What s new for If you don t enroll

Transcription

1 Welcome to open enrollment! CHE Trinity Health and Mount Carmel Health (which includes Mount Carmel Health System and Mount Carmel Medical Group) are pleased to provide you with the information you ll need to enroll for next year s benefits. This information applies to colleagues in the Trinity Health division (hereafter referred to as Trinity Health in this communication). We believe this comprehensive enrollment guide will make it easier for you to learn about your benefit plan options, decide on the levels of coverage that are right for you and your family, and compare costs before you log in to the My Benefits website to complete your online enrollment. In addition to details about the 2014 benefit plan options, this enrollment guide provides other important information, such as colleague and dependent eligibility requirements, step-by-step instructions on how to enroll online, and how to get answers to your questions. Before you enroll, take a few minutes to review all of your benefit plan options and their corresponding premium contributions before making your selections for NOTE: premium contributions may vary from the amount shown on your pay advice due to rounding. Be sure to consider what your needs may be for the upcoming year, and choose your benefits accordingly. Refer to the For more information section if you have questions about open enrollment that aren t addressed in this enrollment guide. If you don t enroll You must enroll to elect benefits of your own choosing for Open enrollment for medical coverage is mandatory this year. If you don t make benefit elections on or before Nov. 6, 2013, you will not have medical coverage for 2014, and will automatically receive a default package of benefits, which includes the same elections you had last year for dental, vision, life insurance, disability, and legal benefits. Your current elections for the health care and dependent care flexible spending accounts and PLT cash-out will not carry over. If you wish to participate in these programs next year you must complete your enrollment between Oct. 23 and Nov. 6, What s new for 2014 Trinity Health and Mount Carmel Health want to point out what s new in this year s open enrollment: You have the opportunity to choose from three all new medical plan options for 2014: the Traditional PPO Plan, the Health Savings PPO Plan (which includes a health savings account), and the Essential PPO Plan. See the Medical Coverage section for more information on these plan options. Under each of the medical plan options, all copayments, coinsurance amounts, and deductibles will apply toward meeting your out-of-pocket maximum. Keep in mind, because these medical plan options are all new for 2014, you must make a medical plan election or you will not have medical coverage in All colleagues enrolled in a medical plan will receive a new insurance card for As part of the new medical plan designs for 2014, you will now share in the cost of services when you utilize Tier 1 providers: Trinity Health facilities and Health Partners providers. Keep in mind, even with the new cost-sharing structure, you will still pay less when you use Trinity Health facilities and Health Partners providers. We are introducing a new colleague per pay period structure or, contribution levels for the medical plans based on the Social Security taxable wage base ($113,700 for 2013, indexed annually) to ensure our benefit plan cost-sharing model is appropriately aligned with our colleagues income levels. The amount you pay for medical coverage is based on your annual base salary (your base rate of pay times your budgeted hours). If at any time during the 2014 plan year, you earn $113,700 or more, you will pay a higher premium contribution per pay period for your medical insurance. Refer to the Medical Plan Highlights chart and the My Benefits website for premium contribution amounts. We are offering a new way to make benefits more affordable for eligible colleagues enrolled in a Trinity Health medical benefit plan. If you qualify, you may be eligible for the Essential PPO Assist plan. It is the same as the Essential PPO, but includes a Mount Carmel Health-funded Health Reimbursement Account (HRA), which helps you pay for health care costs when you receive services. Refer to the Medical Coverage section and the My Benefits website for more information. We are pleased to introduce our clinically-integrated network (CIN) structure for our medical plan options. The CIN joins local physicians and health care providers with our Regional Health Ministry (RHM) into a single care management system using a common set of quality measurements to ensure high quality, cost-efficient care. Trinity Health and Mount Carmel Health are proud to emphasize the importance of your health and well-being through wellness discounts. When you and your covered spouse complete the Health Assessment (HA) by Jan. 31, 2014, you will continue to enjoy the 30 percent reduction in your medical plan premium contributions for 2014! And, to get a head start on wellness discounts for 2015, adult preventive care visits with your primary care physician (PCP) during 2014 will count toward your 2015 discounts. Visit the My Benefits website for more information on our Life Your Whole Life (LYWL) Wellness Rewards program. 1 Mount Carmel Health

