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Who are Meritain Health and Humana?

MCCCD has partnered with Meritain Health, a TPA (third party administra-tor), to administer your employee health plan benefits and process medical claims. You have access to the Blue Cross/Blue Shield (PPO/EPO Provider Network within the state of Arizona and the First Health Network outside the state of Arizona. Your PBM (pharmacy benefits manager) is Humana. Meritain Health is a nationwide healthcare benefits administrator. Meritain Health services members in all 50 states. As your healthcare benefits admin-istrator, Meritain Health’s goal is to provide you with the information, tools and services you need to choose the best healthcare options for yourself and your family and information about how to use your benefits. When you re-ceive your Meritain Health ID card, please show it to all of your medical pro-viders so they can update your billing information to prevent a delay in claims processes. Humana is your pharmacy benefits manager (PBM). You will need to trans-fer any mail order prescriptions to the Humana Pharmacy mail order program. You can set up an account and initiate your first prescription refill with the directions located on page 14. Once you receive your pharmacy ID card, please show it to your pharmacy providers so they can update your billing. Other benefit options available: MetLife dental Assurant dental MetLife short term disability Aetna life insurance and accidental death and personal loss coverage Wellness incentive dollars. These incentive dollars assist with your premium costs for healthcare; you must com-

plete the health risk assessment and tobacco screening in order to receive your wellness incentive dollars. *The health risk assessment must be completed yearly to continue to receive wellness incentive dollars.

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Core – EPO

Buy-Up PPO

EPO In Network PPO In Network PPO – Out-Of-Network

Deductible (Individual/Family) $1,000 / $2,000 $750 / $1,500 $1,500 / $3,000

Coinsurance Percentage 80% 85% 50%

Coinsurance Max. (Individual/Family Includes Deductible/Co- Pays/RX

$5,000 / $10,000 $3,750 / $7,500 $9,000 / $18,000

Lifetime Maximum Unlimited Unlimited Unlimited

Preventive Services Covered 100% Covered 100% No Coverage

PCP Office Visit Co-Pay $35 $25 Deductible + Coinsurance

Specialist Office Visit Co-Pay $45 $35 Deductible + Coinsurance

Emergency Room Facility Co-Pay $200 $200 $200

Emergency Room Professional Cost-Share

80% coinsurance deductible waived

85% coinsurance deductible waived

85% coinsurance deductible waived

Ambulance Deductible + 80% coinsurance

Deductible + 85% coinsurance

Deductible + 85% coinsurance

Urgent Care Co-Pay $45 $35 Deductible + Coinsurance

Retail Co-Pay (30 day supply) $13/ $35/ $85 $10/ $30/ $70 No Coverage

Mail Order Co-Pay (90 day supply) $26/ $70 / $170 $20 /$60 /$140 No Coverage

Inpatient Hospital Co-Pay $300 + Deductible + Coinsurance

$300 + Deductible + Coinsurance

$300 + Deductible + Coinsurance

Outpatient Hospital Deductible + Coinsurance Deductible + Coinsurance

Deductible + Coinsurance

Laboratory / Pathology / Radiology Deductible + Coinsurance Deductible + Coinsurance

Deductible + Coinsurance

Chiropractic Visits $45 per visit, Up to 12 visits per year

$45 per visit, Up to 12 visits per year

Deductible + Coinsurance Up to 12 visits per year

*This is only a brief summary of the medical plans. A complete list of all plan information can be found on the Benefits Website:

http://www.maricopa.edu/employees/divisions/hr/benefits/index

Balancing healthcare costs: What you pay and what the plan pays.

The Summary of Benefits in this packet shows how much you pay for care, and how much the plan pays. It’s a listing of what is and isn’t included in your bene-fits plan. For more detailed information, see your summary plan description. After you pay your annual deductible and any up-front co-pays, the plan begins to pay a percentage of your provider’s charges, for example 80%. The remaining percentage, for example 20%, is your responsibility—your “out-of-pocket” costs. You’re protected from financial hardship by a maximum out-of-pocket amount each year—the most you’ll have to pay before the plan covers costs at 100%. When using out-of-network providers, the charges are subject to usual and cus-tomary reduction. Providers may bill the patient for charges above usual and customary.

