2022 Benefits Decision Guide - Open Enrollment: October 11 22 - virtual doctor visits
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2022
Benefits
Decision Guide
Open Enrollment: Benefits Effective:
October 11 – 22 January 1 – December 31, 2022
Welcome to Your 2022 Benefits Enrollment!
Take Action to Elect or Change Your Benefits October 11 – 22
2022 Benefit Elections:
You can elect or change your benefits for the
Here’s How it Works
2022 plan year during the Open Enrollment
period October 11 – 22. Visit Mercer Marketplace 365+ at
Changes after Open Enrollment:
You may be able to make changes to some of
for personalized support to guide you
your benefits in 2022 if you experience a
through the enrollment process.
Qualifying Life Event (QLE), such as getting
married or having a baby. You must make the
change within 31 days (30 days for birth or Answer a few short questions to receive expert
adoption) of the event. guidance and build a personalized benefits package.
If you are a New Hire during or after Open
Enrollment and your benefits are effective in Select the benefits package built for you, customize
2021, or you experience a QLE or status change, it further to best meet your needs and budget, or
you will need to make updates to your 2021 build your own package.
and 2022 benefits by following the links for
each year on your enrollment website.
Pet Insurance can be elected at any point in the
year without a QLE.
What Happens If I Don’t Enroll?
Be sure to log in and confirm you have the benefits you need for 2022.
If you don’t enroll or make updates by October 22, you will be automatically enrolled in your
current coverages, with the exception of spending and savings account elections.
Health Savings Account, Flexible, Combination, and Dependent Care Spending Account elections
do not roll over from year to year. You must make a new election each year if you
want to participate.
You must enroll in the Health Savings Account for 2022 during OE in order to receive the HSA
employer contribution.
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the
next 12 months, a Federal law gives you more choices about your prescription drug
coverage. Please see the creditable prescription drug coverage and Medicare notice in the
legal notices at the back of this booklet for more details.
www.mercermarketplace365plus.com/flourishbenefits 2 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.What’s Inside
Your Enrollment
How to Enroll....................................................... 4 Questions
What’s New for 2022 ......................................... 5
Health Benefits Mercer Marketplace 365+ is ready
Medical and Prescription Drug Coverage ........... 6 to help you understand your options and
Critical Illness Insurance ...................................... 12 make the right choices for
Accident Insurance .............................................. 13 your needs and budget.
Hospital Indemnity Insurance ............................. 14
Dental Insurance ................................................. 16
Vision Insurance .................................................. 17
Spending and Savings Accounts .......................... 18
www.mercermarketplace365plus.com/
Financial Protection flourishbenefits
Life and AD&D Insurance .................................... 21
Disability Insurance ............................................. 22
Additional Benefits
Legal Plan ............................................................ 23
Click to Chat
Identity Theft Protection ..................................... 23
Pet Insurance....................................................... 24 A chat bubble is located along the right
Employee Assistance Program ............................ 24 side of each page on the Mercer
Core Advocacy ..................................................... 25 Marketplace 365+ website.
Virtual assistant is available 24/7.
Important Information
Benefit Contacts .................................................. 26 You can also have a secure chat with a
Outside Benefits .................................................. 27 live benefits counselor
Legal Notices ....................................................... 28 Monday – Friday, 4 am – 6 pm PT
Phone
1-855-274-3937
Benefit counselors available via phone
Monday – Friday: 4 am – 6 pm PT
Saturday: 7 am – 11 am PT
www.mercermarketplace365plus.com/flourishbenefits 3 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.How to Enroll
Cost of Coverage
As in past years, Flourish Benefits will pay a portion of your coverage costs. You will be responsible for any
remaining costs for the benefits you select, which will be shown as you shop on Mercer Marketplace 365+.
Flourish Benefits is committed to offering you a competitive benefits program that offers the flexibility to
select coverage that best fits your needs and your budget.
To start your enrollment, visit
www.mercermarketplace365plus.com/ Need Help?
flourishbenefits
• The first time you visit the Mercer Marketplace 365+
website, select “Get Started” and follow the If you don’t have access to a computer
instructions provided to register. or need assistance, you can enroll with a
benefits counselor by calling
• If you have previously enrolled in benefits on the 1-855-274-3937
Mercer Marketplace 365+ website, use the username
and password that you created in the past to log in. Help is available via phone:
Click on “Forgot Username or Password” if needed. Monday – Friday: 4 am – 6 pm PT
Saturday: 7 am – 11 am PT
Multi-factor authentication (MFA): The security of
your information is critical, which is why we use
multi-factor authentication.
• MFA combines your username and password with a temporary numeric code sent to you as an additional
security factor to confirm your identity and keep your information safe.
• As part of the registration process, you’ll be asked to provide the last four digits of your Social Security
Number (SSN), your last name, date of birth and zip code.
• Once the above information is authenticated, you will be presented with the email and/or phone number
provided by Flourish Benefits. You must select one to receive a verification code to complete the
registration process.
• If an email or phone number has not been provided by Flourish Benefits, you will be asked to add an email
address at this time. Should you choose, you can input an alternate email or phone number to be used in
future verification.
• You will be required to go through the MFA verification code process every time you log in.
www.mercermarketplace365plus.com/flourishbenefits 4 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.What’s New for 2022
Below are the coverage offerings that are updated or new for 2022. More details about the plans can be found
in this guide and at www.mercermarketplace365plus.com/flourishbenefits.
Medical Dental Vision
Plans Plans Plan
Kaiser HMO Prescription Benefits • You will be offered the same • You will be offered the same
• The benefit for Tier 4 or dental plans as last year vision plan as last year
Specialty medications is now
30% up to $250. See Page 11
for more information.
Other Changes
• Spending Accounts: The Dependent Care Flexible Spending Account maximum will
return to $5,000.
For additional plan details, visit
www.mercermarketplace365plus.com/flourishbenefits
www.mercermarketplace365plus.com/flourishbenefits 5 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Medical and
Prescription Drug Coverage
Medical coverage offers valuable benefits to help you stay healthy and pay for care if you or your covered
family members become sick or injured.
Which Medical Plan is Right for You?
