Open Enrollment

Active Benefit Eligible Employee 2022 Open Enrollment Letter 

• Click here to go to the Consumer Driven Health Plan webpage.

• OCOPE CDHP with HSA PowerPoint Presentation 

Retiree open enrollment period will be: 10/15/2022 - 12/7/2022

Any changes made will be effective January 1, 2023

2022 Retiree Open Enrollment Letter - Please refer to this letter that will be mailed to your home address.

Pay special attention to information you receive from Oberlin College, Medical Mutual, CVS Caremark, and/or SilverScripts.

Retiree Resources and Forms 

• Retiree Benefits Enrollment/Opt Out Medical Form
• Retiree Dental and Vision Cancellation Form

• Healthcare Deferral option summary for RAMP Retirees
• RAMP Deferral Form 2023

• 2023 RAMP Rate Schedule Effective January 1, 2023

• Retiree Stipend Option Summary 2023
• FAQ Health Reimbursement Arrangement (HRA) 

Medicare Advantage Plan Participants (age 65 or older, and enrolled in Medicare Part A and Medicare Part B)

• Medical Mutual Directory and Evidence of Coverage Requests 2023
• MedMutual Annual Notice of Changes 2023
• MedMutual Evidence of Coverage 2023
• MedMutual Summary of Benefits 2023 
  • Click, here for a copy of the PowerPoint Presentation about the MedMutual Medicare Advantage Plan.
• Medicare Advantage Welcome Kit 2023

Group Medicare Advantage PPO Plan - Providers

• In-network, full-benefit coverage for services incurred anywhere in the US or US territories.
• Must use providers that accept Medicare.
• No travel restrictions.
• Providers that accept Medicare or MedMutual Advantage plans can be found using search tools.
• https://www.medicare.gov/
• https://providersearch.medmutual.com/

SilverScript - Medicare Prescription Drug Plan (PDP)

• SilverScript Summary of Benefits 2023
• SilverScript Formulary List of Covered Drugs 2023
• SilverScript Evidence of Coverage 2023

Medicare Supplement transition plan - Medical Mutual COMP

• COMP Plan - Summary Plan Description

Retirees who are enrolled less than age 65  - 

Consumer Driven Health Plan (CDHP) with a Health Reimbursement Account (HRA)

Do you want to see the cost of your prescription under the CDHP plan before you meet your deductible, and price lower cost options?

The Drug Price Comparison Tool links below are available. The default pharmacy will be CVS. There is an option for you to change the pharmacy. If the prescription is a maintenance medication, it will show the 90 day option. 

• PRE - Deductible - To estimate the cost under the CDHP plan before you meet your deductible.
• POST- Deductible - To estimate the cost under the CDHP plan before after you have met your deductible.

Medical Mutual of Ohio (MMO) will remain our health insurance carrier.

Our provider network is called SuperMed PPO. For providers outside of Ohio, you will use the Aetna Open Choice PPO network until December 31, 2022.

Effective January 1, 2023, for providers outside of Ohio, you will use the Cigna PPO network. To search for a medical facility, physician or specialty physician, search the provider network. New ID cards will be issued for 2023. 

Visit My Health Plan to register for a secure member website. Find doctors in the network, estimate costs, check claims, receive your Explanation of Benefits (EOB), and more! 

Download the Mobile App for free from the Apple App Store or Google Play by searching MedMutual

Do you cover your Spouse or Domestic Partner on your health insurance policy?

If so, a Spousal Coordination of Benefits Form must be completed for 2023. A spouse/domestic partner of an Oberlin College employee is required to participate in his/her employer sponsored health care plan if: the spouse/domestic partner has access to continuous group health coverage through his/her employment, and the employer contributes at least 50 percent of the premium. If these conditions are met, the spouse/domestic partner must enroll in his/her employer’s health care plan.