2 Benefit elections are effective for the entire year Remember, the benefits you elect during open enrollment will be in effect from Jan. 1 through Dec. 31, Open enrollment is your only opportunity during the year to make elections for your 2014 benefits unless you experience a qualified family status change. If you experience a qualified family status change or certain employment status changes and provide any required documentation to your Human Resources representative within 30 days of the event, you will be allowed to make certain benefit changes as long as they are consistent with the status change. For example, if you get married during the plan year, you ll be able to add your spouse to your coverage within 30 days of the marriage because this is consistent with the status change. For more information on qualified family status changes, visit So before you enroll, be sure to consider what your needs may be for the upcoming year and to choose your benefits accordingly. Health Care Reform: an update for 2014 You ve probably heard about the health care reform law, officially called the Affordable Care Act (ACA). One of the primary purposes of the law was to make sure U.S. citizens and legal resident aliens have access to health coverage they can afford. Starting Jan. 1, 2014, the law will require you to have health coverage or you may have to pay a penalty. In order to meet this requirement, you have several options from which to receive health care coverage, including through: An employer (such as Trinity Health or your spouse s employer), A private insurance company, or Health Insurance Marketplace, or other government-sponsored plans and/or agencies (such as Medicare or TRICARE). An important part of the requirement for you to have health care coverage is that the coverage must meet the standards for minimum value and essential health benefits. The Trinity Health plans described in this enrollment guide meet these requirements. This means, if you enroll in medical coverage through a Trinity Health plan, you will have met these key health care requirements for As the health care reform law continues to unfold, the Health Benefits Strategy Work team will continue studying the alternatives and the impact of the legislation on our benefit programs. What you need to do Trinity Health will continue to offer comprehensive health coverage in 2014 for benefits-eligible colleagues. As a benefits-eligible colleague, it is important for you to take the opportunity during the open enrollment period (Oct. 23 through Nov. 6, 2013) to review all of your options Trinity Health s health care plans, private insurance company plans, and government options carefully to make the best decision for you and your family. We will continue to communicate with you about health care reform and are committed to providing you with the latest information as soon as decisions are made. For additional information about the ACA, visit or Women s Preventive Care under the Health Care Reform Law Part of the Affordable Care Act (ACA) (also known as health care reform) requires employers to cover certain women s preventive care services, including contraception, under health insurance benefits at no charge. As a health ministry of the Catholic Church, we have engaged in extensive advocacy with the support of the Catholic Health Association, to find an acceptable resolution to this issue. On July 1, 2013 U.S. Health and Human Services, Treasury and the Department of Labor jointly released the final rules that gave an accommodation to certain religious and religiously-affiliated organizations, like Trinity Health, which would provide exemption from the requirement to provide contraceptive coverage to employees as preventive health services. Because we are a faith-based organization that is not currently providing contraception coverage through our health plan, these new regulations allow Trinity Health to be exempt from the requirement to provide contraceptive coverage. However, your medical plan administrator will be responsible for providing these benefits as mandated by the ACA. Trinity Health colleagues will be provided with access to these benefits but they will not be paid for by Trinity Health or its health plans. Contact your medical plan administrator and/or pharmacy benefit manager for further details. Adding family members If you re adding family members to your benefit plan for the first time during this year s open enrollment, you re required to provide written documentation (for example, marriage certificate or birth certificate) verifying their dependent status to Human Resources no later than Nov. 20, If you don t submit the required paperwork by the deadline, your dependents will not be enrolled for coverage for 2014, and you ll be required to wait until next year s open enrollment period to add them to the plan provided they remain eligible, and you provide written documentation verifying their dependent status at that time. You are required to provide a Social Security number for each of your dependents over the age of one in order for them to be covered. Please provide the missing Social Security numbers to Human Resources. To view the complete eligibility rules and documentation requirements for you and your family members, visit Mount Carmel Health 2

3 Your benefit options Scan the tag with your smartphone to download and view a video about your new medical plan choices for Get the free mobile application at If you don t have a smartphone, visit My Benefits to view the video. Medical coverage You re eligible for medical coverage if you re a regularly scheduled full- or part-time colleague with 32 or more budgeted hours per pay period, and have satisfied the required waiting period. New for 2014! Trinity Health and Mount Carmel Health are proud to offer you all new medical plan choices for Offering these three plan design structures supports our efforts to provide a common experience for all colleagues and to leverage the size of our System. All three plans are administered by Aetna and support our new clinically-integrated network structure. You have a choice between three all new medical plan options to protect you and your family from the financial burden of illness and injury: the Traditional PPO, the Health Savings PPO, and the Essential PPO. All three plans are preferred-provider organizations (PPO), which means you can receive care from any health care provider, but the amount you pay out of pocket is less when you receive care from network providers. Tier 1, or the Health Partners network providers are facilities or physicians aligned with our organization that provide you with the most cost-effective care. For services unavailable through Health Partners network providers, select Aetna Providers will be available at the Tier 2 benefit level. Tier 2 includes select Aetna Providers (facilities and physicians) not listed under Tier 1. Using Tier 2 providers can save you money, but not as much as using our Tier 1 network. Tier 3 providers are out-of-network providers and this Tier provides the lowest level of coverage. You can use these facilities and physicians for care, but you will pay the most out of your pocket when you do. Traditional PPO If you elect coverage under the Traditional PPO, you pay for a portion of the medical services you receive until you meet the annual deductible. Then, coinsurance begins up to the annual out-of-pocket maximum. Health Savings PPO The Health Savings PPO gives you control and responsibility over how you pay for health care services. You pay much less per pay period for coverage than the Traditional PPO, leaving more money in your paycheck. In addition, the Health Savings PPO option features a Health Savings Account (HSA) to help pay for current and future medical expenses. Here s how it works: First. You pay the full cost of medical expenses until you reach the annual deductible (except when you receive preventive care services and fill select preventive 90-day generic prescriptions). Second. Once you meet the deductible, you pay coinsurance until you reach the out-of-pocket maximum. Third. Once you reach the out-of-pocket maximum, Trinity Health and Mount Carmel Health pay 100% of all remaining eligible expenses during the year. If you enroll in the Health Savings PPO, you will automatically have an HSA. Trinity Health and Mount Carmel Health contribute to your HSA to help you pay for expenses toward your annual deductible and out-of-pocket maximum. You can also contribute to this account to build savings for current and future medical expenses. Essential PPO The Essential PPO works the same as the Traditional PPO where you pay a portion of the medical services you receive until you meet the annual deductible. Then, coinsurance begins. If you elect the Essential PPO, you pay less in premium contributions than in the Traditional PPO, however, your out-of-pocket costs are higher. Assistance with your health care costs You may be eligible for the Essential PPO Assist plan if you meet certain income requirements. It is the same as the Essential PPO, but includes a Trinity Health and Mount Carmel Health-funded Health Reimbursement Account (HRA), to help you pay for your health care costs at the time of service. You do not make contributions to the HRA under the Essential PPO Assist plan. To participate in the Essential PPO Assist, you must apply for and meet specific income and eligibility guidelines. You can apply for the Essential PPO Assist by completing an application form and submitting it with a copy of your most recent Federal Income Tax Form 1040 or 1040EZ to Human Resources by Nov. 20, NOTE: Even if you think you qualify for the Essential PPO Assist, you should elect the medical plan you think will be best for you and your family, which could be the Traditional PPO, the Health Savings PPO, or the Essential PPO. If you qualify for the Essential PPO Assist plan, you will be moved from the plan you elect during open enrollment to the Essential PPO Assist plan. Otherwise, you will remain in the plan you elected during open enrollment. 3 Mount Carmel Health

