Choices as unique as you are. Start Here

Transcription

1 Choices as unique as you are Start Here Updated: 1/2/2019

2 Table of Contents Navigate your benefits by clicking on a link below. Introduction...03 Dental Benefits...48 What s New...04 Vision Benefits...50 Coverage & Eligibility...05 How to Enroll...08 Provider Networks...09 Life and Disability Life Insurance Accidental Death and Dismemberment Insurance Medical, Dental and Vision Medical Benefits SEQA Plan EQA Plan...18 PPO Plan HSA Plan Disability Insurance Retirement, PTO and Other Benefits Retirement Benefits...61 Time Away from Work...63 Prescription Drug Benefits Other Programs & Benefits...66 Compare the Plans/Coverage Accidental Injury and Critical Illness Insurance Resources Who to Contact...74 Flexible Spending Accounts... 43

3 Introduction Welcome! At Baylor Scott & White, we re changing healthcare for the better and it all starts with you. Our plans reflect our Strategy, industry best practices and employee feedback. The result is a benefits package that is not only competitive, but among the best in the industry. You make it possible to deliver on our Ambition and we re proud to invest in your health. 3

4 Introduction The following legal notices are available for review on BSWHbenefits.com under Resources: Children s Health Insurance Program Reauthorization Act of 2009 Notice COBRA Initial Notice HIPAA Special Enrollment Rights Notice Medicare Part D Creditable Coverage Notice If you would like a printed copy of these notices or any plan materials, please contact PeoplePlace at This guide summarizes the programs and benefits available to Baylor Scott & White employees and their eligible dependents. Official plan documents, policies and certificates of insurance that contain the details, conditions, maximum benefit levels and restrictions on benefits govern our benefits program are available at BSWHbenefits.com. In case of a conflict between this guide and the official documents, the official documents prevail. The information in this guide isn t a guarantee of benefits. Baylor Scott & White reserves the right to modify or terminate its employee benefit plans and programs at any time for any reason. 4

5 Coverage & Eligibility Coverage & Eligibility Our coverage runs from Jan. 1 - Dec. 31 of each year. Employees, spouses and children who meet our requirements are eligible for coverage by our benefits program. You may waive coverage offered through Baylor Scott & White. However, once you waive coverage, you will not be able to enroll until the next scheduled annual enrollment period or within the deadline required for a qualifying life event, according to applicable federal and/or state laws or the plan documents. 5

6 Coverage & Eligibility Employees You are eligible for medical, dental, vision, flexible spending accounts, short- and long-term disability, life and AD&D insurance if: You are a full-time employee regularly scheduled to work at least 60 hours per pay period You are a part-time employee regularly scheduled to work 40 hours but fewer than 60 hours per pay period Eligible Dependents If you cover yourself, you may enroll your eligible dependents in certain benefits as described in this guide. Eligible dependents include your spouse or common-law spouse, your children or your spouse s children up to the age 26*, including: Natural Step Legally adopted In the process of legal adoption Foster Covered by a Qualified Medical Child Support Order Child(ren) of whom you have legal guardianship Does your dependent also work for Baylor Scott & White? If you and a dependent both work for Baylor Scott & White, only one of you can be covered as a dependent. Neither can be covered as both an employee and a dependent. Please note: Baylor Scott & White will be conducting a dependent verification in 2019 to ensure family members covered by our plans meet the eligibility criteria. Documentation such as marriage certificates, birth certificates, and tax forms may be requested. It is important to submit everything in a timely manner to ensure dependents remain covered. *Subject to approval, the age limit is waived if the child is unmarried, physically and mentally incapacitated and unable to earn an independent living; dependent on you for at least 50% of financial support; claimed by you as a dependent for federal taxes; and disabled and covered under the plan before age 26. 6

7 Coverage & Eligibility Thrive-ing for Better Health Every Baylor Scott & White Health employee and spouse, whether you're full-time, part-time or PRN, enrolled in the medical plan or not can participate in wellness! What type of activities are available? Wellness website with trackers, recipes, free challenges and more Wellness discounts for fitness centers, weight management programs and others Onsite fitness classes at select Baylor Scott & White locations Community Races. How can I find out more? Log into the wellness website at thriveforwellness.com using your Baylor Scott & White computer username and password. What is the Thrive Requirement for 2019? Those employees hired on or after October 1 are exempt from the 2019 Thrive Requirement. 7

8 How to Enroll How to Enroll Simply log in to PeoplePlace and follow these steps: 1. Click Benefit Details 2. Click Benefits Enrollment 3. Click Select to choose your 2019 benefits and add or update your dependents and beneficiaries 4. Click Save and Continue to accept your final choices 5. Click Submit to finalize your choices You only have 30 days to sign up for your benefits after you are first hired, or become benefits eligible. 8

9 Provider Networks Provider Networks Please note that not all plans offer the same network. TIER 1 TIER 2 TIER 3 A Texas-based network managed by Baylor Scott & White Quality Alliance (BSWQA), in conjunction with Scott and White Health Plan (SWHP). The SEQA/EQA plan only includes providers in this network (except in cases of urgent/emergency care or rare situations when an in-network provider is not available and authorization is provided). Available with the SEQA/EQA, HSA and PPO plans. A national network, managed by Cigna, in conjunction with SWHP. Providers who are not included in the Tier 1 or Tier 2 networks. Choosing providers in Tier 3 will always be the most expensive option. Available with the PPO and HSA plans. Out-of-Area Coverage: If you or your dependent(s) live more than 40 miles from a Tier 1 BSWQA Network hospital, you should consider either the Preferred Provider Organization (PPO) plan or Health Savings Account (HSA) plan because of their expanded provider network. To find out if there are network providers who practice in the location where you or your dependent(s) live, click here. 9

10 Provider Networks Tier 1 Baylor Scott & White Quality Alliance (BSWQA) Network Our Tier 1 BSWQA Network is always the best bet. These providers commit to, and are accountable for, providing quality, efficient and cost-effective care. About BSWQA The Baylor Scott & White Quality Alliance (BSWQA) is an Accountable Care Organization (ACO). It s a complete network of more than 6,500 primary care and specialty care physicians, 49 hospitals and more than 95 post-acute care facilities all working together to manage your health and wellbeing at an affordable price. How does an ACO work? You choose a BSWQA primary care doctor, and he or she focuses on your overall wellbeing and coordinates your care so you achieve your health goals. Your doctor keeps your health information in an electronic health record to monitor your health history, test results and any gaps in your care. How it benefits you It s personal. BSWQA doctors and facilities have secure access to your medical history* so they know you before you walk through the door. It s accountable. BSWQA doctors are accountable for achieving specific quality, patient satisfaction and cost measures. It s affordable. Staying in-network with BSWQA doctors and facilities can save you money on copays and out-of-pocket expenses. *Depending on your doctor s electronic health record system. 10

11 Provider Networks Find a Tier 1 BSWQA Network provider today! Visit bswh.swhp.org or call the HealthAccess Line at Or download the MyBSWHealth app from the Apple App Store or Google Play. Log in using the same user name and password you use for the Scott and White Health Plan Member Portal to search for providers. The MyBSWHealth app is the easy and convenient way to manage your healthcare and access your health benefits, including your prescriptions. Did you know? Since 2016, the network has grown nearly 39% providing high-quality care where and when you need it. Pediatric access has increased 32.5% and primary care access has increased 31%. And there s more growth on the horizon. Nearly 88% of employees and dependents covered by our health plan currently use our Tier 1 BSWQA Network! 11

12 Medical Benefits Medical Benefits We offer three different medical plans to fit your lifestyle and your budget: SEQA/EQA, PPO and HSA. No matter what life brings, we ve got you covered. Your Personal Benefits Counselor Choosing the right benefits can be tough but help is just a few clicks away. Ask Alex is our easyto-use virtual benefits counselor who can help you understand and select your benefits for Visit BSWHbenefits.com, click Ask Alex and under "Medical and Prescription" answer a few simple questions. Alex will review your answers, explain your options and help you make the best choices for you and your family. Use his advice as a guide and be sure to use your other resources before making a final decision. 12

13 Medical Benefits SEQA Plan Medical Benefits SEQA Plan The Select Exclusive Quality Alliance (SEQA) plan is available to employees making $25.00 or less per hour. This plan has no deductible and exclusively includes providers in the Tier 1 BSWQA Network, except in cases of urgent/emergency care or rare situations when an innetwork provider is not available and authorization is provided. Live more than 40 miles from a Tier 1 BSWQA Network hospital or have out-of-state dependents? Consider the PPO or HSA plans as they offer an extended network of providers through Tier 2 and Tier 3 coverage. 13

14 Medical Benefits SEQA Plan Plan highlights: There is no deductible Preventive care is covered at 100% (when billed as preventive care) Copays apply for non-preventive visits $10 copay for a PCP visit $40 specialist visit $50 copay for urgent care $150 copay per day for inpatient hospitalization (up to a max of five days) $150 copay for outpatient care $150 copay for MRI $100 copay for advanced imaging (CT, CAT, and PET scans) $250 copay for emergency visit. Waived if admitted, then inpatient copay applies 14