When it’s an emergency: If you can’t see a net-work provider in an emergency, don’t worry! Your plan will cover out-of-network emergency charges at the in-network level. For more information, refer to your summary plan description

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You Have Access To…

Aetna

Your Group Term Supplemental Life insurance policy may qualify for con-

version to an Aetna Individual Whole Life Policy or you can continue

(port) your current group term coverage on an individual basis. Please

see the following link on the Employee Benefits website.

http://www.maricopa.edu/employees/divisions/hr/benefits/coverage/life

Aetna life essentials

Financial

Financial planning

Accelerated death benefits

Financial counseling for beneficiaries

Life insurance calculator

Legal

Legal forms

Documents

Estate planning

Emotional

End-of-life counseling

Grief counseling

Bereavement counseling and Funeral planning

Healthy Lifestyles

The Minute Clinics, The Little Clinic & Take Care Clinics

The clinics are available for you and your covered dependents to use (PCP

office visit benefit applies)

Clinics offer convenient, no-appointment needed options for treatment

by a licensed physician’s assistant or nurse practitioner for non-

emergency medical conditions

See the Employee Benefits website for locations

MHN EAP (Employee Assistance Program)

Provided by MCCCD at no cost to you, the employee

Offers a wide range of confidential financial and legal support in addition

to clinical counseling

Free coaching via Web video

Discounts to legal services

Financial counseling

Identity theft resolution assistance

Daily living services

Visit: members.mhn.com (Company code: Maricopa)

MHN Mental Health Care

MNN also provided quality mental

health and substance use disorder

care*

Services available on an in-

network and out-of-network basis

Inpatient and outpatient assess-

ment and treatment

Different levels of individual and

group care

Crisis intervention

Treatment follow-up

Confidential appointments

*Members must be enrolled in a

MCCCD medical plan in order to be

eligible to receive behavioral health

benefits

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Everest Funeral Planning and Concierge Service

24/7 Advisor Planning Assistance (1-800-913-8318)

Online Planning Tools and access to Everest PriceFinder Reports

Www.everestfuneral.com/aetna

Enrollment identification code AETNA0100

Independent consumer advocate when you and your family need it the most.

Form more information:

http://www.maricopa.edu/employees/divisions/hr/benefits/coverage/

Wellness Incentive Dollars Know Your Numbers!

Everyone knows their phone number and pin number but do you know your cholesterol or glucose numbers? Please consider

attending the Health Risk Assessments. Employees attending the event will receive Wellness Incentive Dollars.

Health Risk Assessments (HRAs) Your individual results are kept private by HonorHealth and will not be shared with anyone in the district. All benefit eligible employees are eligible and encouraged to participate. Employees who participate in the HRAs will receive an annual rebate of $240 in wellness incentive dollars. These rebates will be paid out over 26 pay periods for 12 month pay employees. Less than 12 month pay employees will be prorated. *Screenings include: • Online questionnaire will give you an overview on your general health • Lipids (Total Cholesterol, LDL, HDL, Ratio, Triglycerides) and glucose screening • Blood Pressure and Pulse • Height, Weight (BMI), and Waist Circumference • Cotinine (Nicotine test) mouth swab** • Consult - a health coach will be available to go over your results and answer your questions

Tobacco Free Living Tobacco use is the leading preventable cause of death in the United States and costs organizations more than 193 billion dol-lars annually in lost productivity and health care expenditures. Employees who test negative for nicotine (Cotinine mouth swab) during the HRAs will receive wellness incentive dollars. Those who engage in tobacco free living (by testing negative with the cotinine test) will receive an annual rebate of $360 in wellness incentive dollars. These rebates will be paid out over 26 pay periods for 12 month pay employees. Less than 12 month pay employees will be prorated.

My Wellness 360

Have you enrolled in the new Wellness Maricopa portal, My Wellness 360 and completed your Personal Health Profile (PHP)?

