Loudonville Perrysville Exempted Village

Summary of Benefits, Forms and Contact Information

Overview


Loudonville-Perrysville Exempted Village Schools is proud to provide a comprehensive and competitive benefits package to all of its qualified employees. This website contains summaries and links to the various components of these coverages and should be used as a portal to your benefit needs.

In most cases, you have up to 31 days from your date of hire or eligibility date to complete all of the necessary applications and forms to be retroactively enrolled in the benefits as outlined below. Failure to complete these materials in the allotted time will result in you forfeiting your eligibility for these benefits until the next open enrollment period unless you have a qualifying event.

All completed forms should be sent to:

Loudonville-Perrysville 
Exempted Village Schools 
Attn: Christine Angerer 
210 East Main Street 
Loudonville, OH 44842

Click here to download a copy of the Privacy Policy of the LPEVS Health Plan

Medical and Prescription Drug Insurance (Medical Mutual of Ohio (MMO) – Group #840687)

Summary of Benefits and Coverage (SBC) – High level summary of the medical benefits and what is covered.

Certificate of Coverage – Detailed information about your medical and prescription benefits including coverages, exclusions and limitations.

For purposes of the Affordable Care Act, this plan is considered GRANDFATHERED.

Loudonville-Perrysville Exempted Village Schools contracts with Ceridian to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While Loudonville-Perrysville Exempted Village Schools is aware of events such as terminations of employment, it is YOUR responsibility to notify Christine Angerer of any qualifying events so they can in turn notify MMO.

– Medical Mutual Enrollment Form – ALL new and eligible employees are required to complete this form regardless if you are electing coverage. If you are waiving coverage you must sign and date the bottom portion of the application.

Claim Forms – Network providers are responsible for submitting any claim forms to Medical Mutual on your behalf. However, if you have services provided by a non-network provider, you will need to pay that provider directly and complete the claim forms below for any reimbursements.

Non-Network Medical Claim Form – Mail your completed form to the address on your member ID card or:

Medical Mutual of Ohio
P.O. Box 6018
Cleveland, OH 44101-1018

Nurse Line Brochure – Informational brochure on the Medical Mutual of Ohio nurse Line. Available to members 24/7.

24/7 Medical Mutual Nurse Line: 1-888-912-0636

Chronic Condition Management Brochure – Informational Brochure on the available Chronic Condition Management Program

Non-Network Prescription Claim Form – Mail your completed form to:

Express Scripts
ATTN: Commercial Claims
P.O. Box 2872
Clinton, IA 52733-2872

Prescription Mail Order Form – Complete this form and attach your prescription to receive up to a 90 day supply of your maintenance prescription medications.

IMPORTANT! – You have 31 days from any qualifying event such as marriage, the birth of a child or change in dependent status to make changes to your plan and notify Christine Angerer . Failure to do so could result in a loss of coverage and having to wait until the annual open enrollment period!

Online Provider Lookup – Find in-network physicians, hospitals and other providers:

Medical Questions: 800.525.5957
Prescription Questions: 800.417.1961

Medical Mutual of Ohio Website: www.medmutual.com

Telemedicine

Online Services

$10 for 90 days of 400+ Generic Drugs – MMO has put together a benefit for members who use the mail order for their generic medications. Over 400 generic medications are now available for just $10!

Beltone Hearing Aid Discount – MMO Members are eligible for discounts up to 20% on all Beltone Hearing Aid models.

Dental Insurance (Medical Mutual of Ohio (MMO) – Group #840687)

Dental Benefit Certificate – Certificate of Coverage describing the dental benefits and what is covered.

Loudonville-Perrysville Exempted Village Schools contracts with Ceridian to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While Loudonville-Perrysville Exempted Village Schools is aware of events such as terminations of employment, it is YOUR responsibility to notify Christine Angerer of any qualifying events so they can in turn notify MMO.

Enrollment Application and Change Form – ALL new employees are required to complete this form regardless if you are electing or waiving coverage.

Dental Claim Form

Mail your completed form to: 
Medical Mutual of Ohio, Inc.
P.O. Box 6018
Cleveland, OH 44101-1018

Web: www.mmoh.com
Customer Service Phone: 800-822-1182
Online Provider Lookup

Vision Insurance (Medical Mutual of Ohio (MMO) – Group #840687)

Vision Benefit Certificate – Certificate of Coverage describing the vision benefits and what is covered.

Loudonville-Perrysville Exempted Village Schools contracts with Ceridian to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While Loudonville-Perrysville Exempted Village Schools is aware of events such as terminations of employment, it is YOUR responsibility to notify Christine Angerer of any qualifying events so they can in turn notify MMO.

Vision Claim Form

Mail your completed form to: 
Medical Mutual of Ohio, Inc.
P.O. Box 6018
Cleveland, OH 44101-1018

Web: www.mmoh.com

Customer Service: 800-525-5957

Insurance Benefits Specialist (Agent)

Milestone Benefits Agency, Inc.
521 Village Park Drive
PO Box 2038
Powell, OH 43065

Local Phone: 614-431-9540
Toll-Free Phone: 877-990-4622
Fax: 614-844-5364

Milestone Benefits Agency: www.milestonebenefits.com

Contact information signs – Content information about this website and how to contact your representatives at Milestone Benefits Agency, Inc.

Marie Zuniga
Direct: (614) 318-5220
Extension: 9106
E-mail: Marie@milestonebenefits.com

Chad Smith
Direct: (614) 318-5244
Extension: 9102
E-mail: Chad@milestonebenefits.com

Disclaimer: The information contained on this site serves as a resource for the employees and administrators of your employer and in some instances only contains an overview of the benefits, provisions, limitations and exclusions of these programs. Information can sometimes change and may not be current on this site. In all instances, if the information contained on this site conflicts with the applicable plan documents or carrier administration of these programs, the plan documents and their administrative policies will prevail. Each company reserves the right to change these benefits at any time without prior notice and at their own discretion.

Our Location:

521 Village Park Drive
PO Box 2038 
Powell, Ohio 43065

Contact Info:

614.431.9540 (Phone)
614.844.5364 (Fax)
info@milestonebenefits.com

Hours of Operation:

M-F: 8:00 - 5:00 Eastern