3 cotets What the Affordable Care Act (ACA) Meas to You Advatages of Providig Health Beefits Purchasig Coverage Coverage Optios Additioal Beefits...11 Health Savigs Accouts...12 Flexible Spedig...13 Prevetive Care...14 Focus o Health & Welless...15 Tools & Resources...16 Why Medical Mutual...17 Additioal ACA Termiology...18 Notes
4 We uderstad you wat to provide high-quality health beefits to your employees. Medical Mutual has bee a trusted isurer for more tha 80 years ad we re here 2 to help you avigate the process. Our ew plas are compliat with the Affordable Care Act (ACA) ad offer plety of optios to meet your eeds. What the ACA Meas to You The ACA was siged ito law o March 23, While you have already see several provisios put ito actio, sigificat compoets took effect i Small groups like yours will see several beefit chages ad be faced with a umber of critical decisios. Here is a partial list of the most importat ACA provisios affectig you. You ca fid additioal defiitios o page 18.
5 essetial Health Beefits The ACA defies 10 broad categories of Essetial Health Beefits (EHBs), which isurers must iclude with all small group fully isured plas. Each state defies its ow EHBs ad a full list for Ohio is available o MedMutual.com. Marketplace (public exchage) The ACA requires each state to have a isurace marketplace where small group employers ca shop for health plas. The Small Busiess Health Optios Program (SHOP) Marketplace is a public exchage ru by the govermet. Varieties of plas are available both o ad off the SHOP. Federally Madated Fees Startig o Jauary 1, 2015, the followig fees will be associated with all employer-sposored small group plas: Patiet Cetered Outcomes Research Istitute (PCORI) Reisurace Risk adjustmet Market share Public exchage: For plas sold o the SHOP, a portio of this fee is applied to all small group plas 3 Note: Fees will appear o your mothly ivoice. elimiatio of aual Dollar limits For pla years begiig o or after Jauary 1, 2014, o pla ca impose aual dollar limits o overall beefits or Essetial Health Beefits for ay member. Modified/adjusted commuity ratig For pla years begiig o or after Jauary 1, 2014, health isurers ca oly vary premiums for ogradfathered small groups based o family size (idividual or family), geography (ratig area), age (withi a ratio of 3:1 for adults) ad tobacco use (withi a ratio of 1.5:1). limitatio o Waitig Periods For pla years begiig o or after Jauary 1, 2014, plas geerally ca t have a waitig period that exceeds 90 caledar days. Pre-existig Health coditios coverage For pla years begiig o or after Jauary 1, 2014, o pla ca dey claims based o pre-existig health coditios. Maximum Out-of-Pocket expeses For pla years begiig o or after Jauary 1, 2015, all o-gradfathered plas must limit out-of-pocket expeses for each employee to o more tha $6,600 for sigle coverage ad $13,200 for family coverage. This limit oly applies to costs associated with i-etwork services that qualify as Essetial Health Beefits.
6 4 Advatages of Providig Health Beefits While the ACA requires all idividuals to have health coverage or pay a pealty, you still have a choice whe it comes to your employees. There are several good reasos to offer health beefits: Attract ad retai valuable employees Healthier ad more productive employees Tax deductios o healthcare premiums ad federally madated fees You may qualify for the Small Busiess Health Care Tax Credit A variety of factors will ifluece your decisio, but you should cosider the questios o page 5.
