Plan Documents

City of Portland

Special Notice Documents

City of Portland Health Plan Notice Packet
City of Portland Health Plan Notice Packet (Spanish)
New Health Insurance Market Place Coverage - Options and Your Health Coverage
New Health Insurance Market Place Coverage - Options and Your Health Coverage (Spanish)
Model CHIP Notice
Model CHIP Notice (Spanish)
Model - 1095-C Notice of Availability

Transparency in Coverage Machine Readable Files

Meritain Machine Readable Files

RETIREMENT

MainePERS PLD Welcome Booklet
MainePERS Welcome Booklet
MissionSquare 401(a) Money Purchase
MissionSquare 401(a) Plan Highlights
MissionSquare Saving for Retirement Informational Brochure
MissionSquare - Retirement Education Center
Pension Comparison Chart French
MePERS Rates

SUPPLEMENTAL RETIREMENT SAVINGS PLAN

MissionSquare 5 Reasons to Consider an IRA Flyer
MissionSquare 457 PTS Plan Information Brochure
MissionSquare 457(b) Deferred Compensation Plan Information
MissionSquare Quick Reference Guide
MissionSquare Saving for Retirement Informational Brochure

LIFE INSURANCE

MainePERS Group Term Life Insurance Coverage Fact Sheet

DISABILITY INSURANCE

Unum Long Term Disability - Union for ICMA-RC 401a
Unum Long Term Disability - Non-Union for ICMA-RC 401a
MainePERS Overview of City Benefits
UNUM LTD Contract
UNUM LTD Benefits at a Glance
Income Protection Plan Booklet
Income Protection Plan Booklet - French
Long Term Disability (LTD) Summary
Short Term Disability (STD) Income Protection Plan (IPP) Summary

MEDICAL

Find a Telehealth Mental Health Provider
Find a Telehealth Mental Health Provider (Spanish)
Medical Plan Summary of Benefits (English)
Health Insurance Basics - English
Health Insurance Basics - French
Health Insurance Basics - Somali
Meritain Health - Available Discounts
Medical Plan – Summary of Benefits and Coverage
Medical Plan – Summary of Benefits and Coverage - Portuguese
Medical Plan – Summary of Benefits and Coverage - Spanish
Medical Plan – Summary of Benefits and Coverage - Lingala
Medical Plan – Summary of Benefits and Coverage - Arabic
Medical Plan – Summary of Benefits and Coverage - French
Medical ID Card
Meritain Health - Members Flyer Teladoc Extended Overview BH and Registration
Meritain Health - Members Flyer Meritain Portal Web Guide Extended QR
Meritain Health - Members Flyer OIC Online Access
Meritain Health - Members Flyer Coordination of Benefits
Meritain Health Members Flyer 2023 Surgery Benefits
Meritain Health - Members Flyer YouTube Videos City of Portland
How to Use Your Meritain Medical Portal
How to Use Your Meritain Medical Portal (Spanish)
Find a Telehealth Mental Health Provider
Find a Telehealth Mental Health Provider (Spanish)
Meritain Medical Mobile App - iPhone Instructions (English)
Meritain Medical Mobile App - Android Instructions (English)
Meritain Medical Mobile App - iPhone Instructions (Spanish)
Meritain Medical Mobile App - Android Instructions (Spanish)
MERITAIN Member-Presentation Enrollment City of Portland Maine MERITAIN Member-Presentation Enrollment City of Portland Maine

PHARMACY - MERITAIN & CVS CAREMARK

CVS Caremark Mail Order Form
Medical Plan – Summary of Benefits and Coverage - Portuguese

TELEHEALTH

Teledoc Virtual Doctors Visits

MEDICAL - FORMS

CVS Caremark Mail Order Form
COVID-19 Test Reimbursement Claim Form
Medical Plan – Summary of Benefits and Coverage - Portuguese

