Plan Details
Medical
Benefit Summary
In-Network Services
Out-of-Network Services
Health Savings Account - Employer Contribution
**The out-of-pocket maximum is the most you and your family will be responsible to pay out of pocket for services during the year. The single out-of-pocket maximum amount is embedded in the family out-of-pocket maximum. Therefore, when the deductible and coinsurance for one person reaches the individual out-of-pocket maximum, that individual is covered at 100% for the rest of the year. The family is capped at the family out-of-pocket maximum.
Consumer Choice 250
Family: $3,500 - True Family*
Family: $7,000 - Embedded**
Family: $7,000 - True Family*
Family: $14,000 - Embedded**
Family: $500
Family: $500
Consumer Choice 500
Family: $6,000 - True Family*
Family: $12,000 - Embedded**
Family: $12,000 - True Family*
Family: $24,000 - Embedded**
Family: $1,000
Family: $1,000
Pharmacy
EmpiRx Health manages all of you prescription needs. There are a number of programs that help control your costs. You and your dependents also have access to a board network of pharmacies, which includes all chain pharmacies and most independent pharmacies.
Vision Details
When you enroll in a Medical option, you will automatically be enrolled in Aetna Vision coverage. You can visit any licensed eye care provider.
Savings & Spending Account
Enrollment in a MPM Medical option allows you the opportunity to elect into a Health Savings Account (HSA). The triple-tax savings account can be used to pay for your qualified medical expenses. Momentive contributes money to this HSA on your behalf (assuming you are eligible).
You also have the option of enrolling in a Health Care or Limited Purpose Flexible Spending Account (based on eligibility), or Dependent Care Flexible Spending Account, which offer pre-tax deductions.
Bundled Critical Illness
Critical Illness benefits may help cover costs such as those not covered by your medical plan. When you enroll in a MPM Medical option, you will automatically be enrolled in Critical Illness Insurance that pays a lump sum benefit of up to $2,500 per covered person for each diagnosed covered condition, with a per-person lifetime maximum of $6,000.
Hinge Health
Need assistance with an injury or pain management? Momentive has partnered with Hinge Health to provide all the tools you need to get moving again from the comfort of your home. You’ll receive exercise therapy, tailored to your condition, and an expert personal care team.
Participants must be 18+ and enrolled in a Momentive medical plan to qualify. If qualified, Momentive will cover 100% of the cost!
Sign up today for help with any of the following:
- Conquer pain or limited movement
- Recover from a recent or past injury
- Prepare for and recover from surgery
- Keep joints healthy and pain free
Visit hingehealth.com/momentive to learn more and enroll.
Virta
Reversing type 2 diabetes or managing type 1 diabetes, prediabetes, and obesity with Virta can taste great! Virta uses the research-backed combination of nutritional ketosis, medical supervision, and one-on-one health coaching. You also get all the supplies you need for biomarker tracking, access to a private patient community, and curated recipes, food guides, and meal plans!
Who is Virta for? Virta is available to employees, spouses and adult dependents between the ages of 18 and 79 who are enrolled in the medical plan through Momentive.
What’s the cost? There is no copay or out of pocket cost for the treatment—Virta is fully covered for those that qualify
Dental
Supplemental Critical Illness
Unexpected costs from a critical illness, such as a heart attack or stroke, can add both financial and emotional stress.
Supplemental Critical Illness insurance through MetLife will pay you a tax-free, lump-sum cash benefit if you’re diagnosed with a covered condition. The coverage does not replace your medical benefits. You must have medical insurance to enroll in this coverage (although it is not required that your coverage be through Momentive).
Accident Insurance
If you have an accident, it can lead to extra out-of-pocket costs, beyond what your medical plan may cover.
Group Accident Insurance through MetLife provides you with a lump-sum payment for over 150 different covered conditions, such as fractures, dislocations, concussions, eye injuries and more, as well as covered medical services, like an ambulance ride, emergency care and surgery.
Legal Services Plan
The MetLife Legal Plan gives you access to experts who can assist you with a broad range of personal legal needs you might face throughout your life. This could be when you’re buying or selling a home, starting a family, dealing with identity theft, or caring for aging parents.
Go to the Additional Benefits page for more detailed information.
Disability
Disability benefits help to protect you and your family if you become disabled and are not able to work because of an illness or accident. Disability coverage is administered through Lincoln Financial Group. Momentive provides Basic Short-Term Disability (STD) and Basic Long-Term Disability (LTD) at no cost to you. You can choose to purchase Supplemental STD (subject to eligible classes) or Supplemental LTD during annual enrollment, Evidence of Insurability (EOI) rules apply. Your cost for supplemental coverage will be displayed in the enrollment system.
Life and Accidental Death and Dismemberment
Momentive provides you with Life and AD&D insurance, which gives your family protection and security to cover expenses in the event of your death, such as burial expenses, ongoing mortgage payments, or any other outstanding debts. You also have the option to purchase additional Life and AD&D insurance, Evidence of Insurability (EOI) rules apply, for yourself and your dependents. Amounts can be changed anytime during the year subject to EOI. If you decline coverage as a new hire, you may be subject to EOI should you decide to enroll in the future.
Employee Assistance Program (EAP)
EAP benefits are provided by ComPsych GuidanceResources, which will bring a communications portal, providing video chat, text and secure email options. Confidential support is offered 24/7/365 through unlimited telephonic support and 8 free face-to-face counseling sessions.
EAP is offered to all employees household family members, regardless of participation in Momentive’s medical options.
Connect today:
Assistance Available:
App: GuidanceNow
Link: www.guidanceresources.com
Wed ID: MOMENTIVE
Phone: 800-272-7255
Evidence of Insurability (EOI) – What Is It?
Evidence of Insurability (EOI) is documented proof of good health. An applicant begins the EOI/medical underwriting process by submitting a Medical History Statement (MHS), which along with other information obtained during the underwriting evaluation, is used by Lincoln Financial Group to make a determination.
EOI is generally required for coverage in excess of the guarantee issue amount, elections made after initial eligibility (late entrants), reinstatements due to non-payment and/or applications for previously-declined coverage.
Highmark Northeastern New York creates and publishes Machine-Readable Files on behalf of Momentive. Access the files at mrfdata.hmhs.com.