2021 BENEFIT PLANS

The County of Summit offers a comprehensive benefit package to its eligible employees and their dependents. These benefit offerings include Medical, Prescription, Dental and Vision coverages, Life Insurance, Employee Assistance Program and Wellness programs and are administered by the Department of Human Resources, Division of Employee Benefits.

Click on the links below for benefit information.

BENEFIT ELIGIBILITY AND REQUIREMENTS

EMPLOYEE ELIGIBILITY AND ADULT DEPENDENT COVERAGE

To be eligible for benefit coverage, you must be a full-time employee working at least 35 hours per week. Benefits are effective on the 1st of the month following the employee’s date of hire.

Eligible dependents include:

The employee’s spouse or domestic partner
The employee, spouse or domestic partner’s:
- Natural children
- Stepchildren
- Children placed for adoption or legally adopted children
- Children for whom either the employee, spouse or domestic partner is the legal guardian or custodian
- Any children who, by court order, must be provided health care coverage by the employee or employee’s spouse or domestic partner.

Eligibility verification is only required once upon enrolling in the Summit County Benefit Plan for employees and dependents. You have 30 days from your effective date to submit your Employee Benefit Enrollment and Change Application with your one time verification forms for you and your dependents. (See Required Documents section.)

QUALIFYING EVENTS

Marriage/Domestic Partnership

Addition of Spouse or Domestic Partner. The Division of Employee Benefits Department must be notified within 30 days of an employee marriage or domestic partnership in order for the spouse/domestic partner to be enrolled on the County plan. Remember to update beneficiaries at this time if you choose.

Divorce/Termination of Domestic Partnership/Legal Separation

An application/change form must be submitted to the Division of Employee Benefits Department when there is a change in marital or relationship status. Employees must notify the Division of Employee Benefits Department within 30 days in the case of divorce, dissolution, termination of domestic partnership or legal separation so that COBRA can be offered within 60 days. Remember to update beneficiaries at this time if you choose.

Birth/Adoption of a Child

The addition of a dependent. Employees must notify the Division of Employee Benefits Department within 30 days of the birth or adoption of a child in order for coverage to begin on the event date.

Birthday/Dependent Age Limit

Check your plan to see if your dependent children are eligible beyond age 26. If your dependent no longer meets the eligibility criteria, employees must notify the Division of Employee Benefits Department immediately so that COBRA can be offered within 60 days of their 26th birthdate.

All Qualifying Event changes must be reported to the Employee Benefits department within 30 days of the date of event. Changes must be submitted on an Employee Benefits Enrollment and Change Application and must be accompanied by the appropriate Required Document listed below.

REQUIRED DOCUMENTS (Required for new hires and qualifying events)

Employee/Spouse/Domestic Partner

Copy of Marriage License (Legal Copy)
Copy of Divorce Decree (if applicable)/Separation Agreement
Domestic Partner Affidavit Child and proof listed on affidavit

Child

Legible copy of birth certificate (not proof of birth letter) listing employees name
Copy of adoption or guardianship papers listing employee and child (if applicable)

Step-Child

Legible copy of birth certificate showing one or both parent’s name.

Please note: In addition to the birth certificate you must be able to prove the employee/step-child relationship (a valid birth certificate along with a valid marriage certificate listing both employee and spouse would prove the employee is tied to the step-child).

Copy of a valid court order showing who is responsible for providing healthcare coverage with one or both parent’s name.

In addition to the court order you must be able to prove the employee/step-child relationship (a valid court order along with a valid marriage certificate listing both employee and spouse would prove the employee is tied to the step-child) Federal law allows eligible dependent married or unmarried children to be covered until they reach age 26.

Change of Address

Notify the Division of Employee Benefits Department immediately anytime there is a change of address.

IMPORTANT ENROLLMENT REQUIREMENTS

YOU MUST REPORT ALL CHANGES IN FAMILY STATUS TO THE DIVISION OF EMPLOYEE BENEFITS WTITHIN 30 DAYS OF THE OCCURRENCE. FAILURE TO REPORT CHANGES IN A TIMELY MANNER MAY RESULT IN DELAY OR DENIAL OF COVERAGE OR THE LOSS OF THE OPTION TO EXERCISE COBRA CONTINUATION. IF ELIGIBLE EMPLOYEES, SPOUSES, DOMESTIC PARTNERS AND DEPENDENTS ARE NOT ENROLLED ON THE BENEFIT PLAN WITHIN 30 DAYS OF THEIR ELIGIBILITY DATE, ENROLLMENT WILL BE DEFERRED TO THE NEXT OPEN ENROLLMENT PERIOD.

