Click on the link listed below to connect to our health insurance carrier, Meritain Health, to view eligibility and medical claims; order new identification cards; and access flexible spending account (FSA) information/claims. Please remember some functions on this site require you to establish an ID and password.
| Form |
Purpose |
| 2011 Plan Design – (PDF File) |
Provides the highlights of the 2011 Medical Plan |
| Medical Plan Summary Plan Description as of 1/1/2009 - (PDF File) |
A printable copy of Summary Plan Description of WMHS employee medical plan |
Amendments Document 1 – (PDF File)
Amendments Document 2 – (PDF File)
Amendments Document 3 – (PDF File)
Amendments Document 4 pg. 1 – (PDF File)
Amendments Document 4 pg. 2 – (PDF File)
Amendments Document 5 – (PDF File)
Amendments Document 6 – (PDF File)
Amendments Document 7 – (PDF File)
Amendments Document 8 – (PDF File)
Amendments Document 9 – (PDF File) |
Printable copies of the medical plan amendments since the activation of the plan on 1/1/2009
Amendment 7 contains changes to the medical plan effective January 1, 2009, September 1, 2010 and January 1, 2011. Changes effective January 1, 2011, are based on the HealthCare Reform Act. WMHS maintains a grandfathered status under the Patient Protection and Affordable Care Act (PPACA).
Amendment #9 contains changes to the medical plan that are effective January 1, 2012. |
| Meritain Healthy Balance Booklet - (PDF File) |
A useful guide of the employee medical benefits and flexible spending account information |
2011 Medical and Dental Benefit Rate Sheet - (PDF)
2012 Medical and Dental Benefits Rate Sheet - (PDF) |
A printable cost sheet of the medical and dental cost per pay period based on the employee's authorized hours |
| WMHS Medical Network Directory - (PDF File) |
Lists the WMHS Network of Physicians and other providers, phone numbers and specialty |
| Meritain Flexible Spending Account Direct Deposit Form - (PDF
File) |
A printable form to be used when electing to have your FSA reimbursement deposited to your savings or checking account. Must be faxed or mailed with your reimbursement request to Meritain. (Address/fax number on the form)
|
| Meritain Flexible Spending Account Claim Form - (PDF
File) |
A printable form required when submitting your request for reimbursement of your FSA claims. Must be faxed or mailed to Meritain. (Address/fax number on the form) |
| CATALYST Retail Pharmacy Listing - (PDF File) |
Listing of pharmacies in-network (maximum benefit is provided at WMHS
pharmacy) |
| Flex Benefits Change Form - (PDF File) |
Printable form to change benefits. This form can only be used within
30 days of a life status or employment change (such as divorce, marriage, birth, loss
of coverage, or employment hours change). Upon completion, this form is returned to Human Resources. |
| 2010 FSA Eligible Expenses Form - (PDF File) |
Printable form for your use. The IRS establishes the guidelines for reimbursable expenses and a partial list is provided. For additional verification, please visit www.irs.gov and view Publication 502 for a complete listing. |
| 2011 FSA Eligible Expenses Form - (PDF File) |
Printable form for your use. The IRS establishes the guidelines for reimbursable expenses and a partial list is provided. For additional verification, please visit www.irs.gov and view Publication 502 for a complete listing. |
| Meritain Claim Form - (PDF File) |
Insurance claim form for submission to Meritain Health for services rendered not submitted by provider. |
| 2011 Women's Health and Cancer Rights Act- (PDF File) |
Annual Breast Cancer Notification regarding benefits for reconstruction surgery |
| Health Insurance Privacy Notice - (PDF File) |
Printable copy of the 2011 Notice of the Health Insurance Privacy Practices |
If you have any questions regarding this benefit, please call Human Resources at 240-964-8157 or 48159 or email June Ward, Benefits Coordinator at jward@wmhs.com or Jill Rowley, Benefits Assistant at jrowley@wmhs.com or call 240-964-8159.