4 Medical Plan Highlights The following table highlights the important features of each of your plan options, including colleague coinsurance/copayment responsibility. For more information about your medical plan options, visit MEDICAL Traditional PPO Health Savings PPO Essential PPO Plan Highlights Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 Tier 1 Tier 3 Tier 3 Trinity Health- N/A Health Savings Account (HSA) Health Reimbursement Account (HRA), funded account if you qualify Single $650 $750 Family $1,300 $1,500 Annual deductible Individual $250 $750 $1,500 $1,300 $2,500 $3,500 $1,000 $2,500 $4,000 Family $500 $1,500 $3,000 $2,600 $5,000 $7,000 $2,000 $5,000 $8,000 Coinsurance 10%* 20%* 40% 10%* 20%* 40%* of 20%* 30%* 40%* R&C* R&C* R&C* Preventive Care 0% no 0% no 40% 0% no 0% no 40% 0% no 0% no 40%* deductible deductible R&C* deductible deductible R&C* deductible deductible R&C* Office Visit PCP: $20 PCP: $30 40%* 10%* 20%* 40%* 20%* 30%* 40%* Specialist: Specialist: R&C* R&C* R&C* $30 $40 Urgent care visit 0% after $35 copay 1 b 0 u % g * 0% after $40 copay Emergency room 0% after $100 copay 10%* 0% after $100 copay Inpatient admission $250 $500 $1,000 None $500 $1,000 $250 $750 $1,000 Outpatient admission $50 $100 $200 None $100 $200 $50 $100 $200 Out-of-pocket maximum (includes deductible; copayments, and) coinsurance) Individual $2,500 $4,750 $9,500 $2,600 $5,000 $7,000 $3,500 $5,500 $9,000 Family $5,000 $9,500 $19,000 $5,200 $10,000 $14,000 $7,000 $11,000 $18,000 Prescription drug Retail/In-house pharmacy (34-day supply) Generic $10 20%*, 0% after out-of-pocket maximum $10 Brand formulary 20% ($30 minimum, $80 maximum) (Deductible and out-of-pocket maximum 25% ($30 minimum, $80 maximum) Brand non-formulary 40% ($60 minimum, $100 maximum) based on Tier 1) 50% ($60 minimum, $120 maximum) Mail/In-house pharmacy (90-day supply) Generic $25 20%*, 0% after out-of-pocket maximum $25 Brand formulary 20% ($75 minimum, $200 maximum) (Deductible and out-of-pocket maximum 25% ($75 minimum, $200 maximum) Brand non-formulary 40% ($150 minimum, $250 maximum) based on Tier 1) 50% ($150 minimum, $300 maximum) Full-time Part-time Full-time Part-time Full-time Part-time Your per pay period With Without With Without With Without With Without With Without With Without cost HA HA HA HA HA HA HA HA HA HA HA HA For colleagues earning less than the 2013 SSTWB Colleague only Colleague plus spouse Colleague plus child(ren) Colleague plus family For colleagues earning the 2013 SSTWB or more Colleague only Colleague plus spouse Colleague plus child(ren) Colleague plus family * Subject to deductible. Select, generic preventive drugs are covered at 100% and are not subject to the annual deductible. See My Benefits for the complete list of eligible drugs. The 2013 Social Security taxable wage base (SSTWB) is $113,700. Mount Carmel Health 4

