天天吃瓜

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Medical 2024

天天吃瓜 State offers two medical plans through -- the 85/60 PPO Plan, and the High Deductible Health Plan (HDHP). To assist 天天吃瓜 employees and families, Medical Mutual has provided a . Once there, you can search for in-network providers and view videos regarding Medical Mutual online tools and resources.

If you need to see a doctor while traveling or if your care provider is outside the state of Ohio, your coverage will be through Cigna.

New employees have 31 days to enroll from their date of hire. If you do not select a plan within that time, you default into "refused coverage" status and you cannot select a plan until open enrollment, or until a qualifying life event occurs. Simply put, TAKE ACTION!! Review your benefits offerings and actively select a plan that works for you and your family.

Getting Started

How much will I pay for health insurance?

天天吃瓜 State health insurance premiums are deducted from your paycheck twice monthly. The cost of these premiums is determined by your salary, the number of pays you鈥檒l receive annually, and whether you are selecting single or family coverage.

Below is the contribution table, where you can see what you might expect to pay in monthly premiums, based on which Medical Mutual plan you choose.

2024 CONTRIBUTION TABLE (PDF)

Other costs, such as deductibles and out of pocket, will be determined based on the Medical Mutual plan you select. Medical Mutual offers a PPO plan and a High Deductible Health Plan (HDHP).

2024 MEDICAL PLANS COMPARISON CHART - FACULTY (PDF)

2024 MEDICAL PLANS COMPARISON CHART - STAFF (PDF)

How can I enroll my dependents?

If you have dependents to be added to your elections, you must submit a Dependent Verification Form (PDF) along with supporting documentation.  If adding a spouse, a copy of the marriage certificate is needed and if adding a child, a copy of the birth certificate(s) is needed.  If you are adding a domestic partner, you must complete the application for Domestic Partner.

Working Spouse/Domestic Partner Fee

A working spouse fee/domestic partner fee will be applied each pay for employees providing medical coverage to a spouse or domestic partner who is employed full-time, eligible for group health care coverage through their employer and elects not to enroll.

You might be eligible to waive that fee if your spouse/domestic partner is:

  • Part-time employed
  • Retired
  • Enrolled in Medicare
  • Self-employed/unemployed
  • Employed in a benefits-eligible position at 天天吃瓜
  • Employed, but does not qualify for or is not offered group health insurance 
  • Employed, but in a non-天天吃瓜 State medical plan as primary coverage, utilizing 天天吃瓜 State for secondary coverage

Relevant Forms

FormWhat is it?Is it required?Due Date
Affidavit of Working Spouse/Domestic Partner Insurance Status (PDF)Use this form to declare the employment and insurance status of your spouse/domestic partner.  YES31 Days after your hire date

 

Medical Mutual Plan Details

Coverage highlights of the 85/60 plan

As with all our medical plans, your medical premium includes prescription and vision benefits. The following are what you can expect if you select the 85/60 plan:

  • Preventive services are covered at 100% with in-network providers at NO COST to you. Examples of preventive care services (PDF) are annual exams, immunizations, and preventive screenings.
  • You can enroll in a Flexible Spending Account (FSA) to use pre-tax dollars to pay for eligible healthcare expenses incurred by you or your eligible dependents. Dependent Care FSAs allow you to use pre-tax dollars to pay for DAYCARE expenses for dependents up to the age of 13 or for elderly care. Visit our FSA and HSA web page for more information.
  • Deductible for in-network providers: $300 for single coverage and $600 for family coverage.
  • Coinsurance for in-network providers: 15%
  • Office co-pays for non-preventive healthcare services: $15 for primary care doctors and $30 for specialists. *Co-pays do not go toward meeting your deductible.
  • Out of Pocket Maximum for in-network providers:  $1,500 for single coverage and $3,000 for family coverage.
  • Out of Pocket Maximum for in-network providers for FACULTY:  $1,200 for single coverage and $2,400 for family coverage.
  • Preventive Services for Medical Mutual 85/60 and HDHP (PDF)
Complete coverage details of the 85/60 plan

2024 Plan Year:

Medical Mutual Plan Booklet - 85/60 - Staff (pdf)

Medical Mutual Plan Booklet - 85/60 - Faculty (pdf)

 

Coverage highlights of the High Deductible Health Plan (HDHP)

The High Deductible Health Plan (HDHP) is an option for all full-time benefits-eligible employees, including the bargaining units. As with all medical plans that 天天吃瓜 State offers, your medical premium includes your prescription and vision benefits.