When you go online, you will have two options to navigate and select your benefits:
• Through the Expert Guidance tool, you can answer a few questions about your medical insurance usage,
payment preference and ability to afford an unexpected medical expense. Then, Mercer Marketplace 365+
will show you one or more medical plans that best match your situation. While the decisions are yours,
these matches will help you make an appropriate choice.
• Choose your own: You will have an experience similar to shopping online, navigating through different
categories and adding benefits to your shopping cart. Just click "check out" when you are finished!
Before you choose your benefits, think about:
• How much healthcare and what type of care did you need this year?
• Do you expect your needs to be similar next year?
• Do you prefer to pay less from your paycheck or less out of your pocket when you need care?
Have You Considered a High Deductible Health Plan?
High deductible health plans have lower premiums and may result in lower annual medical costs. These plans
offer several advantages to reward you for taking an active role in your healthcare spending:
• Lower paycheck costs – allowing you to keep control over more of your money
• Tax-advantaged savings account – enrolling in a Health Savings Account (HSA) helps you pay your
deductible and out-of-pocket costs
• Flourish Benefits will contribute to your HSA – helping you with your out-of-pocket costs
• Comparable benefits – these plans use the same networks that other plans offer, and in-network
preventive care is still 100% covered
Need More Coverage?
Are you interested in a higher-deductible plan with a lower premium? Critical
You may want additional coverage that pays benefits directly to you to
help cover deductibles and out-of-pocket expenses. Illness
Consider combining your medical coverage with Supplemental Medical
Insurance. These plans are a great complement to your medical plan Accident
choice and can help reduce the financial risk associated with illness and
injury.
Depending on your situation, you may be able to save money by Hospital
purchasing a lower-cost medical plan and adding one or more
supplemental plans to achieve effective protection at a lower plan cost.
Indemnity
Refer to the Supplemental Medical section for more information.
www.mercermarketplace365plus.com/flourishbenefits 6 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Medical and
Prescription Drug Coverage
Key Words to Know:
Coinsurance: Percentage of the charge that your plan will pay, typically after you have met the deductible
Copay: An amount you pay for a covered service each time you use that service, which usually does not apply
toward the deductible
Deductible: The amount you pay before the plan begins to pay
Out-of-Pocket Costs: Expenses you pay, such as deductibles, copays and the remaining amounts after plan
coinsurance is paid
Out-of-Pocket Maximum: The maximum amount you pay for covered services in a year (you may need to pay
additional amounts if coverage is received from an out-of-network provider)
Using In-Network Providers
You’ll save money when receiving care from an in-network provider. To access a list of in-network providers,
click on the link provided on the Mercer Marketplace 365+ enrollment site. Using an out-of-network provider
could result in a higher out-of-pocket cost.
Prescription Drug Coverage
Your prescription drug coverage depends on the type of medication you choose. Medications are grouped into
tiers, which determine your portion of the drug cost.
TIER YOU PAY WHAT’S COVERED
Most Generic Prescription Drugs
1 Lowest Cost Sharing Generic drugs that are equivalent to a brand product in dosage form, strength,
quality and intended use.
Preferred Brand Name Drugs
2 Second-Lowest Cost Sharing Drugs sold under specific trade names that are favorably priced by the
pharmacy plan.
Non-Preferred Brand Name Drugs
3 Third-Lowest Cost Sharing Drugs sold under specific trade names that have a more cost-effective
alternative on Tier 1 or Tier 2.
Specialty Drugs
Specialty medications treat rare or complex conditions and are typically higher
4 Highest Cost Sharing cost medications. Most will require pre-authorization before your plan will help
pay for them, and some may require you to fill the prescription at a specialty
pharmacy.
www.mercermarketplace365plus.com/flourishbenefits 7 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Medical and
Prescription Drug Coverage
Helpful Information about Deductibles and Out-Of-Pocket Maximums
When electing coverage for any family members in addition to yourself, deductibles and out-of-pocket
maximums are applied differently for different plans.
PLAN DEDUCTIBLE OUT-OF-POCKET MAXIMUM
The entire Family Out-of-Pocket Maximum must
EPO Plan $0 Deductible
Not applicable be met before the plan pays in full for any family
Kaiser HMO Plan California
member
$1,500 Deductible Plan Once one family member meets the Individual Once one family member meets the Individual
Deductible, benefits begin to be paid for that Out-of-Pocket Maximum, the plan pays covered
$2,500 Deductible Plan
individual benefits in full for that individual
For additional plan details, visit
www.mercermarketplace365plus.com/flourishbenefits
www.mercermarketplace365plus.com/flourishbenefits 8 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Medical and
Prescription Drug Coverage
Review Your Medical Plan Options
Blue Shield of California
(Blue Shield of California PPO Network)
Prescription Drug: MedImpact
Medical and Prescription Drug Plan Summary
The following benefits are included in your plan options. Unless otherwise noted, benefits are per insured person and after deductible.