5 More about the Health Savings PPO The Health Savings PPO is called a consumer-driven health plan. The Health Savings PPO gives you the opportunity to participate in a plan where your health care costs are more closely determined by your decisions. Keep the following features of the Health Savings PPO in mind as you are considering which medical option to choose for your 2014 benefits: The Health Savings PPO lets you pay for medical services when you use medical care, instead of paying higher premium contributions throughout the year. The Health Savings PPO plan includes a combined deductible. This means, if one covered family member s costs for health care services is more than the individual deductible amount, it will count toward meeting the family deductible. The Health Savings PPO offers a Health Savings Account (HSA) that allows you to save for and manage health care expenses. Trinity Health and Mount Carmel Health will automatically make the full contribution to your Health Savings Account (HSA) based on your elected coverage level on Jan. 1, The Health Savings PPO plan includes 100% coverage for select, generic, preventive drugs and you don t have to meet your deductible first. For a complete list of 100% covered generic, preventive drugs under the Health Savings PPO, visit My Benefits. 5 How the Health Savings Account (HSA) Works When you enroll in the Health Savings PPO plan, you automatically have a Health Savings Account (HSA) through Health Equity to help you pay for current or future health care costs. Trinity Health and Mount Carmel Health make contributions to your account based on the coverage level you elect. In addition, you can also contribute to this account up to IRS limits: Coverage Level Trinity Health and Mount Carmel Health Contributions Your Contributions* Total IRS Allowed HSA Contributions Colleague only $650 $2,650 $3,300 All other coverage levels $1,300 $5,250 $6,550 *If you are 55 or older, you can contribute an additional $1,000 in catch-up contributions to your HSA. Here are some additional highlights of the HSA: You may use the HSA to pay for qualified medical expenses now and during retirement for you and your qualified dependents. Keep in mind... In order to be eligible for the HSA, you must enroll in the Health Savings PPO. In addition, you cannot have coverage under any other medical plan, such as Medicare, TRICARE, or coverage through a spouse s health plan. With the HSA you do not pay taxes on the amount you contribute through payroll deductions, the amount you withdraw for medical expenses, and the interest you earn in the account (up to amounts set by federal law). You can change the amount you contribute to your HSA at any time during the plan year. When you receive eligible health care services, you can pay for those services with your HSA debit card, or through several online and smartphone app options. You ll receive more information about your payment options if you enroll in the Health Savings PPO with the HSA. Any money you do not use during the year is carried over, without any limits. You own the money in your HSA and it is yours to keep even when you change jobs or retire. Because the HSA pays for eligible health care expenses, when you enroll in the Health Savings PPO, you will not have access to the health care spending account (HCSA). The HSA works just like the HCSA to help pay for eligible medical, dental, and vision expenses, plus, it includes additional benefits such as: The opportunity to carry over savings from year to year. In other words, you do not forfeit any amount in your HSA at the end of the plan year; Contributions of up to $6,550 in tax-free HSA dollars each year (the HCSA maximum is $2,500); Your HSA dollars are saved in a bank account that may earn interest. How do I know if the Health Savings PPO, including an HSA, is right for me? Your medical plan choice depends on your personal situation. Here are some questions to ask yourself to determine if the Health Savings PPO plan is right for you: Would you like to have lower per pay period contributions deducted from your paycheck? Do you want to save on taxes by contributing to the HSA for your health care costs? Do you need a way to pay for future health care costs? Can you see your HSA balance growing as you keep making contributions each year? If you answered yes to some of these questions, the Health Savings PPO with the HSA may be right for you. For more information about the Health Savings PPO, including the Health Savings Account (HSA), visit My Benefits. Mount Carmel Health

