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The annual benefits enrollment period runs from Tuesday, Nov. 4
to Tuesday, Nov. 18, 2014 for coverage effective Jan. 1, 2015.
Changes for 2015 are outlined in this booklet. Please read it
carefully and get answers to your questions (see Contacts on page
21) as you prepare to make benefit choices for 2015.
What’s inside 2 | Benefits enrollment to-do list 3 | Changes you
can make during annual
benefits enrollment 3 | Medical coverage 6 | Health savings
accounts (HSAs) 7 | New! Get free guidance on treatment options 8 |
The right care at the right time: Know where to go 9 | Wellness
within – and fun along the way:
The 2015 Live Healthy, Live Well program 10 | Dental coverage 12
| Vision coverage 13 | Health care flexible spending accounts
(FSAs) 14 | Life insurance coverage changes and reminders 14 |
Premium assistance under Medicaid and the Children’s
Health Insurance Program (CHIP) 17 | Annual reminders 20 |
Benefit rates 21 | Contacts 22 | Enrollment instructions
DISCLAIMER: This communication describes benefits that become
effective Jan. 1, 2015. This communication has been prepared for
benefits-eligible active employees of Massachusetts Mutual Life
Insurance Company (MassMutual); The MassMutual Trust Company fsb;
MassMutual International, LLC; Babson Capital Management LLC;
Babson Capital Finance, LLC; Invicta Advisors LLC; and Cornerstone
Real Estate Advisors LLC. It is not for agents, field staff or
retirees. This document is not a Summary Plan Description (SPD) but
sections of this document represent Summaries of Material
Modifications (SMMs) for the MassMutual Employee Welfare Benefits
Plan.
All information contained in this booklet is for general
information purposes only and is not tax or financial advice.
Benefits are determined by the terms of the plans in effect.
Receipt of this material does not imply your eligibility for any
one or all of the benefits and programs described. The Company
reserves the right to terminate, modify, amend or suspend any or
all of its benefit plans and programs at any time and from time to
time. In case of conflict between this information and the plan
terms, the plan terms and documents will govern. Provisions are
based on current law and regulations, which are subject to change.
All information described here is current as of the November 2014
publication date.
November 2014
Annual benefits enrollmentFor employee benefits effective Jan.
1, 2015
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Review the information in this booklet and share it with any
other decision-makers in your household.
Research your options:
• Visit ALEX®.• Visit
https://member.express-scripts.com/preview/
massmutualemployees to estimate your 2015 prescription drug
costs.
Ask questions:
• Call Cigna 24/7/365 at 800-548-3980 for questions about 2015
medical or dental coverage. (If you’re not a current participant,
say, “Open Enrollment” at the prompt.)
• Call Express Scripts 24/7/365 at 866-219-1933 for questions
about 2015 prescription coverage. (If you’re not a current
participant, press 0 and follow the system prompts to reach a
patient care advocate.)
• Call the Ayco AnswerLine® at 866-325-0092 with questions about
the financial aspects of your benefits.
• And more! See page 21 for more contact info.
Decide what changes, if any, you want to make for 2015. If you
don’t want to make any changes, you may not need to go through the
enrollment process. If you don’t make any changes, the benefit
elections you had in place prior to Sept. 2, 2014 will carry
forward into 2015 automatically, subject to 2015 plan provisions
and costs.
Exceptions:
• If you made or make changes to your benefits due to a mid-year
qualifying event or were hired on or after Sept. 2, 2014, you must
go through annual benefits enrollment to establish your 2015
benefits, as changes made on or after Sept. 2, 2014 will not carry
forward automatically to the new year.
• If you only need to make your health savings account (HSA)
contribution election, you can do that either during annual
benefits enrollment or on or after January 1, 2015. Your 2014 HSA
election will not automatically carry forward to 2015.
Enroll in your 2015 benefits using Employee Center by 11:59
p.m., ET, on Tuesday, Nov. 18, 2014. Enrollment instructions are on
page 22.
Print or save a copy of your 2015 benefits confirmation form for
your records as proof of your enrollment, and review it to make
sure it’s accurate.
Benefits enrollment to-do list
Pick the benefit options that are best for you
www.alexformassmutual.com/2015/employees
can help.
ALEX® logo and characters used with permission.
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Annual benefits enrollment is the one time during the year that
you can make changes to your benefit options without a mid-year
qualifying event. Benefits you can elect or change at this time are
as follows:
• Medical
• Dental
• Vision
• Group Term Life
• Dependent Life
• Long-Term Disability
• Dependent Care Flexible Spending Account (DCFSA)
• Health Care Flexible Spending Account (HCFSA)
Health savings account (HSA) contributions can be elected or
changed at any time of the year. However, if you don’t elect a
contribution amount during annual benefits enrollment, your
contribution amount will revert to zero as of Jan. 1, and will
remain at zero until you change it.
To learn more about all of the benefit options available to you,
visit myHR on MX. On myHR, links to your current elections are
listed under “Current information” on the left. Options you’re not
currently enrolled in may be found under “Other options,” further
down on the left. You may view summary plan descriptions for all of
your benefit options by going to SPD Source.
Changes you can make during annual benefits enrollment
Medical changes for 2015This section of medical and prescription
drug coverage information represents a Summary of Material
Modifications (SMM) for the MassMutual Employee Welfare Benefits
Plan High Deductible Health Plan (HDHP) Option 1 and Option 2
Medical SPD, effective Jan. 1, 2014. Changes described here are
effective Jan. 1, 2015, unless otherwise specified.
Note: This list of changes is accurate as of the November, 2014
publication date, but it may be subject to further discretionary or
legally required changes. Any further changes will be communicated
as necessary on MX or by email.
Your health is important – to you and your family, and to
MassMutual. MassMutual offers comprehensive medical coverage with a
robust wellness incentive program that allows participants to earn
company contributions to their health savings accounts (HSAs). A
schedule of preventive services based on federal guidelines
continues to be covered at 100%.
In 2015, the deductible for MassMutual High Deductible Health
Plan Option 1 increases for individual and family coverage, and the
out-of-pocket maximum increases for Option 1 family coverage. The
deductibles and out-of-pocket maximums for MassMutual High
Deductible Health Plan Option 2 are unchanged.
Medical coverage
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Medical coverage
For more information about how your medical coverage works,
including the deductible, coinsurance and out-of-pocket maximum,
please read the Summary of Benefits and Coverage (SBC), which has
been updated for 2015:
• Option 1 SBC: English | Spanish | Chinese
• Option 2 SBC: English | Spanish | Chinese
• Puerto Rico SBC: English | Spanish
• Hawaii SBC: English | Spanish | Chinese
Tobacco-use surchargeSince 2011, if you or a covered dependent
uses tobacco products, you’ve been paying a surcharge on your
medical “premiums” ranging from $400 annually for individual
coverage to $1,200 annually for family coverage. The surcharge
remains the same in 2015; however, e-cigarettes are added to the
list of products whose use is subject to the surcharge. The time
you must be tobacco-free to enroll as a tobacco non-user is 12
months. You will have to attest to having stopped use of tobacco
products and/or e-cigarettes for 12 consecutive months to avoid the
tobacco-use surcharge.
You may be exempt from the tobacco-use surcharge, if, for
example, it is medically inadvisable or unreasonably difficult due
to a medical condition to stop smoking or using
tobacco/e-cigarettes. You may avoid this surcharge if you provide
attestation and satisfy an alternative standard. If there is any
reason you believe you may be exempt from this surcharge, please
contact MassMutual Benefits at [email protected] for
more information.