$1,500 DEDUCTIBLE PLAN $2,500 DEDUCTIBLE PLAN EPO PLAN
WITH HSA WITH HSA $0 DEDUCTIBLE
HEALTH SAVINGS ACCOUNT
HSA Eligible Yes Yes No
HSA Employer $400/year Employee Only $625/year Employee Only N/A
Funding $800/year Employee + family $1,250/year Employee + family
OUT-OF- OUT-OF- OUT-OF-
IN-NETWORK IN-NETWORK IN-NETWORK
NETWORK NETWORK NETWORK
ANNUAL DEDUCTIBLE
Individual $1,500 $2,000 $2,500 $3,000 $0 Not covered
Family $3,000 $4,000 $5,000 $6,000 $0 Not covered
OUT-OF-POCKET MAXIMUM
Individual $3,000 $4,000 $4,000 $5,000 $1,500 Not covered
Family $6,000 $8,000 $8,000 $10,000 $3,000 Not covered
MEDICAL BENEFIT COVERAGE
Plan Coinsurance 90% 70% 80% 60% 80% Not covered
Preventive Care 100%* 70% 100%* 60% 100% Not covered
Primary Care Visit 90% 70% 80% 60% $20 copay Not covered
Specialist Visit 90% 70% 80% 60% $40 copay Not covered
Inpatient Hospital 90% 70% 80% 60% 80% Not covered
Outpatient Hospital 90% 70% 80% 60% 80% Not covered
Urgent Care 90% 90% 80% 80% $50 copay Not covered
Emergency Room 90% 90% 80% 80% $100 copay $100 copay
www.mercermarketplace365plus.com/flourishbenefits 9 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Medical and
Prescription Drug Coverage
$1,500 DEDUCTIBLE PLAN $2,500 DEDUCTIBLE PLAN EPO PLAN
WITH HSA WITH HSA $0 DEDUCTIBLE
OUT-OF- OUT-OF- OUT-OF-
IN-NETWORK IN-NETWORK IN-NETWORK
NETWORK NETWORK NETWORK
RETAIL PRESCRIPTIONS
Tier 1 30 day: $15 Not covered 30 day: $15 Not covered 30 day: $15 Not covered
copay copay copay
90 day: $38 90 day: $38 90 day: $38
copay copay copay
Walgreens 30 Walgreens 30 Walgreens 30
day: $30 copay day: $30 copay day: $30 copay
Walgreens 90 Walgreens 90 Walgreens 90
day: $53 copay day: $53 copay day: $53 copay
Tier 2 30 day: $30 Not covered 30 day: $30 Not covered 30 day: $25 Not covered
copay copay copay
90 day: $75 90 day: $75 90 day: $62
copay copay copay
Walgreens 30 Walgreens 30 Walgreens 30
day: $45 copay day: $45 copay day: $40 copay
Walgreens 90 Walgreens 90 Walgreens 90
day: $90 copay day: $90 copay day: $77 copay
Tier 3 30 day: $50 Not covered 30 day: $50 Not covered 30 day: $40 Not covered
copay copay copay
90 day: $125 90 day: $125 90 day: $100
copay copay copay
Walgreens 30 Walgreens 30 Walgreens 30
day: $65 copay day: $65 copay day: $55 copay
Walgreens 90 Walgreens 90 Walgreens 90
day: $140 day: $140 day: $115
copay copay copay
Tier 4 30 day: 25% Not covered 30 day: 25% Not covered 30 day: 25% Not covered
coinsurance to coinsurance to coinsurance to
$100 max $100 max $100 max
MAIL-ORDER PRESCRIPTIONS (90-DAY SUPPLY)
Tier 1 $38 copay Not covered $38 copay Not covered $38 copay Not covered
Tier 2 $75 copay Not covered $75 copay Not covered $62 copay Not covered
Tier 3 $125 copay Not covered $125 copay Not covered $100 copay Not covered
Tier 4 30 day: 25% Not covered 30 day: 25% Not covered 30 day: 25% Not covered
Coinsurance to Coinsurance to Coinsurance to
$100 max $100 max $100 max
*Deductible does not apply
www.mercermarketplace365plus.com/flourishbenefits 10 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Medical and
Prescription Drug Coverage
Review Your Medical Plan Options
Kaiser Permanente
(Northern California Network, Southern California Network) – Available To California Residents Only
Medical and Prescription Drug Plan Summary
The following benefits are included in your plan options. Unless otherwise noted, benefits are per insured person and after deductible.
HMO PLAN
IN-NETWORK OUT-OF-NETWORK
ANNUAL DEDUCTIBLE
Individual $0 Not covered
Family $0 Not covered
OUT-OF-POCKET MAXIMUM
Individual $1,500 Not covered
Family $3,000 Not covered
MEDICAL BENEFIT COVERAGE
Plan Coinsurance 80% Not covered
Preventive Care 100% Not covered
Primary Care Visit $20 copay Not covered
Specialist Visit $20 copay Not covered
Inpatient Hospital $500 copay per admission Not covered
Outpatient Hospital $100 copay per procedure Not covered
Urgent Care $20 copay $20 copay
Emergency Room $100 copay $100 copay
RETAIL PRESCRIPTIONS (30-DAY SUPPLY)
Tier 1 $15 copay Not covered
Tier 2 $35 copay Not covered
Tier 3 $35 copay Not covered
Tier 4 30% up to $250 Not covered
MAIL-ORDER PRESCRIPTIONS (100-DAY SUPPLY)
Tier 1 $30 copay Not covered
Tier 2 $70 copay Not covered
Tier 3 $70 copay Not covered
Tier 4 30% up to $250 Not covered
www.mercermarketplace365plus.com/flourishbenefits 11 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Supplemental Medical:
Critical Illness Insurance
Critical Illness Insurance
Unum Benefit Example
Critical illnesses, such as heart attack, stroke, cancer or organ
failure, are usually unexpected and may not be preventable.
Recovering from a serious illness often brings significant
expenses other than medical costs, which can amount to
thousands of dollars. Critical Illness coverage
is selected
Critical Illness Insurance can help with the treatment costs of
covered critical illnesses and enhance your medical plan,
giving you the flexibility to pay bills related to treatment or to
help with everyday living expenses.
Highlights You experience
symptoms of a critical
illness
• Coverage is guaranteed issue, which means you can qualify
for coverage without having to answer any health
questions
• Pays upon diagnosis of a covered condition
• Pays a lump-sum cash benefit directly to you to help cover
out-of-pocket expenses associated with a covered critical You are treated by a
physician
illness
• Pays in addition to existing medical insurance benefits
• Examples of covered conditions include: cancer, heart
attack, stroke, major organ transplant, end stage renal
failure*
• Some programs offer additional wellness incentives* You are diagnosed with a
covered critical illness
*Benefits and covered conditions vary by state. Review plan documents to verify
covered benefits.
For additional plan details, visit
www.mercermarketplace365plus.com/ Submit a claim and
flourishbenefits receive a lump-sum
benefit from your plan
to help cover your
expenses
www.mercermarketplace365plus.com/flourishbenefits 12 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Supplemental Medical:
Accident Insurance
Accident Insurance
Unum Benefit Example
An accident can require a variety of treatments, testing,
therapies and other care to assist in recovery. Even the best
medical plans may leave you with extra costs to pay out of
your own pocket. Everyday expenses like your mortgage, car
payment or childcare may be harder to cover due to lost or Accident Insurance
reduced income. coverage is selected
Accident Insurance can help you bounce back by providing
cash benefits if you experience a covered accident. These
benefits help with expenses and protect your savings, letting
you focus more on recovering.
