Medical: Aetna Prescription: CVS Caremark Health Savings PPO Tier 1
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1 TRINITY HEALTH OF NEW ENGLAND BENEFITS SUMMARY Program B Senior Officers, Vice Presidents, Directors, Managers & Advanced Practice Clinicians Eligibility: Full-Time (30 + hrs/wk) or Part-Time (20-29 hrs/wk) MEDICAL INSURANCE (PRE-TAX) Effective 1 st of the month following 30 days of employment [Colleague and Employer Pays] Benefit Exclusions are consistent with Catholic Religious Health Care Directives Dependent children are covered up to the end of the plan year of their 26 th birthday 3 Networks available: ****Colleagues receive the most cost effective quality health care with the Tier 1 Trinity Health Network**** Tier 1: Trinity Health Network Tier 2: Aetna Network Tier 3: Out of Network Preventive care in tier 1 and 2 covered at 100% in all plans Medical: Aetna Prescription: CVS Caremark Traditional PPO Tier 1 Copays PCP $20 Specialist $30 Deductible Individual $250 Family $500 Some Services subject to upfront deductible Coinsurance 10% Once deductibles have been met- coinsurance applies for some services Out of Pocket Individual $2,500 Family $5,000 Prescription* Retail Generic: $10 Copay Formulary Brand: 20% with $30 Min and $80 Non Formulary: 40% with $60 Min and $100 Mail Order 90 Day Supply Generic: $25 Copay Formulary Brand: 20% with $75 Min and $200 Non Formulary: 40% with $150 Min and $250 *min/max reduced by 50% for asthma and diabetes class prescriptions Medical: Aetna Prescription: CVS Caremark Health Savings PPO Tier 1 Deductible Individual $1,500 Family $3,000 All Services and Rx subject to upfront deductible Coinsurance 10% Once deductibles have been metcoinsurance applies Out of Pocket Individual $2,600 Family $5,200 HSA Contribution by SF: Individual $650 Family $1,300 Prorated for mid-year enrollments Prescription* All Rx Subject to Plan deductible** Retail and Mail Order 90 Day supply Generic: 20% Coinsurance after deductible Formulary Brand: 20% Coinsurance after deductible Non Formulary: 20% Coinsurance after deductible *Generic Preventive Drugs are covered at 100% (not subject to the deductible) ** Deductible and out-of-packet maximum based on Trinity Health Tier 1 benefit level Medical: Aetna Prescription: CVS Caremark Essential PPO Tier 1 Deductible Individual $1,000 Family $2,000 Most services subject to upfront deductible Coinsurance 20% Once deductibles have been met- coinsurance applies for most services Out of Pocket Individual $3,500 Family $7,000 Prescription * Retail Generic: $10 Copay Formulary Brand: 25% with $30 Min and $80 Non Formulary: 50% with $60 Min and $120 Mail Order 90 Day Supply Generic: $25 Copay Formulary Brand: 25% with $75 Min and $200 Non Formulary: 50% with $150 Min and $300 *min/max reduced by 50% for asthma and diabetes class prescriptions 1
2 DENTAL INSURANCE (PRE-TAX) Effective 1 st of the month following 30 days of employment [Colleague and Employer Pays] Dependent children are covered up to the end of the plan year of their 26 th birthday Delta Dental of Michigan High Plan Preventive Services covered in Network at 100% Basic Services covered at 80% Major Services covered at 60% Orthodontic Services covered at 50% up to $1,500 (no age limit) Deductible PPO or Premier Dentist: Individual $25 Family $50 Non Participating Dentist: Individual $50 Family $100 imum Benefit PPO or Premier Dentist /$1,750 per person on all services except orthodontic Non Participating Dentist/$1,250 per person on all services except orthodontic Delta Dental of Michigan Standard Plan Preventive Services covered in Network at 100% Basic Services covered at 60% Major Services covered at 50% Deductible PPO or Premier Dentist: Individual $50 Family $100 Non Participating Dentist: Individual $100 Family $150 imum Benefit PPO or Premier Dentist $1,500 per person Non Participating Dentist $1,000 per person VISION INSURANCE (PRE-TAX) Effective 1 st of the month following 30 days of employment [Colleague Pays] Dependent children are covered up to the end of the plan year of their 26 th birthday United Healthcare High Plan Vision Exam: covered at 100% Lenses (single vision, bifocal, trifocal, lenticular: $0.00 Copay (additional lens options are covered in full: standard scratch resistant coating, standard basic and high-end progressive, standard