Verify your covered dependents’ tax identification numbersAs
part of the Patient Protection and Affordable Care Act (PPACA),
MassMutual must report information about who is covered under
MassMutual medical options to the federal government. For that
reason, during the annual benefits enrollment period, please enter
or verify your covered dependents’ names, dates of birth and Social
Security numbers (SSNs). If any of your dependents does not have an
SSN, please include their Individual Taxpayer Identification Number
(ITIN) in the SSN field. This information is required for all
covered dependents age 1 and older.
If any of your dependents does not have an ITIN, please request
one. The General ITIN Information page on www.IRS.gov may provide
helpful information.
All SSNs and ITINs for covered dependents must be provided to
MassMutual by Dec. 31, 2014.
1 Cigna’s Maximum Reimbursable Charge (MRC) is based on typical
charges made by providers in a given geographic region for a
similar service or supply. Only out-of-network charges are subject
to the MRC. Coinsurance applies only to charges up to the MRC
limit; any charges exceeding MRC do not count towards your
deductible or out-of-pocket maximum and are your
responsibility.
Medical 2015 2014 (for reference)
Option 1 Option 2 Option 1 Option 2
DeductibleIndividual $1,500 $2,500 $1,300 $2,500Individual plus
one or more dependents (family) $3,000 $5,000 $2,600 $5,000
Out-of-Pocket Maximum
Individual $3,000 $4,500 $3,000 $4,500Individual plus one or
more dependents (family) $6,000 $9,000 $5,000 $9,000
CoinsuranceIn-Network After deductible, you pay 10%; Plan pays
90%
Out-of-Network After deductible, you pay 30%; Plan pays 70% up
to Maximum Reimbursable Charge (MRC)1
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Per-script maximums
Drug tierPlan pays
(% or more)You pay
(up to maximum)2015 maximums 2014 maximums (for reference)
30-day supply 90-day supply 30-day supply 90-day supplyGeneric
85% or more 15% up to max $25 $63 $20 $50Preferred brand 70% or
more 30% up to max $100 $250 $80 $200Non-preferred brand 50% or
more 50% up to max $150 $375 $120 $300
Change in Express Scripts formularyThe lists of drugs included
and excluded from Express Scripts’ formulary will change in 2015.
Please see the 2015 Express Scripts National Preferred Formulary,
which includes both lists, available at www.express-scripts.com or
by calling Express Scripts.
New Express Scripts preventive drug listThe list of drugs
covered as preventive has been updated by Express Scripts to
conform with guidelines set by the Department of Health and Human
Services. See the updated Preventive Drug List at
www.express-scripts.com.
Change in specialty drug pharmacyAs of Jan. 1, 2015, Express
Scripts’ specialty drug pharmacy will change from CuraScript to
Accredo®. Members with specialty drug prescriptions will receive a
call and mailing before this change takes place.
Compound Management ProgramExpress Scripts is implementing a
Compound Management Program. As of Jan. 1, 2015, certain compound
drugs that
do not meet the program’s guidelines for inclusion will no
longer be covered. If your compound drug will be excluded from
coverage as of Jan. 1, Express Scripts will contact you prior to
this change. Please contact Express Scripts for further
information.
Preventive use of certain breast cancer drugsIf a woman is
prescribed tamoxifen, raloxifene or Soltamox (liquid form of
tamoxifen) for primary prevention of breast cancer, these drugs may
be covered as preventive with no deductible or coinsurance if the
following conditions are met:
• Female gender
• Age 35 or older
• High risk for breast cancer
• No current or previous diagnosis of breast cancer
The woman’s physician must contact Express Scripts for
coinsurance review. If the request is approved, the patient may be
reimbursed for any deductible amount or coinsurance paid for the
drugs listed above. Contact Express Scripts for more
information.
Medical coverage
Certificates of Creditable Coverage will no longer be issued
after December 31, 2014Under the Patient Protection and Affordable
Care Act (PPACA), HIPAA Certificates of Creditable Coverage
will
no longer be issued by Cigna as of Jan. 1, 2015. They are no
longer needed because the Affordable Care Act prohibits insurers
from limiting coverage for people with pre-existing conditions and
because of the availability of health insurance exchanges.
Prescription drug changesNew per-script maximumsDue to the
rising cost of prescription drugs, MassMutual’s prescription drug
coverage per-script maximums will increase for the first time since
2011. These changes apply to those covered under MassMutual Medical
Options 1 and 2 and the Hawaii PPO plan. Reminder: Per-script
maximums apply only in the “coinsurance” phase of coverage. Once
you meet your deductible in 2015, the following coinsurance
schedule will apply:
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Increase in health savings account (HSA) contribution limits The
Internal Revenue Service has raised the health savings account
(HSA) annual contribution limits as follows:
IRS maximums apply to both your own HSA contributions and any
company contributions you receive (such as wellness incentive
dollars).
10 facts every HSA owner should knowBecause of their tax
advantages, health savings accounts (HSAs) provide a valuable way
to save on health care expenses now and in the future. The savings
percentage will depend on your tax bracket, but for most people the
savings are significant. (Generally, HSAs are available to those
enrolled in a high-deductible health plan, such as MassMutual
Medical Options 1 and 2. See page 3 of IRS Publication 969 for
eligibility guidelines.)
Here are 10 things to know that can help you get the most from
your Cigna Choice Fund® HSA.
1 | HSAs offer a triple tax advantage. Under federal tax law and
in most states, your contributions are tax-free, your balance earns
interest tax-free and your withdrawals for qualified expenses are
tax-free, too. As long as you use it for qualified expenses, you
never pay federal taxes on the money you contribute to your HSA.
(While most states follow federal tax treatment of HSAs, Alabama,
California and New Jersey tax HSA contributions.)
2 | There’s no use-it-or-lose-it rule. Unlike health care
flexible spending accounts (FSAs), unused funds aren’t forfeited at
the end of the year. Your balance can grow from year to year.
3 | You can contribute up to the IRS maximum every year that
you’re enrolled in a high-deductible health plan. Both company
contributions, such as wellness incentive dollars, and your
contributions count toward the annual IRS maximum.
4 | Your HSA funds can be used for: • qualified medical,
prescription, dental and vision
expenses now,
• certain qualified medical expenses in the future – including
in retirement, and
• qualified long-term care insurance premiums.
5 | Your HSA belongs to you – and becomes part of your estate.
Remember to name a beneficiary.
6 | You must be enrolled in a qualified high-deductible health
plan (e.g., Option 1 or Option 2) to contribute to an HSA.
7 | You don’t need to be enrolled in a high-deductible health
plan to use your HSA funds – which means you can use them in the
future for qualified medical expenses. There’s no time limit on
when reimbursements can be made for expenses incurred after the HSA
was established. (Keep your receipts!)
8 | Deposits earn interest – tax-free interest. 9 | Balances of
$2,000 or more can be invested in certain
designated funds. Investment earnings are also tax-free.
10 | You can change your contribution amount or timing at any
time during the year. On or after Jan. 1, 2015, you can change your
2015 contribution amount or the pay periods that your contributions
are made in by logging on to Employee Center. Click on “Enrollment
Event,” choose “Health Savings Act” in the drop-down menu, and
follow the system prompts.
Remember: Keep your receipts! You must be able to document that
your withdrawals from your HSA were used for qualified medical
expenses.
For information on HSA tax rules see IRS Publication 969. For
qualified medical expenses, see IRS Publication 502.
IRS Annual Contribution Limits for HSAs
2015 2014
Individual $3,350 $3,300
Individual plus one or more dependents $6,650 $6,550
Catch-up for participants who turn age 55 or older in 2015
$1,000 $1,000
Health savings accounts (HSAs)
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Learn more about your HSA and eligibility requirements on myHR.
