Health Plan Changes for 2025

The Maine Municipal Employees Board of Trustees has elected to make a number of significant changes to the Health Trust medical plans for 2025, as a result of the increasing cost of healthcare and to reduce barriers to receiving necessary care.

A letter describing these changes was mailed to all Health Trust members in mid-September.  It is also available for your reference here.

The changes being made include:

  • Insurance referrals will no longer be required for members in the current POS plans. Effective January 1, 2025, a PCP referral will no longer be required for insurance coverage to be paid at the in-network level of benefits. Some specialists may still require that you be seen by another provider before receiving specialty care, however you will no longer need to designate a PCP with the Health Trust.
  • Prescription Copays are being increased. Pharmacy costs continue to escalate at a rapid rate.  In order to keep premium increases down for all members, the Board of Trustees have determined that it is necessary to increase member copays for prescription drugs for 2025.  Copays will increase most significantly for specialty (Tier 4) drugs.  Some preventive medications will also be changing tiers, so you may see the copay lowered for these drugs.
  • The POS A Plan is being eliminated. If you currently participate in the POS A plan, you will need to elect another plan that your employer offers during Open Enrollment.
  • All of the Health Plans are being renamed as follows:

 

Current Plan New Name 1/1/2025
POS A N/A
POS C Acadia
POS 200 Baxter
PPO 500 Katahdin
PPO 1500 Moosehead
PPO 2500 Pemaquid

Please be watching for more information this fall via mail, and on this website.  Information about premiums for 2025 will be distributed in mid-November.  If you wish to make changes to your benefit elections for 2025, you may do so during the Health Trust’s Annual Open Enrollment period, November 15 – December 15, 2024, for a January 1, 2025 effective date.  Because of the changes listed above, all members will receive a new ID card in January 2025.

Resources to Help You Take Care of Yourself or Others

If you or a loved one is struggling with life’s challenges, finding a mental health professional to talk to quickly can make a big difference.  The Health Trust offers several resources to assist members, so that you can choose the one that best meets your needs.

Don’t forget that the Health Trust waives the copays for all visits for mental health and substance use disorder conducted via telehealth.  It has been shown that technology works well for this type of care, and telehealth has greatly expanded access to experienced professionals.

Talkspace is a service that provides confidential counseling by text, audio, or video — whatever way feels right for you.  The service pairs you with a licensed, experienced therapist who fits your needs and preferences, so that you feel comfortable from the start.  You can message your therapist whenever something comes up — or schedule a virtual visit to connect in real time.

Talkspace is covered under the Anthem EAP for three visits, or it is also now covered under your behavioral health benefits if you have a Health Trust medical plan.  To get started, use a web browser to register at talkspace.com/associatecare, and enter the letters “EAP”, a space, and “MMEHT” in the “Organization name” field. Once all your information has been completed you will receive information on providers who match your criteria.

To better address mental health and substance use disorders as the chronic conditions they are, Aspire365 was created to deliver long-term in-home treatment and recovery to patients 12 years of age and over.  Aspire365 clients are paired with a multidisciplinary team of mental health professionals to deliver one on one personalized care over a 12-month period. To learn more about Aspire 365 please see the brochure on the Health Trust website, call 385.352.9696, or email info@aspire-365.com.

The Health Trust, in conjunction with Anthem, provides an Employee Assistance Program (EAP) to all employers that participate in the Health Trust health plan.  Anthem EAP offers many great resources to deal with everyday problems and questions, in addition to mental health services. Licensed mental health professionals are available 24/7 without an appointment and at no charge. Employees may speak with a professional counselor near their work or home, and you get a referral for up to three in-person visits at no cost. The service is confidential, in accordance with federal and state law, and professional ethical standards.

The Anthem EAP covers all employees, even those who are not enrolled in the health plan.  It also covers the household members of all employees.  Unfortunately, retirees are not eligible to use this service. To access the EAP call 1-800-647-9151 or go to www.anthemeap.com, choose Login in the Members box and enter “MMEHT”.

The Health Trust has a one-page flyer which outlines the many resources and programs available to you and your family.  Please call Member Services at 1-800-852-8300 with any questions.

Forms 1095-B will be arriving soon

As required by the Affordable Care Act, the Health Trust will be sending out Forms 1095-B to all employees (including non-Medicare retirees and COBRA participants) who were covered under a Health Trust health plan during calendar year 2023. The 1095-B forms provide information on each individual (employee and dependents) who had health coverage through the Trust in 2023, including which months they were covered. Forms will be mailed in mid-February, prior to the March 1, 2023 deadline.

The 1095-B forms provide information that may assist you in preparing your taxes, however they do not need to be filed with the tax returns. The IRS has stated that taxpayers need not wait for these forms, and should file their returns as they normally would. Copies of all of the forms will be filed with the IRS by the Health Trust, through its eligibility vendor.

If you have any questions about your Form 1095-B, please contact the Billing & Enrollment staff at 1-800-452-8786, or htbilling@memun.com.

