2019 My Medical Neighborhood Plan -

Northwest Georgia

Mohawk’s benefits are here to help you make the right choices for you and your family. That’s why we offer so many resources to help you stay healthy and happy - from helping you budget for health care expenses through an HSA or FSA, to providing innovative telemedicine access with Amwell and our virtual Healthy Life Centers, to delivering resources to help you live better and spend less.

We believe prevention plays a vital role in health care. To catch problems early, we encourage you to get preventive screenings and annual checkups. Don’t forget—your in-network preventive care is 100% covered! It’s never too late to start your journey to become a healthier you. Your good health is important–to you and your family.

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What to Know for 2019
Medical Plan Changes

Beginning Jan. 1, 2019, office visits to primary care physicians as well as specialists will have a $35 copay once the deductible has been met. Urgent Care facilities will have a $25 copay once the deductible has been reached.

My Medical Neighborhood

My Medical Neighborhood remains the plan for employees living in selected ZIP Codes in northwest Georgia/Chattanooga. Providers in the Neighborhood work together to offer care coordination to our health plan members.

Healthy Life Centers / Healthy Life Team

Our Healthy Life Centers continue to expand services, including onsite behavioral health and virtual coaching and offer innovative ways to connect with you.

We are pleased to introduce Spruce Health, an exciting new way to communicate with your Healthy Life Care Team via text messages. Schedule your appointments by texting “Hi” to 877-365-0015 or to go www.mymohawkbenefits.com/hlct to download the app. More exciting uses for Spruce will be announced in 2019!

Finding a Doctor

As always, we encourage you to confirm your doctor(s) are in the Neighborhood for 2019. To find a provider or hospital in the Neighborhood:

If you or your dependents seek health care outside the Neighborhood area, then Aetna will apply to those health care expenses.

Pharmacy

Pharmacy, through Express Scripts, is included when you elect medical coverage. The formulary with Express Scripts can change yearly. To avoid paying full price, please click here to review the 2019 formulary to ensure medications are covered.

Zip Code Search

Use the ZIP code search feature below to see if you're eligible for the My Medical Neighborhood Plan in 2019.

Zip Code Search

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Plan Overview

The medical plan uses Employers’ Health Network of medical providers and combines traditional medical coverage with an optional tax-free savings account with HSA Bank, called a Health Savings Account (HSA). It's designed to encourage you to focus on being a smart health care consumer.  The HSA can help pay for health care expenses not paid by your medical plan now and in the future.
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  • NO REFERRALS - Choose the doctors you want to see – no referral required to see a specialist.
  • DEDUCTIBLE -You pay 100% of your health care expenses until you meet your annual deductible. This includes physician office visits and prescription drugs. See deductible amounts below.
  • COST SHARING - After meeting your annual deductible, you share the cost of health care expenses by paying co-insurance (a percentage of the total office visit cost).
  • PREVENTIVE CARE - In-network routine preventive care and qualifying preventive prescriptions are covered at 100%.
  • ALLOWANCE MAXIMUMS - Note that there are allowance maximums for preventive mammogram ($225), preventive mammogram-3D ($285), preventive colonoscopies ($2,250), all MRIs ($2,300 after deductible is met), and CT Scans ($2,000 after deductible is met). See details.
  • OUT-OF-POCKET MAXIMUM ALLOWANCE - The most a plan member will pay per year for covered health expenses before the plan pays 100% of covered health expenses for the rest of that year.
    > In-Network  - Employee Only - $5,000; Family - $13,000
    >Out of Network  - Employee Only - none; Family - none
  • PRESCRIPTION - Qualifying Walmart prescriptions ($4 List) are covered at 100% after meeting your deductible.
  • MEDICARE - If you are covered under Medicare, you are eligible to participate in the Company Medical Plan, however, you are not eligible to own an HSA Account per IRS guidelines.
  • HSA ELIGIBILITY - Per IRS rules, you must be enrolled in the Company's Medical Plan to have an HSA account; have no other health coverage; not be enrolled in Medicare; and cannot be claimed as a dependent on someone else's tax return.

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Medical Plan Details

Employees living in the selected ZIP codes in the northwest Georgia/Chattanooga area will continue to be a part of the My Medical Neighborhood plan. The Neighborhood includes a select group of providers with access to high-quality, affordable health care. If you or your dependents seek health care outside the Neighborhood area, then Aetna will apply to those health care expenses.  As always, important preventative health care screenings and procedures are available at no cost to you, and the Company will continue its contributions to employee Health Saving Accounts (HSA). Please note in-network and out-of-network deductibles and out-of-pocket expenses are all separate and do not crossover. To find a provider and additional detail, visit mymohawkneighborhood.com.