My Wellness 360 is a secure HIPAA-compliant comprehensive wellness portal designed for employees and their spouses/

partners to maintain or improve their overall health and well-being. Participants are able to track health behaviors; complete

a PHP; review their latest biometric screening results and health summary report; browse an expansive health library; create a

personal wellness plan; track incentives and rewards, and register for events and challenges.

You will need to be enrolled into the My Wellness 360 in order to sign up for future annual HRAs. Enroll at:

www.maricopa.edu/wellness-360-portal with your MCCCD email and password to start exploring.

Employees must be

enrolled in a

MCCCD medical

plan to earn the

wellness incentive

dollars.

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This service is available to you at

no cost when you select a

MCCCD Medical Plan

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EPO Core Plan PO Buy-Up Plan

In-Network Out-of-Network In-Network Out-of-Network

Retail (30 day supply)

Generic drugs $13 N/A $10 N/A

Preferred Brand-name drugs $35 N/A $30 N/A

Non-preferred brand-name $85 N/A $70 N/A

drugs

Mail Order (90 day supply)

Generic drugs $26 N/A $20 N/A

Preferred Brand-name drugs $70 N/A $60 N/A

non-preferred brand-name drugs $170 N/A $140 N/A

Why Generics make sense—and dollars.

Because companies that develop new drugs have long-term patent protection for their prod-

ucts, other drug companies are prevented by law from manufacturing those drugs—even if

they can produce them less expensively.

When patents expire, other companies can make equivalent drugs, usually at a much lower

price. Generic equivalents go through rigorous FDA testing regularly to assure that they are

just as effective as the brand-name drugs.

Consider all of the compelling reasons to protect your pocketbook with the lower-price ge-

netic drugs:

Generics can cost up to 75 percent less than their brand-name equivalents.

FDA testing is exactly the same for generic and brand-name drugs.

Generics contain the same active ingredients as the original, brand-name drug, in the

same amounts and dosages.

Generic drugs sometimes look different from the original brand-name drug in color or

shape, but only because they may have different inactive ingredients that won’t change

how the drug works.

Nearly half of all brand-name drugs have genetic equivalents-but you may have to ask for

them.

Generics have the lowest copay under this plan, so you save on every prescription.

A prescription for a healthier budget. Your prescription drug benefit---available when you need prescriptions filled---is admin-istered by Humana Pharmacy Solutions.

Controlling your prescription copay. To get the most from your benefits plan, it pays to be a wise consumer. In many cases you can control how much your share of costs will be when you fill a prescription. How? Generic drugs cost less to manufacture and they’re just as effective as the name brands. You’ll save money when you request them because generics have a lower co-pay than preferred or non-preferred drugs.

Prescription drug copays:

Contact Humana___

Member Services: 1.877.823.2386 Humana Pharmacy Mail Order: 1.855.297.7120 Online:

www.human.com

The preferred drug listing

Also called a formulary, a

preferred drug listing is

created by pharmacy

experts and lists FDA-

approved, safe, effective

and economical drugs

How the preferred drug list work Drugs are added to the list

on a quarterly basis. Brand-name drugs can be

removed at the end of the calendar year.

You may obtain a formu-lary on

Humana.com If a generic becomes avail-

able, the brand-name drug will become a “non-preferred” drug, and may only be avail-able for a higher co-pay.

When a generic drug be-comes available, you’ll pay the lowest copay if you choose the ge-neric.

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Meritain Mobile Capabilities for Members

Meritain Health Mobile Capabilities for Members

Meritain Health offers user-friendly mobile access for members. With this enhanced mobile feature,

Meritain Health members will have convenient, around-the-clock access to healthcare benefits information from their smart

phones and tablets. Our mobile capabilities for members feature attractive, quick-to-navigate displays, which help members

easily.

Download and view ID Cards

Access deductibles, out-of-pocket amounts, claims and Explanations of Benefits (EOBs)

Search for providers

View FSA balances if applicable

Members can access mobile capabilities by visiting:

www.myMeritian.com

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No Surprises, Just Information

How healthcare reform affects your plan:

In March 2010, President Obama signed the Affordable Care Act, or ACA, into law. The

ACA, also known as health care reform, includes certain consumer protections that apply

to your health plan, for example, the requirement for the provision of preventive health

services without any cost sharing. Be sure to review the important information about the

ACA that is included throughout this kit.

