Benefits Open Enrollment

Yes, the CMH Health Savings Account (HSA) health insurance plan has a zero-dollar premium for wellness participants. If you participate in the wellness plan, no premiums are deducted from your paycheck for employee-only coverage.

To enroll in the CMH Wellness program, download these instructions. To get the discount for the first quarter of 2025, you must meet the annual requirements and achieve the 75 points in the last quarter of 2024.

Health plan premiums are on average 35% higher at other health care systems. They do not have a zero-premium option.

No.

Yes.

A deductible is a fixed dollar amount the covered member must pay out of pocket each calendar year before the plan will begin to pay for eligible expenses.

Co-insurance is the percentage of cost the covered member pays after meeting the deductible

The maximum amount a member might pay during a covered plan year, excluding copayments.

The CMH health insurance plan pays for one free routine eye exam per calendar year. You must go to an in-network provider, and the office must run the exam through medical insurance.

The Vision Plan is a hardware plan. This reimburses an individual for purchasing glasses or contacts. There are some vision offices that will take the reimbursement off up front.

A health savings account functions like a personal bank account that can be used to pay for health related expenses. These health-related expenses include but aren’t limited to:

• Pharmacy expenses
• Physician office visits
• Contact lens solution
• Hearing aids
• Over-the-counter medications (cold, flu, allergy, sinus, indigestion)
• Chiropractor visits
• Adult diapers
• Feminine hygiene products
• Dental and orthodontia care (including braces)
• C-pap machine and supplies 
• Deductible and coinsurance amounts
• Sunscreen 
• First aid supplies 
• Nebulizers
• Prenatal vitamins
• Rehabilitation (physical therapy, occupational therapy, speech therapy)
• Glucometers

You choose how much money to contribute to your HSA. Money added to the HSA is not taxable income.

For example, if your gross income (before deductions) is $1,000 each pay period and you contribute $50 per pay period to your HSA, only $950 is subject to income tax, not the full $1,000. 

A $50 HSA contribution per pay period adds up to $1,300 in an HSA at the end of the calendar year if you don’t incur any medical expenses.

You are responsible for all health care costs up to your deductible before coinsurance applies to expenses. Contributions to a Health Savings Account will help pay for these costs. You are not required to contribute money to your HSA each pay period, but it is advisable to do so. Contributing to your HSA is a personal choice based on the health care needs of you and your family. Please reference page 6 of the employee benefit guide for deductible and coinsurance amounts.

You can contribute any amount you choose up to the maximum set by federal law:

• Individual — $165 ($4,300/year)
• Family — $328 ($8,550/year)

Employees 55 years of age and older:

• Individual — $203 per pay period ($5,300/year)
• Family — $367 per pay period ($9,550/year)

You can change your per-pay-period contribution to your HSA at any time throughout the year.

Money in your HSA account carries over from year to year and goes with you even if you change employers. What you don’t spend this year will be available for health care costs next year.

Yes, it is health insurance. In compliance with federal law, the health plan requires the deductible to be met before the plan covers any portion of the medical and prescription expenses.

The employee must pay “out of pocket” up to the deductible amount before the health plan pays for any medical expenses. It does not have a fixed “copay” for office visits.

Yes. However, CMH elected to keep the deductible low ($2,500 for an individual and $4,000 for a family). This amount is lower than the Basic plan and comparable to the Buy-Up plan.

If you elect the HSA health insurance plan, you may contribute to a Health Savings Account. It functions like a personal bank account to pay for health-related expenses. See more details about the Health Savings Account below.

Yes, the HSA covers prescription medications. You will be responsible for the cost of the drug and the full amount that you pay applies to your deductible. Once you meet your deductible, you are responsible for 15% of the drug cost. Our Health Plan is moving to a new prescription benefit manager and more details will be provided once those costs are known.

With the HSA Health Plan, you will pay 15% of the total charges after the provider discount has been applied (as indicated on your Explanation of Benefits).