SPECIAL ENROLLMENT RIGHTS

You or your Eligible Dependent who has declined the coverage offered by County of Summit may enroll for coverage under this plan during any special enrollment period if you lose coverage or add a dependent for the following reasons, as well as any other event that may be added by federal regulations:

In order to qualify for special enrollment rights because of loss of coverage, you or your Eligible Dependent must have had other group health plan coverage at the time coverage under this plan was previously offered.
If coverage was non-COBRA, loss of eligibility or the Group's contributions must end. A loss of eligibility for special enrollment includes:
- Cessation of dependent status (such as attaining the maximum age to be eligible as a dependent child under the plan)
- Death of an Eligible Employee
- Termination of employment
- Reduction in the number of hours of employment that results in a loss of eligibility for plan participation (including a strike, layoff or lock-out)
- Loss of coverage that was one of multiple health insurance plans offered by an employer, and the Eligible Employee elects a different plan during an open enrollment period
- An individual no longer resides, lives, or works in an HMO Service Area (whether or not within the choice of the individual), and no other benefit package is available to the individual through the other employer
- A situation in which a plan no longer offers any benefits to the class of similarly situated individuals that includes the individual
- A situation in which an individual incurs a claim that would meet or exceed a medical plan lifetime limit on all benefits (additional requirements apply)
- Termination of an employee's or dependent's coverage under Medicaid or under a state child health insurance plan (CHIP)
- The employee or dependent is determined to be eligible for premium assistance in the Group's plan under a Medicaid or CHIP plan
If you or your Eligible Dependent has COBRA coverage, the coverage must be exhausted in order to trigger a special enrollment right. Generally, this means the entire 18, 29 or 36-month COBRA period must be completed in order to trigger a special enrollment for loss of other coverage.
Enrollment must be supported by written documentation of the termination of the other coverage with the effective date of said termination stated therein. With the exception of items "j" (termination of Medicaid or CHIP coverage) and "k" (eligibility for premium assistance) above, notice of intent to enroll must be provided to Medical Mutual by the Group no later than thirty-one (31) days following the triggering event with coverage to become effective on the date the other coverage terminated. For items "j" and "k" above, notice of intent to enroll must be provided to Medical Mutual by the Group within sixty (60) days following the triggering event, with coverage to become effective on the date of the qualifying event. If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your Eligible Dependents provided that you request enrollment within thirty (30) days after the marriage, birth, adoption or placement for adoption.

To request special enrollment or obtain more information, contact Kym Komaschka, Division of Employee Benefits (330) 643-2621.

MEDICAL PLANS

Summit County offers four health plans that are designed to meet your individual needs. Visit the “My Health Plan” section of the Medical Mutual website to set up a personal secure password and search for provider, order a new ID card, check the status of your claims or print a claim form, reprint an Explanation of Benefits (EOB), view a member handbook or E-mail customer service. Through this site you can also locate SuperMed PPO or MedFlex in-network providers and access your prescription information. Medical Mutual of Ohio Customer Service: 1-800-228-6472.

With My Care Compare, you can:

•Get cost estimates for multiple services from routine lab work and office visits to minor and major surgeries

•Compare costs at different locations for the same medical procedure.

•View quality ratings of doctors and hospitals.

Summary of Benefits and Coverage

Advantage Plan Guide
MedFlex Plan Guide
MedFlex Member Brochure
Maximum Value/HSA Plan Guide
Minimum Value Plan Guide

Summary of Benefits and Coverage-Advantage Plan
Summary of Benefits and Coverage-MedFlex Plan
Summary of Benefits and Coverage-Maximum Value/HSA Plan
Summary of Benefits and Coverage-Minimum Value Plan

Prevention Care Screenings and Immunizations
Preventive Care Prescription Drugs
HSA Preventive Immunization Coverage List
MMO Claim Form
First Stop Health Telemedicine

Learn more about continuing coverage through COBRA - contact Kym Komaschka, (330) 643-2621, kkomaschka@summitoh.net.

HEALTH SAVINGS ACCOUNT (HSA)

The County’s Maximum Value Plan also offers a Health Savings Account (HSA). An HSA is a personal savings account you can use to pay for qualified out-of-pocket medical expenses with pretax dollars. Both you (through pretax funds from your paycheck) and the county (through Virgin Pulse wellness dollars) are able to make contributions to your account, but you own and control the account.

Contributions are not taxed, and you can invest the balance in a variety of options. Your account (including interest and investment earnings) grows tax-free and as long as the funds are used to pay for qualified medical expenses, they are spent tax-free.

You can use the money in your HSA to pay for qualified medical expenses now or in the future. Your HSA can be used for your expenses and those of your spouse/domestic partner and dependents even if they are not covered on the HDHP.

You are eligible to open and fund an HSA if you:

Are enrolled in an HSA-Eligible HDHP
Are not covered by other non-high deductible health plans, such as your spouse’s health plan, Health Care Flexible spending Account, or Health Reimbursement Account
Are not eligible to be claimed as a dependent on someone else’s tax return
Are not enrolled in Medicare
Have not received Veterans Administration benefits

Employee HSA Enrollment Link: www.tasconline.com

If you have questions or concerns about your account, please contact TASC at (800) 422-4661 or www.tasconline.com.

HSA Qualified Expenses
HSA Participant Benefits
HSA Transfer Form
Transferring 2020 HSA: HSA Transfer forms can be emailed to: HSADeposits@avidiabank.com after 12/31/2020.
HSA and Medicare Brochure

PRESCRIPTION PLANS

Summit County's prescription provider is Express Scripts (administered by Medical Mutual of Ohio). Your ID card includes both medical and prescription plan information. Once you receive your ID card you can access your prescription information via the Medical Mutual website to locate an in-network pharmacy, review prescription history, view claims, price medications, refill mail orders, check mail order status and update mail order payment information. Express Scripts Customer Service: 1-800-417-1961.

