The Archdiocese of Chicago Department of Human Resources

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1 The Archdiocese of Chicago Department of Human Resources This pamphlet is intended to be a summary of the benefit plans for For a more detailed explanation, please refer to the 2009 Employee Overview available online at or obtain a copy from your parish/school benefits administrator. If you have further questions, please contact Human Resources at

2 Summary of 2009 Benefit Changes The Archdiocese now offers Flexible Spending Accounts through Employee Corporation. The Archdiocese now offers voluntary Short Term Disability through Reliance Standard, the new provider of Life and Long Term Disability benefits. All benefit eligible employees who have not previously opted out or are participating at 0% in the 403(b) plan will have their deferral amount increased by 1%. Health and Dental Costs for Plan Year 2009 Blue Cross Blue Shield Monthly Employee Co Pay Amounts First Commonwealth Monthly Dental Employee Co-Pay Amounts 1/1/2009 6/30/2009 7/1/ /31/2009 Individual Family Individual Family Individual Family PPO $ $ PPO $ $ $ $ HMO $ $ HMO Illinois $ $ $ $ Blue Advantage $ $ $ $ Medco Prescription Drug Retail 30 day Mail Order 90 day supply supply Generic $7.00 $15.00 Brand name, Formulary $22.00* $45.00* Brand name, Non-Formulary $37.00* $75.00* *Plus half the difference between the cost of the name brand drug and the generic equivalent. When a brand name medication is chosen and a generic equivalent is available, the member will pay the co-pay plus half the difference.

3 Flexible Spending Accounts A Flexible Spending Account (FSA) allows you to cover the cost of certain out-of-pocket health care and dependent care expenses for you, your spouse and your dependents. You decide how much money to put into an account during the enrollment period. Then, when you incur an eligible expense, you receive taxfree reimbursements from the FSA. Since the money is not taxed, you will realize a tax savings on each paycheck. The plan year will initially be January 1 st to June 30 th, Then, effective July 1 st, 2009 the plan year will be from July 1 st to June 30 th. The Archdiocese offers two types of FSAs: Health Care FSA This account covers medical, dental, vision care and other qualified costs. Eligible costs include plan deductibles, co-insurance, co-payments and expenses that insurance may not cover such as over-thecounter drugs and orthodontia. Dependent Care FSA This account covers expenses you incur for dependent care while you are at work. Eligible expenses include daycare, nursery school and day camp for children, as well as services for older dependents that can not care for themselves., if you claim them as a dependent for tax purposes. Plan Maximums from 1/1/2009 6/30/2009 Maximum Amount Plan Maximums from 7/1/2009 6/30/2010 Maximum Amount Health Care $ 1500 Health Care $ 3000 Dependent Care $ 2500 Dependent Care $ 5000 When paying for your eligible expenses, there are two different pay options you can choose from: Option 1: The "Benny Card" (For Health Care Only) The "Benny Card" works just like a debit card. It automatically debits your FSA account when you use the card to pay for eligible health care expenses. You can use your benny card anywhere Mastercard is accepted. Option 2: Claim Form (For Health and Dependent Care) For dependent care expenses and for health expenses not paid using the Benny Card, you must fill out a claim form to be reimbursed for the approved expenses. The form is easy to use and your reimbursement will either be direct deposited or a check will arrive quickly in the mail after submission.