Questions regarding how healthcare reform affects your plan can be directed to Meritain

Health at 1.800.762.2234. You may also contact the Employee Benefits Security

Administration, U.S. Department of Labor at 1.866.444.3272 or online at

www.dol.gov/ebsa/healthreform.

Important things to know about eligibility.

Health plans are put together carefully to provide the best benefits possible for

participants. Meritain Health knows how important it is for healthcare consumers like you

to really understand how your plan works. In this way, you can make the changes you want

in your health and in your life. The next section of this packet describes some of the most

important provisions of your benefits. It’s another way we’re working with you to help you

get the most from your benefits—so you can live a life that’s balanced and informed, with

no “surprises.”

Healthy balance for your family, too.

Your family members can reap the rewards of the plan, too. Healthcare benefits are

available for every eligible dependent. It’s a great way to help your family members find the

right balance between life’s “roller-coaster ride” and their best health. Be sure your family

knows about the opportunities open to them—share this packet and other materials you

receive from the plan!

Your eligible dependents.

This benefit plan is open to you and your eligible dependents.

Qualified dependents include:

Your spouse or domestic partner

Your children, step children and adopted children under age 26.

Excluded from the benefit coverage provided by MCCCD are brothers, sisters, parents,

grandparents, grandchildren, aunts uncles, ex-spouses, ex-partners, children of ex-spouses

and ex-partners. However, medical support orders for children will qualify for eligibility.

ACA note: Dependent coverage is now available for any child (regardless of marital status,

residency, student status, etc.) of an employee who is deemed to be the employee’s

biological, step, foster or adopted child (including a child placed for adoption) until such

child reaches age 26.

In this section:

Health benefits for your

family

Enrolling at a later date

Special enrollment situa-

tions

If your spouse already has

coverage

When you have benefits

from two group plans.

Please refer to the summary

plan description for order of

benefit determination

information

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When your dependents are not eligible for benefits under your plan. Tell your employer if: You become divorced or are legally separated from a spouse who was covered under this plan. A dependent child ceases to meet the terms of the plan. To enroll the dependent for COBRA—a special limited-time plan for continuing benefits at your own expense—you must notify your employer within 30 days of that person’s change in dependent status.

If say “no” to this plan now. You can refuse the benefits of this plan, but be sure you’ve looked at the pluses and minuses of that decision. Important: If you

don’t enroll in a MCCCD medical plan, you must submit a medical waiver form with proof of coverage through another group’s medical plan.

If you lose other group benefits that you or your dependents might have, and it’s not your fault (for example, the covered person

is laid off or let go from a job) you’ll be able to sign up for this plan. Likewise, if you have an event such as your own mar-riage, divorce or the birth or adoption of a child, you will have another brief period to sign up for this plan without waiting for your employer’s open enrollment period. These are considered “Qualifying Events.” You have 30 days to notify and submit all required documents to the MCCCD Employee Benefits Department after a “Qualifying Event.”

Medical Waiver requirement. Medical waivers must be re-approved each fiscal year. If you are covered by another employer’s group medical plan and are waiving the MCCCD medical coverage, please complete the medical waiver form and return it to the Benefits office. The MCCCD medical waiver is available at: http://www.maricopa.edu/employees/division/hr/benefits/newhire Failure to provide a completed required medical waiver form (including proof of coverage) will result in the loss of the waiver and you will be enrolled in the single coverage Core (EPO) Plan for FY2016-17. Acceptable group coverage: Military Coverage Spouse’s Coverage Medicare Coverage Retiree Coverage Indian Health Coverage A MCCCD spouse who is covered under a MCCCD medical plan with family coverage of another active MCCCD employee

Submission methods: Intercampus mail, U.S. mail or fax. Mail: Maricopa Community Colleges Benefits Department 2411 W. 14th Street Tempe, AZ 85281 Fax: 480.731.8484 Telephone: 480.731.8492

No Surprises Just Information

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Please Note:

You must be enrolled in a MCCCD

medical plan and participate in the

Wellness Health Risk Assessment and

Tobacco test in order to be eligible

for the wellness incentive dollars.