polycarbonate, standard antireflective coating, UV, tints, photochromatic Transitions, edge coating. Frames: $150 retail allowance Contact lenses (in lieu of eye glasses): Fitting/evaluation fees, contact lenses and up to two follow up visits are covered in full after copay. Disposable contacts up to 8 boxes included when obtained from innetwork provider United Healthcare Standard Plan Vision Exam: $10 Copay Lenses (single vision, bifocal, trifocal, lenticular: $0.00 Copay (additional lens options are covered in full: standard scratch resistant coating and standard polycarbonate) Frames: $150 retail allowance Contact lenses (in lieu of eye glasses): Fitting/evaluation fees, contact lenses and up to two follow up visits are covered in full after copay. Disposable contacts up to 6 boxes included when obtained from innetwork provider 2
3 BASIC GROUP LIFE INSURANCE and AD&D-Effective 1 st of the month following 30 days of employment [Employer Pays] The Hartford Pays your beneficiary a death benefit amount equal to your base annual salary, rounded up to the next $1,000 to a maximum benefit of $1,500,000. SUPPLEMENTAL LIFE INSURANCE and AD&D-Effective 1 st of the month following 30 days of employment [Colleague Pays] The Hartford COLLEAGUE Colleagues have the option to purchase supplemental life insurance coverage in the increments shown in the table below. Premiums for this benefit will be deducted on an after-tax basis. Supplemental Life Supplemental AD&D One to eight times annual base salary Guaranteed Issue up to 3x base salary upon hire or newly eligible One to eight times annual base salary imum Amount $1,500,000 ($3,000,000 combined with Basic Life) *Personal Health Application (PHA) : Any amount over 3x base salary will require completion and submission of a PHA form to The Hartford DEPENDENT SUPPLEMENTAL LIFE INSURANCE OPTIONS Colleagues have the option to purchase coverage for his/her dependents (including spouse, eligible adult or eligible children). Spouse /Eligible Adult Life Coverage Amount $10,000 $20,000 $50,000* $80,000* $100,000* Child(ren) Life Coverage Amount $5,000 $10,000 $20,000 *Personal Health Application (PHA) : Any of these amounts will require completion and submission of a PHA form to The Hartford 3
4 FLEXIBLE SPENDING ACCOUNTS Effective the 1 st of the month after 30 days of employment [Colleague Pays] Wageworks The amount you contribute to the Flexible Spending Accounts must be spent in total during the year. If the amount or any part thereof is not spent during the year, it is forfeited in total to Hospital. HEALTH CARE FLEXIBLE SPENDING ACCOUNT - If NOT enrolled in the Health Savings PPO with Health Savings Account. The HCFSA allows colleagues to fund an account on a pre-tax basis to pay for health care costs that are not covered by the health care plan. The maximum amount a colleague may fund is $2,650. Contributions made to the HCFSA during the 2019 plan calendar year can be used for claims with dates of service between January 1, 2019 and March 15, Examples of eligible expenses include eye glasses, orthodontia, and the co-pays, deductibles and co-insurance requirements that are part of the health plans. DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT The DCFSA may reimburse a colleague for up to $5,000 ($2,500 for a married colleague filing separate tax returns) of dependent care expenses each plan year. Childcare expenses for children up to the age of 13 are eligible for reimbursement under this benefit. Also considered to be qualified dependents are disabled spouses and other dependents that are physically or mentally incapable of self-care, and who regularly spend at least 8 hours each day in the taxpayer s household. Contributions to the DCFSA during the 2019 calendar year can be used for claims with dates of services between January 1 and Dec 31, HEALTH SAVINGS ACCOUNT Effective 1 st of the month following 30 days of employment [Colleague Pays] Health Equity IRS Annual imum contribution (Employer and colleague combined) : Individual: $3,500 Family: $7,000 **Additional $1,000 if over the age of 55 Employer Contribution 2019* Individual $650 Family $1,300 *Prorated for mid-year enrollments HEALTH SAVINGS ACCOUNT If enrolled in the Health Savings PPO Enrollment in the Health Savings PPO will automatically include a health savings account through