6 Be a smart health care consumer As you know, the cost of high-quality health care continues to increase each year. Being a smart consumer means getting the best price on something you need, whether it s a new car or health care. Being a smart health care consumer doesn t mean you should avoid trips to the doctor it means making the best decisions about when to go to the doctor. Regular checkups can improve your health and extend your life. By getting the recommended exams and tests, you increase your chances of discovering problems before an illness significantly affects your health. Plus, preventive care is beneficial not only to your physical well-being, it also makes sense for your financial health because generally, it s covered by your medical plan. For more information on preventive care benefits, visit An easy way to be a smart health care consumer is to choose a Trinity Health Tier 1 provider when you or a family member needs medical care. Besides receiving excellent care at our own facilities, you receive the highest level of benefits while paying the lowest available copayment and coinsurance amounts. The Importance of Primary Care Physicians (PCPs) Maintaining a relationship with your PCP is important because they are trained to recognize any health problems you may have. A PCP is the doctor you see for most services, including annual check-ups. Your PCP can also help you identify and meet your health goals and help you prevent serious, long-term health conditions. And, by following their preventive recommendations, they can help keep your health care costs low. Preventive care services are free under each of our medical plan options when you choose Tier 1 or Tier 2 providers. And, when you and your covered spouse receive an adult preventive care check-up during 2014, you are one step closer to receiving a discount on your 2015 medical plan premium contributions. To find an in-network physician and facility, visit the My Benefits website. Take the Health Assessment (HA) The Health Assessment (HA) asks about your health habits and lifestyle to help identify some of your health needs. Your answers are kept secure and confidential; summary data is used to identify areas of focus for future wellness and prevention programs. Best of all, just by completing the online assessment, you can save money on your premium contributions. When you enroll in medical coverage, you can keep your premium contributions low when you (and your covered spouse, if applicable) take the HA from Oct. 1, 2013 through Jan. 31, Information collected in this assessment will not affect your participation in the plan or negatively impact your health care costs. It will be kept confidential and shared only with population health nurse navigators who will help colleagues make choices to improve health and quality of life, and may be used to develop future health and wellness programs for colleagues. Here s how to complete the HA: Log on to Aetna Navigator at If you are not currently registered, complete the registration process by clicking on the box under Register Now. Choose the name of your Regional Health Ministry (RHM). First time users will do this automatically during the registration process while returning users will have to click My Profile. Update your profile indicating which RHM you work for (and change at least one item on the questionnaire in order to receive the incentive). New users Select take a Health Assessment on the navigation bar on the left hand side of the main screen. Answer the questions and click continue on each screen. Because your Aetna benefit will not be available until Jan. 1, 2014, you will not be able to take your HA until that date. Returning users After choosing your RHM location, click on the Update your current Health Assessment here link. Answer the questions and click continue on each screen. Once you are finished answering the questions, print and retain your results page for your records. If you need assistance completing your HA, or have any questions, contact your Human Resources representative. Remember, if you do not complete the HA by Jan. 31, 2014, your premium contributions will increase beginning with the first pay that includes March 1, 2014, and continue through the remainder of the 2014 plan year. You will not have the option to lower your premium contributions until the 2015 plan year. Mount Carmel Health 6

7 Dental coverage You re eligible for dental coverage if you are a regularly scheduled full- or part-time colleague with 32 or more budgeted hours per pay period, and have satisfied the required waiting period. You have a choice between two dental plan options: the Premier High plan and Premier Standard plan. Shown below is a brief summary of each plan s features, along with your portion of the coinsurance/copayment responsibility. DENTAL Plan Highlights Premier High Plan Premier Standard Plan Annual deductible Individual Family Preventive services $25 $50 100% covered ($0 colleague cost) $50 $ % covered ($0 colleague cost) Basic services 20% after deductible 40% after deductible Major restorative services 50% after deductible 50% after deductible Orthodontics (to age 19) 50% Not covered Maximums Per person annual (non-orthodontics) Per person lifetime (orthodontics) Your per pay period cost periods Full-time $1,500 $1,500 Part-time (32-71 hours) Full-time $1,000 Not covered Part-time (32-71 hours) Colleague only Colleague plus spouse Colleague plus child(ren) Colleague plus family $ $ $ $ Note: Fluoride treatments are covered once every 12 months to age 14. Bitewing x-rays are covered once every 12 months. If you are on a 12 or 19 pay periods per year schedule, you can review your per pay period costs on Insight Online. For more information about your dental plan options or about Delta Dental, visit 7 Mount Carmel Health

8 Vision care coverage You re eligible for vision coverage if you re a regularly scheduled full- or part-time colleague with 32 or more budgeted hours per pay period, and have satisfied the required waiting period. You have a choice between two United Health Care vision plan options: the High plan and the Standard plan. Shown below is a brief summary of each plan s features, including how much the plan covers, and your per pay period cost. Visit for providers in your area. UHC VISION Plan Highlights In-network High Plan Out-of-network (reimbursement schedule) In-network Standard Plan Out-of-network (reimbursement schedule) Benefit frequency Calendar year Calendar year Calendar year Calendar year Vision exam Covered in full Up to $40 $10 copayment Up to $40 Pair of lenses Single vision Bifocal Trifocal Lenticular Frames Covered frame Non-covered frame Contact lenses (in lieu of eyeglasses) Elective Necessary Additional pair of eyeglasses or contact lenses Additional lens options Your per pay period cost Colleague only Colleague plus one Colleague plus family $0 copayment The preferred price is a $50 wholesale allowance at independent locations or a maximum of $150 retail allowance at retail locations $0 copay $200 allowance toward contact lenses, fitting/ evaluation fees and two follow-up visits instead of glasses once every 12 months. Up to 8 boxes of contact lenses are included. Up to $40 Up to $60 Up to $80 Up to $80 Up to $45 Up to $200 Up to $210 $0 copayment The preferred price is a $50 wholesale allowance at independent locations or a maximum of $150 retail allowance at retail locations $0 copay $175 allowance toward contact lenses, fitting/ evaluation fees and two follow-up visits instead of glasses once every 12 months. Up to 6 boxes of contact lenses are included. Up to $40 Up to $60 Up to $80 Up to $80 Up to $45 Up to $175 Up to $210 20% discount 20% discount 20% discount 20% discount The following lense options are covered in full: standard scratchresistant coating, standard basic and high-end progressive lenses, standard polycarbonate lenses, standard anti-reflective coating, UV, tints, photochromic, Transitions, edge coating $ If you are on a 12 or 19 pay periods per year schedule, you can review your per pay period costs on Insight Online. The following lense options are covered in full when from a network provider: standard scratch-resistant coating, standard polycarbonate lenses. For more information about your vision care plan options, visit $ Mount Carmel Health 8

