of Premium
You will not be required to pay premium during any time of approved total or partial disability.
Survivor Income Benefit
A survivor benefit may be paid to your beneficiary if you should die while receiving qualifying disability payments.
EmployeeConnectSM
Access to an employee assistance program for the employee or an immediate household family member who may be experiencing personal or workplace issues.
Benefit Limitations
Mental Illness: 24 months Substance Abuse: No limit Specified Illness: No limit
Portability
If your employment is terminated for any reason other than retirement, disability, or a leave of absence, you can keep your current LTD coverage at the same rate for up to 12 months. Your current coverage must have been in force for at least 12 months.
Long-term disability is intended to protect your income for a long duration after you have depleted short-term disability or any sick leave your company may offer.
Short Term Disability
Short-term disability is intended to protect your income for a short duration in case you become ill or injured.
Eligibility
All full-time active employees working 30 or more hours per week in an eligible class are eligible for coverage.
Maximum Weekly Benefit
60% of weekly salary up to $1,000 per week
Maximum Benefit Duration
13 weeks
Elimination Period
Benefits begin on: 15th day for an accident 15th day for an illness
Pre-Existing Condition
You may not be eligible for benefits if you have received treatment for a condition within the past 12 months until you have been covered under this plan for 12 months.
Waiver of Premium
You will not be required to pay premium during any time of approved total or partial disability.
Enrollment (Newly Eligible)
You are able to take advantage of this coverage now without a health examination. You may not be offered this opportunity again.
Semi-Monthly Premium Calculation
Example: John Doe is 35 and earns $500 per week. $500 x 0.0141 = $7.05 Semi-Monthly premium
California Employees may also participate in their state short-term disability program. More information can be found here: http://www.edd.ca.gov/Disability/
All full-time active employees working 30 or more hours per week in an eligible class are eligible for coverage.
Maximum Monthly Benefit
60% of salary up to $5,000 per month
Maximum Benefit Duration
To Age 65/Reduced Benefit Duration
Own Occupation Period
24 Months
Elimination Period
90 days The number of days you must be disabled prior to collecting disability benefits.
Accumulation of Elimination Days
You can satisfy the days of your elimination period with either total (off work entirely) or partial (working some hours at your current job) disability. If you are working on a partial basis, you will have 2x the elimination period days to satisfy the total of 90 days.
Pre-Existing Condition
You may not be eligible for benefits if you have received treatment for a condition within the past 12 months until you have been covered under this plan for 12 months, or if you remain treatment free for a period of 12 consecutive months.
Enrollment (Newly Eligible)
You are able to take advantage of this coverage now without a health examination. You may not be offered this opportunity again, or may be responsible for the cost of required examinations.
Waiver of Premium
You will not be required to pay premium during any time of approved total or partial disability.
Survivor Income Benefit
A survivor benefit may be paid to your beneficiary if you should die while receiving qualifying disability payments.
EmployeeConnectSM
Access to an employee assistance program for the employee or an immediate household family member who may be experiencing personal or workplace issues.
Benefit Limitations
Mental Illness: 24 months Substance Abuse: No limit Specified Illness: No limit
Portability
If your employment is terminated for any reason other than retirement, disability, or a leave of absence, you can keep your current LTD coverage at the same rate for up to 12 months. Your current coverage must have been in force for at least 12 months.
Long-term disability is intended to protect your income for a long duration after you have depleted short-term disability or any sick leave your company may offer.
Short Term Disability
Short-term disability is intended to protect your income for a short duration in case you become ill or injured.
Eligibility
All full-time active employees working 30 or more hours per week in an eligible class are eligible for coverage.
Maximum Weekly Benefit
60% of weekly salary up to $1,000 per week
Maximum Benefit Duration
13 weeks
Elimination Period
Benefits begin on: 15th day for an accident 15th day for an illness
Pre-Existing Condition
You may not be eligible for benefits if you have received treatment for a condition within the past 12 months until you have been covered under this plan for 12 months.
Waiver of Premium
You will not be required to pay premium during any time of approved total or partial disability.
Enrollment (Newly Eligible)
You are able to take advantage of this coverage now without a health examination. You may not be offered this opportunity again.
Semi-Monthly Premium Calculation
Example: John Doe is 35 and earns $500 per week. $500 x 0.0141 = $7.05 Semi-Monthly premium
California Employees may also participate in their state short-term disability program. More information can be found here: http://www.edd.ca.gov/Disability/
Basic Life Insurance
Basic Life Insurance is provided by the company at no cost to you. 1 times your annual salary up to $25,000. Spousal coverage is $5,000. Child: 14 days to six months $200. Child: Six months to age 19 $2,000 (to age 26 if full-time student).
Voluntary (or Supplemental) Life Insurance guarantee issue for the employee is the lesser of $150,000 or three times your annual salary under age 70. Spouse guarantee issue is $30,000 if the employee is under 60. Dependent guarantee issue is $250.00 Child: 14 days to six months. $10,000 Child: Six months to age 26 (to age 26 if full time student). Employee must elect coverage for dependent to be eligible for a benefit.
Please note that if you go above the limitations set forth in the document below, that you MUST complete an Evidence of Insurability Form. A link to that form is listed below, but you can also complete the form online at https://www.lincoln4benefits.com.
Beneficiary Designation: If you are a new enrollee or if your beneficiary has changed from your initial enrollment, please complete a new beneficiary from. Contact MyHealthCare@mlrehab.com to determine your current beneficiaries.
Aflac
Aflac is different from health insurance; it's insurance for daily living.
Major medical pays for doctors and hospitals. Aflac is insurance for daily living. It pays cash benefits directly to you, unless otherwise assigned, to help with daily expenses when you are sick or hurt.
If you would like to enroll in new benefits, make any changes to your current elections, or just have questions, please contact our AFLAC Representative.
Dell's Member Purchase Program allows Mountain Land Rehabilitation employees to receive member only pricing on all personal PCs from Dell, including:
Up to 30% OFF list prices for select configurations
10% OFF Dell branded mobility
Free 3-5 day shipping on select systems of $699 or more
Monthly coupons for Members Only
You can shop online at www.dell.com/epp or can call 1-800-695-8133 to speak with a sales representative. Be sure to enter or mention Member ID PS120081962. I have attached a flyer highlighting the basics of the program.
Tickets-At-Work
Mountain Land Rehabilitation, Inc employees can now take advantage of discounts and special offers to popular theme parks and entertainment attractions nationwide! Discounts are available for the Walt Disney World Resort, Universal Studios, SeaWorld, Six Flags, Cirque du Soleil, Las Vegas and New York City performances, movie tickets and much more! You can order your tickets directly from their website or by calling 1-800-331-6483.
A: If you are currently enrolled in Mountain Land’s benefit plan, Human Resources will provide the certificate of prior coverage to Aetna, for you. If you are on any other plan, you will need to request a certificate from your insurance and send it into Natalie Pons.
A: P5 will claims up until December 31st 2011, if you are having issues with your claims not being paid please email myhealthcare@mlrehab.com or call Natalie Pons at Ext. 174