You are injured
in a covered
Highlights accident
• Receive cash benefits to help cover out-of-pocket
expenses associated with a covered accident
• Pays in addition to existing medical insurance
• Pays benefits for each covered occurrence
• Examples of covered services include: emergency room,
You visit a physician
hospitalization, doctor’s visits, physical therapy*
• Additional benefits available for certain injuries, such as
dislocations, fractures, burns and lacerations*
*Not a guarantee of coverage. Benefits vary by state. Review plan documents to
verify covered benefits.
You are treated for
your injuries
For additional plan details, visit
www.mercermarketplace365plus.com/
flourishbenefits Submit a claim and
receive cash benefits
from your plan to help
cover your expenses
www.mercermarketplace365plus.com/flourishbenefits 13 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Supplemental Medical:
Hospital Indemnity Insurance
Hospital Indemnity Insurance Benefit Example
The following benefit is not administered by
Mercer Marketplace 365+, but is offered to you by
Flourish Benefits. If you have questions regarding this benefit
please refer to the contact information below or on page 27.
Hospital Indemnity
coverage is selected
Voya
Hospital stays are often unexpected, and just a few days can
strain even the healthiest of budgets. Hospitalization can
cause serious financial setbacks due to out-of-pocket medical
costs or loss of income. When you’re recovering, the last thing You experience illness
symptoms and visit a
you need to worry about is how much it will cost to get better. physician
Hospital Indemnity Insurance offers financial protection when
you’re hospitalized due to a covered illness or injury. Benefits
can help with the hospital bill or everyday expenses.
Highlights You are admitted to the
hospital
• Collect a lump-sum benefit each day you’re in the hospital
• No coinsurance, copays, waiting periods or deductibles
• Benefits are paid directly to you, in addition to other
insurance you may have
• Benefits are provided for hospital admission and daily
You spend several days
hospital confinement in the hospital before
• If you enroll in one of the HSA Medical Plans, Flourish release
Benefits will cover the cost of the Basic Hospital
Indemnity Plan at no cost to you
• Enroll by contacting: hrbenefits@medimpact.com
Submit a claim and
receive benefits for
each day you are in
the hospital
www.mercermarketplace365plus.com/flourishbenefits 14 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Supplemental Medical:
Hospital Indemnity Insurance
Choose from two benefit coverage options:
• Supplemental – includes $1,000 hospital admission benefit and $200 daily hospital
confinement benefit
• Basic – includes $500 hospital admission benefit and $100 daily hospital
confinement benefit
If you enroll in the $1,500 or $2,500 Deductible Medical Plans with HSA:
• You will automatically receive Company-paid basic hospital indemnity coverage at the
basic benefit level.
• You may select the supplemental benefit level and pay the difference in cost to “buy up”
to the supplemental coverage.
For additional plan details, visit
https://presents.voya.com/EBRC/MedImpact
www.mercermarketplace365plus.com/flourishbenefits 15 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Dental Insurance
Research shows there may be a connection between poor dental health and serious health conditions. Regular
dental check-ups and good oral hygiene are an essential part of your general health and well-being.
Key Words to Know:
The service examples below are not guarantees of coverage; refer to Plan Documents to confirm covered services.
Annual Maximum Benefit: Maximum total amount the plan will pay during the plan year
Basic Services: Services such as basic restorations, some oral surgery, endodontics and periodontics
Deductible: The amount you pay before the plan begins to pay
Major Services: Services such as crowns, dentures, implants and some oral surgery
Orthodontia: Straightening or moving misaligned teeth and/or jaws with braces and/or surgery
Preventive Services: Services designed to prevent or diagnose dental conditions, including oral evaluations,
routine cleanings, X-rays, fluoride treatments and sealants
Review Your Dental Plan Options
Delta Dental
(DPPO – PPO Network) (DHMO – DeltaCare USA Network)
Dental Plan Summary
The following benefits are included in your plan options. Unless otherwise noted, benefits are per insured person and after deductible.
DENTAL PPO PREMIER WITH ORTHODONTIA DENTAL HMO
ANNUAL DEDUCTIBLE
Individual $50 $0
Family $150 $0
BENEFIT MAXIMUM
Annual Maximum $2,000 Unlimited
DENTAL BENEFIT COVERAGE
Preventive Services Plan pays 100%* Plan pays 100% / Copays vary by service
Basic Services Plan pays 90% Copays vary by service
Major Services Plan pays 60% Copays vary by service
ORTHODONTIA
Benefit Coverage Plan pays 50% Copays vary by service
Lifetime Maximum $1,500 N/A
Eligibility Eligible children to age 19 and adults Eligible children to age 19 and adults
*Deductible does not apply
In the DPPO, In-Network and Out-of-Network benefit provisions are the same, but may be applied differently for Out-of-
Network services. Please refer to Plan Documents for additional details.
The DHMO is available in AZ, CA, CO, MA, MI, NJ, OR, PA and TX.
www.mercermarketplace365plus.com/flourishbenefits 16 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Vision Insurance
Having an annual eye exam is one of the best ways to make sure you’re keeping your eyes healthy. Eye exams
can help prevent and treat easily correctable vision problems, which can cause permanent vision impairment.
Key Words to Know:
Copay: An amount you pay for a covered service each time you use that service
Retail Allowance: Maximum allowance paid toward the cost of vision materials; you are required to pay any
amounts in excess of the retail allowance
Review Your Vision Plan Options
VSP
(VSP Signature Network)
Vision Plan Summary
The following in-network benefits are included in your plan options. Unless otherwise noted, benefits are per insured person. Please refer to plan
documents for out-of-network benefits.