• 2023 Faculty, A&PS, Confidential, UAW, OSCA
• 2023 OCOPE Members 

Consumer Driven Health Plan (CDHP) with a Health Savings Account (HSA)

Consumer Driven Health Plan (CDHP) with a Health Reimbursement Account (HRA)

Additional Information and Resources

• FAQ - Medical Mutual Member Guide
• Preventive Care Services 
• Colorectal Cancer Awareness
• Make the Most of Your Benefits
• Explanation of Benefits (EOB) Guide
• Fitness Discounts
• Disease Management Programs
• LifeStyle Coaching
• My Care Compare
• Nurse Line - Just a phone call away.
• Online Tools
• Quit Line - Enjoy life without tobacco.
• WW - Wellness that Works
• Take control of your Diabetes.

CVS Caremark will continue to administer the college’s prescription drug benefits. 

To make accessing your prescription benefits easier and more convenient, register your account at Caremark.com. Many tools and resources are available.

Plan participants are not required to manage their prescription benefits at a CVS pharmacy. Find a network pharmacy. CVS Caremark’s national network includes more than 68,000 pharmacies including retail chains. 

The ID card from Medical Mutual will include prescription benefit information. 

List of Medications 

Formulary changes happen from time to time when drugs are: recalled from the market; replaced by a new generic drug; or, Clinical restrictions are added, including, but not limited to, prior authorization, quantity limits or step therapy.

• 2023 updates to Non-Specialty Medications
• 2023 updates to Specialty Medications 
• Preferred Non-Specialty Formulary List of Medications  October 2022
• Specialty Formulary List of Medications October 2022
• No Cost ACA Preventive Services and Drug List July 2022 
• Preventive Drug List - CDHP plan (Generic and Name Brand Drugs) January 2023

Do you want to see the cost of your prescription under the CDHP plan before you meet your deductible, and price lower cost options?

The Drug Price Comparison Tool links below will help. The default pharmacy will be CVS. There is an option for you to change the pharmacy. If the prescription is a maintenance medication, it will show the 90 day option. 

• PRE - Deductible - To estimate the cost under the CDHP plan before you meet your deductible.
• POST- Deductible - To estimate the cost under the CDHP plan before after you have met your deductible.

Additional Information 

• Who is CVS Caremark
• Welcome to CVS Caremark
• Transferring Prescriptions
• Prescription Reimbursement Claim Form 

Eligible employees who elect the Consumer Driven Health Plan (CDHP) High Deductible PPO Plan with HSA have the option to fund your HSA account with pre-tax dollars through payroll deduction. 

Oberlin College will fully fund the employer contribution to your HSA account in January 2023. 

HSA dollars can be used to cover 100% of HSA-eligible expenses. If dollars remain at year-end, they roll over for you to use in the future. The HSA account is owned by you and is also portable; you take it with you if you leave the plan or the college. 

Customer Service can support you regarding account balances, setup investment options, pay bills, transfer funds and navigation starting My Health Plan regarding the Medical Mutual HSA.

Customer Service: (800) 522-2037

Email: MySpendingAccounts@MedMutual.com

Required Form - New account holders only 

• Medical Mutual HSA Authorization Form 

Optional Form - New and existing account holders

• Health Savings Account (HSA) Employee Contribution Election Form 2023

Additional Information

• Oberlin College HSA/HRA Funding details 2023
• HSA Welcome Kit
• HSA Enrollment Guide
• How to transfer funds into your HSA account. 
• IRS Publication 502 Medical and Dental Expenses

Superior Dental Care (SDC) will continue to administer our dental insurance.

There are no changes to the rates in 2023.

Beginning, January 1, 2023, the Enhanced plan option will have an increased contract annual maximum by going from $1,500 to $2,000 per person, per contract period; it applies to Preventive, Basic and Major services. 

SDC’s network offers over half a million access points throughout the United States! Find a Participating Dentist

Go online to Superior Direct Connect or download the mobile app, which is available through the Apple App Store or Google Play Store. You will have the ability to securely access plan information, view claims, print ID cards, and more.