4 Basic Life, Supplemental Life and Long Term Disability Insurance The Archdiocese of Chicago provides Basic life insurance for all benefit eligible employees in the amount of 1X your base salary. You may purchase additional life insurance up to four times your yearly salary. A personalized enrollment form is provided during open enrollment by our life insurance provider, Reliance Standard, for all benefit eligible employees. If you do not receive this statement, please contact your local benefits administrator. Short Term Disability If you are a full or part time benefit eligible employee with an annualized salary of at least $15,000 you are eligible to participate in the plan. A personalized enrollment form is provided during Open Enrollment for current employees. If you wish to participate in the short term disability plan, you should complete the form and return it to your benefits administrator. Blank forms are also available online at: Each eligible employee may elect an amount of insurance, in increments of $25 from a minimum of $100 to a maximum of $1,250 per week, up to 60% of covered earnings. $100 Minimum $1250 or 60% of Covered Earnings Employee Rates (per $10 of Weekly Benefit) Age Rate $ $ $ $ $ $ $ $ $ $ and over $ 0.87 Employee rates are listed on the left side. These rates are per $25 worth of coverage. For a more detailed description of how to calculate your rate see the example below: Example of Coverage 45 year old employee Weekly rate of pay = $850 60% of weekly pay = $510 Maximum Benefit (rounded down) = $500 Premium Calculation (Weekly Benefit 10) x Monthly Rate $50 x $0.58 = $29.00 $29.00 per month for $500/week in coverage Plan Highlights A pre-existing condition clause applies to this plan. will not be paid for a twelve month period if disability is caused by a condition treated within three months of your enrollment in the plan. begin on the 30 th consecutive calendar day of disability. Sick and vacation time can be used while you receive short term disability payments. for one period of disability will be paid up to a maximum of 22 weeks. Evidence of insurability will be required for anyone who increases their coverage or enrolls in coverage after the 2009 open enrollment period. New hires are also exempt from the evidence of insurability upon initial plan enrollment.

5 Archdiocese Retirement Plans and Overviews Archdiocese Contribution Only Share Plan The Share Plan offers all benefit eligible employees an age-weighted contribution or flat percentage depending on hire date. All contributions are quarterly and based on salary Hired before July 1 st, 2007 = Age Weighted Hired on or after July 1 st, 2007 = 4% The Archdiocese offers you three separate programs to help save for retirement. Depending on your hire date, these programs may affect you in different ways. The programs are listed below. Archdiocese Contribution Only Pension Plan All employees hired before July, 1 st, 2007 are eligible for a pension. For more information, please call HR at: The benefit is based on your career average earnings through 6/30/2007. Employee Contribution Plus Diocese Match 403(b) Plan All employees can participate in the 403(b) plan. All benefit eligible employees are matched fifty cents on the dollar up to four percent of their salary. For more information on the 403(b) plan, call HR or Mass Mutual at: FLASH Vesting: 100% after five years of service Vesting: 100% after five years of service Vesting: 25% per year of service Beginning January 1st, 2009 all benefit eligible employees who have not opted out and are not currently participating at or above 4% will have their deductions increased by 1%. For example: 1% will increase to 2% 2% will increase to 3% 3% will increase to 4% Any employee that DOES NOT want to auto increase by 1% and has not previously opted out of auto enrollment, should contact Mass Mutual.