15 Medical Benefits SEQA Plan How You Pay for Care: You pay for care from your pocket. You can also set aside pre-tax dollars through a flexible spending account (FSA) to help cover certain expenses. Deductible: This plan does not have a deductible. Copays: You pay copays from your pocket. You can also set aside pre-tax dollars through a FSA to help cover certain expenses. Preventive visits are covered at 100%. This plan also offers very low copays for non-preventive office visits (for example, a primary care visit is $10). Urgent care visits, inpatient and outpatient services also have copays making it easy to understand your out-of-pocket responsibility. Prescriptions: You pay copays for prescriptions (as low as $3-$5) from your pocket or from your FSA. There s no cost for diabetic medicine and supplies with this plan! Network: This plan only includes providers in our Tier 1 BSWQA Network. Be sure to check bswh.swhp.org to verify your provider is available with this plan. No out-of-network coverage is available, except in cases of urgent/emergency care or rare situations when an in-network provider is not available and authorization is provided. How does this plan work? This plan is available to employees who make $25.00 or less per hour. Coverage is in-network only, meaning the cost of care will only be covered if you see a provider in the Tier 1 BSWQA Network. Exceptions include urgent/emergency care or rare situations when an in-network provider is not available and authorization is provided. If you live more than 40 miles from a Tier 1 BSWQA Network hospital or cover dependents who live out-ofstate, you should consider the PPO or HSA plans due to their expanded network coverage. Still have 2018 HRA dollars? You can still use remaining HRA funds to pay for care in 2019 if you enroll in the SEQA/EQA or PPO plan and receive care from a Tier 1 BSWQA Network provider (or urgent/emergency care). If you don t have HRA rollover dollars, consider setting money aside in an flexible savings account (FSA) to pay for eligible expenses. Just remember that FSAs are subject to use-it-or-lose-it rules. 15

16 Medical Benefits SEQA Plan How much do I pay for preventive care? Preventive care*, such as physicals, screenings, immunizations and more are provided at no cost. Preventive eye exams are not included as part of our medical plans. If you or a covered dependent need routine eye care, our vision plan can help make glasses and contacts more affordable. *Services will be covered at 100% when billed with a preventive diagnosis code. How much do I pay for prescription drugs? You ll pay low fixed copays or coinsurance for prescription drugs with Baylor Scott & White Health Pharmacies (mail order and retail), as well as Contracted Pharmacies. When you utilize a Baylor Scott & White Health Pharmacy, covered generics are just $3. With such low copays, the prescription costs are not eligible for payment from your HRA, but do count toward your out-of-pocket maximum. Click here to learn more about our prescription drug benefits. How much is the deductible? The SEQA plan does not have a deductible! How much is the out-of-pocket maximum? Your out-of-pocket maximum will vary based on how many dependents you are covering. All plans have an embedded outof-pocket maximum so that no one in the family must pay more than the individual maximum. Will I have out-of-pocket protection? Yes. Your copays and coinsurance count toward your outof-pocket maximum. Once you reach your out-of-pocket maximum, the plan will pay 100% of the cost of any additional eligible care expenses. Can I pair this plan with a Flexible Spending Account (FSA)? Yes. You can open a general-purpose FSA to pay for your eligible healthcare expenses with tax free dollars. You can use this account to pay for copays, coinsurance, qualifying dental and vision costs, as well as any other eligible expenses. In the rare event you require medically necessary treatment and a provider is not available in the Tier 1 BSWQA Network, your provider can work with Scott and White Health Plan to submit a request for authorization. 16

17 Medical Benefits SEQA Plan Employee Premiums Medical Benefits SEQA Plan Employee Premiums 2019 Medical Premiums Per Pay Period Part-Time Employee Premiums Per Pay Period Your Hourly Rate Coverage Tier SEQA Coverage Tier SEQA Up to $13/hour Employee only $9 Employee + spouse $63 Employee + child(ren) $62 Employee + family $106 Employee only $18 Employee only $92 Employee + spouse $274 Employee + child(ren) $194 $13.01 to $25/hour Employee + spouse $103 Employee + child(ren) $90 Employee + family $146 Employee + family $327 $25.01 to $48/hour Employee only Employee + spouse Employee + child(ren) Employee + family Employee only The SEQA Plan is unavailable for this hourly rate If you are a commissioned employee, your hourly rate is determined by your prior year W-2 earnings divided by annual hours worked. The hourly rate to determine medical premiums for new commissioned employees who haven t had a W-2 yet will be the standard rate of pay that is in PeoplePlace. Employee + spouse $48.01/per hour and above Employee + child(ren) Employee + family 17

18 Medical Benefits EQA Plan Medical Benefits EQA Plan The Exclusive Quality Alliance (EQA) plan is available to employees making $25.01 or more per hour. This plan has a lower deductible than the PPO or HSA plan and exclusively includes providers in the Tier 1 BSWQA Network, except in cases of urgent/emergency care or rare situations when an in-network provider is not available and authorization is provided. Live more than 40 miles from a Tier 1 BSWQA Network hospital or have out-of-state dependents? Consider the PPO or HSA plans as they offer an extended network of providers through Tier 2 and Tier 3 coverage. 18

19 Medical Benefits EQA Plan Plan highlights: Wellness visits are covered at 100% (there are no copays for these visits) Copays apply for non-wellness office visits, urgent care and prescriptions $30 copay for a PCP visit $50 specialist visit $75 copay for urgent care $150 copay per day for inpatient hospitalization (up to a max of five days) $150 copay for outpatient care $150 copay for MRI $100 copay for advanced imaging (CT, CAT, and PET scans) $250 copay for emergency visit. Waived if admitted, then inpatient copay applies 19

20 Medical Benefits EQA Plan How You Pay for Care: You pay for care from your pocket. You can also set aside pre-tax dollars through a flexible spending account (FSA) to help cover certain expenses.* Deductible: This plan offers a lower deductible than the PPO and the HSA plans. You meet your deductible with durable medical equipment expenses, private duty nursing, hearing aids, skilled nursing, home health and hospice care. After the deductible, you have a 10% coinsurance for these services. Copays: You pay copays from your pocket. You can also set aside pre-tax dollars through an FSA to help cover certain expenses. Preventive visits are covered at 100%. This plan also offers low copays for non-preventive office visits (for example, a primary care visit is $30). Things like urgent care visits, inpatient and outpatient services also have copays, making it easy to understand your out-ofpocket responsibility. Prescriptions: You pay copays for prescriptions (as low as $3-$5) from your pocket or from your FSA. Network: This plan only includes providers in our Tier 1 BSWQA Network. Be sure to check bswh.swhp.org to verify your provider is available with this plan. No out-of-network coverage is available, except in cases of urgent/emergency care or rare situations when an in-network provider is not available and authorization is provided. How does this plan work? This plan is available to employees who make $25.01 or more per hour. Coverage is in-network only, meaning the cost of care will only be covered if you see a provider in the Tier 1 BSWQA Network. Exceptions include urgent/emergency care or rare situations when an in-network provider is not available and authorization is provided. If you live more than 40 miles from a Tier 1 BSWQA Network hospital or cover dependents who live out-of-state, you should consider the PPO or HSA plans due to their expanded network coverage. Still have 2018 HRA dollars? You can still use remaining HRA funds to pay for care in 2019 if you enroll in the SEQA/EQA or PPO plan and receive care from a Tier 1 BSWQA Network provider (except in cases of urgent/emergent care). If you don t have HRA rollover dollars, consider setting money aside in an flexible savings account (FSA) to pay for eligible expenses. Just remember that FSAs are subject to use-it-or-lose-it rules. *Prescription expenses cannot be paid with HRA dollars. If you have ongoing prescription expenses, think about setting aside money in a FSA. Be conservative with what you set aside in this account as the use-it-or-lose-it rule applies. Learn more about FSAs. 20

21 Medical Benefits EQA Plan How much do I pay for preventive care? Preventive care*, such as physicals, screenings, immunizations and more, are provided at no cost. Preventive eye exams are not included as part of our medical plans. If you or a covered dependent need routine eye care, our vision plan can help make glasses and contacts more affordable. How much is the deductible? Your deductible will vary based on how many dependents you are covering. The plan will provide after-deductible coverage once an individual has met the individual deductible even if the family deductible has not been met. Click here to learn more about this plan s deductible. *Services will be covered at 100% when billed with a preventive diagnosis code. How much do I pay for prescription drugs? You ll pay low fixed copays or coinsurance for prescription drugs at Baylor Scott & White Health Pharmacies (mail order and retail), as well as Contracted Pharmacies. When you use a Baylor Scott & White Health Pharmacy, covered generics are just $3. With such low copays, the prescription costs do not count toward your deductible but do count toward your out-ofpocket max limit. Click here to learn more about our prescription drug benefits. How much is the out-of-pocket maximum? Your out-of-pocket maximum will vary based on how many dependents you are covering. All plans have an embedded outof-pocket maximum so that no one in the family must pay more than the individual maximum. Will I have out-of-pocket protection? Yes. Your deductible and copays count toward your outof-pocket maximum. Once you reach your out-of-pocket maximum, the plan will pay 100% of the cost of any additional eligible care expenses. In the rare event you require medically necessary treatment and a provider is not available in the Tier 1 BSWQA Network, your provider can work with Scott and White Health Plan to submit a request for a prior authorization. Can I pair this plan with a Flexible Spending Account (FSA)? Yes. You can open a general-purpose FSA to pay for your eligible healthcare expenses with tax-free dollars. You can use this account to pay for copays, the deductible, coinsurance and qualifying dental and vision costs, as well as any other eligible expenses. More information about FSAs can be found here. 21