Ayco AnswerLine® financial counselors can answer questions about
HSAs and help you develop a savings strategy that considers both
your current medical claims and future savings goals. Contact them
on business days at 866-325-0092, 9 a.m. to 5 p.m., ET. Evening
appointments are also available.
Six steps to figuring out your 2015 HSA contribution amount:
1. Start with your estimated 2014 health care expenses
2. Multiply by 1.05 (assumes a 5% increase in costs; you may
choose another amount)
3. Add any additional contribution you wish to make for expected
2015 expenses – or for future years, including retirement
4. Subtract any Live Healthy, Live Well wellness incentives you
expect to earn
5. Check the 2015 IRS maximum contribution limits to make sure
you don’t exceed them; adjust accordingly
6. Divide by 24 pay periods and elect your 2015 contributions
accordingly. (Dividing by 24 will spread your contributions evenly
throughout the year; however, you may choose to contribute on a
different schedule and may change them throughout the year)
Note: If your spouse has their own HSA, their contributions to
their HSA may affect the amount you can contribute to your HSA.
Consult your tax advisor.
New! Get free guidance on treatment optionsIn 2015, MassMutual
is excited to introduce ConsumerMedicalTM – a new, free-to-you
resource to help MassMutual medical option participants and their
covered dependents navigate the health care system.
ConsumerMedical offers a variety of services to help you make
informed decisions about medical treatments to lead to better
outcomes. ConsumerMedical is unaffiliated with Cigna. An overview
of their services:
Guided Patient Support (GPSTM) delivers confidential,
comprehensive, and up-to-date information about any health topic.
GPS can help you –
confirm whether the diagnosis you’ve been given is correct
understand your treatment options
get to leading doctors and hospitals for care
shop for the best quality care at the best price
build a strong support network
Surgery Decision Support provides specialized support for
members whose doctors have recommended elective surgery for low
back pain or weight loss, a hip or knee replacement, or a
hysterectomy. This program offers a financial incentive to patients
who engage with experienced ConsumerMedical representatives to
learn about risks, benefits and alternative treatment options.
Remote Second Opinion provides free, timely and easily
accessible expert second opinions from world-leading
specialists.
Claims Advocacy Services helps members resolve health care
access, claims and billing issues.
There’s no limit to the number of times a member may access
ConsumerMedical services. We’ll tell you more about this new
program as it rolls out in 2015.
Health Savings Accounts (HSAs)
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The right care at the right time: Know where to go
Health care setting Conditions treated* Cost & time
MDLIVE
MDLIVE provides immediate, on-demand 24/7/365 access to quality,
non-emergency care through a national network of licensed,
board-certified, U.S.-based doctors and pediatricians by video,
phone or email.
• Allergies• Bronchitis• Common cold/flu• Fever• Gout
• Headache• Ear infection• Pink eye• Rashes or
skin conditions
• Low cost: $38 per consultation – and it’s an in-network
expense so after deductible is met, cost is $3.80!
• No appointment needed – start on myCigna.com and click MDLIVE
or call 888-726-3171 to register. Then speak to a doctor from
anywhere.
• Wait times are typically less than 20 minutes.
Convenience Care Clinic
Usually located in retail stores and pharmacies and staffed by
nurse practitioners and physician assistants. Treat minor medical
concerns that are not life-threatening. They’re often open nights
and weekends.
• Common cold/flu• Rashes or
skin conditions• Sore throat, earache,
sinus pain
• Minor cuts or burns• Pregnancy testing• Vaccinations
• Costs are same or lower than office visit.
• No appointment needed.• Wait times typically 15 minutes
or less.
Doctor’s Office
The best place to receive routine or preventive care, track
medications, or get a referral to see a specialist.
• General health issues• Monitoring and
treatment of chronic conditions
• Preventive services
• Routine checkups• Immunizations and
screenings
• May include coinsurance and/or deductible.
• Appointment usually needed.• May have short wait time.
Urgent Care Center
For conditions that are not life-threatening. They’re staffed by
nurses and doctors and usually have extended hours, including
nights and weekends.
• Minor cuts, sprains, burns, rashes
• Fever and flu symptoms• Headaches• Chronic lower back pain
• Joint pain• Minor respiratory
symptoms• Urinary tract
infections
• Costs are lower than an ER visit.• No appointment needed.•
Wait times vary.
Emergency Room (ER)
Open 24/7 for the immediate treatment of critical injuries or
illness. If a situation seems life-threatening, call 911 or go to
the nearest emergency room.
• Sudden numbness, weakness
• Uncontrolled bleeding• Seizure or loss of
consciousness• Shortness of breath• Chest pain
• Head injury/ major trauma
• Blurry or loss of vision
• Severe cuts or burns• Overdose
• Costs are highest.• No appointment needed.• Wait times may be
long.
use the myCigna Mobile App, log on to myCigna.com or call Cigna
at 800-548-3980, 24/7/365.
This chart can help you choose the right care at the right time
– for the right price. To find a provider near you in a jiffy,
To find a specific health care facility or doctor, go to
myCigna.com using any web-enabled device or use the myCigna Mobile
App. Or, call Cigna at 800-548-3980. The listing of a health care
professional or facility in the online directory does not guarantee
that the services rendered by that professional or facility are
covered under your specific medical plan. Check your summary plan
description (available on SPD Source) for information about the
services covered under your plan benefits. The information provided
here is for informational purposes only. During a medical
emergency, you should always visit the nearest hospital or call 911
for assistance.
*List is not all-inclusive
Cost
& ti
me
High
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wer
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The 2015 Live Healthy, Live Well program
Change is the essence of modern life. In 2015, the Live Healthy,
Live Well program is adding two features to keep up with the
changes – and help you do so as well.
The first new feature you’ll notice is ZenseySM. Zensey
(zen-say) is a secure wellness website with a social network that’s
designed to make health goals fun. Accessed through myCigna.com,
Zensey offers opportunities to earn wellness incentive dollars by
accruing “coins” through a variety of
individual and group goals. Several of these goals support
popular mobile fitness apps.
While change can be energizing, at times it can challenge our
inner resources. A new wellness incentive, “Personal Strength and
Life Balance,” recognizes this and encourages participants to use
resources to foster balance and resilience. We’ll talk more about
this in the year ahead.
Most of the 2014 wellness incentives are being carried forward
into 2015. Here’s a preview of the 2015 Live Healthy, Live Well
program:
Wellness within – and fun along the way
Note: Live Healthy, Live Well is not available to Hawaii and
Puerto Rico participants.
Live Healthy, Live Well 2015 program highlights
Important guidelinesEligibility for incentives
To be eligible, you must be enrolled in a MassMutual medical
option and be in active service both when you complete and report
the activi-ties and when wellness incentive dollars are deposited
into your health savings account.
If you cover a spouse or domestic partner…
He or she may also participate.
Health assessment
Between Jan. 1 and Oct. 15, 2015, you and your covered spouse or
domestic partner must complete a health assessment on myCigna.com.
(Required before any wellness incentive dollars will be awarded for
your incentive activities.)
2015 incentive maximum
• $500 if you participate
• $500 if your covered spouse/domestic partner participates
• … for a total of up to $1,000 if you both participate
It’s confidential
• Your health assessment and all other personal health
information pertaining to the Live Healthy, Live Well program is
confidential.
• MassMutual complies with federal laws prohibiting it from
access-ing personal health information obtained by Cigna, the
company that administers MassMutual’s medical plan and wellness
program.
Deadline: Oct. 15, 2015
All health assessments, program activity results and alternative
standards must be completed and received by Cigna no later than
11:59 p.m., ET, on Oct. 15, 2015.