MEDICAL - COMPLIANCE NOTICES

Surprise Billing Notice
Medical Plan – Summary Plan Description

WELLNESS

2025 Wellness Program Overview
Fitness Reimbursement Program
Provider Biometric Form
2025 OMC Wellness Portal Instruction QR Code Flyer
2025 OMC Wellness Portal Instructions QR Code Flyer (French)
2025 OMC Wellness Portal Instructions QR Code Flyer (Spanish)
2025 OMC Wellness Portal Instructions QR Code Flyer (Portuguese)
2025 OMC Wellness Flyer
2025 OMC Wellness Flyer (French)
2025 OMC Wellness Flyer (Spanish)
2025 OMC Wellness Flyer (Portuguese)

FSA

Navia - Claim Form
Navia - Claim Submission Tools
Navia - Enrollment Kit
FSA Summary Plan Description
MyNavia - App Registration Guide
Navia - Participant Online Registration Instructions
Navia Worksheet - Health and Day Care FSA Expense Estimation

DENTAL

Delta Dental - Carryover Benefit
Delta Dental - Claim Form
Delta Dental - Terms You Should Know - French
Delta Dental - Terms You Should Know - Somali
Delta Dental - Terms You Should Know
Delta Dental - Nondiscrimination Notice
HOW Patient and Provider Instructions
HOW FAQs
HOW Summary of Enhanced Benefits

Vision

Aetna Voluntary Vision - Benefit Summary
Aetna Voluntary Vision Out of Network Claim Form (English)
Aetna Voluntary Vision Out of Network Claim Form (Spanish)

SUPPLEMENTAL HEALTH

Cigna - Accidental Injury Insurance
Cigna - Critical Injury Insurance
Cigna Supplemental Health – CI Wellness Benefit
Cigna - Hospital Care Insurance
Cigna – How to File a Claim
Cigna - How to File a Claim (Arabic)
Cigna - How to File a Claim (Chinese)
Cigna - How to File a Claim (Croatian)
Cigna - How to File a Claim (French)
Cigna - How to File a Claim (Haitian Creole)
Cigna - How to File a Claim (Portuguese)
Cigna - How to File a Claim (Somali)
Cigna - How to File a Claim (Spanish)

Critical illness

Cigna Benefit Summary - Critical Illness Insurance
Cigna Supplemental Health – CI Wellness Benefit
Cigna Benefit Summary - Critical Illness Insurance - Arabic
Cigna Benefit Summary - Critical Illness Insurance - Croatian
Cigna Benefit Summary - Critical Illness Insurance - French
Cigna Benefit Summary - Critical Illness Insurance - Hatian Creole
Cigna Benefit Summary - Critical Illness Insurance - Lingala
Cigna Benefit Summary - Critical Illness Insurance - Portuguese
Cigna Benefit Summary - Critical Illness Insurance - Somali
Cigna Benefit Summary - Critical Illness Insurance - Spanish
Cigna Benefit Summary - Critical Illness Insurance - Traditional Chinese

Accident Insurance

Cigna Benefit Summary - Accident Insurance
Cigna Benefit Summary - Accident Insurance - Arabic
Cigna Benefit Summary - Accident Insurance - Croatian
Cigna Benefit Summary - Accident Insurance - French
Cigna Benefit Summary - Accident Insurance - Hatian Creole
Cigna Benefit Summary - Accident Insurance - Lingala
Cigna Benefit Summary - Accident Insurance - Portuguese
Cigna Benefit Summary - Accident Insurance - Somali
Cigna Benefit Summary - Accident Insurance - Spanish
Cigna Benefit Summary - Accident Insurance - Traditional Chinese

Hospital Indemnity Insurance

Cigna Benefit Summary - Hospital Indemnity Insurance
Cigna Benefit Summary - Hospital Indemnity Insurance - Arabic
Cigna Benefit Summary - Hospital Indemnity Insurance - Croatian
Cigna Benefit Summary - Hospital Indemnity Insurance - French
Cigna Benefit Summary - Hospital Indemnity Insurance - Hatian Creole
Cigna Benefit Summary - Hospital Indemnity Insurance - Lingala
Cigna Benefit Summary - Hospital Indemnity Insurance - Portuguese
Cigna Benefit Summary - Hospital Indemnity Insurance - Somali
Cigna Benefit Summary - Hospital Indemnity Insurance - Spanish
Cigna Benefit Summary - Hospital Indemnity Insurance - Traditional Chinese