STANDARD
COPAY FREQUENCY
Exam $10 1 per 12 months
Lenses $25 1 per 12 months
Contact Lens Fitting Not to exceed $60 1 per 12 months
RETAIL ALLOWANCE FREQUENCY
Frames Up to $120** 1 per 24 months
Contact Lenses* Up to $150** 1 per 12 months
*Contact lens coverage provided in lieu of frames and lenses
**20% off any amount over the retail allowance
For additional plan details, visit
www.mercermarketplace365plus.com/flourishbenefits
www.mercermarketplace365plus.com/flourishbenefits 17 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Spending and Savings Accounts
You can save money on your healthcare and dependent care costs through the use of tax-advantaged
accounts that allow you to use before-tax dollars to pay for eligible expenses. For additional details about the
following accounts, visit www.mercermarketplace365plus.com/flourishbenefits.
Access Your Accounts Anywhere
The “Mercer Marketplace Accounts” mobile app is available for Healthcare Flexible Spending Accounts (FSA),
Dependent Care Flexible Spending Accounts and Health Savings Accounts. Use it to view account balances,
upload receipts, review plan details, see your account activity and contact customer service.
The mobile app is available to download from the App Store or Google Play. Once downloaded,
you will log in to the mobile app with the spending and savings account username and password
you created when you opened your reimbursement account. These login credentials may differ
from your Mercer Marketplace 365+ enrollment account.
What Are Eligible Healthcare Expenses?
For a complete list of eligible expenses, visit www.irs.gov and see Publication 502. Some examples may include:
• Office visits • Speech/occupational/physical therapy
• Prescription drugs • Dental and vision care
• Hospital stays • Lab work
Reminder: Keep documentation to support your use of the money in these accounts for tax purposes.
For additional plan details, visit
www.mercermarketplace365plus.com/flourishbenefits
www.mercermarketplace365plus.com/flourishbenefits 18 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Spending and Savings Accounts
Health Savings Account (HSA)
With the $1,500 Deductible and $2,500 Deductible Plans, you’re eligible to contribute money to a Health
Savings Account. HSAs are tax-advantaged savings accounts you can use to help pay for eligible healthcare
expenses as your contributions are accrued.
Key Features:
• Receive a contribution from Flourish Benefits just for opening an HSA account, even if you aren’t planning to
contribute (see HSA Contributions section below for details). Note: Your contributions and Flourish Benefits
contributions cannot exceed the maximum allowable amount defined by the IRS.
• Works like a bank account. You decide how much to contribute to your HSA (up to the IRS maximum) and can
change that amount at any time. Access account funds to pay for eligible healthcare expenses by using your debit
card when you receive care, or submit a claim for reimbursement for payments you’ve made (up to the available
balance in your account).
• It’s tax-advantaged. You don’t pay taxes on contributions made from your paycheck, and you can earn tax-free
interest on your HSA balance.
• It’s your money. Unused funds can be carried over each year. Once your account reaches a certain balance you
will be able to choose how your money is invested. You can even take the account with you if you leave Flourish
Benefits, or save it to use during retirement.
• Can be paired with a Combination Flexible Spending Account for additional tax savings. Eligible dental and vision
expenses can be paid for with Combination FSA funds from the first day of the plan year. Once you have incurred
$1,400/individual or $2,800/family in out-of-pocket medical expenses (or the indexed amounts announced by the
IRS for the plan year, if different) and submit the required form, you can also use your account to pay for eligible
medical expenses for the rest of the year.
Please note, you are not eligible to contribute to an HSA if you:
• Are enrolled in Medicare or TRICARE
• Are covered by any health insurance other than a qualified high deductible health plan
• Can be claimed as a dependent on another person’s tax return
• Have access to reimbursement under a Healthcare Flexible Spending Account established by another
employer for you or another family member (including grace period from a prior plan year)
HSA Contributions
To help you get your HSA started, Flourish Benefits will contribute:
For the $1,500 Deductible Plan: For the $2,500 Deductible Plan:
• Individual coverage: $400/year • Individual coverage: $625/year
• Family coverage: $800/year • Family coverage: $1,250/year
For 2022, you can make pre-tax contributions from your paycheck up to the following amounts, or to the
maximum indexed amount announced by the IRS for the plan year, if different:
• Individual coverage: $3,650* • Family coverage: $7,300*
• If you’re age 55 or older, you can contribute an additional $1,000 per year.
*The contribution amounts listed above include both your contributions and any contributions you receive from Flourish Benefits.
www.mercermarketplace365plus.com/flourishbenefits 19 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Spending and Savings Accounts
Flexible Spending Accounts (FSA)
Flexible Spending Accounts provide a great way to save money on your health and dependent care expenses.
HEALTH CARE FLEXIBLE COMBINATION FLEXIBLE SPENDING DEPENDENT CARE FLEXIBLE
SPENDING ACCOUNT ACCOUNT SPENDING ACCOUNT
Do You Have a You are not eligible to have a You or Flourish Benefits must You are eligible to have a
Health Savings Health Care FSA if you or Flourish contribute to an HSA to have a Dependent Care FSA whether or
Account (HSA)? Benefits contribute to an HSA. Combination FSA. not you contribute to an HSA.
Eligible Eligible medical, dental and vision Eligible dental and vision expenses, Expenses for child/elder care for
Expenses expenses. and medical after you have incurred eligible dependents that allow you
$1,400/individual or $2,800/family in and/or your spouse or domestic
out-of-pocket medical expenses (or partner to work (medical, dental
the indexed amounts announced by and vision expenses are not eligible
the IRS for the plan year, if different.) for reimbursement with this
account).
How It’s • You can make paycheck • You can make paycheck • You can make paycheck
Funded contributions up to $2,750 per contributions up to $2,750 per contributions up to $5,000 per
year, or to the maximum year, or to the maximum indexed year per household (or to the
indexed amount announced by amount announced by the IRS for maximum indexed amount
the IRS for the plan year, if the plan year, if different. announced by the IRS for the plan
different. • Your election is made during your year, if different) to use for
• Your annual election amount is enrollment period. You cannot qualified dependent care or elder
made during your enrollment change it unless you have a care expenses.
period. You cannot change it qualifying life event during the year • Your election is made during your
unless you have a qualifying life (such as getting married or having enrollment period. You cannot
event during the year (such as a baby). change it unless you have a
getting married or having a • Your entire annual contribution is qualifying life event during the
baby). available to you at the beginning of year (such as having a baby or a
• Your entire annual contribution the plan year. change in dependent care
is available to you at the expenses).
beginning of the plan year. • Your funds are only available to
you after they have been
deposited into your account each
pay period.*
Unused Funds You should estimate your expenses carefully before enrolling because unused funds in your account do not carry
over at the end of the plan year and are forfeited.