Incentive GoalsBlood Pressure: Earn $150 when you or your
covered spouse or domestic partner achieves a verified blood
pressure of 139/89 or less.
Body Mass Index (BMI): Earn $150 when you or your covered spouse
or domestic partner achieves a verified BMI of less than 30 or
verified weight loss of 5%.
Physical Activity: Earn $100 per month for up to two months when
you or your covered spouse or domestic partner completes 150
minutes of physical activity each week for four consecutive
weeks.
Earn 500 Coins with Zensey: Earn $150 in wellness incentive
dollars when you “cash in” Zensey “coins” earned through fun
individual or group wellness activities. (More details in
January!)
Colon Cancer Screening: Earn $200 if you or your covered spouse
or domestic partner completes an age-appropriate colon cancer
screen-ing (if eligible).
Personal Strength and Life Balance: Earn $150 by working with a
health coach, EAP network counselor or other licensed counselor on
any personal issue, or by devoting a total of 60 minutes a week to
a relaxation, yoga or meditation practice for four consecutive
weeks.
Healthy Pregnancies, Healthy Babies: Earn $200 or $100,
depend-ing on trimester when starting program, when you or your
eligible spouse or domestic partner completes the Healthy
Pregnancies, Healthy Babies program.Alternative standards
• If you’re unable to meet the requirements of the blood
pressure and/or BMI incentive, first submit a verified blood
pressure or BMI to Cigna, then talk to a Cigna health coach at
800-548-3980 about how to meet an alternative standard.
• If you’re unable to meet the requirements of the physical
activity incentive, you may meet an alternative standard determined
by your doctor. Contact Cigna for details.
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This section of dental coverage information represents a Summary
of Material Modifications (SMM) for the MassMutual Employee Welfare
Benefits Plan Dental Summary Plan Description for Employees,
effective Jan. 1, 2014.
MassMutual offers Basic and Major dental options administered by
Cigna Dental.
Effective January 1, 2015, Cigna Dental will be moving to a
single preferred provider organization. This network, Total Cigna
DPPO, will incorporate all of their contracted providers as
in-network providers.
What does this mean to you? If your dental provider is part of
Cigna Radius (the dental option’s current network), he or she will
continue to be an in-network provider as part of Total Cigna DPPO,
but “Radius” will no longer be the network’s name. In addition,
some providers who were not previously part of the Radius network
will now be part of Total Cigna DPPO. This provides MassMutual
dental option members with more choices for in-network care.
Dental providers in the Total Cigna DPPO network will always
charge at or below the maximum reimbursable charge (MRC) (see page
4).
Oral health is overall health – and prevention is key. Each
year, Cigna Dental members can receive two preventive visits
covered at 100% up to MRC. (If you’re pregnant, you can receive a
third preventive visit covered at 100% up to MRC. Contact Cigna for
details.) Schedule your and your family’s preventive visits in
advance to make the most of this benefit.
Reminder: You will not receive a dental card. Bring a copy of
the Dental Claim Form to the dentist with you, or, if you have
MassMutual medical coverage, use your Cigna medical ID card.
To learn more about dental coverage, visit the dental topic on
myHR or read your summary plan description. For questions about
your dental options, call Cigna at 800-548-3980 or visit
myCigna.com.
See page 20 for rates.
Dental coverage
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Dental options coverage chart
Deductible – The amount you pay each year before the plan pays
any benefits
Per individual $75
Per family $225
Services Basic Dental Major Dental
Preventive and Diagnostic Care (Type I)
Oral exams (twice per year), cleanings (two per year; may be
spaced less than six months apart), two periodontal cleanings
within 12 months of periodontal work, fluoride treatment (twice per
year for persons younger than age 19), routine exams, sealants (for
a person younger than 18 years old, one treatment per tooth per
every three calendar years), space maintainers, x-rays
You pay $0 in network plus any amount over maximum reimbursable
charge (MRC) (no deductible)
Plan pays 100% up to MRC
You pay $0 in network plus any amount over MRC (no
deductible)
Plan pays 100% up to MRC
Basic Restorative Care (Type II)
Anesthesia, extractions, fillings (amalgam, acrylic, porcelain,
composite, or silicate), oral surgery, root canal, bite guards,
periodontal root scaling and planing, bridge and crown repairs,
dentures (adjustments, repairs, relining, rebasing more than 6
months after installation), injection of antibiotics
After deductible, you pay 20% of the charges plus any amount
over MRC
Plan pays 80% up to MRC
After deductible, you pay 20% of the charges plus any amount
over MRC
Plan pays 80% up to MRC
Major Restorative Care (Type III)
Bridgework, crowns, dentures, gold fillings, inlays, onlays,
periodontics, devices for TMJ (temporomandibular joint),
prosthetics, orthodontic appliances, implants
Not covered After deductible, you pay 50% of charges plus any
amount over MRC
Plan pays 50% up to MRC
Orthodontia (Type IV)
Orthodontia
Not covered You pay 50% of charges plus any amount over MRC (no
deductible; $2,000 per person lifetime maximum)
Plan pays 50% up to MRC
Maximums
Calendar year per-person dental services $1,500 $2,000
Lifetime orthodontia, per person Not covered $2,000
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MassMutual’s vision coverage (administered by EyeMed) offers an
array of benefits for you and your eligible dependents. There are
no changes in the vision option for 2015. You can receive services
from any vision provider. If you receive services from a vision
provider who’s part of EyeMed’s Select network, it may cost you
less than using an out-of-network provider.
To learn more about vision coverage, visit the vision topic on
myHR or read your summary plan description. For questions about the
vision option, call EyeMed at 877-217-2539 or visit
www.eyemedvisioncare.com.
See page 20 for rates.
Vision coverage
In-Network Member CostOut-of-Network Reimbursement(claim form
required)
Exams – Once every calendar yearExam $15 Up to $65Contact lens
fit and follow-up Standard Up to $40 N/AContact lens fit and
follow-up Premium 10% off retail price N/ARetinal imaging Up to a
$39 copay N/AFrames – Once every calendar year 1
Frame $0 if $130 or less plus 80% of the balance over $130, if
any Up to $75Lenses – Once every calendar year1
Single Vision $15 copay Up to $75Bi-focal $15 copay Up to
$85Tri-focal $15 copay Up to $95Standard Progressives $80 copay Up
to $95
Premium Progressives$80 copayPlus 80% of any retail chargeMinus
a $120 allowance
Up to $95
Lenticular $15 copay Up to $115Lens OptionsTints $15 copay N/AUV
Coating $15 copay N/AStandard Scratch Resistance $0 copay
$12Standard Polycarbonate $40 copay N/AStandard Anti-reflective
Coating $45 copay N/AOther Lens Options 20% off retail price
N/AContact Lenses – Once every calendar year1
Contact Lens – Conventional $0 if $130 or less, plus 85% of the
balance over $130, if any Up to $125Contact Lens – Disposable $0 if
$130 or less, plus 100% of the balance over $130, if any Up to
$125Medically Necessary Contacts Plan pays 100% Up to $200Laser
Surgery – Call 877-5LASER6 for nearest facility and authorization
for discountLASIK
15% off retail price or 5% off promotional pricing N/APRK
Correction Procedures
Vision coverage chart
1 Participants cannot get eyeglasses and contacts in the same
calendar year.
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With a heath care flexible spending account (FSA), you can set
aside between $120 and $2,500 in before-tax income for qualified
out-of-pocket health care expenses. The funds are deducted in
installments from your pay throughout the year. However, you have
access to the full amount of your election at the beginning of the
plan year. You may use the My Care Card® Visa to pay at point of
service, or you may pay out of pocket and apply for reimbursement.