7 are you a small group employer? ACA provisios apply differetly to small ad large group employers. To be cosidered a small group employer o the SHOP, you must have fewer tha 50 employees, which icludes full-time ad full-time equivalet (FTE) employees. The umber of FTE employees is calculated usig ayoe you employ who works fewer tha 30 hours per week o average. Here is how to calculate your Ftes: Step 1 Add total hours of service for all employees who worked less tha 30 hours per week for the moth. (Total per employee should ot exceed 120 hours worked that moth.) Hourly employees Calculate actual hours of service from records of hours worked ad hours for which paymet is made or due for vacatio, holiday, illess, icapacity (icludig disability), layoff, jury duty, military duty or leave of absece. No-hourly employees Use oe of the followig methods: 1. Cout actual hours of service (as i the case of employees paid o a hourly basis) from records of hours worked ad hours for which paymet is made or due for vacatio, holiday, illess, icapacity (icludig disability), layoff, jury duty, military duty or leave of absece. 2. Use a days-worked equivalecy method whereby a employee is credited with eight hours of service for each day the employee is required to work or is credited/paid. 3. Determie umber of full weeks (40 hours per week) a employee has worked. Iclude paid time off i terms of weeks worked. Exclude ay upaid leaves. Multiply umber of weeks by 40 to calculate the hours credited to that employee. 5 Step 2 Divide total hours of service for the moth by 120. Step 3 Add total umber of full-time equivalet employees to umber of full-time employees. If this equals fewer tha 50 employees, you qualify as a small group employer uder federal law. (Note: There may be a exceptio if your total employee cout icludes seasoal employees). are you eligible for a tax credit? If you provide health isurace coverage to employees, you may qualify for the Small Busiess Health Care Tax Credit. If you have fewer tha 25 total employees based o the calculatio above, complete the followig chart to calculate the average aual wages of employees (do t cout owers or family members). 1. Eter your total umber of employees (from step 3 above). 2. Eter the total aual wages paid to employees. $ 3. Divide the amout i lie 2 by the umber i lie 1. $ If the dollar amout i lie 3 is less tha $50,000 ad you pay at least half of the isurace premiums for your employees at the sigle (employee-oly) coverage rate, you may be able to claim the Small Busiess Health Care Tax Credit if you buy isurace o the exchage. For more iformatio, visit
8 Purchasig Coverage Oce you decide to offer coverage, the ext step is to determie which type is best for your busiess. Workig with you ad your broker, Medical Mutual ca provide ACA-compliat plas, as well as a wide rage of pla desigs ad beefit optios. 6 Employers have several optios for purchasig health isurace for I additio to our plas o the federal govermet s SHOP Marketplace, Medical Mutual offers small group employers optios off the exchage. Whether you choose to buy from the SHOP or directly from Medical Mutual, we re here to help. Buyig from Medical Mutual Marketplace (off the exchage) To help you cotrol the cost of providig health beefits, Medical Mutual ca work with you to create a customized offerig where your employees ca choose from a list of ACA-compliat plas that you select. Advatages for employers: More pla optios Admiistrative support Advatages for employees: Ability to keep group coverage Wide rage of health pla optios Buyig from the SHOP (public marketplace) Small employers ca buy Medical Mutual group coverage from the SHOP. Whe you purchase coverage from the SHOP, you may qualify for a small busiess healthcare tax credit worth up to 50 percet of premium costs for commerical busiesses ad 35 percet for o-profit etities. The credit is limited to two years for both types of orgaizatios. If you qualify, you are able to deduct the rest of your premium costs (that are ot covered by the credit) from your taxes.
