2018 Open Enrollment Materials

Below is a list of Open Enrollment materials 

Active Clergy/Active TAC Fiscal Office Lay Employees

  Document What it's for...
1 2018  Active Employee OE Letter 2018 group health highlights for active clergy and TAC Fiscal Office lay employees
2 2018 OE Instructions

Active clergy and TAC Fiscal Office lay employee open enrollment instructions

3 2018 Overview of Changes

What's changing in 2018 for active clergy and TAC Fiscal Office lay employees

4 Applicable Zip Code List for Non-Utilization of Houston Methodist Hospitals  A $2,000 co-pay applies to non-emergency inpatient hospital admission at a non-Houston Methodist Hospital if you live within an applicable zip code on this list. 
5 2018 Group Health Enrollment Form Submit enrollment form only if making changes in your plan elections or dependent coverages in 2018
6 2018 Boon-Chapman Annual Additional Insurance Form (required each year for enrolled dependents) Must be submitted by January 1 each year or dependent benefits are limited to $1,000 until completed form is received.
7 American United Life Insurance

Overview of clergy and lay employee life insurance benefits

8 Humana Dental/Vision Plan Summary

Comparison of plans, premiums and enrollment instructions

9 Humana Dental HMO Plan Overview of plan details
10 Humana Dental PPO Plan Overview of plan details
11 Humana Vision 130 Plan Overview of plan details
12 Script Care Pharmacy Benefits Summary Overview of prescription drug plan
13 Script Care Premier Plus Formulary Drug List

Overview of plan details

14 Script Care Premier Plus Formulary Exclusions

Exclusions to the Premier Plus Formulary drug list

15 Script Care ACA Preventive Medications and Immunizations Preventive medications, immunizations, contraceptives, and smoking cessation covered under the Affordable Care Act
16 Script Care Specialty Pharmacy Program and Specialty Drug List

Overview of plan details

17 Teladoc® Overview of plan details
18 Standard PPO Plan Summary of Benefits and Coverage

Your benefits in health care reform standard format

19 High Deductible PPO Plan Summary of Benefits and Coverage

Your benefits in health care reform standard format

20 HIPAA Privacy Notice

Protection of your personal health information

21 Medicaid and CHIP Premium Assistance Notice

Assistance to help pay for your employer group health plan coverage if you or your children are eligible for Medicaid or CHIP

22 TAC Wellness Program Notice

Wellness program personal health information

23 Women’s Health and Cancer Rights Act Notice

Women’s health and cancer benefit information

 

Under 65 Retirees / Under 65 Spouses of Medicare Primary Participants / Under 65 Surviving Spouses

  Document What it's for...
1 2018 Open Enrollment Letter 2018 group health highlights for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses
2 2018 OE Instructions 2018 enrollment information and instructions for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses
3 2018 Overview of Changes What's changing in 2018 for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses
4 Applicable Zip Code List for Non-Utilization of Houston Methodist Hospitals  A $2,000 co-pay applies to non-emergency inpatient hospital admission at a non-Houston Methodist Hospital if you live within an applicable zip code on this list. 
5 2018 Group Health Enrollment Form Enrollment form for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses who want to change plan elections
6 2018 Boon-Chapman Annual Additional Insurance Form (required each year) Must be submitted by January 1 each year or dependent benefits are limited to $1,000 until completed form is received
  All documents numbered 7 – 23 above pertain to under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses Additional 2018 OE documents


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