MassMutual’s health care FSA is administered by Benefit
Concepts.
Health care FSAs may be “full-use” – for eligible medical,
dental and vision expenses, or “limited-use” – for vision and
dental expenses only. Due to tax laws, contributing to a health
savings account (HSA) makes you ineligible for a full-use FSA.
If you elect a health care FSA, you’ll automatically be enrolled
in a limited-use FSA unless you attest in the enrollment portal
that you are enrolled in Medicare or have recently used Veterans
Affairs benefits. If you have “Other health coverage” as defined in
IRS Publication 969 that makes you ineligible to contribute to an
HSA (for example, Tricare), you may be eligible for a full-use FSA.
Contact MassMutual Benefits for more information.
Reminders:• Health care FSA funds not used for qualified
health
expenses by Dec. 31, 2015 are forfeited (the IRS “use-it-or-lose
it” rule).
• If you don’t wish to change your election: Your 2014 election
will be carried forward automatically to 2015 unless you elect
otherwise.
• To change your election: You must make an election during
annual benefits enrollment.
• The “limited-use” or “full-use” feature of your FSA cannot be
changed mid-year for any reason.
Health care flexible spending accounts (FSAs)
Important tax information
Save your receipts! Benefit Concepts will ask for itemized
receipts to prove that you used your My Care Card® Visa for
qualified expenses. (For qualified health care expenses, see IRS
Publication 502.) Similarly, when you pay out of pocket and submit
your claim for reimbursement from Benefit Concepts, you must
provide a receipt along with a reimbursement request form. If you
don’t substantiate your expenses by March 31 following the end of
the plan year, any unsubstantiated expenses will be taxed
retroactively. MassMutual will deduct the taxable portion of any
unsubstantiated expenses from your pay.
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This section of life insurance coverage information represents a
Summary of Material Modifications (SMM) for the MassMutual Employee
Welfare Benefits Plan Group Term Life, Business Travel Accident and
Group Variable Universal Life Insurance Options Summary Plan
Description for Employees and Retired Employees of MassMutual,
effective Jan. 1, 2014. The following changes are effective Jan. 1,
2015:
Effective Jan. 1, 2015, the requirement to carry a specific
minimum amount of Basic Life coverage will no longer apply for
Dependent Life option 2.
As a reminder, for Supplemental Life and Dependent Life, the
cost per thousand dollars of coverage is based on
your age and increases at certain intervals. See a chart of
Age-Based Rates for Supplemental Life and Dependent Life Insurance
Coverage, available on the Group Term Life and Dependent Life
topics on myHR.
In addition, as of January 1, 2015, Group Variable Universal
Life’s (GVUL) guidelines for mid-year qualifying events will be the
same as for all other MassMutual benefit plans. Subscribers will be
able to make changes to GVUL coverage within 90 days of the birth,
adoption or placement for adoption of a child. For all other
mid-year qualifying events, the time period remains 30 days
following the event.
Life insurance coverage changes and reminders
Premium assistance under Medicaid and the Children’s Health
Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and
you are eligible for MassMutual-sponsored health coverage, your
state may have a premium assistance program that can help pay for
coverage. These states use funds from their Medicaid or CHIP
programs to help people who are eligible for these programs, but
who also have access to health insurance through a
company-sponsored plan. If you or your children are not eligible
for Medicaid or CHIP, you will not be eligible for these premium
assistance programs, but you may be able to buy individual
insurance coverage through the Health Insurance Marketplace. For
more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or
CHIP and you live in a state listed below, you can contact your
state Medicaid or CHIP office to find out if premium assistance is
available.
If you or your dependents are not currently enrolled in Medicaid
or CHIP, and you think you or any of your dependents might be
eligible for either of these programs, you can either contact your
state Medicaid or CHIP office at 877-KIDS-NOW or go to
www.insurekidsnow.gov to find out how to apply. If you qualify, you
can ask the state if it has a program that might help you pay the
premiums for a company-sponsored plan.
Once it is determined that you or your dependents are eligible
for premium assistance under Medicaid or CHIP, as well as under a
company plan, your company’s health plan is required to permit you
and your dependents to enroll in the plan if you and your
dependents are not already enrolled. This is called a “special
enrollment” opportunity, and you must request coverage within 60
days of being determined eligible for premium assistance.
If you have questions about enrolling in the company-sponsored
plan, you can contact the Department of Labor electronically at
www.askebsa.dol.gov or by calling toll-free 866-444-EBSA
(3272).
http://benecontent.massmutual.com/FORMS/GTLratesEE.pdfhttp://benecontent.massmutual.com/FORMS/GTLratesEE.pdfhttps://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttp://www.healthcare.gov/http://www.askebsa.dol.gov/
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KANSAS – MedicaidWebsite: www.kdheks.gov/hcf Phone:
800-792-4884
KENTUCKY – MedicaidWebsite: http://chfs.ky.gov/dms/default.htm
Phone: 800-635-2570
LOUISIANA – MedicaidWebsite: www.lahipp.dhh.louisiana.gov Phone:
888-695-2447
MAINE – MedicaidWebsite:
www.maine.gov/dhhs/ofi/public-assistance/index.html Phone:
800-977-6740 TTY 800-977-6741
MASSACHUSETTS – Medicaid and CHIPWebsite:
www.mass.gov/MassHealth Phone: 800-462-1120
MINNESOTA – MedicaidWebsite: www.dhs.state.mn.us Click on Health
Care, then Medical Assistance Phone: 800-657-3629
MISSOURI – MedicaidWebsite:
www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone:
573-751-2005
MONTANA – MedicaidWebsite:
http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml
Phone: 800-694-3084
NEBRASKA – MedicaidWebsite: www.ACCESSNebraska.ne.gov Phone:
855-632-7633
NEVADA – Medicaid Medicaid Website: http://dwss.nv.gov/ Medicaid
Phone: 800-992-0900
NEW HAMPSHIRE – MedicaidWebsite:
www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218
NEW JERSEY – Medicaid and CHIPMedicaid Website:
www.state.nj.us/humanservices/dmahs/clients/medicaid Medicaid
Phone: 609-631-2392 CHIP Website: www.njfamilycare.org/index.html
CHIP Phone: 800-701-0710
ALABAMA – MedicaidWebsite: www.medicaid.alabama.gov Phone:
855-692-5447
ALASKA – MedicaidWebsite:
http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside
of Anchorage): 888-318-8890 Phone (Anchorage): 907-269-6529
ARIZONA – CHIPWebsite: www.azahcccs.gov/applicants Phone
(Outside of Maricopa County): 877-764-5437 Phone (Maricopa County):
602-417-5437
COLORADO – Medicaid Medicaid Website: www.colorado.gov Medicaid
Phone (In-state): 800-866-3513 Medicaid Phone (Out-of-state):
800-221-3943
FLORIDA – MedicaidWebsite: www.flmedicaidtplrecovery.com/ Phone:
877-357-3268
GEORGIA – MedicaidWebsite: http://dch.georgia.gov Click on
Programs, then Medicaid, then Health Insurance Premium Payment
(HIPP) Phone: 800-869-1150
IDAHO – MedicaidMedicaid Website:
http://healthandwelfare.idaho.gov/Medical/Medicaid/PremiumAssistance/tabid/1510/Default.aspx
Medicaid Phone: 800-926-2588
INDIANA – MedicaidWebsite: www.in.gov/fssa Phone:
800-889-9949
IOWA – MedicaidWebsite: www.dhs.state.ia.us/hipp/ Phone:
888-346-9562
Medicaid and CHIP Notice
If you live in one of the following states, you may be eligible
for assistance paying your company-sponsored health plan premiums.