Advantage and MedFlex Plans Rx Summary
Mail Order Form
Zero Copay Program
SMART90 Pharmacy List
Prescription Drug Formulary
In-Network Pharmacy Directory

DENTAL PLANS

Summit County offers you and your eligible dependents a dental program that gives you the choice of two plan options. The PPO plan offers out-of-network benefits and the Value Plan includes increased in-network benefits. Both plans offer Rollover Options. Click on Guardian Dental to register and obtain additional plan information by calling customer service 1-888-600-1600. You will need the Guardian Dental Group ID 00543971 to register.

Guardian Dental-PPO PLAN

With the PPO Plan, you can visit any dentist; but you pay less out-of-pocket when you choose a in-network PPO dentist.

Guardian Dental-VALUE PLAN
With the Value Plan, you can visit any dentist; but you pay less out-of-pocket when you choose a in-network PPO dentist. Out-of-network benefits are limited to Guardian's fee schedule and subject to balance billing.

Dental ID and Online Access
Dental PPO and Value Plan Comparison
Dental PPO and Value Plan Benefit Summary
Dental PPO Benefit Book
Dental Value Plan Benefit Book
Dental Claim Form
Dental Provider Search

College Tuition Benefit
Guardian College Tuition Benefit
College Tuition Benefit Video

VISION PLANS

Summit County provides you and your eligible dependents a Vision Care Program through Davis Vision. Click on Davis Vision or call 1-800-999-5431 to access network providers.

Davis Vision Benefits Summary
Davis Vision ID Card
Glass.com Online Retailer
Davis Vision Lasik Services Flyer
Davis Vision Mobile App Flyer
Warranty Policy Versant Health
Hearing Health Care Plan

LIFE INSURANCE

The County of Summit provides Life Insurance and Accidental Death and Dismemberment coverage for full time employees. Additional Voluntary Life and AD&D may be purchased in amounts from $10,000 to $300,000 in increments of $10,000 at the employees own expense through payroll deductions.

Guardian Voluntary Life Summary
Guardian Voluntary AD&D Summary
Guardian Voluntary Insurance Enrollment Form
Evidence of Insurability Form
Guardian TravelAid
Guardian Will Prep Service
Guardian Life Insurance Video

You can update your beneficiary during open enrollment, or anytime during the year using the beneficiary forms posted below. Completed forms should be submitted to Kym Komaschka, Employee Benefits in the Russell M. Pry Building, Suite 378 or email kkomaschka@summitoh.net.

County Provided Life Beneficiary Form
Voluntary Life Beneficiary Form

FLEXIBLE SPENDING AND HEALTH REIMBURSEMENT ACCOUNTS

Summit County offers employees a Flexible Spending Account (FSA) program. These accounts set aside funds, on a pre-tax basis, through payroll deduction, to pay eligible out-of-pocket medical, dental, and dependent care costs. Participating employees are issued a debit card to make payments for eligible items or employees can file paper claims.

The Flexible Spending Account program is administered by TASC. If you have questions or concerns about your account, please contact TASC at (800) 422-4661 or www.tasconline.com.

TASC Online Account Enrollment
TASC Debit Card
FSA Eligible Expenses
FSA Participant Benefits
Dependent Care FSA Qualifications
Flexible Spending Account Summary Plan Description
Health Reimbursement Account Summary Plan Description

SUMMARY PLAN DESCRIPTION AND CERTIFICATES

Medical/Prescription Plans

County of Summit Medical/Prescription Summary - Advantage Plan
County of Summit Medical/Prescription Summary - MedFlex Plan
County of Summit Medical/Prescription Summary - Maximum Value/HSA Plan
County of Summit Medical/Prescription Summary - Minimum Value Plan
Summit County Children Services Board - Medical/Prescription Summary - Advantage Plan
Summit County Children Services Board - Medical/Prescription Summary - MedFlex Plan
Summit County Children Services Board - Medical/Prescription Summary - Maximum Value/HSA Plan
Summit County Children Services Board - Medical/Prescription - Minimum Value Plan
Summit County Public Health - Medical/Prescription Summary - Advantage Plan
Summit County Public Health - Medical/Prescription Summary - MedFlex Plan
Summit County Public Health - Medical/Prescription Summary - Maximum Value/HSA Plan
Summit County Public Health - Medical/Prescription - Minimum Value Plan

Dental Plans

Dental Certificate PPO
Dental Certificate Value Plan

Vision Plans

Vision Certificate

Life Insurance

The County of Summit provides Life Insurance and Accidental Death and Dismemberment coverage for certain full time employees. If you would like a copy of this policy, please email you request to kkomaschka@summitoh.net.

Flexible Spending and Health Reimbursement Accounts

Flexible Spending Account Summary Plan Description
Health Reimbursement Account Summary Plan Description