Medical Plan Changes

Beginning Jan. 1, 2019, office visits to primary care physicians as well as specialists will have a $35 copay once the deductible has been met. Urgent Care facilities will have a $25 copay once the deductible has been reached and Emergency Room copay for non-emergencies will be $500.

Deductibles

EE Only:  In-Network - $1,650 | Out-of-Network - $3,300
EE+SP, EE+CH, Family:  In-Network - $3,300 | Out-of-Network - $6,600

Co-Insurance

In-Network - 80% after deductible
Out-of-Network - 50% after deductible

Out-of-Pocket-Max

EE Only: - In-Network - $5,000 | Out-of-Network - None
Family: - In-Network - $13,000 | Out-of-Network - None

Medical Plan Rates

medical icon My Medical Neighborhood Plan

2019 MMN NWGA Rates

*For coverage, Spouse also refers to Common Law

pdf button Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

Medical Plan Surcharges

New enrollees to company medical plan will be required to complete a biometric screening within 60 days of your benefit effective date to avoid a wellness surcharge. For additional details, visit the Biometrics and Health Coaching page.

Based on results, employees and/or covered spouses may be required to complete face-to-face, telephonic or online health coaching. Employees and covered spouses who choose not to work with a Healthy Life Team Navigator (HLN), do not make contact with their HLN or do not complete biometrics testing, will be charged an additional $28.85 per week or $125 per month as a surcharge on top of your medical plan premium.

If you enroll a spouse in the Company Medical Plan, they will be included in a spousal audit for other medical coverage. If your spouse’s employer offers insurance and you elect to cover him/her on Mohawk’s Medical Plan, you will pay an additional $125 per month in medical contributions.

*New hires and those new to the medical plan as a result of a Qualifying Life Event, please visit the Biometrics & Coaching page for details.

Surcharges:

The information below outlines ways in which medical surcharges will be applied. Keep in mind, the maximum surcharge is $57.70 per week or $250 per month in addition to your Medical plan contribution.

  • $28.85/wk or $125/mo:  If covered Employee does not complete a Biometric Screening when notified.
  • $28.85/wk or $125/mo:  If covered Spouse* does not complete a Biometric Screening when notified.
  • $28.85/wk or $125/mo:  If covered Employee requires Coaching based on biometric screening results and refuses to work with a health coach.
  • $28.85/wk or $125/mo:  If covered Spouse* requires Coaching based on biometric screening results and refuses to work with a health coach.
  • $28.85/wk or $125/mo:  If Spouse* enrolls in the Mohawk Medical plan and has access to other group medical coverage through their employer.

*For coverage, Spouse also refers to Common Law.

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How the Medical Plan and HSA Work

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Your HSA

  • Elect the Health Savings Account (HSA) during the medical enrollment process.
  • You can contribute pre-tax dollars to a Health Savings Account (HSA).
  • In order to receive the Company's HSA contribution, you must contribute to your account, up to the current 2019 federal limit (See “HSA Contributions” section below).
  • It’s your choice how and when to use the money – use it to pay for your qualified medical, dental, or vision expenses, or save it for future needs.
  • The HSA dollars you use go toward paying your annual deductible.
  • Whatever you don’t use in 2019 earns interest and rolls over to 2020.
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Your Deductible

  • With the plan, you’ll pay an annual deductible before your health plan begins to pay for eligible expenses. A deductible is the amount of money that you’ll be required to pay before your plan starts paying benefits.
  • You can meet your deductible by using your HSA dollars, your own money or both.
  • Only services covered by your health plan count toward your deductible. (See Summary of Benefits below for more details.)
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My Medical Neighborhood Health Plan

  • Once you meet your deductible, you pay co-insurance, which is a percentage of your medical cost. The plan pays for the rest.
  • Your deductible counts toward your out-of-pocket maximum (the most you’ll pay in a given year for all covered expenses). Once you meet your out-of-pocket maximum (which includes your deductible), your plan pays covered expenses at 100%.

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Health Savings Account (HSA)

Contributions

The Company contributions* to employee Health Savings Accounts remain the same in 2019.