Dental ID card:

• If you enroll in a new dental option, you will receive a new ID card by 1/1/2023.
• If you change your option, you will receive a new ID card by 1/1/2023.
• If you do not make any changes, you will not receive a new ID card.

Additional Information and Forms

• SBC Dental Plans and Rates 2023 

• For specific plan coverage, select one of three plan options:

1. Network Only plan

2. Core plan

3. Enhanced plan

• SDC Mobile App
• SDC Value Added Benefits
• SDC Evidence of Coverage

Our Vision plan will continue to be administered by Medical Mutual using the EyeMed national vision care network.

There are no changes to the plan options or rates in 2023.

The provider network is called Access. Find a participating provider using the Eye Med Provider Locator.

Vision ID card:

• If you did not have vision in 2022, and enrolled in vision for 2023, you will get a new ID card from Medical Mutual. 
  • If you are enrolled in the Medical and Vision plan, you may use the same ID card for vision, medical, and prescription benefits. 

Additional Information and Forms

• Vision Plan Highlights and Rates
• Summary Plan Description
• Vision Claim Form 

Unum will continue to administer our Optional Life and Accidental Death & Dismember ment benefits. 

There are no changes to the plan options, or rates in 2023.

All benefit-eligible employees will have the opportunity to enroll in valuable coverage, with benefits beginning on January 1, 2022. Read more, by clicking here to see how this can help protect you, your family, and your finances. 

If you currently have coverage and would like to make changes you may do this online or complete the Optional Life/AD&D Enrollment Form. 

Email completed form to HR by Friday, October 28, 2023. 

If you elect or increase your amount over the guarantee issue amount, you will need to Sign in to complete your Statement of Health (Evidence of Insurability) online with Unum.

• Access Code: SUHYWHB

Before you start, review the Statement of Health Checklist so you have necessary information to complete this process.

The effective date of coverage for all amounts over the guarantee issue amount is determined when you are approved. All amounts up to the guarantee issue about will begin January 1, 2023.

• Optional Life/AD&D Rate Sheet
• Optional Life Insurance Enrollment Form
• Life Insurance Beneficiary Form

Have questions regarding your status of your pending application? Unum is here to help. Call: (800) 421-0344; hours are 8 a.m. to 8 p.m., Monday through Friday

Our Flexible Spending Account (FSA) will continue to be administered through WageWorks. 

Beginning, January 1, 2023, the Medical FSA benefit option is no longer available.

All 2022 Healthcare and/or Dependent Care FSA accounts will terminate on December 31, 2022. 

If you have money left in your Healthcare FSA account at the end of the year, you will have until April 30, 2023, to get reimbursed for expenses incurred up through December 31, 2022. If not action is taken by April 30, 2022, amounts will be forfeited. 

If you have money left in your Dependent Care FSA account at the end of the year, you will have until April 1, 2023, to get reimbursed for expenses incurred up through December 31, 2022. If not action is taken by April 1, 2022, amounts will be forfeited.

• Dependent Care FSA (for children under the age of 13 or for elderly dependents who reside with you) reimburses the participant for eligible dependent care expenses such as day care, preschool, before/after school care programs, summer camps, and Nanny expenses attributed to dependent care.

• FSA Dependent Care Enrollment Form 2023
• QuickStart Guide to Managing Your FSA
• WageWorks EZ Receipts® mobile app
• Examples of Eligible Expenses
• FAQ's - FSA Online Store
• FSA Payment Options
• Questions and Answers

Maximize Your Impact by Making a Gift to Oberlin.

Oberlin College is committed to supporting and investing in the local community. Employees have the option to donate through payroll deduction.

If you are enrolled in this benefit - you must re-enroll - to continue your donation in 2023.

Enroll online or complete our Charitable Donation Form.