9 Life insurance Colleague life insurance options If you re a regularly scheduled full- or part-time colleague with 32 or more budgeted hours per pay period, you receive employer-provided basic life/ad&d insurance at one times your annual base salary. In addition, you have the option to purchase supplemental coverage for yourself in the increments shown in the table below. If you purchase colleague supplemental life insurance and you re approved, the premium contributions will be deducted from your paycheck on an after-tax basis. If you elect supplemental life insurance and you re approved, you will be eligible for will preparation services through ComPsych Legal Plans at no charge. To get started, access ComPsych at and enter the Trinity Health Web ID THWILL in the Promotional Code box. COLLEAGUE LIFE INSURANCE Plan Highlights (full- and part-time) Basic life Supplemental life 1x annual base salary (employer-paid) 1x annual base salary 2x annual base salary 3x annual base salary 4x annual base salary 5x annual base salary Costs for colleague supplemental life insurance coverage are based on your age as of Jan. 1, 2014 and will be available when you enroll online. The maximum combined Basic and Supplemental Life benefit is $3 million ($1.5 million Basic Life, $1.5 million Supplemental Life). Colleagues can increase their supplemental life election by one level without Evidence of Insurability. The life insurance amount cannot be in excess of the Guarantee Issue Limit of $1 million. If you have waived the Supplemental Life Insurance benefit in the past, or if your election exceeds the Guarantee Issue amount, the colleague will be required to complete an Evidence of Insurability form. Spouse and/or child life insurance options You have the option to purchase coverage for your dependents in the increments outlined below. You may elect coverage for your dependents without electing coverage for yourself. Spouse life insurance rates are based on the age of the colleague as of Jan. 1, DEPENDENT LIFE INSURANCE Plan Highlights (full- and part-time) Spouse life 1 Child(ren) life 2 Coverage amount $10,000 $20,000 $50,000 $100,000 1 Costs for spouse life insurance coverage are based on your age, and will be available when you enroll online. 2 Child(ren) life insurance costs per pay period cover all of your eligible children, and will be available when you enroll online. Coverage amount $2,000 $5,000 $10,000 $20,000 Some colleague and spouse life insurance elections may require you to complete and submit an Evidence of Insurability form. If your election requires Evidence of Insurability, the enrollment system will prompt you to submit the form. For more information about your life insurance benefits or to obtain an Evidence of Insurability form, visit NOTE: Evidence of Insurability forms should be sent to your Insurance Provider by Jan. 10, Review your beneficiaries You may want to take a moment to review the beneficiary(ies) you have on file for your basic life coverage. If some time has passed since you named beneficiaries, are they still appropriate? If you haven t yet designated beneficiaries, your life insurance benefits will be paid according to the plan provisions as outlined in the Summary Plan Description. You ll have an opportunity to review (and change, if you wish) your life insurance beneficiary(ies) during the open enrollment process. 9 Mount Carmel Health

10 Time away from work The information below provides a summary of your time away from work benefits. Short-term disability You re eligible for short-term disability (STD) coverage equal to 60 percent of base pay if you re a regularly-scheduled active colleague with 32 or more budgeted hours per pay period. You become eligible to receive benefits as of the first day of the month following 30 days of continuous active employment. Colleagues are required to use banked time off (PLT) for days scheduled to work during the first seven calendar days. Short-term disability benefits, administered through The Hartford, begin after this 7 calendar day elimination period and continue until you are able to return to work, are deemed no longer disabled, or for a maximum of 180 days from the date of disability. NOTE: No election is required to receive this benefit. DIS bank hours (if available) are paid at 100% until depleted, then STD coverage is in effect for the rest of the approved disability. The Hartford assumes all responsibility in determining whether disability benefits are payable. Long-term disability You re eligible for long-term disability (LTD) coverage equal to 60 percent of base pay (subject to a maximum monthly payment) if you re a regularly-scheduled, active colleague with 32 or more budgeted hours per pay period. Benefits begin after the 6-month elimination period. You have the option to buy up LTD coverage to 66-2/3 percent of base pay. LONG-TERM DISABILITY Plan Highlights Benefit amount 60% of pay (employer provided/paid) 66-2/3% of pay Costs for LTD buy up are based on your income level, and will be available when you enroll online. For more information about your LTD benefits, visit PLT cash-out You can cash out up to 40 hours of PLT once annually during the open enrollment period. A separate form must be completed to elect your PLT cash-out and can be found on Insight Online under the Associates tab. You will receive your cash-out in pay period 23 of Mount Carmel Medical Group colleagues may substitute the term PTO where references of PLT are used. For more information about the program, visit Mount Carmel Health 10