9 Coverage Optios Because every busiess ad every employee has differet eeds, Medical Mutual offers a variety of coverage optios. To choose the right plas for your employees, it s importat to cosider factors such as their aual medical expeses ad how may prescriptios they purchase i a year. The ACA defies four levels of metal plas to desigate the level of coverage offered to small busiesses. Each level sigifies a rage of actuarial values, or estimates, of how much a pla will pay of a average perso s medical expeses. All plas, both o the SHOP ad off the exchage, are ACA compliat. Plas offered by Medical Mutual (off the exchage) Note: For o-hsa compatible plas, the maximum out-of-pocket icludes deductibles, coisurace ad copays, icludig those for prescriptio drug. Oce employees reach this amout, Medical Mutual pays the remaider of the cost. 7 Gold 2000 HSa aggregate MMrx I-Network No-Network Deductible $2,000 Idividual/$4,000 Family $4,000 Idividual/$8,000 Family Coisurace (member cost) 0% 50% Coisurace limit $0 Idividual/$0 Family $4,000 Idividual/$8,000 Family Copay primary care Deductible the Coisurace Deductible the Coisurace Copay specialist Deductible the Coisurace Deductible the Coisurace Copay urget care Deductible the Coisurace Deductible the Coisurace Maximum out of pocket $2,000 Idividual/$4,000 Family $8,000 Idividual/$16,000 Family Gold rx 1 I-Network No-Network Deductible $1,000 Idividual/$2,000 Family $2,000 Idividual/$4,000 Family Coisurace (member cost) 20% 50% Coisurace limit $4,000 Idividual/$8,000 Family $8,000 Idividual/$16,000 Family Copay primary care $25 Deductible the Coisurace Copay specialist $50 Deductible the Coisurace Copay urget care $50 Deductible the Coisurace Maximum out of pocket $5,000 Idividual/$10,000 Family $10,000 Idividual/$20,000 Family Gold rx 1 I-Network No-Network Deductible $2,000 Idividual/$4,000 Family $4,000 Idividual/$8,000 Family Coisurace (member cost) 20% 50% Coisurace limit $1,500 Idividual/$3,000 Family $3,000 Idividual/$6,000 Family Copay primary care $25 Deductible the Coisurace Copay specialist $50 Deductible the Coisurace Copay urget care $50 Deductible the Coisurace Maximum out of pocket $3,500 Idividual/$7,000 Family $7,000 Idividual/$14,000 Family
10 Silver 1000 MMrx I-Network No-Network Deductible $1,000 Idividual/$2,000 Family $2,000 Idividual/$4,000 Family Coisurace (member cost) 30% 50% Coisurace limit $5,350 Idividual/$10,700 Family $10,700 Idividual/$21,400 Family Copay primary care Deductible the Coisurace Deductible the Coisurace Copay specialist Deductible the Coisurace Deductible the Coisurace Copay urget care Deductible the Coisurace Deductible the Coisurace Maximum out of pocket $6,350 Idividual/$12,700 Family $12,700 Idividual/$25,400 Family 8 Silver rx 1 I-Network No-Network Deductible $2,000 Idividual/$4,000 Family $4,000 Idividual/$8,000 Family Coisurace (member cost) 30% 50% Coisurace limit $4,350 Idividual/$8,700 Family $8,700 Idividual/$17,400 Family Copay primary care 2 $35 Deductible the Coisurace Copay specialist 2 $70 Deductible the Coisurace Copay urget care 2 $70 Deductible the Coisurace Maximum out of pocket $6,350 Idividual/$12,700 Family $12,700 Idividual/$25,400 Family Silver 3000 HSa MMrx I-Network No-Network Deductible $3,000 Idividual/$6,000 Family $6,000 Idividual/$12,000 Family Coisurace (member cost) 0% 50% Coisurace limit $0 Idividual/$0 Family $6,000 Idividual/$12,000 Family Copay primary care Deductible the Coisurace Deductible the Coisurace Copay specialist Deductible the Coisurace Deductible the Coisurace Copay urget care Deductible the Coisurace Deductible the Coisurace Maximum out of pocket $3,000 Idividual/$6,000 Family $12,000 Idividual/$24,000 Family Silver 4000 HSa MMrx (es 3 350/700) I-Network No-Network Deductible $4,000 Idividual/$8,000 Family $8,000 Idividual/$16,000 Family Coisurace (member cost) 0% 50% Coisurace limit $0 Idividual/$0 Family $8,000 Idividual/$16,000 Family Copay primary care Deductible the Coisurace Deductible the Coisurace Copay specialist Deductible the Coisurace Deductible the Coisurace Copay urget care Deductible the Coisurace Deductible the Coisurace Maximum out of pocket $4,000 Idividual/$8,000 Family $16,000 Idividual/$32,000 Family Silver 5000 HSa MMrx (es 4 500/1000) I-Network No-Network Deductible $5,000 Idividual/$10,000 Family $10,000 Idividual/$20,000 Family Coisurace (member cost) 0% 50% Coisurace limit $0 Idividual/$0 Family $10,000 Idividual/$20,000 Family Copay primary care Deductible the Coisurace Deductible the Coisurace Copay specialist Deductible the Coisurace Deductible the Coisurace Copay urget care Deductible the Coisurace Deductible the Coisurace Maximum out of pocket $5,000 Idividual/$10,000 Family $20,000 Idividual/$40,000 Family