Plan Highlights

  • With the election of an HDHP, a Health Savings Account (HSA) can be created for you. For the 2024 plan year, 天天吃瓜 State will contribute to your HSA $1,300 for single plans or $2,000 for family plans. To increase your savings in your HSA, you can elect to contribute to the HSA at any time throughout the year. You can also increase or decrease your contributions throughout the year. Another great thing about an HSA is that it allows you to use your pre-tax dollars to pay for eligible healthcare expenses incurred by you or your eligible dependents. 
  • Got Dependents? No problem! You can enroll in the Dependent Care FSA that allows you to use pre-tax dollars to pay for DAYCARE expenses for dependents up to the age of 13 or for elderly care; however, be aware that you cannot increase or decrease your elections to your FSA during the plan year. Visit our FSA and HSA web page for more information. 
  • Preventive services are covered at 100% with in-network providers at NO COST to you. Examples of preventive care services (PDF) are annual exams, immunizations, and preventive screenings.   
  • Deductible for in-network providers:  $3,200 for single coverage and $5,400 for family coverage.
  • Coinsurance for in-network providers: $0.00
  • Office Co-pays: $0.00
  • Out of Pocket Maximum for in-network providers:  $3,000 for single coverage and $5,400 for family coverage.
  • Employer contribution to your health savings account (HSA) of $1,300 for single coverage and $2,000 for family coverage effective at the first of the year!
  • Preventive Services for Medical Mutual High Deductible Health Plan and 85/60 PPO plan (PDF)
  • Preventive Therapy Drug List (PDF) 
Complete coverage details of the High Deductible Health Plan (HDHP)

2024 plan year:

Medical Mutual Plan Booklet - HDHP (pdf)

 

How does my prescription coverage work when enrolled in a High Deductible Health Plan?

When enrolled in the High Deductible Health Plan, you can expect to pay the negotiated price for your prescriptions, that are not on the Preventative Drug List, until your HDHP annual deductible is met. The cost of these prescriptions will go towards meeting your annual deductible.  Once your deductible is met, your prescription co-insurance will apply (see below) and the maximum you would pay for your prescription will be $60. For more information about your prescription coverage, visit our CVS/Caremark prescription webpage.  

To get pricing information for prescriptions under the HDHP plan, you can contact CVS/Caremark at 1-888-202-1654.

Prescription co-insurances:

  • 10% coinsurance of the negotiated price for generic medications
  • 20% coinsurance of the negotiated price for brand-name prescriptions when a generic equivalent is not available
  • 40% coinsurance of the negotiated price for brand-name prescriptions when a generic equivalent is available

If you or your dependents are taking prescriptions appearing on the Preventive Therapy Drug List (PDF), the cost of that drug is not subject to your deductible. However, co-insurance will apply as stated above and the co-insurance amount will be applied to your combined medical/prescription maximum out-of-pocket deductible.

What if I don't select coverage through 天天吃瓜 State?

Can I opt-out of 天天吃瓜 State coverage? What does that mean for me if I do?

Sometimes employees have other insurance through their parents or a spouse/domestic partner. If you are not covered under 天天吃瓜 State's insurance, you can receive $50 per pay ($100 per month) for opting out. Opting out means that you chose not to receive the medical, vision, prescription, and dental benefits through 天天吃瓜 State. To receive the cash incentive, you will need to submit an affidavit of alternate coverage (PDF). 

Note: The Opt-Out election must be completed each year in the Open Enrollment portal, and a current signed affidavit must be on file to receive the incentive.

If I opt-out of 天天吃瓜 Coverage, then lose insurance, what then?

If you opted out and later lost insurance coverage, you can enroll in 天天吃瓜 State's plans under a Qualifying Event. A qualifying event is a major life event such as loss of insurance coverage, birth, adoption, marriage, and/or divorce. Qualifying life events may make you eligible to enroll in benefits or make changes to your benefits outside of the annual open enrollment period. Just email benefits@kent.edu within 31 days of the qualifying event to enroll or make any necessary changes to your benefits.

What is default status and what does it mean for me?

New Employees have 31 days to enroll from their date of hire. If you do not select a plan within that time, you default into "refused coverage" status and you cannot select a plan until open enrollment, or until a qualifying life event occurs. Simply put, TAKE ACTION!! Review your benefits offerings and actively select a plan that works for you and your family.

Resources

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