FY2017-18 Premium Rates Per Pay Period

Prepaid—SunLife/Assurnt Dental

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FY2017-18 Premium Rates Per Pay Period

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Important Notices

SUMMARY OF BENEFITS AND COVERAGE (SBC)

Enclosed in your Open Enrollment packet you will find a

document called a Summary of Benefits and Coverage,

commonly referred to as a “SBC”. This SBC provides a

brief overview of the medical plan benefits provided by

Maricopa Community Colleges. You will want to review

this and share it with your other family members who

enroll for coverage.

As required by law, across the US, insurance companies

and group health; plans like ours are providing plan

participants with a consumer-friendly SBC as a way to

help you understand and compare medical benefits.

What the SBC Contains

Each SBC contains concise medical plan information,

in plain language, about benefits and coverage, including,

what is covered, what you need to pay for various benefits,

what is not covered and where to go for more information

or to get answers to questions. Government regulations

are very specific about the information that can and cannot

be included in each SBC. Plan sponsors are not allowed to

customize very much of the SBC. There are detailed

instructions the Plan had to follow about how the SBCs look,

how many pages the SBC should be (maximum 4-pages),

the font size, the colors used when printing the SBC and

even which words were to be bold. An SBC includes:

A health plan comparison tool called “Coverage

Examples.” The coverage examples illustrate how the

medical plan covers care for two common health

scenarios: having a baby and diabetes care. The

examples show the projected total costs associated with

each of these two situations, how much of these costs

the Plan covers and how much you, the participant,

needs to pay. In these examples, it’s important to note

that the costs are national averages; and do not reflect

what the actual services might cost in your area. Plus,

the cost for your treatment might also be very different

depending on your doctor’s approach, whether your

doctor is an In-Network PPO Provider or a Non-PPO

Provider, your age and any other health issues you may

also have. These examples are there to help you compare

how different health plans might cover the same

condition - not for predicting your own actual costs.

A link to a “Glossary” of common terms used in

describing health benefits, including the words

“deductible,” “co-payment,” and “co-insurance.” The

glossary is standard and cannot be customized by a Plan.

Websites and toll-free phone numbers you can contact

if you have questions or need assistance with benefits.

PATIENT PROTECTION NOTICE

The medical plans offered by MCCCD do not require the

selection or designation of a primary care provider (PCP).

You have the ability to visit any network or non-network

health care provider; however, payment by the Plan may be

less for the use of a non-network provider. You also do not

need prior authorization from the Plan or from any other

person (including a primary care provider) in order to obtain

access to obstetrical or gynecological care from a health care

professional who specializes in obstetrics or gynecology. The

health care professional, however, may be required to

comply with certain procedures, including obtaining prior

authorization for certain services, following a pre-approved

treatment plan, or procedures for making referrals. For a list

of participating health care professionals who specialize in

obstetrics or gynecology, contact the PPO network at their

website: http://www.azblue.com/CHSNetwork.aspx

PRE-EXISTING CONDITION LIMITATIONS

Pre-existing condition limitations will no longer apply to

MCCCD medical plans as of 07/01/2014.

NO RETROACTIVE CANCELLATION OF COVERAGE

In accordance with the requirements of the Health Care

Reform Act, the MCCCD medical plan will not retroactively

cancel coverage except when contributions are not timely

paid, or in cases of fraud or intentional misrepresentation of

material fact.

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WOMEN’S HEALTH AND CANCER RIGHTS ACT

The Women's Health and Cancer Rights Act of 1998 requires

group health plans and health insurance issuers that cover

mastectomies to also cover re-constructive surgery or other

related services following a mastectomy

Medicare HICN and Dependent Social Security Number

Mandate

Social Security Numbers, or qualified alternate identification

numbers, are required for all covered dependents due to the

requirements of the implementation of Medicare Secondary

Payer Mandatory Reporting Provisions in Section 111 of the

Medicare, Medicaid and SCHIP Extension Act of 2007.

