Olentangy Local Schools

 

Summary of Benefits, Forms and Contact Information

Overview


Olentangy Local 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:

Olentangy Local Schools
Attn: Susan Coleson
7840 Graphics Way
Lewis Center, OH 43035

Click below for the Privacy Policies for the Olentangy Local Schools Health Plan

Administration

Professional Staff

Classified Staff

Please click here for health (medical, dental and vision) insurance premium costs effective December 1, 2017 through November 30, 2018

AFFORDABLE CARE ACT (ACA) UPDATE: 

The Affordable Care Act (ACA) created reporting requirements under Internal Revenue Code (Code) Sections 6055 and 6056.

Under these reporting rules, certain employers must provide information to the IRS about the health plan coverage they offer or provide to their employees.

Please see attached documents below that provide important information on the documentation you will be receiving as a result of this ACA Reporting Requirement.

1095 Form – What Is It?

1095 Form – What Does it Mean for Your Taxes?

Medical Insurance (Medical Mutual of Ohio (MMO) – Group #744855)

SUMMARY OF BENEFITS & COVERAGE (SBC)

The Affordable Care Act (ACA) requires health plans and health insurance issuers to provide a summary of benefits and coverage (SBC) to applicants and enrollees. The SBC requirement applies to both grandfathered and non-grandfathered plans. The SBC is a concise document providing simple and consistent information about health plan benefits and coverage. It must be provided free of charge. Its purpose is to help health plan consumers better understand the coverage they have and to help them make easy comparisons of different options when shopping for new coverage.

$250/$250 PPO

$2700/$4800 Health Savings Account

Glossary of Terms – This document was prepared by the Department of Health and Human Services to serve as a source of uniform definitions for terms used in the newly required SBC’s above.

Comprehensive Major Medical Health Care Benefit Book – Detailed information about your medical benefits including coverages, exclusions and limitations.

$250/$250 PPO

$2700/$4800 Health Savings Account

2018 Standard Plus Preventive Medications List

Health Savings Account FAQ – Frequently Asked Questions about HSA Plan Usage

Olentangy Local Schools contracts with Discovery Benefits to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While Olentangy Local Schools is aware of events such as terminations of employment, it is YOUR responsibility to notify administration of any qualifying events so they can in turn notify MMO.

Employee Enrollment/Waiver 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.

Benefits Selection and Waiver Form – Please complete the General Information section and indicate your selection of coverage. Note: The appropriate enrollment form(s) must be completed for each type of coverage. *If you WAIVE any benefits at this time, please also complete the acknowledgement on the reverse of this form.

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 form below for any reimbursements.

Non-Network Medical Claim Form Mail your completed form to the address on your member ID card or Medical Mutual P.O. Box 6018 Cleveland, OH 44101-1018.

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

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

Mail Order Prescription Questionnaire – must be completed for first time mail order prescription setup

Mail Order Prescription 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 administration. 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

my health plan– MMO’s member and consumer self-service web site that provides a single source for online benefits and health related information. Access your personalized health care, look at your Explanation of Benefits (EOB), health cost estimators, health management programs, stop smoking programs, claim appeal forms, fitness club discounts and numerous other items. (Registration is available to individuals currently enrolled with MMO).

Beltone Hearing Aid Discounts – MMO Members are eligible for up to 20% discounts on all Beltone Hearing Aid models. Benefits are extended to parents and grandparents as well!

Dental Insurance (MetLife – Group# 145231)

Benefit Summary – High level summary of the dental benefits and what is covered.

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

Certificate Rider – Amends the eligibility definition in the certificate of coverage

Olentangy Local Schools contracts with Discovery Benefits to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While Olentangy Local Schools is aware of events such as terminations of employment, it is YOUR responsibility to notify administration of any qualifying events so they can in turn notify MetLife.

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

Benefits Selection and Waiver Form – Please complete the General Information section and indicate your selection of coverage. Note: The appropriate enrollment form(s) must be completed for each type of coverage. *If you WAIVE any benefits at this time, please also complete the acknowledgement on the reverse of this form.

Dental Claim Form – In-network dentists will complete and send your claims to MetLife on your behalf. However, if you use a non-network dentist you may have to pay up front, complete this form and send it to MetLife at the address below:

MetLife Dental Claims
P.O. Box 981282
El Paso, TX 79998-1282

MetLife Web: www.metlife.com

Customer Service Phone: 800-942-0854

MetLife Dental Center – Tools and resources such as online provider searches, view past claims, FAQ’s, mybenefits, etc.

MetLife Oral Health Library – Tools and resources to help you make more informed choices about your oral health and dental benefits.

Why use a participating dentist? – Demonstrates the savings and advantages of using a participating dentist.

Vision Insurance (VSP – Group #12701592)

Vision Summary of Benefits – High level summary of the dental benefits and what is covered.

Certificate of Coverage – Detailed descriptions of your benefits and exclusions for both plan options.

Certificate Rider – Amends the dependent eligibility definition in the certificate of coverage to include coverage for dependent children to the end of the month in which the dependent turns 26 years of age.

Olentangy Local Schools contracts with Discovery Benefits to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While Olentangy Local Schools is aware of events such as terminations of employment, it is YOUR responsibility to notify administration of any qualifying events so they can in turn notify VSP.

Benefits Selection and Waiver Form – Please complete the General Information section and indicate your selection of coverage. Note: The appropriate enrollment form(s) must be completed for each type of coverage. *If you WAIVE any benefits at this time, please also complete the acknowledgement on the reverse of this form.

Vision Non Network Claim Instructions: While VSP providers will file claims electronically, you may still need to submit information for reimbursement of non-network vision claims.

Web: www.vsp.com

Vision Customer Service Phone: 800.367.5897

Online Provider Lookup – Select the VSP Choice Network

Miscellaneous Information:
– Primary EyeCare Benefit
– Frequently Asked Questions (FAQ) 
– Informative and Convenient from VSP

Group Life and Voluntary Life Insurance (Mutual of Omaha – Group #G000B4ZZ)

Beneficiary Form – Please complete this form so Mutual of Omaha knows who to pay the life benefit to in the event of your death. You may update your beneficiary at any time. Submit this form to the Business Office at Hudson City Schools.

Evidence of Insurability Form

Accelerated Death Benefit Application (Also known as the Living Benefit Option)

Additional Benefits Available:

Mutual of Omaha website

Mutual of Omaha Customer Service: 800.775.8805 (M-F, 7:30 AM to 5:00 PM CST)

Flexible Spending Account (FSA)

Insurance Benefits Specialist (Agent)

Milestone Benefits Agency, Inc.
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

 

Stacy Green
Direct: (614) 318-3163
E-mail: Stacy@milestonebenefits.com

Chad Smith
Direct: (614) 318-5244
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