Enrolling for Benefits What s New for Medical Benefits Wellfocused Healthy Rewards Program Prescription Drugs...

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2 Table of Contents Enrolling for Benefits... 2 What s New for Medical Benefits... 7 Wellfocused Healthy Rewards Program Prescription Drugs Dental Benefits Vision Benefits Flexible Spending Accounts Life, Disability and EAP Other Valuable Benefits Important Considerations for the UPHSflex Benefits program How to Enroll Benefits Plan Contact Chart Legal Notices

3 Enrolling for Benefits UPHS is proud to offer generous, competitive and affordable benefits for you and your family. Our benefits include a medical plan and your choice of three plan options for dental and vision coverage. We also offer life and disability benefits to protect you and your family financially in the event of an illness or accident. In this Guide, you will find descriptions of the benefits available to you as a UPHS employee, information about how to enroll and where to go if you have questions. Please refer to the legal notices at the back of this document for other important enrollment information, including legally required notices that you should be aware of as they may apply to you Open Enrollment Open Enrollment is here! This is your opportunity to make changes to your benefits. Open Enrollment begins Monday, April 14 and ends on Sunday, April 27, Your election changes will be effective July 1, You must take action to confirm your benefit elections and take advantage of the premium discount for non-tobacco use. During enrollment you must: Enroll online at EnrollOne ( Complete the online Tobacco Certification for you, your spouse and your dependents and select the Tobacco Free medical option to earn the premium discount. Verify the accuracy of your life insurance beneficiaries. Enroll in a Health Care FSA and/or Dependent Care FSA if you wish to participate for the plan year. View your Summary of Benefits and Coverage. You can enroll 24 hours a day during Open Enrollment. Any elections you make during Open Enrollment are effective July 1, 2014 through June 30, If you do not make an election by April 27, 2014, you will miss your once-a-year opportunity to make any changes to your benefits and take advantage of the premium discount for non-tobacco use, unless you experience a Life Event. (for example, marriage, new baby, spouse loses/gains health coverage). New Hire Enrollment Full-time and part-time employees are eligible for benefits. Benefits are effective on the first day of the month after 30 days of continuous employment. You have 30 days from your benefit effective date to make your elections or waive coverage. If you do not make an election within 30 days, you will be enrolled in the default benefits. Default Benefits Full-time employees default benefits: PennCare PPO (including Caremark Prescription Drug coverage) Single Coverage Core Life Insurance Coverage equal to 1x annual base salary Also note that you will not receive the earned premium discount on your medical contributions, even if you do not use tobacco products or are enrolled in a tobacco cessation program. Part-time employees default benefits: Core Life Insurance Coverage equal to 1x annual base salary 2

4 Making Benefit Changes During the Year Once your enrollment choices take effect, they stay in effect for the remainder of the plan year, unless you experience a Qualified Life Event: Change in legal marital status (Including marriage, divorce, death of a spouse, legal separation, or annulment) Domestic partnership status (You enter into or terminate a domestic partnership) Number of dependents (Including birth, death, adoption, legal guardianship and placement for adoption) Employment status (Any event that changes your, your spouse s, your same-sex domestic partner s or your other dependent s employment status that results in gaining or losing eligibility for coverage Dependent status (Any event that causes your dependent to become eligible or ineligible for coverage) Eligible Dependents Eligible dependents include: Your legal spouse or same-sex domestic partner. Your unmarried or married children until the end of the calendar month of their 26th birthday. Your disabled dependents. * Please note that your eligible dependent cannot be married if you want to cover him/her under your life insurance plan. Eligible Dependent Children Children are eligible for medical, dental and vision coverage regardless of their student, marital or IRS dependent status. Employees may buy dependent life insurance for children up to age 26, however, the dependent would be not eligible if married. Children do not have to live with you or depend on you for financial support to be eligible. Children over age 19 no longer have to be full-time college students to remain on coverage. The coverage does not extend to your child s spouse/partner or children. Eligible expenses incurred by children up to age 26 can be reimbursed from your Health Care Flexible Spending Account. Summary of Benefits and Coverage U.S. Health Care Reform requires that UPHS provide you with a uniform Summary of Benefits and Coverage (SBC) for the medical plan. Go to to access the SBC. 3

5 Earn a Premium Discount for Being Tobacco Free To be eligible for the medical plan premium discount, you AND your covered spouse/domestic partner and any covered dependents ages must be tobacco free or enrolled in a tobacoo cessation program. To earn the premium discount, all employees enrolled in medical coverage must: 1. Complete the online Tobacco Certification, and 2. Select the Tobacco Free medical plan option for medical coverage. Tobacco products include cigarettes, pipes, cigars, e-cigarettes, and any form of smokeless tobacco such as snuff or chewing tobacco. If you do not complete both steps, certifying that you and your eligible dependents are non-tobacco users or enroll in a tobacco cessation program by June 30, 2014, your medical contributions will not relect the earned premium discount and you will pay additional money per paycheck for your medical benefits. For more information on the UPHS tobacco cessation program, call Health Advocate at or visit their website at Quick Checklist for Enrolling Go through the entire Guide carefully, including the medical, dental and vision plan charts. Review the Full-Time and Part-Time contribution rates by going to and click on Cost for Coverage. Complete the two step Tobacco Certification process. Print your Confirmation statement, click on the Benefits Profile page and print your summary. Name a beneficiary for your life insurance benefits. If you are enrolling your dependents, you need to provide their correct Social Security number at the time of enrollment. If you have any questions, please contact the UPHS Benefits Office at and select the option for Benefits. 4