Life Insurance Benefit Enhancements

The Health Trust is pleased to announce several enhancements to our life insurance benefits, offered through the Standard Insurance Company, and also a special open enrollment period for those who may wish to add or modify coverage.  These changes take effect April 1, 2024.

The maximum benefit for Basic Life will increase from one times the covered employee’s annual base salary up to $100,000, to one times the annual base salary up to $150,000.  If you are covered by a Health Trust health plan, the Basic Life benefit is included, and is paid for by the Trust.

This maximum salary increase will also be applicable to voluntary Supplemental Life elections of one, two or three times the employee’s annual base salary.  If you have this coverage and your salary exceeds $100,000, your premiums may increase based on the increased volume covered.

Members with the Dependent Life Option B plan may also see an increase in the spousal benefit.  This coverage is equal to half of the employee’s base salary.  Therefore, the maximum benefit will increase to $75,000, from $50,000.  The premiums for this plan increased to $3.75 per month January 1, 2024, and there will not be an additional increase April 1. (There are no coverage changes to the Dependent Life Option A plan.  Premiums for this plan increased to $1.75 per month, effective January 1, 2024.)

The Basic Life benefit for retirees who are covered by a Health Trust health plan will increase from $2,000 to $3,000.  This is paid for by the Trust.

The Health Trust will be offering a one-time special Open Enrollment Period February 15 through March 15, 2024 for an effective date of April 1, 2024.   If you did not enroll in Supplemental or Dependent Life coverage when you were first eligible, or if you would like to increase the amount of Supplemental or Dependent Life you currently have, you may do so during the Open Enrollment period.  If you elect coverage that is less than $375,000, your approval will be guaranteed, and you will not be required to submit medical Evidence of Insurability.  This is subject to the Standard’s eligibility policies, and the plans your employer offers.  If you were previously declined for Supplemental or Dependent Life coverage with your current employer through the evidence of Insurability process, you are not eligible during this special open enrollment period.

If you wish to add or change coverage for April 1, 2024 under this special Open Enrollment, the Life Plan Enrollment Form or Life Plan Change Form must be dated between February 15 and March 15, and received by the Health Trust no later than March 31, 2024.  Forms for established employees received after March 31, 2024 will be subject to evidence of insurability.  We encourage you to consider taking advantage of this one-time opportunity to add coverage to protect your family.

For more information click here

Health Plan Benefit Changes Effective January 1, 2024

The following changes will be effective for the Health Trust POS and PPO health plans, effective January 1, 2024.

Behavioral Health Services via Telehealth – In order to address access and other barriers to receiving behavioral health services during the pandemic, the Board of Trustees has waived the copayment for members who receive in network mental health or substance use disorder services via telehealth since 2021.  The Board recognizes that the need for these services remains strong.  While visits to primary care and specialty physicians have returned to more normal “in-person” utilization patterns, utilization of telehealth for behavioral health services continues to increase.

In order to facilitate continued utilization of these services, the Board of Trustees has eliminated the copayment for members who receive in-network mental health or substance use disorder services via telehealth.  These services will be paid at 100% for all of the Trust health plans.

Fertility BenefitsEffective January 1, 2024, all Trust health plans will include coverage for medically necessary fertility services, as mandated by the State of Maine. Medically Necessary Covered Services will include procedures to determine an individual’s fertility and services such as artificial insemination (three lifetime cycle limit), egg retrieval and cryopreservation, and in vitro fertilization (two lifetime cycle limit). Please contact the Health Trust for additional benefit details.

Coverage for Recreational ProstheticsEffective January 1, 2024, in accordance with state mandates, all Health Trust health plans will provide coverage for one prosthetic device that meets the medical needs of a participant under age 18 for recreational purposes.

Coverage for Certain Dental Procedures for a member who has been diagnosed with cancer – Effective January 1, 2024, in accordance with a new Maine law, certain medically necessary dental procedures for a member who has been diagnosed with cancer will be covered under all Health Trust health plans. Routine preventive dental care is not covered.

Home Delivery Changes Coming in the New Year

Effective January 1, 2024, your home delivery carrier will migrate from CarelonRX Mail to CarelonRX Pharmacy. You will have the same benefits you currently have, with the addition of some new features:

  • 90-day supply of medication for two copayments
  • Free standard mail delivery right to your door
  • Text, chat or talk with a pharmacist 24/7
  • Enhanced order tracking
  • Easy to use online tools
  • Refill reminders and automatic refills

What do you need to do?

If you currently fill prescriptions utilizing mail order delivery, you should have received a letter in fall 2023 with more details.

If you have refills left January 1, they will automatically be moved to CarelonRX Pharmacy. If you are signed up for automatic refills those will automatically transfer to CarelonRX Pharmacy too. There is no need to re-enroll. If you do have any refills left, CarelonRX will contact your doctor and have them send a new prescription to CarelonRX Pharmacy.

After January 1, 2024, you will need to contact CarelonRx Pharmacy to confirm your payment information.  If you have any prescriptions that ship before your payment information is confirmed, your member cost share will be reflected on an invoice included within your shipment.