11 Health care and dependent care flexible spending accounts You are eligible to participate in the flexible spending accounts (FSA) if you re a regularly scheduled full- or part-time colleague with 32 or more budgeted hours per pay period, and you have satisfied the required waiting period. Eligible colleagues can contribute before-tax money to offset eligible health care or dependent care expenses. You can use a variety of payment options to access your FSA savings. These include the WageWorks Health Card; Pay my Provider, Pay me Back; or by using the Mobile application. For more information on these options, please go to Health Care Spending Account (HCSA) You have the option to contribute before-tax dollars in any amount between $130 and $2,500 annually. You can use those savings to pay for eligible health care products and services used by you and/or your eligible dependents. The expenses include items such as: Vision care, including eyeglasses, contact lenses and saline solution Dental care, both preventive and restorative Orthodontia Physical therapy, counseling, or psychological services Chiropractic care and acupuncture Copayments, coinsurance and deductibles Prescribed Over-the-Counter (OTC) medications Contributions made to the HCSA during the 2014 calendar year can be used for claims with dates of service between Jan. 1, 2014 and March 15, Dependent Care Spending Account (DCSA) You have the option to contribute before-tax dollars in any amount between $130 and $5,000 annually. You can then use those savings to be reimbursed for the following types of expenses for your eligible dependents (child under age 13 or qualifying adult incapable of self-care) while you work: Babysitting or au pair services Before and after-school programs Day care and nursery school Pre-school programs Elder care services Contributions made to the DCSA during the 2013 calendar year can be used for claims with dates of services between Jan. 1 and Dec. 31, An extra 2 1 /2 months to use it The Health Care Spending Account (HCSA) has a two-and-a-half month grace period. You can submit eligible claims for expenses incurred through March 15 of the new year for reimbursement of the prior plan year account balance. NOTE: If you elect the Health Savings PPO plan for 2014 and are currently enrolled in the HCSA for 2013, you will need to use any remaining HCSA balance by December 31, 2013 and will not have the two-and-a-half month grace period. Be sure to use it by March 15 and submit your claims to WageWorks so they are received on or before March 31, because you ll be required to forfeit any amounts still in your account after that. For a list of expenses that are eligible for HCSA reimbursement, visit Take Advantage of WageWorks Mobile Site As the nation s largest independent provider of consumer-directed benefit solutions, WageWorks offers FSA participants the latest technology to make it easier to manage your savings. Their mobile site and new EZ Receipts app offer the following features: Check your current HCSA and DCSA account balances Submit HCSA and DCSA claims Submit WageWorks Health Care card receipts Learn more at or contact your Human Resources representative. Reminders: If you choose to enroll in the Health Savings PPO medical plan option, you cannot enroll in the HCSA. The Health Savings Account works just like the HCSA but offers additional benefits, such as the opportunity to carry over unused funds, contribute up to $2,650/individual ($5,250/family), plus an additional $1,000 in catch-up contributions if you are age 55 or over, and earn interest on your savings. You must make health care and/or dependent care spending account elections for 2014 during open enrollment. Your prior year elections will NOT carry forward. Health Care Spending Account and Dependent Care Spending Account claims for the 2014 plan year must be postmarked on or before March 31, For more information about your FSA benefits and to obtain a list of eligible expenses, visit 11 Mount Carmel Health

12 Legal plan You re eligible for the legal plan if you are a regularly scheduled full- or part-time colleague with 32 or more budgeted hours per pay period, and you have satisfied the required waiting period. You have the option of electing legal coverage through Hyatt Legal. The table below contains a brief summary of the plan s features and your per pay period cost. In-network All covered services are paid in full No waiting periods No deductibles or copayments No claim forms HYATT LEGAL Plan Highlights Out-of-network You may choose a non-plan attorney and be reimbursed according to a set fee schedule Following is a brief outline of personal legal services provided: Office consultation and telephone advice Consumer protection Wills and codicils Living wills Living trusts Sale, purchase or refinancing of home Debt collection defense Personal bankruptcy Tax audits Administrative hearing representation Juvenile court defense Eviction defense (tenant only) Tenant negotiation (tenant only) Civil litigation defense Your per pay period cost Colleague only: $5.12 Colleague plus family: $6.97 Incompetency defense Document preparation affidavits, deeds, demand letters, mortgages, notes, powers of attorney Document review Uncontested divorce Premarital agreement Uncontested adoption, guardianship or conservatorship Name change Protection from domestic violence Property tax assessment Traffic ticket defense (no DUI) Identity theft defense Immigration assistance For more information about the legal plan, visit Voluntary benefits available In addition to your group benefits, Trinity Health and Mount Carmel Health have partnered with the Farmington Company to provide eligible colleagues the opportunity to elect personal insurance plans from a portfolio of products. Individual policy options include: Life insurance Accidental Death and Dismemberment (AD&D) Insurance Cancer insurance Critical illness insurance Auto/home insurance Pet insurance Identity theft insurance You can enroll (or cancel your coverage) at anytime by calling Be sure to tell the representative that you are a member of Trinity Health, Mount Carmel Health. Mount Carmel Health 12