22 Medical Benefits EQA Plan Employee Premiums Medical Benefits EQA Plan Employee Premiums 2019 Medical Premiums Per Pay Period Part-Time Employee Premiums Per Pay Period Your Hourly Rate Coverage Tier EQA Coverage Tier EQA Up to $13/hour Employee only Employee + spouse Employee + child(ren) Employee only $92 Employee + spouse $274 Employee + family Employee only The EQA Plan is unavailable for this hourly rate Employee + child(ren) $194 $13.01 to $25/hour Employee + spouse Employee + child(ren) Employee + family Employee + family $327 $25.01 to $48/hour Employee only $59 Employee + spouse $153 Employee + child(ren) $131 Employee + family $202 Employee only $80 If you are a commissioned employee, your hourly rate is determined by your prior year W-2 earnings divided by annual hours worked. The hourly rate to determine medical premiums for new commissioned employees who haven t had a W-2 yet will be the standard rate of pay that is in PeoplePlace. $48.01/per hour and above Employee + spouse $183 Employee + child(ren) $158 Employee + family $240 22

23 Medical Benefits PPO Plan Medical Benefits PPO Plan The Preferred Provider Organization (PPO) plan has a higher per-paycheck cost, multiple network options and a lower deductible than the HSA plan. 23

24 Medical Benefits PPO Plan How You Pay for Care: You pay for care from your pocket. You can also set aside pre-tax dollars through a flexible spending account (FSA) to help cover certain expenses. Deductible: You meet your deductible with lab work, imaging, outpatient procedures, etc. Copays: You pay copays from your pocket, from rollover HRA funds, or from your FSA for office visits, urgent care visits and the emergency room for you and each of your covered dependents. Prescriptions: You pay copays for prescriptions (as low as $3-$5) from your pocket or from your FSA. Network: You have access to the Tier 1 BSWQA Network, Tier 2 Cigna National Network and Tier 3, which is out of network. For this plan, our Tier 1 BSWQA Network is always the best bet. Tier 3 includes providers who are not part of Tier 1 or Tier 2 and will always be the most expensive option. How much do I pay for preventive care? Preventive care*, such as physicals, screenings, immunizations and more, are provided at no cost when you use a Tier 1 BSWQA Network or Tier 2 Cigna National Network provider. Preventive eye exams are not included as part of our medical plans. If you or a covered dependent need routine eye care, our vision plan can help make glasses and contacts more affordable. *Services will be covered at 100% when billed with a preventive diagnosis code. How much do I pay for non-preventive care? You ll pay fixed copays for doctor visits and nearly all prescriptions without having to meet your deductible. The amount you pay depends on the physicians and pharmacies you use. If you chose a provider in the Tier 3 network, you ll first have to meet your deductible before coinsurance kicks in. 24

25 Medical Benefits PPO Plan How much do I pay for prescription drugs? There is no deductible for prescription drugs you pay copays or coinsurance from day one. Prescription costs do count towards your out-of-pocket maximum. How much is the deductible? Your deductible will vary based on how many dependents you are covering. Once your deductible is met, you re responsible for paying a percentage of the cost (coinsurance) until you reach your out-of-pocket maximum. All three tiers have separate deductibles Tier 1 BSWQA Network medical expenses count toward meeting the Tier 2 Cigna National Network deductible, but not vice-versa The plan will provide after-deductible coverage once an individual has met the individual deductible even if the family deductible has not been met Live more than 40 miles from a Tier 1 BSWQA Network hospital or cover out-of-state dependents? If you or a covered dependent live 40 or more miles from the nearest Tier 1 BSWQA Network hospital, you will receive a higher out-of-area benefit (80% vs 50% after deductible) when you see a Tier 2 provider. Contact SWHP at to activate out-of-area coverage. How much is the out-of-pocket maximum? Your out-of-pocket maximum will vary based on how many dependents you are covering. All plans have an embedded out-of-pocket maximum so that no one in the family pays more than the individual maximum. A separate out-of-pocket maximum applies for services provided under each tier. Tier 1 BSWQA Network medical expenses count toward meeting the Tier 2 Cigna National Network out-of-pocket maximum, but not vice-versa Costs of all drugs filled at Baylor Scott & White Health Pharmacies or Contracted Pharmacies apply to Tier 1 BSWQA Network and Tier 2 Cigna National Network There is no out-of-pocket maximum for the Tier 3 Network Amounts paid for Tier 3 do not apply to Tier 1 BSWQA Network or Tier 2 Cigna National Network out-of-pocket maximum Limited drug distribution filled at Contracted Pharmacies are subject to the Tier 1 out-of-pocket maximum Will I have out-of-pocket protection? Yes. Once you pay your out-of-pocket maximum in Tier 1 Network BSWQA or Tier 2 Cigna National Network, the plan will pay 100% of the cost of additional eligible care expenses in that tier. 25

26 Medical Benefits PPO Plan Can I pair this plan with a Flexible Spending Account (FSA)? Yes. You can open and contribute to a general-purpose FSA to help pay for your eligible healthcare expenses with tax-free dollars toward your share of the deductible, copays, coinsurance and qualifying dental and vision costs, as well as any other eligible expenses. Learn more about FSAs. Still have 2018 HRA dollars? Also remember that if you have remaining funds available in your HRA, you can use those dollars for care received from Tier 1 BSWQA Network providers or urgent/emergency care. Take this into account when determining how much you need to set aside in your FSA. 26

27 Medical Benefits PPO Plan Employee Premiums Medical Benefits PPO Plan Employee Premiums 2019 Medical Premiums Per Pay Period Part-Time Employee Premiums Per Pay Period Your Hourly Rate Coverage Tier PPO Coverage Tier PPO Up to $13/hour Employee only $33 Employee + spouse $91 Employee + child(ren) $88 Employee + family $138 Employee only $49 Employee only $225 Employee + spouse $402 Employee + child(ren) $393 $13.01 to $25/hour Employee + spouse $153 Employee + child(ren) $124 Employee + family $198 Employee + family $601 $25.01 to $48/hour Employee only $72 Employee + spouse $189 Employee + child(ren) $161 Employee + family $258 Employee only $93 If you are a commissioned employee, your hourly rate is determined by your prior year W-2 earnings divided by annual hours worked. The hourly rate to determine medical premiums for new commissioned employees who haven t had a W-2 yet will be the standard rate of pay that is in PeoplePlace. $48.01/per hour and above Employee + spouse $224 Employee + child(ren) $187 Employee + family $293 27

28 Medical Benefits HSA Plan Medical Benefits HSA plan The Health Savings Account (HSA) plan is available to all employees. It is a high-deductible plan that works well for those who want to take a more active role in managing their healthcare. Pair this plan with a Health Savings Account and defer pre-tax dollars for future healthcare expenses (including in retirement). Employees with high pharmacy costs or those who aren t used to managing a high-deductible plan should carefully research this plan before selecting. 28

29 Medical Benefits HSA Plan How You Pay for Care: You pay for care from your pocket or from tax-free contributions to your HSA through payroll deductions. You can change your HSA payroll contributions at any time during the year by calling PeoplePlace at Deductible: You meet your deductible by paying 100% of the contracted rate for office visits, prescriptions, urgent care visits, lab work, imaging, etc. How does this plan work? This is a high-deductible medical plan. You pay 100% of the non-preventative costs until your deductible is met. Once the deductible is met, you ll pay coinsurance until you reach the out-of-pocket maximum. This plan is a great option for those who want to take a more active role in managing their healthcare. Copays: Copays are not available with this plan. Prescriptions: You are responsible for 100% of the contracted rate of your prescription costs until your deductible has been met. Once your deductible is met, you pay 10% of costs up to the out-of-pocket maximum. Network: You have access to the Tier 1 BSWQA Network, Tier 2 Cigna National Network and Tier 3, which is out of network. For this plan, our Tier 1 BSWQA Network is always the best bet. Tier 3 includes providers who are not part of Tier 1 or Tier 2 and will always be the most expensive option. 29

30 Medical Benefits HSA Plan Live more than 40 miles from a Tier 1 BSWQA Network hospital or cover out-of-state dependents? If you or a covered dependent live 40 or more miles from the nearest Tier 1 BSWQA Network hospital, you will receive a higher out-of-area benefit (80% vs 50% after deductible) when you see a Tier 2 provider. Contact SWHP at to activate out-of-area coverage. What is a Health Savings Account (HSA)? An HSA allows employees to set aside money on a pre-tax basis to pay for qualified medical expenses. Unused funds roll over year to year and if you leave the organization, your HSA dollars go with you. Our HSA is administered by Optum Bank. You can increase or decrease your contribution amount any time throughout the year by contacting PeoplePlace at Use your HSA to pay for eligible expenses or save it for the future. Your HSA account is an interest-bearing account insured by the FDIC, paying a tiered variable rate. Direct how your HSA is invested when your balance is greater than $2,000. Visit optumbank.com for more details on your investment options. The IRS places limits on how much you can set aside each year. Save up to $3,500 if you re single and up to $7,000 if you have a family. Note: If you re 55 or older, you can make an additional catch-up contribution of $1,000 each year. 30