Our 2023 charities will be:

• Diversity Center of NEO
• Greater Cleveland Community Shares
• Oberlin College Gift
• Oberlin Community Services
• Oberlin Early Childhood Center
• Northern Ohio Youth Orchestra
• Youth Opportunities Unlimited
• United Way of Lorain County

All employees and retirees are responsible for notifying HR of any changes in personal status that change benefits enrollment or contact information on a timely basis.

Relevant changes in status include:

• Name Change
• Address and/or Phone Number
• Change in Marital Status (history of dependents cannot be deleted)
• Emergency Contact Information
• Change in Life Insurance Beneficiary
• Change in Dependents (history of dependents cannot be deleted)
• Change in Tax Withholding

CIT rolled out new Banner functionality that allows you to update your biographical and demographic profile online. You will be limited to updating only specific information, including your preferred name, gender identity, personal pronouns, personal phone number(s), personal mailing address (es), and emergency contact(s). Other information, including legal name, will be displayed without update capability.

Online updates to your profile will reduce the need to fill out a form in person to change your address, telephone, emergency contact, or name information and will also allow for more consistent collection of cell phone numbers which may be used for health safety survey text messages. Please note, it is still your responsibility to submit a complete Ohio IT-4 form to HR when changing your address. This will ensure your school district tax is accurately updated.

To log in, launch the My Self Service Profile task in OberView and click the Start button in the upper right. We encourage you to log in to review your personal information and enter an up-to-date cell phone number. Entering a cell phone number does not automatically opt you in to receive text messages, but makes it possible for you to opt in for text message reminders when they become available and for the college to send you text messages if necessary.

HIPAA Privacy Practices - This notice describes how medical information about you may be used and disclosed.

HIPAA Special Enrollment Rights - This notice provides information about your rights and protections as participants in group health plans. 

Summary Annual Reports - This gives notice of the annual report summarizing each benefit plan subject to ERISA.

• Health
• Dental
• Vision
• Life and AD&D
• Long Term Disability
• Flexible Spending Account
• Retirement Plan

Women's Health and Cancer Rights Act - This notice describes your rights after a mastectomy.

Creditable Coverage Disclosure Notice - This notice is about your prescription drug coverage and Medicare.

USERRA - This notice describes your rights under The Uniformed Services Employment and Reemployment Rights Act.

Drug-Free Workplace Act - This notice informs you about the college policy to maintain a drug-free workplace.

Mercy Allen Hospital in Oberlin has exclusively reserved appointment slots for our employees, spouses, and retirees to schedule a mammogram screening.  Mercy is committed to having a minimal wait time.  If you cannot attend one of these appointments, you may make your own appointment at a location and time convenient for you. An order from a physician must be obtained before a mammogram can be performed. 

The scheduled days are Tuesday October 25, Wednesday October 26, and Thursday October 27.

• Appointments are as follows 
  • Morning: 8:00, 8:15, 8:30, 8:45, 9:00, 9:15, 9:30, 9:45, 10:00, 10:15, 10:30, 10:45, 11:00, 11:15
  • Afternoon: 12:15, 12:30, 12:45, 1:00, 1:15, 1:30, 1:45, 2:00, 2:15, 2:30, 2:45, 3:00, 3:15, 3:30, 3:45, 4:00
• Your Medical Mutual health insurance through Oberlin College will cover a 3D mammogram, so every mamogram will be 3D unless you specify you want a 2D. 
  • If you do not have health insurance through the College, please check with your insurance provider to see which option they cover and if Mercy Hospital is in your network.
• Please request an order from your physician so you will be well prepared in advance.
  • You cannot receive a mammogram without a physician's order. 
  • The order does not need to specify 2D or 3D.

To schedule an appointment, please send an email to human.resources@oberlin.edu or call 440-775-8430 with your preferred date and time. Once scheduled, you will receive additional information and instructions.  You will need:

• A physician's order
• A copy of your insurance card
• Registration paperwork
• An appointment