The following list of states is current as of July 31, 2014.
Contact your state for further information on eligibility.
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Note: The contact information above was listed by the U.S.
Department of Labor as current as of July 31, 2014. For up-to-date
contact information, to find out if any other states have added a
premium assistance program since that date, or for more information
on special enrollment rights, contact either:
TEXAS – MedicaidWebsite: www.gethipptexas.com Phone:
800-440-0493
UTAH – Medicaid and CHIP Website: http://health.utah.gov/upp
Phone: 866-435-7414
VERMONT– MedicaidWebsite: www.greenmountaincare.org Phone:
800-250-8427
VIRGINIA – Medicaid and CHIPMedicaid Website:
www.coverva.org/programs_premium_assistance.cfm Medicaid Phone:
800-432-5924 CHIP Website:
www.coverva.org/programs_premium_assistance.cfm CHIP Phone:
855-242-8282
WASHINGTON – MedicaidWebsite:
www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx Phone:
800-562-3022 Ext. 15473
WEST VIRGINIA – MedicaidWebsite: www.dhhr.wv.gov/bms Phone:
877-598-5820, HMS Third Party Liability
WISCONSIN – MedicaidWebsite:
www.badgercareplus.org/pubs/p-10095.htm Phone: 800-362-3002
WYOMING – MedicaidWebsite: http://health.wyo.gov/default.aspx
Phone: 307-777-7531
NEW YORK – MedicaidWebsite:
www.nyhealth.gov/health_care/medicaid Phone: 800-541-2831
NORTH CAROLINA – Medicaid Website: www.ncdhhs.gov/dma Phone:
919-855-4100
NORTH DAKOTA – MedicaidWebsite:
www.nd.gov/dhs/services/medicalserv/medicaid/ Phone:
800-755-2604
OKLAHOMA – Medicaid and CHIPWebsite: www.insureoklahoma.org
Phone: 888-365-3742
OREGON – Medicaid Website: www.oregonhealthykids.gov
www.hijossaludablesoregon.gov Phone: 800-699-9075
PENNSYLVANIA – MedicaidWebsite: www.dpw.state.pa.us/hipp Phone:
800-692-7462
RHODE ISLAND – MedicaidWebsite: www.eohhs.ri.gov Phone:
401-462-5300
SOUTH CAROLINA – MedicaidWebsite: www.scdhhs.gov Phone:
888-549-0820
SOUTH DAKOTA - MedicaidWebsite: http://dss.sd.gov Phone:
888-828-0059
Medicaid and CHIP Notice
U.S. Department of Labor Employee Benefits Security
Administration
www.dol.gov/ebsa
866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for
Medicare & Medicaid Services
www.cms.hhs.gov
877-267-2323, menu option 4, Ext. 61565
OMB Control Number 1210-0137 (expires 10/31/2016)
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Annual remindersFor information about our integrated health and
wellness program and other benefits and programs, please visit
myHR.
Making benefit changes after annual benefits enrollmentAnnual
benefits enrollment is the only time during the year that you can
make changes to your benefits without a mid-year qualifying event.
A mid-year qualifying event is a life event that affects your need
for benefits coverage – for instance, getting married, divorced,
having a baby, adopting a child, or losing or gaining coverage due
to a change in your spouse or domestic partner’s employment. (This
is not a complete list. Call MassMutual Benefits or go to myHR for
more information.) Please note that depending on the type of life
event, you may not be permitted to change the medical option you
elected during annual benefits enrollment through a mid-year
qualifying event.
If you experience a mid-year qualifying event, you must notify
MassMutual, provide required documentation and complete the changes
to your coverage online within 30 days of the event. For birth,
adoption, or placement for adoption, you have 90 days from the
event.
Notify MassMutual right away about your event so you can find
out what documentation to provide and what action steps need to be
taken to modify your coverage. Any changes must be consistent with
and on account of your mid-year qualifying event.
When a dependent becomes ineligible for the plan (e.g., divorce,
termination of domestic partnership), please inform MassMutual as
soon as possible – and no later than 30 days after the event.
Coverage termination will be effective as of the date of the event.
The affected dependent has 60 days from the date of the event to
elect COBRA continuation coverage.
Emergency coverage outside of United StatesMassMutual health
options cover only emergency services outside of the United States.
If emergency care is needed, pay out of pocket, obtain an itemized
receipt, and submit your claim to Cigna. Primary and routine care
is not covered outside the U.S.
Mastectomy-related services are coveredMassMutual’s medical
plans, as required by the Women’s Health and Cancer Rights Act of
1998, provide benefits for mastectomy-related services including
reconstruction and surgery to achieve symmetry between the breasts,
prostheses, and complications resulting from a mastectomy,
including lymphedema. For details, contact Cigna at
800-548-3980.
Call Cigna’s 24-hour nurse lineHave a question you’d like to ask
a nurse? Call Cigna at 800-548-3980 and say, “24-hour nurse line”
for answers to basic medical questions and help deciding if you
need to seek further care.
MDLIVE – 24/7 access to a doctor!MassMutual medical plan
participants may consult with a doctor for non-emergency care by
phone (video conference also available with certain providers). At
$38 per session, MDLIVE provides 24/7/365 access to a national
network of licensed, board-certified, U.S.-based doctors and
pediatricians. The fee applies to your deductible and out-of-pocket
maximum. Note: Hawaii participants will pay the PCP copay. MDLIVE
isn’t available to Puerto Rico participants. To access MDLIVE, log
on to myCigna.com or call 888-726-3171.
https://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttps://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttp://www.mycigna.com/
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Have financial questions?Ayco AnswerLine® financial counselors
can provide assistance as you make decisions about retirement
savings, debt management, budgeting, saving for college and much
more. Call today at 866-325-0092 (Hearing impaired: TTY
800-437-6380). The Ayco AnswerLine® is free and available to both
you and your spouse or domestic partner. MassMutual pays for your
access to Ayco whether you use it or not – so please use it!
• Call 866-325-0092, Monday – Friday, 9 a.m. – 5 p.m., ET;
evening appointments available Monday – Thursday until 8 p.m.,
ET
• Want a counselor to contact you? Email Ayco at
[email protected] with the times you’re available
• Or go to the Aycofn® website for web-based tools
ID and debit cardsIf you’re continuing enrollment in any benefit
options with ID or debit cards, keep and use your current card(s).
There’s often a fee for replacement cards.
If you’re newly electing any of the following benefits, you’ll
receive cards at your home address:
• MassMutual medical options – Cigna medical ID; Express Scripts
prescription ID
• Vision – EyeMed ID• Health care flexible spending account
(FSA) – My
Care Card® Visa debit card from Benefit Concepts
• Cigna Choice Fund® HSA – Debit card
There’s no dental ID card. See page 10.
Group Variable Universal Life (GVUL) insurance coverage is not
part of annual benefits enrollmentIf you’re an officer or an
employee earning $100,000 or more in base pay as of Sept. 1, 2014,
your group life insurance effective Jan. 1, 2015 will be through
GVUL, not Group Term Life. Although the enrollment periods overlap,
GVUL has a separate enrollment process and portal from general
annual benefits enrollment. If you’re newly eligible, you’ll
receive a packet of information from MassMutual Executive Group
Life and will need to complete an online GVUL enrollment by Nov.
18. Contact MassMutual Executive Group Life for more
information.
Your confidential Employee Assistance Program (EAP) is just a
phone call awayThis free resource is available to you and every
member of your household, whether or not you’re enrolled in any
other MassMutual benefits. The EAP can help you with a range of
personal, relationship and work/life balance issues in a variety of
ways.