How to Access You will receive a benefits debit card that you can use to pay for eligible expenses. Or, you can submit claims
for reimbursement of eligible expenses.
NOTE: You’ll receive only one debit card to use for all of your Mercer Marketplace 365+ supported accounts.
*Your contribution could be impacted by other reimbursements and your tax filing status. Consult your tax advisor for more information.
www.mercermarketplace365plus.com/flourishbenefits 20 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Life and Accidental Death &
Dismemberment Insurance
The loss of income that results from an unexpected death can create significant strain for your family at an
already difficult time. Life and Accidental Death and Dismemberment (AD&D) insurance provides important
financial protection for your family.
Key Words to Know:
Accidental Death & Dismemberment Insurance: Pays a benefit upon the accidental death of an insured person;
also provides benefits for certain covered accidental dismemberments
Beneficiary: Person or legal entity designated as the recipient of benefits from life or AD&D insurance
Evidence of Insurability (EOI): Statement of health proving a person’s eligibility for certain amounts of coverage
Guaranteed Issue: An amount of insurance that does not require evidence of insurability
Life Insurance: Pays a benefit upon the death of an insured person
Employer-Paid Term Life and AD&D Insurance
Lincoln Financial
Your employer provides you with a base level of employee term life and AD&D insurance at no cost to you.
Visit www.mercermarketplace365plus.com/flourishbenefits to view your coverage level.
Optional Employee-Paid Term Life and AD&D Insurance
Lincoln Financial
SPOUSE/DOMESTIC PARTNER
EMPLOYEE TERM LIFE EMPLOYEE AD&D CHILD TERM LIFE
TERM LIFE
Elect in $10,000 Elect in $10,000 increments, Elect in $5,000 increments, up Elect in $2,000 increments, up to
increments, up to the up to the lesser of five to $500,000 not to exceed $10,000
lesser of five times your times your salary or 100% of employee coverage
salary or $500,000 $500,000*
**If Family AD&D coverage is elected, dependent benefits are a portion of employee benefits
This coverage is tied to your employment and typically ends if you leave your employer. However, you may be offered the opportunity to retain
coverage on your own with the same insurance carrier.
Evidence of Insurability (EOI): Select A Beneficiary:
Life insurance amounts over guaranteed issue Choose a beneficiary to receive the policy’s benefit
coverage may require approval from the payment in the event of the insured person’s
insurance carrier. After electing coverage, you death. The employee is automatically listed as the
will receive more information. beneficiary for dependent coverage.
www.mercermarketplace365plus.com/flourishbenefits 21 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Disability Insurance
A disability can be one of the biggest financial risks you face. Your work income will end, but your living
expenses will continue. When you are unable to work for a period of time due to a disability, disability
insurance can replace a percentage of your lost income.
Key Words to Know:
Short Term Disability: When you are unable to work for a period of time due to a disabling illness or injury, short
term disability insurance can replace a percentage of your lost income (up to a maximum weekly benefit) for a
period of time as defined by the policy
Long Term Disability: When you are unable to work for an extended period of time due to a disabling illness or
injury, long term disability insurance can replace a percentage of your lost income (up to a maximum monthly
benefit) for a period of time as defined by the policy
Disability Benefits Summary
Lincoln Financial
Employer-Paid Disability
EMPLOYER-PAID SHORT TERM DISABILITY EMPLOYER-PAID LONG TERM DISABILITY
Benefit Provided 60% of salary 60% of salary
Maximum Benefit Amount $600 per week $10,000 per month
Until you are no longer considered disabled or
Maximum Benefit Period See website for coverage details
you reach normal retirement age
Waiting Period Accident 0 days / Sickness 7 days See website for coverage details
If your employer is required under state law to offer you short term disability benefits, your disability benefits
will be coordinated between your employer and the state. Check with your employer if this applies to you.
www.mercermarketplace365plus.com/flourishbenefits 22 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Additional Benefits
As part of the benefits package offered by Flourish Benefits, you have access to a variety of additional
programs that can help save you money and provide important assistance with everyday needs. For detailed
benefits information, log on to www.mercermarketplace365plus.com/flourishbenefits and visit the
Documents page of the site.
Legal Plan
MetLife® Legal
Finding an affordable attorney to represent you when you are buying or selling your home, preparing your will or having
trouble with creditors can be a challenge. Now there’s a simple, convenient and affordable solution. This benefit plan
provides legal representation for you and your family for legal matters including:
• Wills and Estate Planning
• Family Law (Name Change, Adoption)
• Consumer Protection (Auto Repair, Consumer Fraud)
• Juvenile Court Matters (Includes Criminal Matters)
• Debt-Related Matters (Bankruptcy, Tax Audits)
• Elder Law Matters (Consultations, Document Review)
• Home and Real Estate Matters (Purchase or Sale of a Home, Security Deposits)
The plan is easy to use—no copayments, deductibles or waiting periods. No one can predict your future, but we can
help you prepare for legal needs that may lie ahead.
Identity Theft Protection
Allstate Identity Protection
Allstate is an industry-leading identity protection plan that includes proactive identity and credit monitoring, offering
you the most comprehensive solution to fight today’s identity fraud issues. Benefits include:
• Identity and credit monitoring alerts to uncover fraud quickly
• An annual credit report and a score each month, making it easier to monitor your credit
• Social media reputation monitoring to protect against cyberbullying and reputational damage within
social media sites
• A digital wallet storage for securely storing documents and credit cards with a lost wallet replacement service
• Threshold monitoring to view and manage all of your financial transactions from all your accounts in one place
• $1,000,000 Identity Theft Insurance Policy
www.mercermarketplace365plus.com/flourishbenefits 23 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Additional Benefits
Pet Insurance Can be elected year-round!
Nationwide®
You work hard to provide your family with everything they need. So whether your family includes kids with two feet or
kids with four paws, you know what responsibility looks like.