31 Medical Benefits HSA Plan How much do I pay for preventive care? Preventive care*, such as physicals, screenings, immunizations and more, are provided at no cost when you use a Tier 1 BSWQA Network or Tier 2 Cigna National provider. Preventive eye exams are not included as part of our medical plans. If you or a covered dependent need routine eye care, our vision plan can help make glasses and contacts more affordable. How much is the deductible? Your deductible will vary based on how many dependents you are covering. You are responsible for paying 100% of the contracted cost (if a Tiers 1 or 2 provider) of medical care (including prescription drugs) until you meet your deductible. If you visit a Tier 3 provider, the claim will process at usual and customary rate and you could be balance billed. *Services will be covered at 100% when billed with a preventive diagnosis code. How much do I pay for non-preventive care? You pay 100% of the contracted rate for non-preventive costs until your deductible is met. Once the deductible is met, you ll pay a percentage of the cost (coinsurance) up until you reach the out-of-pocket maximum. You can always choose to utilize your HSA funds to help pay these costs or save them for later. How much do I pay for prescription drugs? Prescription drug costs count toward your deductible. This means you pay 100% of the contracted rate until you meet your deductible. After your deductible, you will pay coinsurance until your out-of-pocket maximum is met. When you meet your deductible, you and the plan share costs until you meet your out-of-pocket maximum. There is not an embedded deductible with the HSA plan due to IRS requirements. If you have family coverage, you must meet the full family level deductible before coinsurance applies. There are separate deductibles for each tier Tier 1 medical costs count toward the Tier 2 deductible, but not vice versa Costs of all drugs filled at Baylor Scott & White Health Pharmacies or Contracted Pharmacies apply to Tier 1 and Tier 2 31

32 Medical Benefits HSA Plan How much is the out-of-pocket maximum? Your out-of-pocket maximum will vary based on how many dependents you are covering. All plans have an embedded out-of-pocket maximum so that no one in the family pays more than the individual maximum. A separate out-of-pocket maximum applies for services provided under each tier. Tier 1 BSWQA Network medical expenses count toward meeting the Tier 2 Cigna National Network out-of-pocket maximum, but not vice-versa Costs of all drugs filled at Baylor Scott & White Health Pharmacies or Contracted Pharmacies apply to Tiers 1 and 2 There is no out-of-pocket maximum for the Tier 3 network Amounts paid for Tier 3 do not apply to Tiers 1 or 2 out-of-pocket maximum Limited drug distribution filled at Contracted Pharmacies are subject to the Tier 1 BSWQA Network out-of-pocket maximum Can I pair this plan with a Flexible Spending Account (FSA)? Yes. You can open a limited-purpose flexible spending account to pay for dental and vision expenses, as well as any other eligible expenses, with pre-tax dollars until your deductible is met. With a limited-purpose FSA, the IRS requires you first meet your deductible before you can utilize it for medical costs. Be conservative with what you set aside in this account as the use-it-or-lose-it rule applies. Will I have out-of-pocket protection? Yes. After you meet your deductible, you ll pay fixed percentages until you reach your out-of-pocket maximum. Once you pay your out-of-pocket maximum in Tier 1 BSWQA Network or Tier 2 Cigna National Network, the plan will pay 100% of the cost of any additional eligible care expenses in that tier. 32

33 Medical Benefits HSA Plan Employee Premiums Medical Benefits HSA Plan Employee Premiums 2019 Medical Premiums Per Pay Period Part-Time Employee Premiums Per Pay Period Your Hourly Rate Coverage Tier HSA Coverage Tier HSA Up to $13/hour Employee only $11 Employee + spouse $45 Employee + child(ren) $44 Employee + family $67 Employee only $27 Employee only $96 Employee + spouse $279 Employee + child(ren) $199 $13.01 to $25/hour Employee + spouse $87 Employee + child(ren) $71 Employee + family $117 Employee + family $332 $25.01 to $48/hour Employee only $50 Employee + spouse $130 Employee + child(ren) $108 Employee + family $182 Employee only $71 If you are a commissioned employee, your hourly rate is determined by your prior year W-2 earnings divided by annual hours worked. The hourly rate to determine medical premiums for new commissioned employees who haven t had a W-2 yet will be the standard rate of pay that is in PeoplePlace. $48.01/per hour and above Employee + spouse $164 Employee + child(ren) $135 Employee + family $230 33

34 Prescription Drug Benefits Prescription Drug Benefits All three medical plans cover drugs dispensed by Baylor Scott & White Health Pharmacies or pharmacies in our contracted network. If you qualify for the SEQA plan, diabetic medications and supplies are covered at no cost! We re helping reduce the cost of care by moving to the Group Value formulary. The Group Value formulary eliminates high-cost, low value medicines (except for medical necessity). It doesn t mean fewer options, it means more affordability. 34

35 Prescription Drug Benefits What You ll Pay You ll pay different amounts for prescription drugs, based on your medical plan option and the tier of medication you choose: preferred generic, preferred brand, non-preferred brand and generic, chronic and preventive and specialty. To keep your costs low, choose preferred generic drugs when they re available and effective for your care. If you fill a prescription with a brand name drug when a generic is available, prior authorization will be required for coverage of the drug at a nonpreferred copay. Coverage for Drugs not listed If your drug is not listed on the formulary, you can talk with your doctor about switching to a formulary drug that may be lower in cost and as effective. If you need to continue using the drug not listed and the drug is not excluded by your plan, you or your physician may submit a request for coverage based on medical necessity. If approved, you ll pay the applicable copayment or coinsurance. If not approved and you still want to take it, you ll pay the full cost. Preferred Generic Medications These drugs have the lowest copays as they offer the greatest value compared to other drugs that treat similar conditions. Generics have the same active ingredients as a brand name drug, but usually cost less and the quality and effectiveness are the same. Generics have been FDA-approved under strict standards. Preferred Brand Medications Brand name drugs are produced under the original manufacturer s brand name and are often more costly than preferred generic medications. Preferred brands have been proven to be safe, effective and offer greater value than other brand name products that treat similar conditions. Non-preferred Generic and Brand These are brand name and generic drugs that are generally costlier than drugs in the preferred tiers. There are often alternative medications available in the preferred tiers that treat similar conditions but are less costly. Chronic and Preventive Medications To help make some frequently prescribed brand drugs for asthma, diabetes and other chronic conditions more affordable, we ve placed a select group on a special chronic preventive medication list. These medications are available for lower copays to encourage utilization and adherence. If you have certain conditions like asthma, diabetes or other chronic conditions, relax! A select group of these medications are available for lower copays to encourage use and adherence. 35

36 Prescription Drug Benefits Specialty These are high-cost medications that are used to treat complex conditions, and usually require close monitoring. Specialty drugs may be self-administered at home by injection (under the skin or into a muscle), by inhalation, by mouth or on the skin. These drugs may also require special handling, special manufacturing processes, and may have limited prescribing or limited pharmacy availability. That s why all our specialty drugs are handled by our Baylor Scott & White Health Pharmacies. The MyBSWHealth app makes it easy and convenient to manage your healthcare and access your health benefits including prescriptions! Step Therapy With almost every health condition, there are several different prescription drugs from which to choose. In many cases, the medications work similarly, but some cost less. That s where step therapy comes in. Before approving certain brand name medications, your plan may ask you to try a lower-cost alternative first. If it isn t effective, you can step up to the next lowest-cost medication until you find a drug that works best. Remember, you ll pay less if you choose a generic drug instead of a brand name option. Quality Management For safety and cost reasons, certain drugs have limits on the amount you receive at one time. This is often based on the manufacturer s recommended dosages. Prior Authorization Some drugs need approval before the plan will cover them for both safety and cost reasons. If you receive a prescription for a drug that requires prior authorization, you, a representative, or your doctor may submit a request for coverage. If approved, you ll pay the applicable copayment or coinsurance. If not approved and you still want to take the medication, you ll pay the full cost. 36

37 Prescription Drug Benefits Benefits on the Go! The MyBSWHealth app is the easy and convenient way to manage your healthcare and access your health benefits, including your prescriptions. If you don t have the app, visit the App Store or Google Play to download it today! If you already have it, make sure to update to the latest version. Did you know the average total cost of a brand name drug is $403 compared to the average cost of a generic, which is $25? Using a generic drug in place of a brand name drug could save you more than $750 per year in out-ofpocket costs, depending on how many prescriptions you and your family use. By using generics, you can lower your copayment and/or coinsurance amount, which can contribute to lower premiums for all of us. Tips to Save Money Ask your doctor, pharmacist or other healthcare providers about less expensive generic or brand name options Check the Group Value Formulary for preferred medications that may be available at a lower out-of-pocket expense Access the Pharmacy Portal to price prescriptions, view drug information and more Fill prescriptions at a Baylor Scott & White Health Pharmacy near you Order prescriptions through the Baylor Scott & White Health mail-order pharmacy. Business hours are Monday Friday from 7 a.m. 7 p.m., and Saturday from 9 a.m. 1 p.m. If you have any questions about your prescription drug benefits, contact the Scott and White Health Plan pharmacy team at Generic $25 Brand $403 37

38 Compare the Plans / Coverage Compare the Plans/Coverage Use the charts on the following pages to learn more details about your health plan coverage options. 38