• An advocate is ready 24/7 to help assess your needs and help
resolve your concerns. He or she can also direct you to resources
in your community and to online tools.
• You and each of your household members can receive up to six
free face-to-face counseling sessions per issue per year with a
Cigna EAP network provider. Call the EAP or go to their website to
request preauthorization and a list of participating providers in
your area.
• Call for advice or a referral to a service in your community
for legal issues, support for parents and caregivers, eldercare,
identity theft, child care, contractors and pet care.
MassMutual provides EAP services through Cigna free of charge to
help you live a better and more balanced life. The EAP is
confidential to the full extent of the law. No one at MassMutual
will know you contacted the EAP unless you choose to tell them.
• Call 800-548-3980 and say “Employee Assistance Program” to be
connected with an advocate.
• Visit www.CignaBehavioral.com (company ID: mmfgroup) for
additional resources.
Annual reminders
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If you’ll turn age 65 in 2015 and maintain active service,
here’s how it affects your benefits:
• MassMutual will continue to be the primary payer for your (and
your covered dependents’) medical expenses, even though you (or
your dependent) are eligible for Medicare.
• If you enroll in Medicare, you’ll no longer be eligible to
contribute to a health savings account (HSA). It’s your
responsibility to end your contributions. If your dependent enrolls
in Medicare and you do not, you may still be eligible to contribute
to an HSA up to applicable IRS annual limits.
• If you’re enrolled in Medicare, you’ll be eligible to
contribute to a “full-use” health care flexible spending account
(FSA) in 2015 (see page 13).
• Waiver of premium for group term life or group variable
universal life is not available for disabilities that begin on or
after age 65.
• If you have group term life insurance through MassMutual, tax
on imputed income on group term life amounts in excess of $50,000
increases sharply and applies for the full year in which you turn
age 65. Imputed income does not apply to group term life insurance
amounts at or below $50,000. (See pages 5 -7 of IRS Publication 525
for more information on tax rules governing your group term life
insurance.) If you want to avoid imputed income by adjusting your
group term life insurance coverage to basic coverage or to a flat
$50,000, please do so as part of annual benefits enrollment.
Contact MassMutual Benefits for more information.
Automatic adjustments for salary increases occur during the
calendar yearIf you receive a salary increase during the year, your
group term life insurance coverage will automatically increase to
account for it. Your per-paycheck costs will increase as well. Your
salary-based contributions for medical coverage are determined
differently: they’re based on your base salary as of October 1,
2014. They’ll remain the same throughout 2015, regardless of
whether you receive a salary increase. Increased contributions for
medical coverage based on a salary increase take effect the
following January 1. (For Variable Incentive Compensation Plan
employees, these adjustments are based on base salary plus variable
incentive compensation.)
Health coverage assistance is available for children and
familiesIf you’re eligible for company-sponsored health coverage,
but unable to afford the premiums, some states have premium
assistance programs that can help pay for coverage. Refer to the
Medicaid and CHIP Notice on page 14 for more information.
Annual reminders
http://www.irs.gov/pub/irs-pdf/p525.pdf
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20
IndividualIndividual plus Spouse
or Domestic Partner Individual plus Children FamilyMedicalCigna
HDHP – Option 1
Pay b
and1 < $50,000 $50,000 – $99,999
$100,000 – $149,999 $150,000 – $249,999
≥ $250,000
46.1152.8459.8767.1874.78
101.45116.25131.70147.79164.52
92.22105.68119.73134.36149.57
142.95163.81185.58208.26231.83
Cigna HDHP – Option 2
Pay b
and1 < $50,000 $50,000 – $99,999
$100,000 – $149,999 $150,000 – $249,999
≥ $250,000
1.296.52
11.8517.2722.79
2.8414.3426.0637.9950.14
2.5813.0423.7034.5445.58
4.0120.2136.7353.5370.65
Hawaii – PPO2 < $50,000
$50,000 – $99,999 $100,000 – $149,999 $150,000 – $249,999
≥ $250,000
63.6869.4875.4281.4287.52
140.09152.86165.91179.14192.55
127.35138.96150.83162.85175.04
197.40215.40233.78252.42271.32
Puerto Rico – MCS3
< $50,000 $50,000 – $99,999
$100,000 – $149,999 $150,000 – $249,999
≥ $250,000
22.2029.0335.8542.6849.51
44.3958.0571.7085.3699.02
44.3958.0571.7085.3699.02
55.4872.5589.63
106.70123.77
Tobacco-use Surcharge4 (annual) $400.00 $800.00 $800.00
$1,200.00DentalCigna – Basic $4.30 $9.46 $8.60 $13.33Cigna – Major
$9.27 $20.39 $18.54 $28.73VisionEyeMed $2.70 $5.94 $5.40 $8.36
Available coverage levels
1 Your annual base salary as of Oct. 1 each year (or your hire
date, if later) is used to determine medical premiums for the
following year. If you’re eligible for the Variable Incentive
Compensation Plan (VICP), your incentive compensation earned from
September through August will be added to your annual base salary.
If you’re a part-time or hourly employee, your annual base salary
will be based on a 40-hour work week, excluding overtime.
2 Available only to residents of Hawaii.3 Available only to
residents of Puerto Rico. Also includes dental and life insurance
coverage.4 Add this amount to your annual cost if you or any of
your covered dependents uses tobacco products. For the purposes of
this surcharge, “tobacco use”
includes the use of any of the following products: cigarettes,
e-cigarettes, pipes, cigars, snuff, chew, and any other product not
listed here that contains tobacco. You can access national online
self-help programs by calling 800-Quit-Now or visiting
Smokefree.gov. In addition, a Cigna health coach can provide you or
your covered dependents with free nicotine replacement patches and
one-on-one telephonic support to help you identify barriers, form a
plan, and take action toward becoming tobacco-free. Call
800-548-3980 to get started.
The following 2015 rates apply to the health benefit options
available to eligible MassMutual employees. Rates shown are the
amounts deducted each pay period (there are 26 periods per
year).
Note: 2015 medical rates include a reinsurance fee levied on
plan sponsors as part of the Patient Protection and Affordable Care
Act of $44 per covered life. (In 2014, the fee was $63 per covered
life.)
Benefit rates
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Contacts
Resource Contact with questions about Online/Email TelephoneAyco
Financial Network
• Anything related to your finances, including budgeting, saving
for retirement, saving for a child’s education, HSAs and other
financial counseling questions
www.aycofn.com 866-325-0092 business days between 9 a.m. and 5
p.m., ET, or call for an appointment
Benefit Concepts
• Retiree Health Reimbursement Arrangement (RHRA)• Dependent
care or health care flexible spending accounts
(FSAs), including qualified expenses• New or replacement FSA
card (fee for replaced cards)• COBRA
https://mybenefits.benefitconcepts.com 866-629-6350
Cigna • Medical and dental coverage – what’s covered, what’s
not• Preventive care• In-network providers and services• Annual
deductible and out-of-pocket maximum• Explanation of Benefits
(EOB)• Live Healthy, Live Well and wellness incentive activities•
24-hour nurse line, health coaching and disease management•
Employee Assistance Program (EAP)• New or replacement ID cards (N/A
for dental; no card needed)
www.myCigna.com 800-548-3980 24/7/365
Ernst & Young • Health care marketplace application process
[email protected] 855-901-1222
Express Scripts • Prescription drug coverage and preventive
prescriptions – what’s covered, what’s not
• Annual deductible and out-of-pocket maximum• In-network
pharmacies and mail order pharmacy• Step therapy• New or
replacement ID cards
www.express-scripts.com 866-219-1933 24/7/365
Accredo, Express Scripts’ specialty pharmacy: 800-803-2523 (as
of 1/1/2015)
EyeMed • Vision coverage – what’s covered, what’s not•
In-network providers and services• New or replacement ID cards
www.eyemedvisioncare.com 877-217-2539
Internal Revenue Service
• Health savings accounts (HSAs) www.IRS.gov 800-829-1040 Mon. –
Fri., 7 a.m. –10 p.m.