our banking partner Health Equity to help you pay for current or future health care costs. Colleague Contribution: The HSA allows colleagues to fund an account on a pre-tax basis to pay for family health care costs that are not covered by the health care plan. Examples of eligible expenses would include eyeglasses, orthodontia, and the co-pays, deductibles and co-insurance requirements that are part of the health plans. This account is portable and is managed through our banking partner Health Equity. You cannot contribute to the HSA if covered by any other medical plan, such as Medicare, TRICARE, or coverage through someone else s plan. Monies in the HSA can be used for medical, dental, vision expenses colleague and his/her dependents may incur now and in the future. Dependents must be claimed on the colleagues tax return. Any money not used during the year is carried over without any limits. Colleague owns account. 4
5 RETIREMENT PLANS - Transamerica Vesting: after 3 years of service or age 65 (a year of service is earned when a colleague work 1,000 hours in a calendar year) Transamerica Retirement Solutions Call Center : Website: Trinity Health Of New England is committed to providing a retirement benefit that supports the needs of the colleagues and their families. The 401(k)/403(b) Retirement Savings Plan includes both employer contributions and colleague tax deferred savings that, when combined, provide a meaningful retirement benefit. CORE CONTRIBUTION Full-time Trinity Health colleagues will receive the greater of 3% of Retirement Program Pay or the Minimum Core Contribution, which is $1,200. The Minimum Core Contribution will be pro-rated for part-time colleagues. Core contributions are received when colleague has earned 1,000 hours of service in the calendar year. The first deposit will be based on your pay up until that date and subsequent deposits will be made shortly following each pay period. SERVICE-BASED MATCHING CONTRIBUTIONS Eligible colleagues who contribute to the 401(k)/403(b) Retirement Savings Plan will receive service-based matching employer contributions. Colleagues scheduled/budgeted to work 1,560 hours or more annually will begin receiving matching contributions shortly after each pay period, while those scheduled/budgeted to work less than 1,560 hours will receive matching contributions once they have earned 1,000 hours of service in the calendar year. Employer matching contributions will be based on Retirement Program pay and contributions from the beginning of the calendar year up until a colleague works 1,000 hours in the calendar year, and subsequent deposits will be made shortly following each pay period. Years of Benefit Service Service-Based Matching Contribution COLLEAGUE CONTRIBUTION Automatic payroll deduction with a contribution rate of 2% of pay. Pre-tax contributions may be made up to 75% of pay or the annual IRS limit which is $19,000 for If colleague turns 50 or older in 2019, colleague can contribute an additional $6,000, called the age 50 catch-up contributions Contributions can be increased, decreased or discontinued at any time Withdrawals from the Retirement Savings Plan can only occur under the following circumstances: Colleagues leaves employment with Trinity Health Of New England Financial Hardship as defined by the IRS Reaching age 59 ½ while in service Death Loans (in service) Total Service-Based Contribution (When eligible colleagues contribute 6%) 0 but less than 10 25% on 6% 1.5% 10 but less than 20 50% on 6% 3.0% 20 or more years 75% on 6% 4.5% 5
6 Time Away from Work Programs Paid Time Off Effective the 1 st day of employment Program B Includes drop in time of 27 days which can be used for vacation and personal days and is determined by job title. Use it or lose it. imum carryover from year to year is 40 hours. Any unused time after 40 hours will be lost. Holiday Pay Regular colleagues budgeted at least 20+ hours/week will be paid for the holiday whether worked or not 6 Core Holidays o New Year s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day o 1 Floating Holiday Disability Pay Short Term Disability Long Term Disability Short Term Disability 100% of base pay Report disability 7 calendar days after initial disability date Benefit Duration: 6 months Incidental sick time covered through salary continuation not from PTO bank Long Term Disability 70% of base pay with a monthly maximum of $15,000/month 180 Days Elimination Period Benefit duration: Normal social security retirement age or deemed no longer disabled 6