39 Compare the Plans / Coverage Medical Plan SEQA ($25 and below) EQA ($25.01 and above) Network Tier 1 BSWQA Tier 1 BSWQA Annual Deductible Tier 1 BSWQA PPO Tier 2 Cigna National Tier 3 Out-of- Network Tier 1 BSWQA HSA Tier 2 Cigna National Tier 3 Out-of- Network Employee only $0 $500 $1,000 $2,000 $5,000 $1,500 $3,000 $5,000 Employee + family $0 $1,000^ $2,000^ $4,000^ $10,000^ $3,000 $6,000 $10,000 Out-of-Pocket Maximum Employee only $3,000 $4,000 $4,000 $6,750 No Limit $3,950 $6,750 No Limit Employee + family $6,000^^ $8,000^^ $8,000^^ $13,500^^ No Limit $7,900^^ $13,500^^ No Limit Your Cost for Care and Services Preventive care* $0 $0 $0 $0 Not Covered $0 $0 Not Covered Primary care office visit $10 $30 $35 $70 70% AD 10% AD 50% AD 70% AD Specialist office visit $40 $50 $60 $100 70% AD 10% AD 50% AD 70% AD Urgent care office visit $50 $75 $75 $100 $100 10% AD 50% AD 50% AD Diagnostic labs and x-rays Labs: 20% X-rays: $75 Labs: 30% X-rays: $75 10% AD 50% AD 70% AD 10% AD 50% AD 70% AD *In order for preventive care to be covered at 100%, services must be coded as preventive. Please see bswh.swhp.org for a complete list of covered preventive care services. AD means after you ve met your deductible. ^ The plan provides afterdeductible coverage once an individual with family coverage meets the individual deductible, even if the family deductible has not been met. Does not apply to the HSA plan. ^^ Once an individual with family coverage has met the out-of-pocket maximum, the plan provides 100% coverage for that individual, even if the family out-of-pocket maximum has not been met. This applies to the SEQA/EQA, PPO and HSA plans. Advanced imaging Ex. PET, CT, CAT Advanced imaging Ex. MRI, MRA $100 $100 10% AD 50% AD 70% AD 10% AD 50% AD 70% AD $150 $150 10% AD 50% AD 70% AD 10% AD 50% AD 70% AD Emergency room $250 $250 $250 $250 $250 10% AD 10% AD 10% AD Inpatient hospitalization $150/day (max of 5) $150/day (max of 5) 10% AD 50% AD 70% AD 10% AD 50% AD 70% AD Outpatient care $150/visit $150/visit 10% AD 50% AD 70% AD 10% AD 50% AD 70% AD 39

40 Compare the Plans / Coverage Type of Rx BSWH Pharmacy (30 day cost/ 90 day cost) SEQA EQA and PPO HSA Contracted Pharmacy *30 day supply only BSWH Pharmacy (30 day cost/ 90 day cost) Contracted Pharmacy *30 day supply only (BSWH or Contracted Pharmacy) *90 day supplies are only available through the BSWH Pharmacy Preferred generic $3/$6 $5 $3/$6 $5 10% AD Preferred brand $25/$50 $50 $35/$70 $50 10% AD Non-preferred brand and generic Lesser of $50/$100 or 50% Lesser of $75 or 50% Lesser of $50/$100 or 50% Lesser of $75 or 50% 10% AD Specialty $100 N/A 20% ($200 Max) N/A 10% AD** Chronic and preventive $10/$20 $0 Diabetic Treatment $20 $0 Diabetic Treatment $10/$20 $20 10% AD To help make some frequently prescribed preferred brand drugs for asthma, diabetes and some other chronic conditions more affordable, we ve placed a select group on a special chronic and preventive medication list. Find the complete list on bswh.swhp.org. *Only BSWH pharmacies can fill a 90 day supply of a medication. The max day supply through a contracted pharmacy is 30 days. **Specialty drugs only available at BSWH pharmacy. Fertility drugs are covered at 20% with a maximum $400 copay and a $7,500 lifetime maximum pharmacy benefit. Drugs not listed on formulary require prior authorization. If authorized, you ll pay the applicable non-preferred or specialty copay. 40

41 Accidental Injury and Critical Illness Insurance Accidental Injury and Critical Illness Insurance We care about your wellbeing and want to make sure you have a steady source of income during times of unexpected illness or injury. That s why we offer injury and critical illness insurance. Cigna is our vendor for both optional policies. Think about your regular expenses, big and small. What would happen if you couldn t cover them? These plans provide additional financial protection for you and your family in case of a covered accident or illness. Coverage can be elected for eligible family members Lump-sum, cash payment to use as you see fit No copays, deductibles, coinsurance, or networks; benefits are not coordinated with other coverage Coverage available at affordable group rates and premiums are paid by payroll deductions Guaranteed-issue available and no medical underwriting is required during annual enrollment, new hire enrollment or changes due to a qualified life event Coverage is also portable with no change to benefits or rates should you ever leave the organization 41

42 Accidental Injury and Critical Illness Insurance Accidental Injury Insurance With Cigna accidental injury insurance, you get a benefit to help pay for costs associated with a covered accident or injury. It provides a lump sum payment to you, unless otherwise assigned, based on a schedule of covered injuries. The money can be used as you see fit there are no co-pays, deductibles, coinsurance, restrictions, or network requirements to satisfy. And, the coverage continues even after the first accident to provide additional protection for future accident events. For example, benefits are available for Initial and emergency care, hospitalizations, fractures and dislocations, follow-up care, etc. Critical Illness Insurance Everyone has different needs when coping with a critical illness. With Cigna critical illness insurance, you get a benefit paid directly to the covered person, unless otherwise assigned, if they are diagnosed with a covered critical illness. This plan can help ease some of your financial worries so that you can stay focused on your health. You choose how to spend or save your benefit. It can be used for expenses, such as paying for child care or help around the house, travel costs to see a specialist, medical treatment and doctor visits, copays and deductibles and prescription drug costs. Covered critical illnesses include 29 conditions. The plan also pays a $50 per insured person per covered year wellness benefit if a covered health screening is performed (annual check up, colonoscopy, mammogram, etc.). If you elect coverage for your spouse or dependents, their benefit amount is 100% of your elected benefit amount. You may enroll in these voluntary benefits through PeoplePlace when you enroll for your other health benefits. More information is available on BSWHbenefits.com. 42

43 Flexible Spending Accounts FSAs How Flexible Spending Accounts (FSAs)Work With an FSA, you can set aside pre-tax dollars each pay period to pay for covered expenses. The best part you don t pay federal income tax or Social Security tax on your FSA contributions. There are three FSAs available for participation, all administered by Optum Bank: The general-purpose healthcare FSA is available with the SEQA/EQA and PPO plans The limited-purpose healthcare FSA can only be paired with the HSA plan A third FSA allows you to set aside money for dependent day care expenses You can use FSA funds to pay for eligible expenses incurred between Jan. 1, 2019 March 15,

44 Flexible Spending Accounts Save Money with Your FSA The money you contribute to an FSA comes out of your paycheck before taxes. You end up with funds you can use to pay for health and dependent care expenses and pay less in taxes on April 15. General-purpose Healthcare FSA If you choose the SEQA/EQA or PPO plan, you can open a general-purpose healthcare FSA You contribute from $100 to $2,650 for 2019 You can use the account to pay for: Medical, dental and vision expenses not paid for under the plan, including deductibles, copayments and coinsurance Prescription drugs Over-the-counter drugs prescribed by a physician Medical supplies like bandages and contact lens supplies Products like diabetic supplies, hearing aids and wheelchairs Services like orthodontia and laser eye surgery You ll receive a FSA debit card from Optum Bank. You can use this card to make eligible purchases Your debit card is loaded with your full account balance You pay into your account through pre-tax paycheck deductions all year 44

45 Flexible Spending Accounts Limited-purpose Healthcare FSA You may elect a limited-purpose healthcare FSA when you also elect to contribute to a Health Savings Account (HSA) that is tied to the high-deductible plan. The limited-purpose healthcare FSA only allows you to use pre-tax dollars to pay for dental and vision expenses for you and your family. There is a $2,650 maximum contribution limit each year. Funds do not roll over year after year, and any funds remaining in a Limited-purpose Healthcare FSA at the end of the year are forfeited. If you choose the HSA plan, you can open a limited-purpose healthcare FSA You can contribute from $100 to $2,650 for 2019 Until you meet your medical plan deductible, you can use your FSA for dental, vision and qualified expenses the medical plan doesn t cover: Over-the-counter drugs prescribed by a physician Medical supplies like bandages and contact lens supplies Products like diabetic supplies, hearing aids and wheelchairs Services like orthodontia and laser eye surgery After you meet your deductible, you can use FSA funds for all eligible medical and prescription expenses, too You ll receive an FSA debit card you can use to make eligible purchases Your debit card is loaded with your full account on balance You pay into your account through pre-tax paycheck deductions all year Dependent Day Care FSA Open a dependent day care FSA to cover daycare expenses for your child(ren), a disabled spouse, elderly parent or other dependent who s physically or mentally disabled, so you can work. If you re married, it frees your spouse to work, look for work or go to school full time. You can contribute from $100 to $5,000 for 2019 if you re married or a single parent You can contribute from $100 to $2,500 each if you re married and filing separately You can use the account to pay for: Day care at home and licensed centers for children up to age 13 Day care at home and licensed centers for dependents of any age who are mentally and/or physically disabled You pay into your account through pre-tax paycheck deductions all year You can use your funds after they have been set aside into your account You file a claim form to be reimbursed for your expenses 45

