The Menominee Indian Tribe has a partially self-funded group medical plan. The claims processor for this plan is Fiserv Health, Inc. MITW offer’s a Point of Service (POS) plan with three different levels of benefits depending upon where you go for services. Services are subject to deductibles and coinsurance. Inpatient treatment of alcohol/drug abuse and mental/nervous disorders are also covered under the plan, subject to a $250 deductible. There is a $50 co-payment for every emergency room visit.

MITW has a wellness plan included with the POS plan. Routine services that appear on the schedule of benefits will be covered at 100% at MTC or any participating HealthEOS by MultiPlan provider. Routine services received at an “out of network” provider will not be covered.

Coverage is effective the first day of the month following the completion of 60 days of employment. The employee contribution for health insurance is $111 per paycheck for family coverage and $54 per paycheck for single coverage. A Section 125 Premium Plan has been established that allows employees to pay for certain voluntary insurance premiums with pre-tax dollars. By reducing your taxable income you are reducing your taxes and increasing your net take-home pay.

The plan has a Pre-existing Clause. Newly eligible employees must serve a 270-day (9-months) waiting period before benefits will be paid for pre-existing conditions. The 270 days starts on the effective date of coverage. If a new hire has previous health care coverage and there has been no lapse in coverage greater than 63 days, all time covered under previous plan will be credited to satisfy the 270-day period (no waiting period).

Vision care coverage includes; contact lenses and eye glasses payable at 50%, deductible waived, to a maximum benefit paid of $150 per Covered Person, per Calendar Year on a Reasonable and Customary basis. The vision exam will be covered under the wellness plan. No deductible.

Prescription drugs are paid for through a prescription drug program administered by Innoviant. There is a $5 co-payment for generic drugs and a $20 co-payment for brand name drugs. There is also mail order service available for maintenance drugs subject to two co-pays. The brand name prescription will be $45 for a three month supply. Prescriptions will be charged a double co-payment for anything over a 30 day month supply.