13 How to enroll Annual enrollment will once again be conducted via our web-based tool, which allows you to make all of your benefit choices electronically via the My Benefits website. This ensures greater accuracy and efficiency when it comes to delivering the benefits you choose for yourself and your family. And you can be sure that your personal information is secure on the enrollment website. Trinity Health has taken extra precautions to ensure the integrity of all confidential records. It takes only about 10 minutes to make your benefit elections online, and you may not need to fill out any forms. If you don t have a computer with Internet access in your workplace or your home, you can enroll at computer stations provided by your Human Resources department or at your local public library. You can enroll any time that s convenient to you during the open enrollment period 24 hours a day, seven days a week. Following are step-by-step instructions for enrolling for your 2014 benefits: 1. Access the Trinity Health My Benefits website through the Internet at The My Benefits website is available 24 hours a day during open enrollment (Oct. 23 through Nov. 6, 2013). 2. From the My Benefits home page, click on the section titled My Health & Welfare. 3. From the My Health & Welfare page, click on the Name/Location of your Trinity Health Regional Health Ministry. 4. From Mount Carmel Health System s page, select 2014 Open Enrollment. This area of the website provides you with complete information to help you make your enrollment decisions, including an overview of the benefits program, links to provider directories, and a selection of useful benefits forms (for times when a paper signature is required). 5. Once you have read through the benefit explanation information provided, click on Enroll Now. This link will connect you to the PeopleSoft e-benefits online enrollment system sign-in page. 6. To view your personal benefits information, enter your user ID, password and the unique code shown on the screen: User ID: Your employee ID (if you don t remember your employee ID number, refer to your pay advice). Password: Enter your existing password. If you forgot your password and have set up your two security questions, click the Forgot Password link for a new password to be generated. You will be prompted to answer your two security questions. If you have not set up your security questions, your password should be your first initial of your first and last name in capital letters, plus your colleague ID (for example, AB123456). You will be prompted to set up two security questions. Unique Code: Enter the combination of random letters and numbers shown on the screen. Click on Sign In. You may be prompted to change your password. Change the password to something you can remember by following the instructions. Under Main Menu, click Self Service, then click Benefits to continue through your enrollment session. 13 Mount Carmel Health

14 7. Under Benefits, click Benefits Home TH. The e-benefits home page is the starting point for enrolling in your benefits. You may choose from the following options/links: Benefits Summary: Review your current coverage. Benefits Enrollment: Review detailed information on coverage and dependents and make any open enrollment changes for Remember, you must enroll in a medical plan option or you will not have medical coverage for In addition, if you enroll in the Health Savings PPO, you cannot enroll in the Health Care Spending Account (HCSA). 8. The Benefits Enrollment link takes you to an Event page. This page will list your Open Enrollment event as Open for Processing. Click Select to reach your personal enrollment statement. 9. The enrollment statement shows current and new coverage for all of your eligible benefits. New coverage will become effective Jan. 1, Click the Edit button next to each benefit type to review your 2014 cost options as well as your covered dependents. Keep in mind that premium contributions may vary from what is shown on your pay advice due to rounding. Please ensure that a check mark appears in the box next to the name of all eligible dependents you wish to cover. 10. When you are finished making any desired changes to your dependent information and benefit options, print the enrollment page for your records by clicking on the printer icon located at the top of the screen. You will want to compare this information to the confidential confirmation statement that will be mailed to your home shortly after open enrollment ends, as well as to the information shown on your first pay advice in January. 11. After you have printed your online enrollment statement, scroll to the bottom of the page and click on Submit 1 of 2. You will be directed to the Submit Benefit Choices page. Note: If you receive an Errors & Warnings notice, please print it for your records. All errors must be resolved before the beginning of the new plan year. Warnings will highlight additional actions you need to take after submitting your request before your requested benefits can begin. Click on Continue. 12. Scroll to the bottom of the Submit Benefit Choices page and click on Submit 2 of 2. You will be directed to the Submit Confirmation page. 13. On the Submit Confirmation page, click on OK to submit your 2014 benefit elections. You will be returned to the benefits enrollment page. 14. Click Sign Out in the upper right portion of the page to end your enrollment session. 15. Close the browser window by clicking on the X in the upper right corner of the screen. You will be returned to Mount Carmel Health System s area of the My Benefits website. During the two-week open enrollment period, you can make as many changes to your benefit elections as you wish. The last day to modify your choices is Nov. 6, If the confirmation statement that you receive in your home mail does not match the benefits that you elected, it is imperative that you contact the Human Resources representative immediately to make the necessary corrections to your benefit enrollment record. If you do not change or correct your benefit elections, IRS regulations require you to remain in your elections throughout 2014 or until you experience a qualified status change. For more information on qualified status changes, visit Mount Carmel Health 14