11 Broze 3000 MMrx I-Network No-Network Deductible $3,000 Idividual/$6,000 Family $6,000 Idividual/$12,000 Family Coisurace (member cost) 40% 50% Coisurace limit $3,350 Idividual/$6,700 Family $6,700 Idividual/$13,400 Family Copay primary care Deductible the Coisurace Deductible the Coisurace Copay specialist Deductible the Coisurace Deductible the Coisurace Copay urget care Deductible the Coisurace Deductible the Coisurace Maximum out of pocket $6,350 Idividual/$12,700 Family $12,700 Idividual/$25,400 Family Broze MMrx I-Network No-Network Deductible $5,000 Idividual/$10,000 Family $10,000 Idividual/$20,000 Family Coisurace (member cost) 40% 50% Coisurace limit $1,350 Idividual/$2,700 Family $2,700 Idividual/$5,400 Family Copay primary care 2 $40 Deductible the Coisurace Copay specialist 2 $80 Deductible the Coisurace Copay urget care 2 $80 Deductible the Coisurace Maximum out of pocket $6,350 Idividual/$12,700 Family $12,700 Idividual/$25,400 Family 9 Broze 5000 HSa MMrx I-Network No-Network Deductible $5,000 Idividual/$10,000 Family $10,000 Idividual/$20,000 Family Coisurace (member cost) 20% 50% Coisurace limit $1,350 Idividual/$2,700 Family $2,700 Idividual/$5,400 Family Copay primary care Deductible the Coisurace Deductible the Coisurace Copay specialist Deductible the Coisurace Deductible the Coisurace Copay urget care Deductible the Coisurace Deductible the Coisurace Maximum out of pocket $6,350 Idividual/$12,700 Family $12,700 Idividual/$25,400 Family Notes 1.Drug Beefits retail: $15 Geeric, $30 Formulary, $90 No-formulary, 50% up to $350 Specialty Drugs, $100 Oral Chemotherapy Drugs Mail Order: $45 Geeric, $90 Formulary, $270 No-formulary, 50% up to $1,050 Specialty Drugs, $300 Oral Chemotherapy Drugs SuperScript: -Network Pharmacy/Retail (30 day supply) Fourth Fill i 180 days: O the fourth fill withi 180 days member will pay double the applicable copay or coisurace. -Geeric Icetive Applies: If member or provider requests a brad-ame drug whe a geeric equivalet exists, the member pays thegeeric copay PLUS the differece betwee the cost of the geeric ad brad-ame drug. 2.copays: Three visits with copay limit is combied for Primary Care Physicia, Specialist ad Urget Care visits. Coisurace after deductible whe the 3 visits are satisfied. 3.employer Share: Employer is required to cotribute $350 (Idividual) ad $700 (Family) ito each eligible employee s HSA aually. 4.employer Share: Employer is required to cotribute $500 (Idividual) ad $1,000 (Family) ito each eligible employee s HSA aually.
12 Plas offered o the SHOP (public marketplace) Note: For the optio which is ot HSA compatible, the maximum out of pocket icludes deductibles, coisurace ad copays, icludig those for prescriptio drug. I additio, oe pla icludes a maximum dollar amout the member pays for specialty drugs. Oce your employees reach this amout, Medical Mutual pays the remaider of the cost. 10 Market Gold 2000 HSa agg. w/ MMrx I-Network No-Network Deductible $2,000 Idividual/$4,000 Family $4,000 Idividual/$8,000 Family Coisurace (member cost) 0% 50% Coisurace limit $0 Idividual/$0 Family $4,000 Idividual/$8,000 Family Copay primary care Deductible the Coisurace Deductible the Coisurace Copay specialist Deductible the Coisurace Deductible the Coisurace Copay urget care Deductible the Coisurace Deductible the Coisurace Maximum out of pocket $2,000 Idividual/$4,000 Family $8,000 Idividual/$16,000 Family Market Silver rx 5 I-Network No-Network Deductible $2,000 Idividual/$4,000 Family $4,000 Idividual/$8,000 Family Coisurace (member cost) 30% 50% Coisurace limit $4,350 Idividual/$8,700 Family $8,700 Idividual/$17,400 Family Copay primary care 6 $35 Deductible the Coisurace Copay specialist 6 $70 Deductible the Coisurace Copay urget care 6 $70 Deductible the Coisurace Maximum out of pocket $6,350 Idividual/$12,700 Family $12,700 Idividual/$25,400 Family Notes 5.Drug Beefits retail: $15 Geeric, $30 Formulary, $90 No-formulary, 50% up to $350 Specialty Drugs, $100 Oral Chemotherapy Drugs Mail Order: $45 Geeric, $90 Formulary, $270 No-formulary, 50% up to $1,050 Specialty Drugs, $300 Oral Chemotherapy Drugs 6.copays: Three visits with copay limit is combied for Primary Care Physicia, Specialist ad Urget Care visits. Coisurace after deductible whe the 3 visits are satisfied.