Example: If the total charge of the service is $1,000 and the provider discount is $700, the employee would be responsible for $45 (15% of $300) for coinsurance. Remember, this only applies after you have met the deductible.

With the Basic Plan, you will pay 20% until you meet the out-of-pocket maximum. You will still pay $35 for primary care or walk-in clinic visits, $75 for specialist visits and prescription copays.

With the Buy-Up Plan, you will pay 20% until you meet the out-of-pocket maximum. You will still pay $30 for primary care or walk-in clinic visits, $60 for specialist visits and prescription copays.

Regardless of the health insurance plan you select, preventative care (including eye exams) is fully covered by your health plan. You will have $0 out-of-pocket cost as long as you go to an in-network provider.

The cost of your medication.

It is advisable to contribute to the HSA account so money is available for unexpected health care expenses, even if it is a small amount like $10 per pay period. You are responsible for all health care costs up to the amount of your deductible. After meeting your deductible, coinsurance applies to the health care costs. You can use funds in your HSA to pay for these expenses. Refer to page 6 of the 2025 Benefits Guide for a complete list of deductibles and coinsurance.

The best way to estimate your potential health care costs is to look at what you spent on health care in 2024. You can view your Explanations of Benefits (EOB) through the Meritain Member Portal. (Download instructions for accessing the portal.)The EOBs have your claim data for the current calendar year. The cost of the service is the “Total Charges” minus the “Provider Discount” (as indicated on the EOB).

In this example of a mental health visit, you would pay $144.36 ($213 - $68.64) on the HSA health insurance plan. This amount applies toward your deductible. If you had met your deductible when this claim was submitted, your cost would be $21.64 (15% of $144.36).

With the Basic plan, you would pay a $35 copay before and after the deductible is met until you meet your out-of-pocket maximum. The $35 payment would not apply to your deductible.

With the Buy-Up plan, you would pay a $30 copay before and after the deductible is met until you meet your out-of-pocket maximum. The $30 payment would not apply to your deductible.

The Basic and Buy Up plans have a separate pharmacy deductible you must meet before getting any benefit when using a pharmacy other than Stephens. The deductible does not apply when using Stephens Pharmacy.

For employees on the HSA plan, you likely will pay more for your medications while working toward your deductible. Stephens will give you the most significant savings on medications.

Stephens Pharmacy offers free home delivery in Bolivar and to any CMH clinic or long-term care facility outside of Bolivar. Stephens can also mail prescriptions for the cost of the prescription plus postage.

Stephens can mail your prescription at the best price, plus postage. If you need a prescription sooner, Stephens can help you find a pharmacy that is part of our nationwide secondary network. You can also call the number on your card or use Ventegra’s member portal to locate in-network pharmacies.

Yes, a three-month supply of medications is available for the cost of two monthly co-pays. You will also have the convenience of only filling your prescription every three months.

A 90-day supply requires a prescription from your doctor specifying the 90-day supply. Even if you have refills left on a monthly prescription, ask your doctor to write a new prescription for a 90-day supply and send it to Stephens Pharmacy.

No, because Stephens Pharmacy’s cash prices are better than what you will find on GoodRx.

Yes. Stephens Pharmacy will honor the $4 generics list. When you fill these prescriptions at Stephens, your prescription payment applies toward your deductible and out-of-pocket maximum. If you fill the prescription anywhere else, the payment will not apply to your deductible or out-of-pocket total.

Stephens can provide a majority of medications. In the unlikely event that your medication is not available, Stephens will help you find the right pharmacy.

Ask your provider to change your preferred pharmacy in your medical record and send a new prescription to Stephens, even if you have refills remaining on your current prescription.

Contact Stephens Pharmacy to see if your medication and supplies can be provided.

No. However, Stephens Pharmacy will help you find the best pricing and manufacturer assistance coupons.

Call Stephens Pharmacy at 417-328-4747. Stephens Pharmacy has a dedicated employee to help CMH employees find the best prescription prices.