46 Flexible Spending Accounts Here s an example of how Dependent FSAs work. Ashley spends $5,000 a year to send her daughter Kennedy to day care. To cover the cost, she contributes $5,000 to a dependent day care FSA throughout the year. Here s how she saves: De Here s How it Works for Ashley Without the FSA With the Dependent FSA Annual pay $30,000 $30,000 Total annual FSA contribution (-$0) (-$5,000) = Taxable pay $30,000 $25,000 Taxes (Assuming 15% Federal, 7.65 FICA%*) (-$6,795) (-$5,663) After-tax day care expense (-$5,000) (-$0) = Ashley s annual pay after taxes and day care expenses $18,205 $19,337 Amount saved by using the FSA $0 $1,132 *Employees share of Social Security and Medicare taxes. 46

47 Flexible Spending Accounts Because FSAs have tax advantages, the IRS has rules about how you can use them: No transfers Each account is separate. They have their own funding limits, and you can t transfer money between a medical FSA and dependent care FSA. Deadlines matter Use the funds to cover 2019 expenses. Healthcare FSAs have a grace period that extends eligibility until March 15, Turn in all claims by April 30, Use it or lose it Any money in your accounts after April 30, 2020, is gone for good. There s no rollover to the next year so estimate your expenses carefully. No changes unless Once you decide how much you want to contribute, we ll take the money out of your paycheck automatically. You can t change your contribution unless you have a qualifying life event. Submitting a claim Download the Optum Bank app! Enjoy an easier way to manage your flexible spending account. You can pay bills, view transactions, upload receipts and more! Download today on your Apple or Android device. You can also visit optumbank.com. 47

48 Dental Benefits Dental Benefits We offer two optional dental plans: MetLife PPO and MetLife PPO Plus. Both MetLife plans let you go to any dentist you choose but you ll pay less when you visit one who s a member of MetLife s Preferred Dental Program. Both plans have the same deductibles $50 for you only and $150 for you and your family. Both plans cover 100% of preventive care costs with no deductible. MetLife Dental PPO The MetLife Dental PPO plan pays 50% of the cost of basic and major care after you ve met your deductible. The maximum benefit the plan will pay in a year is $1,250 and orthodontia isn t covered. MetLife Dental PPO Plus The MetLife Dental PPO Plus plan pays 80% of the cost of basic care and 50% of the cost of major care after you ve met your deductible. The maximum benefit the plan will pay in a year is $2,500 and orthodontia is covered at 50% with a separate lifetime maximum benefit of $2,000. Implants are also covered at 50% under this plan and will be subject to your annual maximum of $2,

49 Dental Benefits Dental Plan Coverage and Costs Dental Plan Deductible MetLife Dental PPO MetLife Dental PPO Plus Employee only $50 $50 Employee + family $150 $150 Your cost for care and services Preventive care (Checkups, cleanings, X-rays) $0 $0 Dental Benefits / Employee Premiums Dental Plan Coverage Tier Employee Premiums Per Pay Period MetLife Standard PPO Employee only $8.50 Employee + spouse $17.03 Employee + child(ren) $22.79 Employee + family $28.91 MetLife Plus PPO Employee only $16.89 Basic care (Fillings, extractions, root canals) Major care (Dentures, crowns, bridges) 50% AD 20% AD 50% AD 50% AD Employee + spouse $32.94 Employee + child(ren) $42.39 Employee + family $58.44 Dental implants Not covered 50% AD Orthodontia (Braces, retainers) Not covered 50% AD Lifetime max: $2,000 Annual maximum benefit (After the plan has paid this much, you pay any additional costs.) $1,250 $2,500 NOTE: AD means after you ve met your deductible. 49

50 Vision Benefits Vision Benefits We offer a vision plan administered by EyeMed to help with you and your family s vision needs. If you or a covered dependent need routine eye care, vision coverage can make your glasses and contacts much more affordable. Plus, our vision plan coordinates seamlessly with our FSAs, so that most expenses are automatically substantiated meaning you don't have to submit as many receipts! Here s how it works: The plan covers preventive exams, lenses, frames and contacts When you visit an optician in the EyeMed network, your eye exam copay is only $10 If you need glasses, frames are covered up to $170. Anything above $170 would be out of pocket, but discounted. Most lenses are covered after a $10 copay If you wear contact lenses, you will pay a contact lens fitting exam copay of $25, which then covers contacts up to $170. Anything above $170 would be out of pocket 50

51 Vision Benefits Vision Plan Coverage and Costs Service (once per calendar year) What You Pay In Network Out of Network Member Reimbursement** Service (once per calendar year) What You Pay In Network Out of Network Member Reimbursement** Exams $10 Copay Up to $45 Lenses Single vision or lined multifocal lenses* $10 Copay Single: Up to $45 Bifocal: Up to $65 Trifocal: Up to $85 Contacts* Consult with your provider if you believe your contact lenses are medically necessary. Elective lenses: $0 Copay, $170 allowance Medically Necessary: $0 Copay- covered in full Elective lenses: Up to $136 Medically Necessary: Up to $210 Progressive lenses Lens Options Standard: $65 Copay Premium: $95 $185 Copay based on tier Polycarbonate: Covered in full for children under 19 All lens options available to members at fixed pricing Up to $65 Varies based on option Diabetic Care Services Up to 2 services per benefit year Laser Vision Correction LASIK or PRK from U.S. Laser Network $0 Copay Includes additional testing such as retinal imaging, extended ophthalmoscopy, gonioscopy and scanning laser 15% off the retail price or 5% off the promotional price Not covered Not Covered Frames Contact Lens Fit and Follow-up $0 copay, $170 allowance, 20% off balance over $170 Standard: $25 Copay, paid-in full fit and two follow-up visits Premium: $25 Copay; 10% off retail price, then apply $55 Allowance Up to $65 Up to $40 Vision Premiums Per Pay Period Coverage Tier Employee only $3.08 Employee + spouse $6.12 Employee + child(ren) $6.00 Employee + family $9.12 Preventive eye exams are not included as part of our health plan coverage, so you may want to consider our *Lenses or contact lenses once per calendar year.! stand-alone vision plan through EyeMed. ** If you go out of network, you will need to pay for all services and materials in full and then submit your receipt for reimbursement. 51

52 Life Insurance Life Insurance We provide basic employee life insurance through Cigna that pays a benefit to your beneficiary equal to one time your annual base salary with a minimum of $20,000 and a maximum of $500,000*. There s no medical underwriting, and coverage begins on your first day of active employment. *Other coverage levels for life, AD&D and disability are available for certain executive and physician roles and are visible in the PeoplePlace enrollment system. Be sure you have a beneficiary designated for your life insurance policy in PeoplePlace A beneficiary is the person or organization you choose to receive your life insurance benefit in the event of your death. It is important to choose a beneficiary, so you can ensure the benefit is paid out according to your wishes. Click here to learn how to designate a beneficiary. 52

53 Life Insurance Supplemental Life Insurance You can buy coverage worth three times your annual salary up to $1 million without medical underwriting. You can elect up to seven times your annual base salary up to a maximum of $2 million. Any amount over three times your annual salary requires medical underwriting with the life insurance carrier. You can also insure your spouse up to $250,000, but the total can t be more than your coverage amount. Up to $75,000 can be elected without medical underwriting. Any amount that exceeds this limit will require medical underwriting with the life insurance carrier. Lastly, you have the ability to purchase a $10,000 benefit for your children. The following service is also available, at no cost, as part of your employer-paid Life and AD&D Insurance coverage: Cignassurance Program For Beneficiaries The loss of a loved one is an emotional time that can make it hard to think clearly. You and your family may feel overwhelmed by legal paperwork and financial decisions. That s why we offer life planning services through our relationship with Cigna. Life planning services are available to Cigna life and AD&D insurance beneficiaries. The services include financial and legal support and grief counseling. At age 65, the total amount of life insurance you have will be reduced to 65% of the original value. This includes company-provided coverage and any additional coverage you may have purchased. At age 70, your total life insurance is reduced to 50% of the original value. The Cignassurance counselors understand the challenge of making decisions when a loved one has died. They re specially trained to provide objective, customized financial, legal and emotional support and they don t receive commissions on any service or solution they suggest. To learn more about life planning financial and legal services, contact Cigna at

54 Life Insurance Life Insurance / Employee Premiums Supplemental Life Insurance Premiums Per Pay Period Person Covered Basic Life Insurance We Pay For Supplemental Coverage You Pay For Your Age Per $1,000 Coverage for You Per $1,000 Coverage for Your Spouse Per $1,000 Coverage for Your Child(ren) You One time your annual base salary up to $500,000 One to seven times your annual base salary up to $2 million* <25 $0.013 $ $0.016 $0.031 Your spouse $10,000 or $25,000 increments up to $250,000 (not to exceed your coverage amount**) $0.022 $ $0.028 $ $0.036 $0.054 Your child(ren) $10,000 per eligible child $0.054 $ $0.084 $0.138 $0.035 (one premium covers all children in family) *If you buy within 30 days of first becoming eligible, coverage totaling the lesser of three times your base salary or $1 million is guaranteed without medical underwriting. **If you buy within 30 days of first becoming eligible, coverage up to $75,000 for your spouse is guaranteed without medical underwriting. NOTES: The Internal Revenue Service taxes you on the value of employer-provided group term life insurance over $50,000 as if you received cash in an amount equal to the value of this coverage. This taxable value is called imputed income. Other coverage levels for life, AD&D and disability are available for certain executive and physician roles and are visible in the PeoplePlace enrollment system $0.138 $ $0.192 $ $0.313 $ $0.630 $ $0.819 $1.563 NOTE: All premiums are based on your age at the time of purchase not on the age of your spouse and/or child(ren). When you move into a higher age bracket, premium increases will be processed immediately. In addition, if your eligible dependent is totally disabled on the date your dependent s coverage would normally begin, your dependent s coverage will begin on the date your eligible dependent is no longer totally disabled. For definition of totally disabled and further information, please refer to the Summary Plan Description (SPD). 54