Pets are unpredictable. While it’s hard to anticipate accidents and illnesses, Nationwide® Pet Insurance makes it a little
easier to be prepared for them. From preventive care visits to significant medical incidents, Nationwide® provides
protection for pets when you need it most.
Nationwide® policies cover a multitude of medical problems and conditions related to accidents and illnesses, including
cancer. You are free to use any veterinarian worldwide—even specialists and emergency care providers. Best of all,
Mercer Marketplace 365+ participants are eligible to receive preferred pricing.
You will be provided with the link to enroll in or change your Pet Insurance coverage once you have submitted your
other primary benefits. Note: The Mercer Marketplace 365+ confirmation statement, which is generated once you have
completed your 2022 elections, will not immediately show the Pet Insurance election or the cost of the coverage.
Employee Assistance Program
Managed Health Network (MHN)
Flourish Benefits understands how challenging it can be to balance your work and personal life. Your employee
assistance program can help you find solutions for the everyday challenges of work and home as well as for more
serious issues involving emotional and physical well-being.
This program can assist with:
• Childcare and/or eldercare referrals
• Personal relationship information and counseling
• Health management support and referrals
• Financial planning assistance
• Stress management
Help is Easy to Access:
• Telephone consultation: Speak confidentially with a master’s-level consultant to clarify your need, evaluate
options and create an action plan
• Face-to-face consultations: You and each of your dependents can consult with a local counselor up to eight
times per issue for short-term problem resolution
• Educational materials: Receive information on a variety of issues through a library of CDs and booklets
• Online resources: Access interactive tools, articles and free materials online
www.mercermarketplace365plus.com/flourishbenefits 24 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Additional Benefits
Core Advocacy
Health Advocate
Through this program, you have access to a Personal Health Advocate. Skilled at working with healthcare providers,
insurance plans and other health-related organizations, they can help you resolve complex issues and get the right care
at the right time.
One phone call connects you to a Personal Health Advocate who can help resolve a wide range of clinical, claims,
coverage and billing issues. This includes:
• Finding qualified doctors, hospitals, dentists and other providers nationwide
• Identifying top medical institutions and clinical trials
• Locating leading doctors, hospitals and other providers for second opinions
• Scheduling earliest appointments with hard-to-reach specialists; arranging for specialized treatments and tests
• Clarifying complex conditions; researching available treatment options
• Resolving insurance claims, uncovering billing errors and negotiating payment arrangements
• Finding options for non-covered services; negotiating provider discounts
• Answering questions about test results, treatments and medications recommended or prescribed by the
physician
• Addressing eldercare issues; clarifying Medicare; locating adult day care, assisted living and long-term care;
researching transportation to appointments
• Assisting with special needs; finding caregiver support services, in-home care, rehabilitation resources and
hospice; expediting coverage for special procedures and medical equipment
www.mercermarketplace365plus.com/flourishbenefits 25 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Contact Information
You will find many details about the Flourish Benefits benefit plans on the Mercer Marketplace 365+ website.
However, you can use this table if you need to contact a benefit provider directly. Please note that some
websites and phone numbers may not be accessible until your benefits are effective.
PHONE
BENEFIT ADMINISTRATOR WEBSITE
NUMBER
Mercer Marketplace
Enrollment Support 1-855-274-3937 www.mercermarketplace365plus.com/flourishbenefits
365+ Benefits Center
Medical Blue Shield of California 1-855-599-2657 www.blueshieldca.com
MedImpact Rx
Prescription Pharmacy Help Desk 1-888-265-4980 www.medimpact.com/plan/flourish
24/7 representative
Medical and
Kaiser Permanente 1-800-464-4000 http://my.kp.org/mercermarketplace/
Prescription
Supplemental Medical: www.unum.com/employees/benefits/
Unum 1-800-635-5597
Accident accident.aspx
Supplemental Medical: www.unum.com/employees/benefits/
Unum 1-800-635-5597
Critical Illness criticalillness.aspx
PPO:
Delta Dental of 1-888-335-8227
Dental DHMO: www.deltadentalmercermarketplace.com/
California
1-800-422-4234
Vision VSP 1-800-877-7195 www.vsp.com/
Spending and Savings Mercer Marketplace
1-855-274-3937 www.mercermarketplace365plus.com/flourishbenefits
Accounts 365+
www.mylincolnportal.com
Basic Life/AD&D Lincoln Financial Group 1-888-787-2129
Company Code: MedImpact
Disability & Leave of www.mylincolnportal.com
Lincoln Financial Group 1-800-320-7585
Absence Company Code: MedImpact
Legal MetLife® Legal 1-800-821-6400 www.legalplans.com
Allstate Identity
Identity Theft 1-800-789-2720 www.myaip.com/mercermarketpp
Protection
Pet Insurance Nationwide® 1-855-525-1458 www.petbenefitsportal.com
Employee Assistance www.members.mhn.com
MHN 1-800-535-4985
Program Company code: medimpact
Health Advocacy Health Advocate 1-866-695-8622 www.healthadvocate.com
www.mercermarketplace365plus.com/flourishbenefits 26 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Outside Benefits
The following benefits are not administered by Mercer Marketplace 365+, but are offered to you by your employer. If
you have questions regarding these benefits, please refer to the Contact Information table at the bottom of the page.