JPMorgan Chase
• Health savings account (HSA) details, including qualified
medical expenses
• New or replacement HSA debit cards (fee)• Excess contribution
forms
www.myCigna.com
Select “Review My Coverage” then “Health Savings Account”
866-524-2483
Liberty Mutual • Short- and long-term disability benefits and
claim process
• FMLA benefits and claim process
www.MyLibertyConnection.com
(Company code: “MassMutual”)
888-408-7300
MassMutual Benefits
• General benefit questions, including benefit changes due to a
mid-year qualifying event
• Group term life and dependent life questions• Excess Pension
Plan questions
https://mmfgonline.massmutual.com (select “myHR”)
[email protected]
866-662-6448 or Ext. 46169, 10 a.m. – 4 p.m. on business
days
MassMutual Executive Group Life
• Questions about Group Variable Universal Life Insurance (GVUL)
[email protected]
Newly eligible: [email protected]
800-548-0073, prompt 1. Then, choose prompt 2 for coverage and
product questions or prompt 3 for online enrollment questions.
MassMutual Retirement Services
• Thrift Plan/401(k) contributions, funds and benefits• Pension
Plan benefits
www.RetireSmart.com 800-743-5274 8 a.m. – 9 p.m., ET
The Newport Group
• Nonqualified deferred compensation contributions, funds and
benefits
www.plandestination.com
[email protected]
800-230-3950 8 a.m. – 8 p.m., ET
Your Personal Tax Advisor
• Advice on how to maximize your MassMutual benefits and health
savings account, if applicable
Contact your personal tax advisor directly.
https://mmfgonlineep6.massmutual.com/irj/servlet/prt/portal/prtroot/mm.com.mm.ebs.aycoforward.DoRedirecthttps://mybenefits.benefitconcepts.com/http://www.mycigna.com/mailto:MassMutual.Marketplace%40ey.com?subject=http://www.express-scripts.comhttp://www.eyemedvisioncare.comhttp://www.IRS.govhttp://www.mycigna.com/http://www.MyLibertyConnection.comhttps://mmfgonline.massmutual.commailto:BenefitQuestions%40MassMutual.com?subject=mailto:LCMClientServices%40MassMutual.com?subject=mailto:EGL%40MassMutual.com?subject=http://www.RetireSmart.comhttps://www.plandestination.com/mailto:support%40plandestination.com?subject=
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Step 1 Click here, or, on the MassMutual network, go to Mutual
Exchange (MX). Under, “I need to…,” choose “Access Employee Tools”
to get to Employee Center.
Step 2 From Employee Center, click on Enrollment Event under the
‘Benefits’ heading.
Step 3 Below ‘Select the appropriate enrollment event below,’
select 2015 Enrollment from the drop-down menu and click Enter.
Step 4 From the Research Benefits page, click the links on the
right side of the screen to research your options. Worksheet shows
all your available options and costs. When you click on any of the
research links, they’ll pop up in another window and won’t disturb
your enrollment process. Close any new windows to return to the
enrollment portal.
Step 5 Click Start Enrollment Process.
Step 6 You will be prompted to Maintain
Dependents/Beneficiaries. Make any adjustments by selecting add or
edit. If you’re married, certify that you’re legally married by
checking the box at the bottom of the screen. Verify that all
information is correct.
If you’re adding a new dependent to your coverage during annual
benefits enrollment:
• Be sure you add your dependent as part of your 2015 Enrollment
(rather than as a separate “enrollment event”) and complete the
annual benefits enrollment process in order to connect them to your
coverage.
• Enter your dependent’s name, date of birth and Social Security
number (SSN) or Individual Taxpayer Identification Number
(ITIN).
• After adding a dependent, you must provide documentation to
MassMutual Benefits upon request (e.g., birth certificate for a
child).
You can’t delete a dependent (historical information must be
maintained), but you can have some historical information hidden
from your view. Contact MassMutual Benefits at Ext. 46169 or
866-662-6448 or email [email protected] for more
information.
Step 7 If you plan to enroll in medical coverage, confirm the
Health Partnership Acknowledgement and attest to your and your
dependents’ tobacco use status.
Step 8 Follow the on-screen directions to continue your
enrollment process.
Step 9 In the Savings Account Setup section, enter the total
amount you want deducted from your pay to be deposited into your
health savings account (HSA), and the number of pay periods for
that deduction (e.g., $100 per pay statement, for 24 pay periods).
Note: Your HSA election from 2014 will not carry forward. You must
elect an amount for 2015. Acknowledge that you have read and
understand the HSA/FSA disclosures.
If you don’t already have an HSA, the system may ask you if you
want to set up an account. To enable before-tax contributions to be
automatically deducted from your pay, MassMutual must facilitate
the opening of your HSA. Click I accept to allow this.
Step 10 Review your selections and click I Accept. You’ve
completed the online enrollment process. Print a Confirmation Form
for your records. You may need to take additional action before
your enrollment is complete. For example, if you elect to cover a
domestic partner, you must provide MassMutual Benefits with a
Domestic Partner Affidavit, available in the enrollment portal as
well as on myHR. Important: If you were hired or had a mid-year
qualifying event after Sept. 2, 2014, you’ll need to complete two
separate enrollments (2014 and 2015).
Step 11 Review your printed Confirmation Form for accuracy. Make
sure that any dependents you want covered are listed on the form.
If you need to make any adjustments to your elections, please do so
prior to the end of the annual benefits enrollment period.
Enrollment instructions
• For technical assistance, including browser compatibility
issues, call IT Customer Service at Ext. 44357 or 800-767-1000,
Ext. 44357.
• For questions about your benefits, contact MassMutual Benefits
at 866-662-6448 or internally at Ext. 46169.
• Use only the back button within the enrollment application.
Don’t use your browser’s back button.
• If enrolling from home, log on to
https://mmfgonlineep6.massmutual.com/irj/portal/beneenroll (use
your MM number and the same password you use to log on to your work
computer).
• For password resets, use the PRESTO – The Password Reset
Tool.
Enrollment instructionsEnroll online for your 2015 benefits by
11:59 p.m., ET on Nov. 18, 2014. Elections are effective Jan. 1,
2015.
https://mmfgonlineep6.massmutual.com/irj/portal/beneenrollmailto:BenefitQuestions%40MassMutual.com?subject=https://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttps://mmfgonlineep6.massmutual.com/irj/portal/beneenrollhttps://mmfgonlineep6.massmutual.com/irj/portal/beneenrollhttps://presto.massmutual.com/ResetPWhttps://presto.massmutual.com/ResetPW
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AskALEX!
ALEX is a smart, funny benefits expert who explains your benefit
options and helps you choose what’s best for you.
Visit at www.alexformassmutual.com/2015/employees during annual
benefits enrollment, Nov. 4 – 18!
ALEX® logo and characters used with permission.
http://www.alexformassmutual.com/2015/employees
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© 2014 Massachusetts Mutual Life Insurance Company, Springfield,
MA 01111-0001. All rights reserved. www.massmutual.com. MassMutual
Financial Group is a marketing name for Massachusetts Mutual Life
Insurance Company (MassMutual) and its affiliated companies and
sales representatives.
BM1017 1114