55 Accidental Death and Dismemberment Insurance Accidental Death and Dismemberment Insurance Accidental Death and Dismemberment Insurance (AD&D) coverage pays accidental death and dismemberment benefits if you or a covered family member dies or is injured because of an accident. 55

56 Accidental Death and Dismemberment Insurance Basic AD&D Insurance Baylor Scott & White provides basic employee AD&D insurance from Unum equal to one time your base salary with a minimum of $20,000 and a maximum of $500,000. There s no medical underwriting, and your coverage begins on the first day of active employment. Note: We do not offer basic AD&D for spouses or children. Supplemental AD&D insurance In addition to the basic AD&D that is provided, you can purchase supplemental coverage up to seven times your annual base salary up to $2 million. Outside of your new hire enrollment period, you can make changes during annual enrollment or if you have a qualifying life event. You can also insure your spouse up to $250,000 but the total can t be more than your coverage amount. For children, you can purchase $10,000 in coverage. At age 65, the total amount of AD&D insurance you have will be reduced to 65% of the amount of AD&D insurance you had prior to age 65. This includes company-provided coverage and any additional coverage you may have purchased. At age 70, your total AD&D insurance is reduced to 50% of the original value. Accidental Death and Dismemberment Insurance / Employee Premiums AD&D Insurance Coverage Person Covered You Your spouse Your child(ren) Basic AD&D Insurance We Pay For One time your annual base salary up to $500,000* Supplemental AD&D Premiums Per Pay Period Per $1,000 Coverage for You Per $1,000 Coverage for Your Spouse Supplemental Coverage You Pay For One to seven times your annual base salary up to $2 million* $10,000 or $25,000 increments up to $250,000 (not to exceed your coverage amount) $10,000 per eligible child Per $1,000 Coverage for Your Child(ren) $0.006 $0.007 $0.008 *Other coverage levels for life, AD&D and disability are available for certain executive and physician roles and are visible in the PeoplePlace enrollment system. 56

57 Disability Insurance Disability Insurance Disability insurance is important coverage in case you re sick or injured and can t work or add a child to your family by birth or adoption. 57

58 Disability Insurance The Absence Center To improve the leave and short-term disability process for employees and supervisors, we ve created the Absence Center. The center administers Family and Medical Leave Act (FMLA) leaves, military leaves, non-fmla medical leaves, nonmedical personal leaves and short-term disability. Bereavement leave and jury duty leave should be requested directly from your supervisor. Short-term disability is the only way to receive maternity, parental and adoption benefits. You will be automatically enrolled in our shortterm disability coverage you must opt out if you don t want it. The Absence Center: Processes new absence requests Determines eligibility Approves or denies leaves and other absences Provides support and advocacy Manages return to work You ll find the Absence Center online at 360absence.com/bswh. You can also talk to leave specialists by calling , Monday Friday from 7 a.m. 7 p.m. CT. 58

59 Disability Insurance Choose Your Level of Disability Coverage We offer three levels of disability coverage to employees voluntary short-term disability, which you buy yourself; basic longterm disability, which we buy for you; and supplemental long-term disability, which you buy for yourself if you want additional protection. Short-Term Disability Insurance Short-term disability coverage pays a portion of your salary for a fixed period up to 180 days if you re sick or injured or the new parent of a child. (It doesn t cover disabilities caused by occupational illness or injury please contact Safe Choice at for occupational illnesses and on-the-job injuries.) We auto-enroll all benefit-eligible employees in short-term disability (STD) coverage. If you do not wish to purchase STD coverage, you will need to take action to opt out. Pre-Existing Condition Prevision (does not apply to new hires or newly eligible employees) If you ve been diagnosed, treated or received medical advice for a condition within three months of your effective date on the plan, that condition will be excluded for a period of 12 months. For example, if you are pregnant at the time you enroll, your delivery and recovery will be excluded from the STD benefit for that coverage year. Once approved, short-term disability benefits begin on the eighth calendar day of disability. Since you pay for short-term disability coverage yourself with premiums taken out of your paycheck before taxes, your benefits are taxable. Remember, the only way to receive paid maternity leave is if you keep the short-term disability insurance. Rate calculations for short-term disability can be seen in PeoplePlace. 59

60 Disability Insurance Basic Long-Term Disability Insurance Basic long-term disability insurance from Cigna provides 50% of your base pay up to $15,000* a month. Once approved, benefits begin on the 181st day of disability and may continue for as long as you meet the definition of disability or until you reach your normal Social Security retirement age. (Some pre-existing condition limitations may apply.) Voluntary Long-Term Disability Insurance You can increase your disability benefit to 60% of your base salary, up to $15,000* a month, by purchasing voluntary long-term disability insurance (pre-existing provisions may apply). Like basic coverage, benefits begin on the 181st day of disability. Rate calculations for short- and long-term disability are available in PeoplePlace. Person covered You Coverage you pay for Additional 10% of your base salary following 180 days of disability NOTE: Pre-existing condition limitations may apply. *Other coverage levels for life, AD&D and disability are available for certain executive and physician roles and are visible in the PeoplePlace enrollment system. 60

61 Retirement Benefits Retirement Benefits While you re reviewing your benefits, it s a good idea to check on your retirement savings. Keep in mind that you can sign up, make changes and adjust your retirement savings account anytime during the year. There s an app for that! The Empower Retirement app currently available on iphone, Apple Watch, and Andriod allows you to view and manage your plan anywhere, anytime. Download the app on the Apple App Store or on Google Play by searching for Empower Retirement. 61

62 Retirement Benefits Participating is simple. You choose a percentage of your salary to save. We subtract that amount each pay period and deposit the funds in your 401(k) retirement account. Because we want your retirement savings to grow, we match your contribution dollar for dollar up to the first 5% of your eligible pay. You become 100% vested in the employer match after three years of employment. Start Participating Today! Sign up for your retirement plan anytime by visiting BSWHretirement.com or by clicking Retirement in PeoplPlace. It only takes a few minutes and you don't want to miss out on the employer match! The Empower site helps you: Make before-tax or Roth (after-tax) contribution elections Enroll in auto increase to make saving easier Update your beneficiary(ies) See how much income you may have in retirement Make changes to improve your retirement security View your Lifetime Income Score summary Process a rollover Make additional catch-up contributions (if you are 50*). This requires a separate election with Empower. *If you turn 50 in 2019, you can begin your catch-up contribution in January Read the high-level plan summary or check out the full summary plan description: 401(k) Summary Plan Description 62

63 Paid Time Off Paid Time Off At one time or another, we all need time away from work. It may be for a serious reason or just to take a break and recharge. We support your personal time and offer generous paid time off (PTO) benefits that provide flexible options to fit your life and needs. You begin accruing PTO hours on your first day of work and can use your PTO time immediately. 63

64 Paid Time Off If you re a regular full-time or part-time employee: You earn PTO to use for holidays, vacations, sick days and other personal reasons You earn PTO based on the number of regular hours you work and you earn more the longer you work with us You begin accruing PTO hours on your first day of work and are eligible to use accrued PTO immediately You may carry a negative balance up to your daily hours during a holiday only You can check your PTO balance in PeoplePlace Time and Attendance. You won t accrue PTO while you re on a leave of absence. PTO Carry Over If you are PTO-eligible, you may carry over up to 200 hours of paid time off to the next calendar year. Employees who have a PTO balance of more than 200 hours after the first pay period of the new calendar year will have their balances reduced to 200 hours at the beginning of the next pay period. The chart on the next page shows how PTO accrual works for most employees. Two-day-alternative employees and non TDA employees in the North Texas Division hired before June 15, 1992, earn PTO at different rates. All employees at the director level and above participate in the Senior Management Time Off (SMTO) program. To learn more about the regular PTO policy and the SMTO program, visit the Policy and Procedure Library. 64

65 Paid Time Off Annual Paid Time Off Accrual Years of Service 8 Authorized Hours per Shift 10 Authorized Hours per Shift 12 Authorized Hours per Shift Less than hours (22 days) 182 hours (18.2 days) hours (14.4 days) hours (23 days) 190 hours (19 days) 180 hours (15 days) hours (24 days) 198 hours (19.8 days) hours (15.6 days) hours (25 days) 206 hours (20.6 days) hours (16.2 days) hours (26 days) 214 hours (21.4 days) hours (16.8 days) 5 to hours (27 days) 222 hours (22.2 days) hours (17.4 days) 10 to hours (29 days) 238 hours (23.8 days) hours (18.6 days) 15 or more 272 hours (34 days) 278 hours (27.8 days) hours (21.6 days) 65