13 Additioal Beefits Prescriptio Drug Beefits Prescriptio drug beefits are icluded with every pla we offer. We parter with Express Scripts, our pharmacy beefits maager, to offer itegrated solutios with more tha 50,000 etwork providers for each of our cliets. We make sure your employees receive the care ad attetio they deserve by: Coordiatig ad itegratig care with other cliical areas Ecouragig the use of formulary drugs (a formulary is a list of preferred brad-ame ad geeric medicatios for which members pay a lower out-of-pocket charge) Offerig prescriptio drug beefit cosultatios Providig olie tools to view both medical ad prescriptio drug claims Makig sure high-cost specialty drugs are maaged cosistetly, regardless of whether they are admiistered as part of medical services or through a prescriptio 11 Through itegratio, we help ehace members care experiece, a essetial part of improvig their health. We effectively deliver a prescriptio drug beefit that balaces quality care with total healthcare costs, which is especially importat whe maagig chroic ad/or complex coditios. Admiistratio is easy for both members ad pla sposors. Detal Beefits Because we parter with DeteMax, a atioal detal etwork, your employees will have access to a extesive etwork of geeral practitioers, periodotists, prosthodotists, orthodotists ad oral surgeos. Pediatric detal coverage is a Essetial Health Beefit ad is required for all covered depedets up to age 19. visio Beefits Offer your employees comprehesive, hassle-free visio beefits at the right price with Medical Mutual. Our plas provide coverage that icludes eye exams, eyeglass leses, frames ad cotact les beefits through a expasive etwork of participatig EyeMed provider locatios. Pediatric visio coverage is a Essetial Health Beefit ad is icluded with all ACA-compliat medical plas. life Isurace Beefits Medical Mutual wats to make sure your employees ad their loved oes are fiacially prepared i the evet of a utimely or uexpected death. With our group term life isurace plas, you ca provide coverage based o salary or a flat beefit amout. These beefits are offered through Cosumers Life Isurace Compay, a subsidiary of Medical Mutual.
14 Health Savigs Accouts Health Savigs Accouts (HSAs) allow employees greater choice ad flexibility whe maagig their healthcare dollars. HSAs are available to employees erolled i a qualified highdeductible health pla. Most of these plas will offer lower mothly premiums ad cover a wide rage of beefits. 12 Employees ca use a HSA to make tax-free cotributios for qualified medical expeses. Those expeses cout toward the pla s deductible (e.g., $3,000). Whe employees do t use their HSA cotributios to pay for medical expeses, the fuds roll over ad accumulate year over year. The Iteral Reveue Service limits how much ca be cotributed aually to a HSA. I 2015, the limit is $3,350 for sigle coverage ad $6,650 for family coverage. Note: To esure ACA compliace ad avoid fiacial pealties, employers should cotact Medical Mutual before cotributig fuds to their employees HSAs. HSa admiistratio We provide multiple HSA solutios to brig you quality pla admiistratio. Cotact your broker or Medical Mutual Service Represetative to lear more.
15 Flexible Spedig Accouts Flexible spedig accouts (FSAs) allow your employees to put a portio of each paycheck ito a accout before payig icome taxes. Depedig o the FSA, employees ca be reimbursed for expeses related to healthcare, work-related trasportatio ad depedet daycare. With a flex accout, your employees ca save o federal icome tax, state ad local taxes (where applicable) ad Social Security tax (for salaries below the maximum Social Security wage base). Medical Mutual offers several flex accout optios to meet the eeds of your employees: Medical FSAs: Allows employees to set aside a portio of their paycheck o a pre-tax basis ad place it ito a accout to pay for qualified medical expeses. Child daycare, elder care ad adult daycare accout optios: For depedet childre uder age 13 or depedet adults who caot care for themselves. Adoptio assistace accouts: For expeses directly related to a legal adoptio, such as applicatio fees, court costs ad legal bills. Commuter beefit accouts: For parkig or public trasportatio expeses related to commutig to ad from work. 13 FSa cotributio limits The ACA limits the amout employees ca cotribute to medical FSAs for ay year to $2,550, subject to cost-of-livig adjustmets. The IRS sets rules for what happes to uused fuds at the ed of the pla year. You decide whether your employees have to forfeit the fuds or ca carry over up to $500 ito the ext pla year. Employees who have a health savigs accout (HSA) are prohibited from keepig fuds i a medical FSA.