Medicare Health Insurance Claim Numbers (HICN),

if applicable, must be submitted to the District Employee

Benefits Department.

Non-Eligible Dependents and the Change in Status Rule

Only qualified dependents are eligible for coverage under your

benefit plans provided by MCCCD. Qualified dependents

include your spouse or domestic partner and your children,

step children and adopted children under age 26. Excluded

from the benefit coverage provided by MCCCD are brothers,

sisters, parents, grandparents, grandchildren, aunts uncles, ex-

spouses, ex-partners, children of ex-spouses and ex-partners.

However, medical support orders for children will qualify for

eligibility. It is a fraudulent practice to add ineligible

dependents to MCCCD provided benefit coverage and

disciplinary action will be taken, up to and including

termination, should this occur.

If you have a change in family status, you must notify and

submit all required documentation to the Benefits

Department (HR Administration) within 30 days of the

qualifying event. A qualified event include such examples as:

birth, adoption, marriage, domestic partnership, divorce,

death or a child reaching age 26.

Special Enrollment Rights

Effective April 1, 2009, special enrollment rights apply in

accordance with the Children’s Health Insurance Program

Reauthorization Act of 2009, which funds and expands the State

Children’s Health Insurance Program (SCHIP). The rights will

apply if 1) you or your dependents experience a loss of eligibility

for Medicaid or your SCHIP coverage; or 2) you or your

dependents become eligible for premium assistance under an

optional state Medicaid or SCHIP program that would pay the

employee’s portion of the health insurance premium. In order

to be entitled to the special enrollment right, the employee

must request coverage within 60 days of coverage termination

or the date the parent or child is determined to be eligible for

assistance.

CREDITABLE COVERAGE DISCLOSURE NOTICE

Yearly notice about your MCCCD prescription drug

program and Medicare will be mailed to your home

address in October. Please contact Meritain Health if you

need this notice prior to October.

HIPAA REGULATIONS

The Standards for Privacy of Individually Identifiable

Health Information (“Privacy Rule”) establishes a set of

national standards for the protection of certain health

information. The U.S. Department of Health and Human

Service issued the privacy Rule to implement the

requirement of Health Insurance Portability and

Accountability act of 1996 (HIPAA).

MCCCD maintains a HIPAA Notice of Privacy Practices

describing how health information about individuals

covered under our insurance plans may be used and

disclosed. Detailed information regarding HIPAA

regulations can be found on the Benefits web site.

Important Notices

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Important Numbers

For questions about… You may call… At this number

Medical/Vision benefits Meritain Health Customer Service 1.866.300.8449

Concierge Service – Benefits Assistance Compass / Health Pro Consultant- 1.800.513.1667 x654

Mycah Miller MycahM@compassphs.com

Flexible Spending Accounts Meritain Health FSA department 1.800.566.9305

Option 5

Prescription drug benefits Humana Pharmacy Solutions 1.877.823.2386

BCBS of Arizona Participating providers Meritain Customer Service 1.866.300.8449

Out of State Service providers First Health Network 1.800.226.5116

firstealth.coventryhealthcare.com

Behavioral Health / EAP MHN 1.800.603.2970

www.members.mhn.com Company Code: Maricopa

SunLife / Assurant Dental (DHMO) SunLife/Assurant 1.800.443.2995

www.assurantemployeebenefits.com

MetLife Dental (PDP PLUS) MetLife Dental 1.800.942.0854

MetLife Co-Pay Option 2 www.metlife.com/mybenefits Group #117777

Disability MetLife 1.800.769.4638

www.metlife.com/mybenefits

Retirement Arizona State Retirement System 1.602.240.2000

www.azasrs.gov/web/home.do

403B Information TSA Consulting www.tsag.com

Precertification Meritain Health Medical Management 1.800.242.1199

Enrollment or Benefit questions Maricopa Community College District 480.731.8492

Human Resources Representative rx@domail.maricopa.edu