66 Other Programs & Benefits Other Programs & Benefits Tuition Reimbursement We believe that learning is a lifetime process and we encourage employees to take advantage of the opportunities available through the Tuition Reimbursement benefit. If you are seeking to continue your education for professional or personal reasons, be sure to take a look at the program. We re proud to partner with EdAssist to help our employees achieve their education goals. 66

67 Other Programs & Benefits Annual reimbursement amount tied to degree path. You make it possible to achieve our Mission and Ambition. That s why we proudly invest in those who want to further their education. We take into consideration the type of education our employees are pursuing. Click here to view the fields of study for clinical and non-clinical programs. Clinical degree programs provide: Reimbursement up to $5,250 for full-time employees $2,500 for part-time employees Non-clinical degree programs allow: Reimbursement up to $4,250 for full-time employees $2,000 for part-time employees Repayment provision Any employee who applies for tuition reimbursement on or after Tuesday, Jan. 1, 2019, will be subject to a repayment provision if you leave employment within 12 months of receiving reimbursement. Start on the road to your future! In addition to administration and processing, EdAssist offers significant benefits when you want to return to school. Free academic and college finance advising. You ll get personalized help to solidify your career goals, find the best schools and target financial aid sources Discounted tuition and fees. Partnerships with more than 220 top-tier regionally accredited educational institutions enable EdAssist to offer significant tuition savings Family discounts. Many schools in the EdAssist network offer tuition discounts to immediate family members The system is available 24 hours a day, seven days a week, with live customer support Monday Friday, 7 a.m. 7 p.m. CT. You ll need your employee ID number, which you can find on your paycheck in PeoplePlace. Ready to take the next step? Read the Benefacts sheet and Frequently Asked Questions Watch the EdAssist website video Visit bswh.edassist.com or call EdAssist at , Monday Friday, 7 a.m. 7 p.m. CT Download the EdAssist grade and receipt documentation checklist Download sample grade and receipt documents 67

68 Other Programs & Benefits The tuition reimbursement policy has complete details, but here s a look at the key elements of our program: Program Elements Who s eligible Full-time and benefits-eligible part-time employees Waiting period for new employees* Must complete 90 days of employment before enrolling in courses Supervisor approval process Repayment provision Reimbursable non-nursing college courses Reimbursable nursing courses One-time degree approval online through EdAssist An employee who voluntarily terminates employment or is terminated for cause within 12 months of receiving tuition reimbursement will be required to refund BSWH 100% of the tuition reimbursement received within that time period. Must be part of degree plan and taken at a regionally accredited college or university Must be part of a degree plan and taken from a program accredited by the Commission on Collegiate Nursing Education or the Accreditation Commission for Education in Nursing or the Texas Board of Nursing Other reimbursable programs High school general equivalency diploma from a high school or onsite testing facility recognized by the state s Department of Education Application deadline No sooner than 90 days and no later than 30 days after course start date Reimbursable expenses Required grades to be reimbursed Reimbursement request deadline Tuition and required fees Undergraduate: C- or higher Graduate: B- or higher No later than 90 days after course completion date Maximum FT annual reimbursement $5,250 (clinical), $4,250 (non-clinical) Maximum PT annual reimbursement $2,500 (clinical), $2,000 (non-clinical) NOTE: If you work for the HealthTexas Provider Network, check first to be sure your facility participates, then get approval from your supervisor and executive committee. HTPN offers an education fund as another resource for career development. Please contact your HR business partner to learn more. *Nurse technicians can participate from their hire date and are eligible for the full-time maximum if they work at least 16 regularly scheduled hours per pay period. 68

69 Other Programs & Benefits Family Life Through our partnership with Bright Horizons Care Advantage, employees have access to a wide range of services. From regular and backup care for children and adults to help finding tutors, babysitters, housekeepers even pet care the benefits we offer help the whole family. Using the service is simple and available 24 hours a day. Just visit our dedicated Care Advantage portal at careadvantage.com/bswh or call

70 Other Programs & Benefits Backup Care for Children and Adults If regular care arrangements for your child or an adult relative fall through, you can purchase up to five days of affordable, high-quality backup care a year at a center or in your own home. Center-based child care is $15 a day for a single child or $25 a day for multiple children. In-home care for well and mildly ill children and adults is $6 an hour (for up to three care recipients) with a four-hour minimum. To use the backup care benefit, you ll need to register and make reservations by clicking on Register & Reserve Care on the portal. Log in with BSWHbackup as the username and BSWH as the password, then create your own account. Helping find care for the entire family: Bright Horizons gives you free access to a comprehensive database of care options you can select and pay for yourself: nannies and sitters for evening and weekend care; senior care resources, planning and referrals; pet sitters; household help; discounts on test prep and tutoring and more. Adoption Assistance Baylor Scott & White provides adoption assistance for full-time employees who ve worked with us for at least 12 consecutive months. If you adopt a child under the age of 18 who s not biologically related to you (or to your spouse if you re married), we ll reimburse up to $4,000 for the cost of the adoption and legal fees for each child you adopt. You can receive reimbursement for up to two adoptions per family. The benefit doesn t cover foster care, legal guardianship or adoption of a spouse s child. To learn how the process works, visit PeoplePlace and click Request Help and then select the Adoption Benefits request. If we approve your request, we ll include the reimbursement in your next scheduled paycheck. If we don t approve your request, we ll notify you by phone or . You can read the complete adoption assistance policy in the Policy and Procedure Library. If you ve purchased short-term disability insurance, you re also eligible for parental leave when you adopt a child. You can review caregiver background checks at no cost and even request advanced checks at discounted rates. You ll find listings on the portal under Additional Family Support. 70

71 Other Programs & Benefits Pre-paid Legal Services Hyatt Legal Services gives you access to high-quality services without worrying about paying too much or trying to find a trustworthy attorney. When you enroll, you ll receive: No deductibles, claim forms, or copays No usage limits Attorneys average 25 years of experience; minimum 8 years Access to services in all 50 states, U.S. territories, and worldwide Easy to find attorneys through web or phone A network of more than 14,000 participating Network Attorneys With Hyatt Legal Services, you can resolve issues more easily, worry less and save time and money. To learn more, visit Hyatt Legal Plans. Employee Only $4.22 For Your Family (Including Spouse and Children) $5.54 Hyatt attorneys and legal professionals can help you with a wide range of personal legal matters, including: Buying and selling houses Refinancing Adopting/having children Consumer/creditor problems Divorce Debt collection Important paperwork review Avoiding bankruptcy/foreclosure Creating a will or living will Protecting your rights as a tenant Managing the estate when a spouse or parent dies 71

72 Other Programs & Benefits Travel Assistance When you re on the road and the unexpected happens, you need smart, trustworthy help fast. Baylor Scott & White s emergency travel services are ready any time, day or night. All benefit-eligible employees can take advantage of these benefits. Cigna Travel Assistance ( ) provides added helping hands in those times of need when you re away from home. Whether you travel 100 miles or more from home, go across the state or around the world, they take care of the details. Secure Travel assistance services from Cigna provided through Generali Global Assistance (GGA) are by your side. When you call, medically certified agents will help with: Pre-trip planning Inoculation and visa requirements Cultural information and special events Weather information and ski reports for major cities and ski areas Foreign exchange rates between the U.S. dollar and other currencies Traveling assistance Referrals to translators or translation services in emergencies Address and phone for the nearest American embassy and consulate Toll-free urgent message relay to family, friends or colleagues (GGA will also accept and keep messages for you for up to 15 days) Emergency assistance Locating lost items (luggage, wallet, passport, etc.) and helping with replacements from home, if needed Finding legal assistance or putting up bail in an emergency, where permitted by local law Emergency cash advance up to $1,500 Providing names, addresses and phone numbers of local physicians, hospitals, dentists and attorneys, as needed Medical monitoring when GGA is notified of a medical emergency, their staff will attempt to contact you and your attending physician for a full report on your situation, including next steps. This service continues until the problem is resolved or you return home Emergency medical payments, when necessary, up to $10,000 for on-site medical expenses Obtaining medication replacement either locally or from home if you lose, forget or run out of prescription medication while traveling If you have elected Voluntary Accidental Death & Dismemberment coverage for your spouse and children, then they have access to this benefit as well. But remember to call Generali Global Assistance first you can t be reimbursed for services you arrange on your own. 72

73 Other Programs & Benefits Purchasing Power Purchasing Power makes it easy to get the products you need and pay for them over time, directly from your paycheck. There s no interest, no credit check and no hidden fees. By using Purchasing Power s payroll deductions, you can avoid taking out a high-interest loan to buy more than 50,000 products and services! You can take advantage of this benefit anytime throughout the year by visiting bswh.purchasingpower.com. Employee Assistance Program Cigna is our new Employee Assistance Provider (EAP). This service is available 24/7 at no additional cost. You also have three free, face-to-face sessions with a behavioral counselor. Other benefits include: Legal consultation Receive a free 30-minute consultation and up to 25% discount on select fees. Pet care From grooming to boarding to veterinary services, find what you need to care for your pet. Financial services and referral Receive a free 30-minute consultation and a 25% discount on select fees with network providers. You can take advantage of this by calling or visiting 73