Please be aware that CarelonRX Pharmacy may call members to confirm account information, such as payment method and allergies.

If you have any questions please contact Member Services at 1-800-852-8300 Monday to Friday, 8 a.m. to 4:30 p.m. or login to your Anthem.com account.

Download flyer

Trustee Changes – Thank You and Welcome

After serving for more than forty years on the Maine Municipal Employees Health Trust Board of Trustees, Richard Metivier, formerly the Finance Director for the City of Lewiston, has retired from the Trust Board, effective December 31, 2023.

Dick was a dedicated member of the Trust Board since its inception, and served as its Chairman from 1993 to 1998. After Dick graduated from Husson College with a B.S. in Business Administration, his first job was for the City of Lewiston as Assistant to the Controller.  This allowed him to work in his hometown, and to gain a highly respected  level of expertise in municipal government and finance.  He has been truly committed to representing the interests of MMEHT members and retirees, and to ensuring they have access to the best possible coverage, and to controlling costs and limiting premium growth. Dick will continue as a nominee of the Maine Municipal Association on the MainePERS board, representing the Participating Local Districts.  The MMEHT Board of Trustees and the MMA staff thank Dick Metivier for his four decades of devoted service to the Health Trust and wish him all the best.

The Board of Trustees would also like to thank Martin Puckett and Belle Ryder for their dedicated service to the Trust.  Martin, the former City Manager of Presque Isle, was a member of the Board of Trustees from 2011 to 2023, and was the Board’s most recent Chair.  Belle served on the Board from 2021 to 2023, representing the Town of Orono.  Both Martin and Belle have recently taken new positions outside of municipal government, and we wish them well.

The Trust’s Selection Committee has appointed three new Trustees to replace these departing Trustees on the Board.  The Board of Trustees is pleased to welcome Stephen Fields, Jessica Maloy and Heather Hunter to the MMEHT Board.

Stephen Fields, Town Manager of Corinth, was selected to fill the remainder of the vacant term through December 31, 2023, and then to a three year term commencing January 1, 2024 and ending December 31, 2026.  Stephen has more than ten years’ experience in municipal government in leadership and human resource management roles, representing larger Maine cities and now a very small town. He also served many years in operations management in the Maine Air National Guard.

Jessica Maloy, Finance Director of the Town of Freeport, was appointed as Trustee to fill the remainder of the term ending December 31, 2025.  Jessica has a strong municipal financial background, as she has served 13 years as the Finance Director for two different towns.  She is also the current Chair of the Maine Municipal Tax Collectors Treasurers Association.

Heather Hunter, City Administrator, City of Lewiston, will serve effective January 1, 2024 through December 31, 2026.  Heather has worked for the City of Lewiston for past 34 years, the bulk of which was in the finance department, where she dealt with employee and plan and benefit administration, enrollment, and rate cost-sharing considerations, and also sat on the City’s Wellness Committee.

 

Additional Crisis Support Resources

In response to the recent shooting in Lewiston, Anthem Blue Cross and Blue Shield and its behavioral health partner, Carelon Behavioral Health, are offering all Mainers free access to crisis support, regardless of whether they are Anthem members.

Anthem Blue Cross and Blue Shield in Maine has stated that they “are committed to helping our community heal in the wake of this tragedy,” and “hope that by providing free crisis support to anyone in need, we can support our neighbors and our community during this difficult time.”

Carelon Behavioral Health indicated that mass violence and shootings affect people in many different ways,” which is why “it’s important to share your concerns and monitor your mental health during these extremely difficult circumstances. A phone call can often lessen anxiety, fear and channel our emotional response within times of crisis.”

Any Mainer needing assistance can speak to a behavioral health professional via phone by calling 1-800-580-6934. The crisis support line is confidential and available 24/7 at no cost.

EAP Services Available

The Health Trust expresses its deepest concerns for all affected by the tragic event that occurred in the City of Lewiston. We want to remind our employers and their employees that the Health Trust, in conjunction with Anthem, provides an Employee Assistance Program (EAP) to all employers that participate in the Health Trust health plan.  For many employees, talking with a professional resource can be the key to recovering from a traumatic event.

The Anthem EAP covers all employees, even those who are not enrolled in the health plan.  It also covers the household members of all employees.  Unfortunately, retirees are not eligible to use this service.

To access EAP resources, call 1-800-647-9151 or go to www.anthemeap.com and choose Login in the Members box and enter “MMEHT”.

The Health Trust also offers Critical Incident Response (CIR) services to employers who offer the health plan.   This program provides trained professionals to help your employees through times of crisis when they are exposed to events such as this.

For more resources and flyers about the EAP or CIR programs please visit the Health Trust website:

https://www.mmeht.org/other-benefits/employee-assistance-program/

https://www.mmeht.org/wp-content/uploads/employer-resources/CIR-Handout-4-2023.pdf

1 2 3 6

Search

+