16 14 Prevetive Care Whe you prevet illess, it helps reduce your healthcare costs. Prevetive care is oe of the most importat steps your employees ca take to maage their health. Routie prevetive care ca idetify ad address risk factors before they lead to illess. Whe your employees receive prevetive care services from a provider i our etwork, they are covered with o cost sharig. That meas employees will ot be charged a copay, coisurace or deductible. However, out-of-etwork charges may apply if the services are performed by a o-etwork provider. A prevetive care visit may iclude a complete physical exam, vaccies to prevet disease, cacer screeig tests ad certai lab tests. Primary care providers will also discuss actios your employees ca take to improve their health. The list of covered prevetive services is subject to chage based o federal ad state regulatios. However, most fall ito oe of these broad categories: Prevetive physical exams ad screeig tests (e.g., diabetes, cholesterol, high blood pressure ad sexually trasmitted diseases) Immuizatios (e.g., hepatitis, shigles, iflueza ad chicke pox) Couselig ad educatio itervetios (e.g., diet ad utritio, disease prevetio ad alcohol or drug abuse) Wome s services (e.g., cotraceptio, preatal services, breast cacer screeigs ad well-woma visits)
17 Focus o Health ad Welless Medical Mutual offers a comprehesive suite of programs desiged to promote healthy lifestyle behaviors. Through our welless programs, your employees ca better uderstad their health, idetify risk factors for disease ad make positive chages to improve their well-beig. Health Assessmet Completig this assessmet ca help your employees uderstad their overall health ad idetify risk for certai chroic diseases. Based o the results, employees ca receive a persoalized set of recommeded behavior chages to improve their overall health. Aggregate reportig is also available to help determie appropriate welless programs to address risk withi your employee populatio. Health Resource Ceter Through the Health Resource Ceter, your employees ca watch videos desiged to teach them how to eat healthier, be more active or quit smokig. They ca also access iteractive tools ad quizzes, a searchable health ecyclopedia ad a symptom checker tool to determie what s holdig them back from optimum health. Health Promotio Mailigs Based o your employees records of healthcare activity (e.g., claims, prescriptios, Health Assessmet results), they will receive educatioal materials about medical coditios ad lifestyle issues, missed services ad recommeded prevetive screeigs. Healthy Outlooks Newsletter This publicatio offers i-depth articles o a wide variety of importat health issues, provides cosumer health pla educatio ad gives tips for accessig services available through Medical Mutual. Persoal Health History Your employees are able to review ad search their ow cofidetial, iteractive, electroic medical history report. Fitess Discouts Your employees ca save moey o memberships to local ad atioal fitess clubs through our Fitess Discouts Program. QuitLie Program Our QuitLie is available to help tobacco users give up the habit for good by providig oe-o-oe coachig, a persoalized quit pla ad educatioal materials. I additio, icotie replacemet therapy is available to maximize their chaces of quittig. Weight Watchers Reimbursemet To help employees reach their health ad weight goals, we offer a special reimbursemet for completig a Weight Watchers meetig series. Covered employees ad their depedets age 10 ad older ca participate i At Work or Local (commuity) Meetigs ad are reimbursed up to $150 of their registratio fees per caledar year based o attedace. Walkig for Welless Program For the basic walkig program, Medical Mutual provides a overview ad helpful materials, such as persoal walkig logs, to get your employees movig. 15
18 Tools ad Resources As your healthcare parter, Medical Mutual offers olie tools to make maagig health isurace easy for you ad your employees. 16 employerlik With EmployerLik, you ca quickly take care of your day-to-day health maagemet duties: Add/cacel employees Chage persoal ad depedet iformatio Order ID cards Pay your mothly bill View certificate books My Health Pla With our secure, members-oly website, covered employees ca maage their health beefits from the coveiece of their computer. I additio to usig our Fid a Provider tool ad My Care Compare, members ca use My Health Pla to: View pla beefits ad claims iformatio Referece Explaatio of Beefits statemets Compare provider ad treatmet costs Mobile app for iphoe ad adroid Devices With the MedMutual mobile app, your employees ca use their health pla more effectively wherever they go. The app allows members to: Access their ID card from their phoe ad or fax it to their healthcare providers Fid i-etwork doctors, hospitals ad urget care facilities ad get directios to the earest locatio Paperless Optios Employees ca store their health iformatio olie i a safe, coveiet locatio ad sig up to receive alerts whe ew Explaatio of Beefits statemets or Summary of Beefits ad Coverage documets are available. Other beefits of goig paperless iclude: Fast ad safe access to olie claims iformatio (for up to two years) Protectio agaist idetity theft ad mail fraud Less paper clutter ad less evirometal impact
