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Under the terms of the federal Affordable Care Act, employers are responsible for providing employees with certain prescribed notices regarding their health insurance coverage.  For example, all employers offering health insurance benefits to their employees must provide employees with a Summary of Benefits and Coverage, or SBC. This SBC, which follows a standard format prescribed by the federal government, should be distributed to all benefits-eligible employees prior to the beginning of the plan’s open enrollment period each year.

The Health Trust’s open enrollment period will begin on November 15, 2024, and end on December 15, 2024, for a coverage effective date of January 1, 2025.  This means that SBCs must be distributed to all current benefits-eligible employees before November 15 in order to comply with the law.  SBCs must also be provided to any new benefits-eligible employees, so that they are able to review and compare benefits for any health plan(s) in which they are eligible to enroll.

The 2025 SBCs are now available on the Health Trust website, at https://www.mmeht.org/employer-resources/summaries-of-benefits-and-coverage/.

Please note that the Plans have been renamed for 2025.  This information was shared via a letter to all participating employers and members, and in a follow-up email to employers, in mid-September.  For more information on the plan names and other health plan changes for 2025, including a copy of the member letter, please refer to the news article on the Trust website here: https://www.mmeht.org/news/health-plan-changes-for-2025/.

It is important to note that employees must be provided with a copy of the SBC for each plan in which they are eligible to enroll.  So, for example, if employees can choose between the Acadia (formerly the POS C Plan) and the Baxter (formerly the PPO 500) plans, the employer must provide each benefits-eligible employee with the SBC for both plans (Acadia and Baxter).

SBCs may be provided to employees electronically (e.g., via e-mail), as long as certain requirements are met.  If an employee is able to access documents electronically at work, at a location where the employee is reasonably expected to perform his/her work duties, and as long as access to the employer’s electronic information system (e-mail, internet, etc.), is an integral part of the employee’s work duties, the notice may be provided electronically.

However, if there are employees who do not have access to computers at work, and for whom electronic access is not a regular integral part of their work responsibilities, notice must be provided in hard copy (paper) form, unless the employee requests otherwise.  In addition, even if an employee may be provided with an electronic version of the SBCs, if he or she requests a paper copy, you must provide it.

If you have any questions, please feel free to call the Health Trust at 1-800-852-8300.  Thank you.

Employees who wish to make changes to their medical, vision or dental benefits coverage for 2025 may do so during the Health Trust Annual Open Enrollment period.  Open Enrollment starts on November 15 and ends on December 15.  Changes will be effective January 1, 2024.  Please note that open enrollment does not apply to life, income protection or long-term disability benefits.

All forms must be received by the Health Trust by December 15, 2024.  Please submit forms to the Health Trust only for employees who are making a change, and as soon as they are received to ensure they are promptly processed.  Thank you for your corporation.

Please post this Open Enrollment Flyer for your employees.

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.