$500 (if you contribute $250 or more) - Employee only
$800 (if you contribute $400 or more) - Employee + Spouse
$800 (if you contribute $400 or more) - Employee + Child(ren)
$1,100 (if you contribute $550 or more) - Employee + Family

  • You receive 50% of the Company funding in January. If you contribute equal to or greater than the 50% during 2019, the Company will match the additional 50%.
  • The federal contribution limit (including employer contribution) is Single:  $3,500; Family:  $7,000. If you are age 55+, you may contribute an additional annual catch-up contribution of $1,000.

*New Hires, New HSA participants and Qualifying life event participants, please see section below regarding HSA Company contributions.

New Hires
New hires may contribute to their HSA once they become benefit eligible. However, the employee will not receive any Company money during the first calendar year of participation.  In 2019, the employee will then be eligible to receive the initial 2019 Company money and the 2019 employer match (as long as the employee is contributing at the appropriate level to the 2019 HSA plan).

  • New Hire Example:  John Doe is hired Jan. 28, 2019. He may start contributing to the HSA plan once he is benefit eligible; however, during the 2019 calendar year he will not receive any company seed or match.  Starting with his first paycheck in 2020, he will receive the 2020 company seed. As long as the employee is contributing to HSA plan, he will receive a match per the terms of the 2020 HSA plan.

New HSA Participants and Qualifying Life Event Participants
New participants to the HSA in 2019 may contribute to their HSA. However, the employee will not receive any Company money during the first calendar year of participation.  In 2020, the employee will then be eligible to receive the initial 2020 Company money and the 2020 employer match (as long as the employee is contributing at the appropriate level to the 2020 HSA plan).  
 
Qualifying Life Events During the Year
If an HSA participant has a qualifying life event during the year and changes their HSA coverage (for example changes their HSA plan contribution from Employee Only to Employee + Spouse), they may continue to contribute and receive appropriate company match, however their initial employer seed money provided in January 2019 will not be modified.

HSA Details

HSA Bank administers your HSA account.  Any balance remaining in your HSA rolls over to the next year, and if you leave or retire from the Company, the money in your account goes with you.  It is never taxable if it is used for qualified medical expenses at any time in the future.

  • Contributions to your HSA are taken out of your paycheck before taxes – so the amount of taxes withheld are reduced.
  • You will receive an HSA Debit card which draws money directly from your HSA. Use your debit card to pay for services at the doctor’s office, at your local pharmacy, eyeglass retailer or other locations where you purchase medical-related items or services
  • The Company pays for the basic banking fees, and the employee is responsible for any additional fees.  Please see attached fee schedule for details.
  • Access your HSA online by visiting www.webtpa.com.

Things to Know About Your HSA

  • To receive the Company's HSA contribution, you must elect the Health Savings account (HSA) during the enrollment process.  
  • HSA Bank may request additional information from you in accordance with the USA Patriot Act. If you don't submit the requested information by the deadline indicated, your account will be closed. Click here for a sample letter and identification verification form to assist you with this process.
  • HSA Bank will mail your HSA debit card to a P.O. Box address however, a physical address is needed to keep the account open.
  • If you do not receive your HSA debit card in the mail, please contact HSA Bank.
  • See additional HSA resources to make the most of your HSA: pdf button How to use your HSA | pdf button HSA 101 | pdf button Navigating your HSA
  • For HSA Debit card disputes, please see HSA Fraud Protection document.

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Plan Documents and Resources

2019 SPD coming soon.

pdf button HSA My Medical Neighborhood Plan - Summary of Benefits & Coverage (SBC)

Additional Links and Information

pdf button WebTPA Claim Form

pdf button HSA Web User Guide

pdf button HSA Beneficiary Form

pdf button HSA Transfer/Rollover Form

pdf_button Medicare and You - Guide 

pdf_button Learn about YourChoice Advocate

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Contact the Benefits Service Center or WebTPA

For questions about your benefits including claims, eligibility, or to order an ID card contact

Benefits Service Center | 1-866-481-4922  OR

WebTPA | 844-380-4564 | Webtpa.com


Important Notes:

  • In Ala., Calif., and N.J., contributions are prior to federal taxes but after state income taxes. Employer contribution, earned interest and investment income are all taxable as gross income for state income tax purposes. 
Cigna
1-855-566-4295
WebTPA
1-844-380-4564
Express Scripts
1-877-887-2879
Cigna MDlive
1-855-818-3627
Metlife
1-855-488-0520
Aflac
1-800-433-3036
TaxSaver Plan
1-888-602-6272
Fidelity
1-800-835-5087
One America
1-855-279-6375
HLC
1-877-365-0051