19 Why Medical Mutual? A trusted isurer for more tha 80 years, Medical Mutual is the oldest ad largest isurace compay headquartered i Ohio. Based i Clevelad, we have sales, service ad iformatio techology offices i ie locatios across the state. We serve more tha 1.5 millio members with 2,300 Ohio-based employees, who pride themselves o their service to our customers ad commuities. 17 We re a mutual compay ad we work for you As a mutual health isurace compay, Medical Mutual is owed ad operated for the beefit of our members, with products ad services desiged ad priced i your best iterest. Ulike publicly traded isurace compaies that must operate to maximize their fiacial retur, we do t aswer to stockholders ad Wall Street aalysts. Ohio s largest etwork of doctors ad hospitals Your employees may have specific doctors they wat to see. Our etwork of providers is the largest i Ohio, givig your employees access to early every healthcare professioal i Ohio ad 99 percet of the hospitals. We parter with atioal etwork providers to make sure our members are covered eve whe they travel. Your employees ca access our etire etwork, whether you buy o the SHOP, through our private marketplace or through a broker. Local customer service, just a phoe call away Most of our employees work ad live i Ohio just like yours. So we re equipped to service the specific eeds of your busiess. Our Customer Care departmet hadles thousads of calls a day, providig prompt respose to customer eeds ad questios. Nearly 95 percet of our calls are resolved durig the iitial cotact. We also process thousads of claims each day, with 99 percet accuracy. Givig back to the commuities we serve We ivest i your commuities, because they are our commuities, too. Medical Mutual is dedicated to improvig the quality of life i the commuities we serve by supportig o-profit ad charitable orgaizatios. Every year, our employees cotribute thousads of hours as voluteers for commuity evets ad iitiatives focusig o health, welless, educatio ad may other worthwhile causes. Our employees are your customers As our customer, you are automatically erolled i Medical Mutual s employee icetive program called Mutual Appreciatio. The program ecourages our employees to shop with our customers. Employees have supported the program with more tha $40 millio i purchases from our customers i just a few years. We have may examples of employees takig the extra time to patroize a Medical Mutual customer.
20 Additioal ACA Termiology It s importat to be familiar with the termiology surroudig the ACA to make sure you uderstad what is covered for your employees ad how much it will cost. Here are a few more brief defiitios. Federal Poverty level Aual guidelie for how poverty is measured i the Uited States. I 2015, the federal poverty level is set at $24,250 (total yearly icome) for a family of four ad $11,770 for a idividual. 18 Gradfathered Pla Ay health pla that already existed whe the ACA was siged ito law o March 23, Icreases i beefit levels ca be made to adjust for medical iflatio without affectig gradfathered status. Guarateed availability The ACA requires issuers to offer coverage without regard to preexistig coditios. Guarateed reewability Carriers must reew coverage or cotiue it i force at the optio of the pla sposor. lifetime limits The ACA prohibits a health pla from establishig lifetime dollar limits. Prevetive care Services Healthcare that emphasizes the early detectio, prevetio ad treatmet of disease (see page 14). Qualified Health Pla (QHP) QHPs are health plas that are certified through the olie marketplace as providig the Essetial Health Beefits package ad beig provided by a isurer that agrees to certai stadards as required by the ACA. Ay pla o the Marketplace must be a QHP. For more iformatio about the provisios of the aca, visit MedMutual.com/reform.
21 Notes 19
22 20 Notes
24 2060 East Nith Street Clevelad, OH Medical Mutual of Ohio Z7902-GHP R2/15 MedMutual.com
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