The PerfectFit benefits program is designed to provide you with a benefits package that is flexible, comprehensive and cost-effective for you and Main Line Health (MLH). PerfectFit allows you to choose the benefits that best meet your and your family's individual concerns and needs, making for a "perfect fit." This program includes five medical plan choices, two dental plan choices and/or a variety of life insurance choices for you and/or your family members.
Medical Plans
You can choose from the following options:
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The coverage levels available to you are:
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Stay Healthy Program
Staying Healthy is a full-time commitment at Main Line Health. That's why we've partnered with Nationwide Better Health (NBH) to expand our Stay Healthy Program. These enhancements include some very exciting, and rewarding, disease management services. If you, or your dependents, suffer from asthma, heart disease, diabetes, high blood pressure, high cholesterol or low back pain, the qualified registered nurses at Nationwide Better Health can help manage your condition. If you or a dependent are pregnant, you can enroll in the Nationwide Better Health Maternity Management program. Both of these programs provide free confidential consultations and valuable health information with a dedicated health coach.
MLH has expanded the current Stay Healthy cancer screen program. MLH has added colorectal screenings to the list of eligible tests.
Now Available: Virtual Colonoscopy - Virtual colonoscopy is the newest technology used by Main Line Health Imaging to screen patients for colon cancer. Similar to optical colonoscopy, a virtual colonoscopy screening can reduce the rate of colon cancer. Virtual colonoscopy is a minimally-invasive procedure that combines sophisticated X-rays and computed tomography (CT) scans of the abdomen, to produce a two-and three-dimensional computer model of the patient's colon. Screenings, either virtual or optical colonoscopy, reveals any cancerous or pre-cancerous polyps and are recommended beginning at age 50. You can self-refer for either type. If schedule in advance, you may receive the optical colonoscopy for the same day, immediately following the virtual colonoscopy, thus avoiding another fasting and colon cleansing cycle. To learn more about the virtual colonoscopy, go to www.mainlinehealth.org/imaging or call 610-560-1800 to schedule an appointment.
Other Stay Healthy Programs:
- Smoking Cessation
- Global Fit
More Information:
Please contact your Benefits Counselor for more information on changes to the MLH Stay Healthy Program.
You take care of others every day - Let Nationwide Better Health take care of you.
See the PerfectFit 2010 e-workbook for further information related to each plan.
Dental Plan Options
Aetna DMO. This option provides care through Aetna's network of providers. You must select a primary care dentist to receive coverage. Your primary care dentist must give you a referral when you need to see a specialist. If you go to a network provider, many services will be covered in full; others require a co-pay. No claim forms are required. No coverage is provided if you do not use a network provider. Note that the Aetna DMO network is limited. Verify your provider's participation before you elect the plan. Provider listing and applications can be obtained from the Human Resources Department. If you elect the Aetna DMO, you must call Aetna at 1-800-843-3088 to elect a Primary Care Dentist (PCD) for yourself and each of your dependents. You will not receive a DMO ID card until you select a PCD.
Delta Dental's DeltaPremier Program. This option covers preventive, restorative and specialty care services. You may receive care from any licensed dentist. If you elect to receive treatment from a DeltaPremier participating dentist, the dentist will generally submit claims for you and your out-of-pocket costs will be lower.
Please Note: ID Cards are not issued for the Delta Dental DeltaPremier program. You will need to provide the MLH group number (2496) when you receive dental care. Claim forms are available onsite at each facility in the Human Resources Department or can be printed off the Benefits Express Website under the forms link.
See the PerfectFit 2010 e-workbook for further information related to each plan.
Your Vision Benefits
Under the MLH Vision plan, vision care is offered through Vision Benefits of America (VBA). You can receive vision care and purchase corrective eyewear at in-network rates through VBA's nationwide network of more than 12,000 optometrists, ophthalmologists and retail optical stores.
You can choose from the following options:
- Waive Coverage
- Vision Benefits of America (VBA)
The coverage levels available to you are:
- Employee Only
- Employee + One
- Employee + Family
About Your Vision Benefits
When you require vision care services, you have the choice of going to a VBA doctor -- which lowers your out-of pocket costs -- or to an out-of-network, licensed ophthalmologist, optometrist or optician of your choice. Generally, you will receive greater benefits if you choose a VBA doctor.
Receiving care from a VBA doctor: Call VBA at 1-800-432-4966 or visit http://www.visionbenefits.com/ to request a benefit form. The form is valid for 90 days from the date of issue and must be presented at your appointment or vision care services may not be covered. You will not receive an ID card if you enroll in the VBA plan.
Receiving care from a non-VBA doctor: You will need to file a claim form to be reimbursed for eligible expenses. Some providers have electronic forms. Please check with the provider office when you schedule your appointment.
See the PerfectFit 2010 e-workbook for further information related to each plan.
The JeffPLUS Network
All MLH employees have access to the JeffPLUS network, which is comprised of participating Jefferson Health Systems (JHS) providers and facilities. When you use a JeffPLUS provider, you are keeping revenue within our system, which helps control costs for you and the health system.
You will always pay lower co-pays and deductibles when you visit a JeffPLUS provider. Many MLH physicians and facilities belong to the JeffPLUS network.
Taking advantage of JeffPLUS is easy. Simply...
- Review the JeffPLUS Provider Directory to determine if your current Primary Care Physician (PCP) is participating in JeffPLUS and the HMO of PPO you choose. If not, review the directory for an alternative PCP - or call 1-866-CALL-MLH for a referral or for more information about participating providers.
- Make an appointment with the PCP you select.
- Confirm your provider's network participation prior to your appointment. Some of the JeffPLUS physicians and facilities participate in the Aetna network; some in the Keystone network; some in the Personal Choice network.
Note: While every effort is made to update the JeffPLUS Directory, providers can join or stop participating in the network at any time.
Not all services will be covered by JeffPLUS. If a JeffPLUS provider does not provide a specific service, you will receive care through the Aetna or Independence Blue Cross PPO networks.
See the PerfectFit 2010 e-workbook for further information related to each plan.
JeffPLUS Aetna HealthFund (CDHP)
Aetna HealthFund (CDHP)
The Aetna HealthFund, MLH's Consumer-Driven Health Plan (CDHP), offers you the opportunity to make elections about how you want to spend your healthcare dollars (including how much to budget for out-of-pocket expenses), which providers to see, and what services fit your personal situation. Essentially, it is a PPO plan with a higher deductible. MLH deposits money into a fund to help you pay for your and your dependents' medical expenses.
How the CDHP Works
The amount you pay for care under the CDHP depends on the provider you use. Here are the network choices available to you:
- Home hospital or facility - When you receive care from any hospital or facility with MLH.
- Tier 1: JeffPLUS facilities/providers - When you receive care from JeffPLUS hospitals/facilities or JeffPLUS physicians that also participate in Aetna's network.
- Tier 2: Aetna network - When you receive care from any non-JHS facility or provider that participates in Aetna's network.
- Tier 3: Out-of-network - When you receive care from a provider or facility that does not fall under one of the above categories.
See the PerfectFit 2010 e-workbook for further information related to each plan.
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