7 HYATT LEGAL SERVICES BIWEEKLY COST: $5.12 Individual $6.97 Family Additional Voluntary Benefits Hyatt Legal provides you with telephone and office consultations for an unlimited number or matters with the attorney of your choice. Services are included, but not limited to: consumer protection, sale, purchase or refinancing of home, deb collection defense, civil litigation defense, traffic ticket defense (no DUI), identity theft defense, immigration assistance, document review. TUITION REIMBURSEMENT Full time: up to $3,000 Part time: up to $1,500 Trinity Health encourages and offers assistance for our colleagues self-development by providing tuition assistance for certain educational courses. Colleagues who wish to participate in this benefit must apply for tuition reimbursement before the start of the course(s). Colleagues must also pass the course(s) with at least a C or better and provide necessary documentation. For more information, please review our policy located on your local Infonet. ADOPTION ASSISTANCE Regular Adoption: up to $4,000 Adoption of a child with special needs: up to $6,000 Trinity Health also believes in the institution of family and is committed to providing financial assistance to colleagues, per the guidelines of the policy, who incur expenses related to adoption. Our organization will assist with any recognized agency and court fees incurred through the legal adoption of a child. For more information and the review of the policy guidelines, please visit your local Infonet. THE PRODUCTS BELOW ARE UNDERWRITTEN BY FARMINGTON COMPANY For more information please contact CRITICAL ILLNESS This plan helps protect your finances from an expense of a serious health problem, such as a stroke or heart attack. You choose a lump-sum benefit of up to $50,000 that s paid directly to you at the first diagnosis of a covered condition. You can use the benefit anyway you choose. Cancer coverage is also available. WHOLE LIFE INSURANCE This plan is designed to pay a death benefit to your beneficiaries, but it can also build cash value you can use while you are living. This benefit offers an affordable, guaranteed level of premium that won t increase with age. Unlike term life insurance, this coverage can continue into retirement. GROUP ACCIDENT INSURANCE This plan can pay a lump sum benefit based on the injury you receive and the treatment you need, including emergency room care and related surgery. The benefit can help offset the out-of-pocket expenses that the medical insurance does not pay, including deductibles and co-pays. HOSPITAL INDEMNITY This plan pays a daily benefit up to 180 days if you or a covered family member is confined to a hospital for a covered condition. Benefits paid for include covered surgeries, anesthesia, physician visits, lab fees, x-rays, injections, and medications. 7
8 CANCER INSURANCE This plan pays in the event of diagnosis. Over 60% of costs associated with fighting cancer are non-medical in nature. This plan pays the colleague directly, in addition to medical or disability benefits. It covers chemotherapy and radiation, as well as hospital confinement, and travel. ACCIDENTAL DEATH AND DISMEMBERMENT This plan pays a lump-sum benefit in the event of a serious injury and can help cover the cost of emergency room case and related surgeries. You also may purchase coverage for your spouse and dependent children. Coverage includes accidents that occur on or off the job and the policy is portable. LIFELOCK This plan works 24/7 to safeguard your personal information both on and off line. Current LifeLock members are eligible for special Trinity Health rates. AUTO, HOME, AND PERSONAL PROPERTY This plan offers a number of coverages that can help you protect your personal assets including: auto, homeowners, boat owners, recreational vehicles, landlord s rental dwelling, renters, condominium, mobile home, fire, and personal excess liability. PET INSURANCE This plan offers an array of coverage for your pet, including vaccination and double cancer coverage endorsement, while allowing you to choose your own veterinarian. 8
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