6 Blue Cross Blue Shield Medical Plan Comparison Chart General Provisions Deductable (Annual) Out-of-pocket Max (Per calendar year not including deductible) BCBS PPO HMO Illinois Blue Advantage In-Network- Out-of-Network $400 Individual $800 Family $2,000 Individual $4,000 Family $3,500 Individual $7,000 Family Lifetime Benefit Max Unlimited Unlimited Unlimited Primary Care Physician/Gatekeeper Copayments/ Coinsurance In-Network Out-of-Network Primary care physician is required Primary care physician is required Physician s Office Visit 85% after deductible 75% after deductible $15 Copay 100% Primary Doctor s Office $15 Copay $0 Copay Specialist Office $15 Copay $0 Copay Routine Adult Physicals $15 Copay $0 Copay Laboratory Services 85% after deductible 75% after deductible 100% 100% Inpatient Hospital 85% after deductible 75% after deductible 100% 100% Preauthorization of Treatment You must call 72 hours to pre certify before a planned hospital admission or the next business day after an emergency. If you fail to pre certify, it will result in a 50% penalty. Outpatient Hospital 100% 100% Emergency Room Visit Maternity Care (pre- and post-natal) Well care/immunizations All ages 85% up to $500 calendar year maximum 75% up to $500 calendar year maximum $75 copay Copay is waived if admitted. $50 copay Copay is waived if admitted. 100% 100% $15 Copay $0 Copay Chiropractic Care 85% after deductible 75% after deductible 100% 100% Physical Therapy 85% after deductible 75% after deductible Mental Health Treatment Substance Abuse Treatment Inpatient: 85% after deductible up to 45 days per year Inpatient: 85% after deductible up to 45 days per year Limited 2 confinements per lifetime Out patient: 100% after $25 copay for individual sessions; In patient: 75% after deductible up to 45 days per year Out patient: 50% after deductible up to 45 days per year In patient: 75% after deductible up to 45 days per year Limited 2 confinements per lifetime Out patient: 50% after deductible up to 48 days per year Inpatient: Plan pays 100% up to 20 days per year Outpatient: $15 copay up to 20 visits per year Inpatient: Plan pays 100% up to 20 days per year Outpatient: $20 copay up to 20 visits per year Inpatient: Plan pays 100% up to 20 days per year. Outpatient: $ 0 copay up to 20 visits per year Inpatient: Plan pays 100% up to 20 days per year. Outpatient: $ 20 copay up to 20 visits per year

7 First Commonwealth Dental Plan Comparison Chart Dental Services Diagnostic and Preventive Care Annual Deductible for Basic and Major Services Office Visit Co-pays First Commonwealth Dental HMO Coverage Level: 100%, after $5 co-pay. These services are provided at no cost to members enrolled in this choice. No deductible to satisfy First Commonwealth Dental PPO In-network Coverage Level: 100% These services are provided at no cost to members enrolled in this choice. $50 per person per year; 3 person maximum Out-of-network Coverage Level: 100% This plan pays 100% of the usual and customary charge. $100 per person per year; 3 person maximum Office Visit (Normal Hours) $5 N/A N/A Emergency Visit (Normal Hours) $20 N/A N/A Emergency Visit (After Hours) $35 N/A N/A Basic Dental Services Major Dental Services Waiting Period Annual Benefit Limitation Orthodontics (Braces) See specific DHMO fee schedule in your enrollment material See specific DHMO fee schedule in your enrollment material Unlimited; member benefits have no annual limit Coverage level: 80% Member pays 20% of the PPO fee Coverage level: 50% Member pays 50% of the PPO fee Coverage level: 80% This plan pays 80% of the Usual & Customary charge Coverage level: 50% This plan pays 50% of the Usual & Customary charge 12-month wait for Major Services for new enrollees $1,500 per person; member pays 100% cost over $1,500 benefit maximum Rollover feature added. If a claim is filed and the total claims paid is less than $700 for the benefit period, you are eligible to carry-over $350 into the next plan year (or $500 if services rendered were from In- Network providers only), in addition to the $1,500 provided on January 1. The maximum accumulated carry-over amount is $1,250 per covered person. Under 19 years of age Co-payment amount Not covered Not covered 19 years of age and over Co-payment amount Not covered Not covered Orthodontic Lifetime Maximum Not applicable Not applicable Not applicable Claim Forms Required No Yes Yes Pre-existing Condition Exclusions No Yes Yes Advance Claim Reviews No Yes Yes Subject to Reasonable and Customary Limits Provider Locator No No Yes or Review your Benefit Plan Enrollment Health Insurance Dental Insurance Optional Life Insurance Flexible Spending Account Short Term Disability If making any changes: Complete Appropriate Enrollment Forms Submit forms to school parish Benefit Administrator by Friday November 21, Complete the WAIVER OF HEALTH BENEFITS form if you are not enrolled in Health Insurance. Contact Human Resources or MassMutual for detailed information regarding Auto Increase for the 403(b) plan. Take note of the 2009 Premium Rates.

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