When you are first hired, you have 60 days to enroll in Midtown's benefit plan. After this initial enrollment period, you are permitted to change your benefits only when your situation changes with a qualifying life event or during Midtown's annual open enrollment period (November 1 to November 30). Your elections will go into effect on the first of the month after when you made your elections.

If you meet a qualifying event or want to make a change during the open enrollment period (see explanations below), go to the 'Update Healthcare Benefits' under the 'Employee Resources' tab.

The rest of this page explains details about making changes to employee healthcare elections.  If you are looking for more basic information regarding our plans and coverage, please see the New Employee tab.

ANNUAL OPEN ENROLLMENT PERIOD

Open enrollment for all insurance packages is from November 1 to November 30 each year. All applications are due by November 30. The effective date for the coverage will be January 1.

Employee healthcare plan contributions will be deducted from your paycheck during the prior months pay period.  For example: Contributions for April will be deducted during the 2 pay periods in March.

QUALIFYING EVENTS

If your personal situation changes during the year, changes to your benefits may occur if they are a qualifying event.

Examples of Qualifying Events

• You get married.

• You have a birth or adoption of a child.

• You experience a death of a spouse or a child.

• Your spouse gains employment with benefits.

• Your spouse's employment terminates.

• You experience any significant change in your family's health care plan coverage, such as a change in your spouse's health care plan or another plan under which you become covered.

• You or your spouse transition from full-time to part-time employment.

• You or your spouse transition from part-time to full-time employment.

• You or your spouse go on an unpaid leave of absence from work.

• You or your spouse go on and/or return to work from an unpaid leave of absence.

Timeframe:

When you have a qualifying event and want to make a benefits change, you must complete application within 31 days of the qualifying event.

When Your Change Takes Effect:

Election changes for all qualifying changes, except for those as a result of the birth or adoption of child, are effective on the first of the month coincident with or next following the date of the qualifying event. In the case of birth or adoption, the effective date is retroactive to the actual date of the qualifying event.

Insurance premiums will be deducted from your paycheck during the prior months pay period.  For example: Insurance premiums for April will be deducted during the 2 pay periods in March.

In the cases in which the qualifying event date was not known in advance, your insurance premium will be pro-rated during the first month.  For example: If you have a birth of child on June 16th, your June 30th paycheck will have an insurance premium deduction for (a) half of the month of June - 15/30 days plus the (b) full months premium for July.  After this, each month your paycheck insurance premium will be a consistent amount and be for the succeeding month (i.e. July paycheck deductions are for August premiums).  

MIDTOWN HEALTHCARE PLAN

COMPREHENSIVE GROUP HEALTH COVERAGE

We have three integrated funding components of our healthcare plan. A summarization of each of them is below and is followed by a little more detail afterwards. A Midtown Health Plan Summary & FAQ document as well as detailed documents for our healthcare plan are also attached below to provide further guidance. The funds are as follows:

• 1. Christian Healthcare Ministries (CHM)

     1. This is our primary payment source.

     2. This is to be used for eligible medical expenses for medical incidents over $500.

  2. Midtown-funded Health Reimbursement Arrangement (HRA)

• • 1. This will be our secondary payment source.

    2. This is for medical expenses not shareable through CHM (i.e. under $500).

• 3. Midtown-funded Compliance Supplement

• • 1. This will be our third payment source.

    2. This is for medical expenses not shared by CHM, once you have exhausted your annual HRA and paid your employee max out of pocket amount which are as follows:

       1. Employee Only: $2,400

       2. Employee + Family: $4,800

    3. In all circumstances, CHM should still be used for eligible medical expenses over $500.

These funding sources apply in the order listed. Each funding source have terms and conditions which apply. All reimbursement requests should be submitted on the 'HRA/CHM Reimbursement Request' form under the 'Employee Resources' tab. Below is a review and summarization of how each funding source will work. 

PRIMARY FUND: CHRISTIAN HEALTHCARE MINISTRIES (CHM)

Christian Healthcare Ministries (CHM) is a health care cost-sharing ministry. For employees covered on the Midtown Healthcare Plan, CHM shares 100 percent of all eligible medical expenses over $500 total cost to an unlimited amount. The $500 total cost is per related medical incident in a given year.

Example: If you go to the doctor twice for the same issue and are prescribed medication for the issue, the $500 total cost would be met if your bills for your doctor visits and prescriptions combined exceed $500 before any discounts.

It is considered a new medical incident if you go 90 days with no further testing or treatment for the same need. 

CHM’s processing time to share eligible medical expenses takes up to 90 to 120 days from when itemized medical bills and completed paperwork are received. The sooner you submit your medical bills, the sooner CHM can begin to work towards sharing your bills. You will be paid directly by CHM in order to pay your medical providers.

CHM does not share for medical bills under $500. Other common items CHM does not share are routine check-ups, maintenance medications or psychological treatment/counseling. This is where the second payment fund can be used.

SECONDARY FUND: HEALTH REIMBURSEMENT ARRANGEMENT (HRA)

If a cost is not shareable through CHM, Midtown will fund a Health Reimbursement Arrangement (HRA) to reimburse you for these medical costs. In general, the HRA is designed to help you cover expenses for routine medical incidents under the $500 CHM threshold. Monthly coverage levels are as follows:

Your monthly HRA allowances will be available in full for the year. For example, an employee covered for a family with 3+ children would be eligible for $6,000 in HRA reimbursable expenses for the year. This $6,000 is available in full to the employee effective January 1 of each year. This amount resets every year at the end of the year. Reimbursements will happen once a month based on all submissions for HRA spending.

TERTIARY FUND: MIDTOWN-FUNDED COMPLIANCE SUPPLEMENT FAQs

After your HRA has been consumed, you will have a third fund available to you for medical expenses not shareable through CHM. You will need to meet the following out-of-pocket amounts prior to getting reimbursed through the Midtown Compliance Health Fund:

• 1. Employee/Dependent Only: $2,400

  2. Employee + Family: $4,800

IF out-of-pocket amounts are reached; coverage for eligible expenses under $500 are covered at 100% for the remainder of the plan year by Midtown through the Health Fund. Midtown covers anything beyond your max out of pocket amount assuming your HRA has been maxed out and it is not shareable through CHM. 

You are responsible for keeping track of your out-of-pocket expenses. Should you reach your out-of-pocket maximum, you will need to substantiate this with your paid out-of-pocket medical bills.

MONTHLY COSTS

Monthly employee contributions to participate in Midtown’s healthcare plan based on coverage levels are as follows:

SUPPLEMENTAL COVERAGES

DENTAL INSURANCE

See Metlife rates pdf to view dental insurance rates through 12/31/2020. Employee pays 100% of dental insurance costs.

In order to make a change for dental insurance go to the 'Update Healthcare Benefits' under the 'Employee Resources' tab.

Also, attached is a Metlife Summary explaining the dental benefit package we have.

VISION INSURANCE

See United Healthcare rates pdf to view vision insurance rates through 12/31/2020. Employee pays 100% of vision insurance costs.

In order to make a change for vision insurance go to the 'Update Healthcare Benefits' under the 'Employee Resources' tab.

Also, attached is a United Healthcare Summary explaining the dental benefit package we have.