Offered Outside the Mercer Marketplace 365+ Platform
BENEFIT ADMINISTRATOR CONTACT INFORMATION WEBSITE
Supplemental
Medical: Voya 1-877-236-7564 https://presents.voya.com/EBRC/MedImpact
Hospital Indemnity
Individual Short https://www.plane.biz/Logons/MedImpactHealthcareS
Unum hrbenefits@medimpact.com
Term Disability ystemsInc-112022AnnualReEnrollment/default.htm
www.mercermarketplace365plus.com/flourishbenefits 27 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.Legal Notices FLOURISH BENEFITS RESERVES THE RIGHT TO CHANGE, AMEND OR TERMINATE ANY BENEFITS PLAN AT ANY TIME FOR ANY REASON. PARTICIPATION IN A BENEFITS PLAN IS NOT A PROMISE OR GUARANTEE OF FUTURE EMPLOYMENT. RECEIPT OF BENEFITS DOCUMENTS DOES NOT CONSTITUTE ELIGIBILITY. THESE NOTICES DO NOT APPLY TO ANY BENEFITS YOUR EMPLOYER OFFERS OUTSIDE OF MERCER MARKETPLACE 365+. The Benefits Decision Guide, combined with these legal notices, provides an overview of the benefits available to eligible employees and their dependents. In all cases, the official plan documents govern and this Benefits Decision Guide is not, and should not be relied upon as a governing document. In the event of a discrepancy between the information presented in the Benefits Decision Guide and official plan documents, the official plan documents will govern. SUMMARY OF BENEFITS COVERAGE A Summary of Benefits Coverage (SBC) for each of the employer-sponsored medical plans is available at www.mercermarketplace365plus.com/flourishbenefits. You may also request a paper copy by calling Mercer Marketplace 365+. MERCER’S ROLE AND COMPENSATION Mercer Health & Benefits LLC facilitates the placement of insurance coverage on behalf of its clients. Mercer is compensated through commissions that are calculated as a percentage of the insurance premiums charged by insurers. This compensation may include payment from insurers for marketing-related expenses, technology investments or service fees. Our compensation may vary depending on the type of insurance purchased, the insurer selected and other factors such as the volume, growth and/or retention of Mercer’s book of business with the insurer or service provider. You may obtain additional information regarding our compensation by sending an email to mercermarketplace.compensation@mercer.com. TAXATION OF BENEFITS The taxation of certain benefits may vary at the local, state and federal level. You should consult your tax advisor if you have any questions about the proper treatment of any benefits. IMPORTANT NOTICE FROM FLOURISH BENEFITS ABOUT CREDITABLE PRESCRIPTION DRUG COVERAGE AND MEDICARE The purpose of this notice is to advise you that the prescription drug coverage listed below under the Flourish Benefits medical plans is expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in 2022. This is known as “creditable coverage.” Why this is important: If you or your covered dependent(s) are enrolled in any prescription drug coverage during 2022 listed in this notice and are or become covered by Medicare, you may decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment penalty — as long as you had creditable coverage within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important records. If you or your family members aren’t currently covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice doesn’t apply to you. Please read the notice below carefully. It has information about prescription drug coverage with Flourish Benefits and prescription drug coverage available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage. NOTICE OF CREDITABLE COVERAGE You may have heard about Medicare’s prescription drug coverage (called Part D), and wondered how it would affect you. Prescription drug coverage is available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium. Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and each year from October 15 through December 7. Individuals leaving employer/union coverage may be eligible for a Medicare Special Enrollment Period. www.mercermarketplace365plus.com/flourishbenefits 28 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.
If you are covered by one of the Flourish Benefits prescription drug plans listed below, you’ll be interested to know that the prescription drug
coverage under the plan is, on average, at least as good as standard Medicare prescription drug coverage for 2022. This is called creditable
coverage. Coverage under one of these plans will help you avoid a late Part D enrollment penalty if you are or become eligible for Medicare and
later decide to enroll in a Medicare prescription drug plan.
Blue Shield of California $1,500 Deductible Plan
Blue Shield of California $2,500 Deductible Plan
Blue Shield of California $0 Deductible EPO Plan
Kaiser HMO Plan
If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also
continue your employer coverage. In this case, the Flourish Benefits plan will continue to pay primary or secondary as it had before you enrolled in
a Medicare prescription drug plan. If you waive or drop Flourish Benefits coverage, Medicare will be your only payer. You can re-enroll in the
employer plan at annual enrollment or if you have a special enrollment event for the Flourish Benefits plan, assuming you remain eligible.
You should know that if you waive or leave coverage with Flourish Benefits and you go 63 days or longer without creditable prescription drug
coverage (once your applicable Medicare enrollment period ends), your monthly Part D premium will go up at least 1% per month for every month
that you did not have creditable coverage. For example, if you go 19 months without coverage, your Medicare prescription drug plan premium will
always be at least 19% higher than what most other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription
drug coverage. In addition, you may have to wait until the following October to enroll in Part D.
You may receive this notice at other times in the future — such as before the next period you can enroll in Medicare prescription drug coverage, if
this Flourish Benefits coverage changes, or upon your request.
FOR MORE INFORMATION ABOUT YOUR OPTIONS UNDER MEDICARE PRESCRIPTION DRUG COVERAGE
More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. Medicare participants
will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans.
Here’s how to get more information about Medicare prescription drug plans:
Visit www.medicare.gov for personalized help.
Call your State Health Insurance Assistance Program (see a copy of the Medicare & You handbook for the telephone number).
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra
help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at
www.socialsecurity.gov or call 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in a Medicare prescription drug plan after your applicable Medicare enrollment period ends, you may
need to provide a copy of this notice when you join a Part D plan to show that you are not required to pay a higher Part D premium amount.
For more information about this notice or your prescription drug coverage, contact:
MedImpact Healthcare Systems, Inc.
Director - Human Resources
10181 Scripps Gateway Court
San Diego, CA 92131
1-858-566-2727
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) SPECIAL ENROLLMENT NOTICE
NOTICE OF SPECIAL ENROLLMENT RIGHTS FOR HEALTH PLAN COVERAGE
If you have declined enrollment in Flourish Benefits’s health plan for you or your dependents (including your spouse) because of other health
insurance coverage, you or your dependents may be able to enroll in some coverages under these plans without waiting for the next Open
Enrollment period, provided you request enrollment within 31 days after your other coverage ends.
In addition, 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 31 days after the marriage or 30 days for birth, adoption or placement for
adoption.
Flourish Benefits will also allow a special enrollment opportunity if you or your eligible dependents either:
Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible, or
Become eligible for a state’s premium assistance program under Medicaid or CHIP.
For these enrollment opportunities, you will have 60 days – instead of 31 – from the date of the Medicaid/CHIP eligibility change to request
enrollment in the Flourish Benefits group health plan. Note that this 60-day extension does not apply to enrollment opportunities other than due
to the Medicaid/CHIP eligibility change.
www.mercermarketplace365plus.com/flourishbenefits 29 Copyright 2021 Mercer Health & Benefits LLC. All rights reserved.You can also read