PROFESSIONAL DEVELOPMENT

50% Tuition Discount on USM Undergrad and Grad Degree Classes
Thomas College Overview
Community College Scholarships
Thomas College Discount Form

Plan Documents

City of Portland

Special Notice Documents

City of Portland Health Plan Notice Packet

City of Portland Health Plan Notice Packet (Spanish)

New Health Insurance Market Place Coverage - Options and Your Health Coverage

New Health Insurance Market Place Coverage - Options and Your Health Coverage (Spanish)

Model CHIP Notice

Model CHIP Notice (Spanish)

Model - 1095-C Notice of Availability

Transparency in Coverage Machine Readable Files

Meritain Machine Readable Files

RETIREMENT

MainePERS PLD Welcome Booklet

MainePERS Welcome Booklet

MissionSquare 401(a) Money Purchase

MissionSquare 401(a) Plan Highlights

MissionSquare Saving for Retirement Informational Brochure

MissionSquare - Retirement Education Center

Pension Comparison Chart French

MePERS Rates

SUPPLEMENTAL RETIREMENT SAVINGS PLAN

MissionSquare 5 Reasons to Consider an IRA Flyer

MissionSquare 457 PTS Plan Information Brochure

MissionSquare 457(b) Deferred Compensation Plan Information

MissionSquare Quick Reference Guide

MissionSquare Saving for Retirement Informational Brochure

LIFE INSURANCE

MainePERS Group Term Life Insurance Coverage Fact Sheet

DISABILITY INSURANCE

Unum Long Term Disability - Union for ICMA-RC 401a

Unum Long Term Disability - Non-Union for ICMA-RC 401a

MainePERS Overview of City Benefits

UNUM LTD Contract

UNUM LTD Benefits at a Glance

Income Protection Plan Booklet

Income Protection Plan Booklet - French

Long Term Disability (LTD) Summary

Short Term Disability (STD) Income Protection Plan (IPP) Summary

MEDICAL

Find a Telehealth Mental Health Provider

Find a Telehealth Mental Health Provider (Spanish)

Medical Plan Summary of Benefits (English)

Health Insurance Basics - English

Health Insurance Basics - French

Health Insurance Basics - Somali

Meritain Health - Available Discounts

Medical Plan – Summary of Benefits and Coverage

Medical Plan – Summary of Benefits and Coverage - Portuguese

Medical Plan – Summary of Benefits and Coverage - Spanish

Medical Plan – Summary of Benefits and Coverage - Lingala

Medical Plan – Summary of Benefits and Coverage - Arabic

Medical Plan – Summary of Benefits and Coverage - French

Medical ID Card

Meritain Health - Members Flyer Teladoc Extended Overview BH and Registration

Meritain Health - Members Flyer Meritain Portal Web Guide Extended QR

Meritain Health - Members Flyer OIC Online Access

Meritain Health - Members Flyer Coordination of Benefits

Meritain Health Members Flyer 2023 Surgery Benefits

Meritain Health - Members Flyer YouTube Videos City of Portland

How to Use Your Meritain Medical Portal

How to Use Your Meritain Medical Portal (Spanish)

Find a Telehealth Mental Health Provider

Find a Telehealth Mental Health Provider (Spanish)

Meritain Medical Mobile App - iPhone Instructions (English)

Meritain Medical Mobile App - Android Instructions (English)

Meritain Medical Mobile App - iPhone Instructions (Spanish)

Meritain Medical Mobile App - Android Instructions (Spanish)

MERITAIN Member-Presentation Enrollment City of Portland Maine MERITAIN Member-Presentation Enrollment City of Portland Maine

PHARMACY - MERITAIN & CVS CAREMARK

CVS Caremark Mail Order Form

Medical Plan – Summary of Benefits and Coverage - Portuguese

TELEHEALTH

Teledoc Virtual Doctors Visits

MEDICAL - FORMS

CVS Caremark Mail Order Form

COVID-19 Test Reimbursement Claim Form

Medical Plan – Summary of Benefits and Coverage - Portuguese

MEDICAL - COMPLIANCE NOTICES

Surprise Billing Notice