6 What s New for UPHS is proud to offer affordable, competitive and flexible benefits for our employees. One Medical Plan Beginning July 1, 2014, UPHS will offer one medical plan the PennCare PPO Plan administered by Independence Blue Cross that includes prescription drug coverage though Caremark. There are changes to your out-of-pocket costs for medical services as described on the medical plan chart. The PennCare PPO Plan offers three networks of providers with different levels of coverage. You receive the highest level of benefits when you visit a PennCare Network provider, facility and pharmacy. If you enroll in medical coverage during Open Enrollment, you will receive a new medical ID card. Behavioral Health Benefits There will be some changes to your Penn Behavioral Health coverage beginning July 1, The Penn Behavioral Health plan design will be similar to the new PennCare PPO Plan. You will have three networks to choose from, but you pay less when you visit a Penn Behavioral Health Preferred Provider. When you go to a provider in the Regional Network or out-of-network, you will be subject to deductibles and coinsurance. Any amount you pay out-of-pocket for these services will now count toward your medical deductible and out-of-pocket maximum. You will also have access to a new Behavioral Health Outpatient Care Management program to improve the coordination of your care. For more information about Behavioral Health Benefits, including the network of providers and covered services, visit or contact Penn Behavioral Health at New! Coverage for Autism Services Parents seeking treatment for autism will now have coverage for services provided by Penn Behavioral Health. Centers of Excellence Certain services will require you to see a provider in the Centers of Excellence of the University of Pennsylvania Health System. The new benefit plan will offer best-in-class services provided by the following UPHS departments: Oncology Cardiology Neuroscience Orthopaedics If you see a provider outside the Centers of Excellence of UPHS, you will pay a $1,000 copay in addition to the regular cost share of the service (does not apply to emergency services). 5

7 Prescription Drug Plan When you enroll in the PennCare PPO Plan, you automatically receive prescription drug benefits administered by Caremark. Beginning July 1, 2014, the prescription drug plan will include an outof-pocket maximum the most you will pay for prescription drugs during the plan year. Any out-ofpocket costs, including copays, will count toward the prescription drug out-of-pocket maximum. Specialty Drugs Please note that specialty drugs will be covered separately as follows: UPHS Pharmacy: You will pay a copay for specialty drugs. The cost will depend on the type of drug (generic, preferred or non-preferred) you receive. Caremark: You will pay 20% coinsurance up to a $100 maximum per prescription. Preventive Medications Covered at 100% As part of the Affordable Care Act, preventive care medications are covered at 100% with a written prescription from your physician. Penn Primary Care Connection Concierge Service Sometimes it s difficult to establish yourself as a new patient with a provider, and it may take some time just to schedule your first appointment. That s where the Penn Primary Care Connection service can help! If you or a family member would like to make an appointment with a primary care physician, contact Penn Primary Care Connection at to schedule an appointment and see a PennCare Network physician right away. Please note that this service is only used to assist you in making the initial appointment. Enhanced Dental Services Beginning July 1, 2014, the Penn Faculty Practice Dental Plan will now be called the Penn Dental Plan. There will be several enhancements to the dental plan including: For existing subscribers: In-office whitening: $325 copay (previously $750) Take-home whitening: $200 copay (previously $500) For new subscribers: Free in-office whitening For all subscribers: Enhanced Invisalign benefits Transit and Commuter Benefit Change The Internal Revenue Service establishes the maximum amount that may be contributed for transit and commuter benefits each calendar year. This year, you may elect pre-tax deductions up to $250 per month for the Parking Program and $130 per month for the Public Transit Program. 6

8 Medical Benefits UPHS will offer a single medical plan administered by Independence Blue Cross called the PennCare PPO Plan. If you are enrolled in the medical plan, you receive prescription drug coverage through Caremark. A key feature of the PennCare PPO Plan is that you have three networks of providers to choose from the PennCare Network, the IBC Network, and non-network providers. With this new plan, you will save more when you visit a provider in the PennCare Network. PennCare provider directories and carrier network listings are available online. /penncarenetwork/ You can choose to receive care through one of the following networks: 1. PennCare Network This network includes any providers in the University of Pennsylvania Health System, including Chester County Hospital and Children s Hospital of Pennsylvania (CHOP). When you use this network, you save on everything from doctor office visits and prescription drugs to X-rays and hospital care. 2. IBC In-Network These providers are in the Independence Blue Cross Network. If a PennCare provider is not an option, you should consider using an IBC in-network provider. You will have to pay more for your care than for the PennCare Network and you will have to meet a deductible for some services before the plan begins to pay for coverage. You can find a list of participating providers by visiting 3. Out-of-Network This includes any providers outside of the PennCare and IBC networks. You will pay more when you visit an out-of-network provider. Remember, preventive care is covered at 100% when you visit a PennCare or in-network IBC provider. Annual exams, age-appropriate screenings, well-woman care, and immunizations, are covered at 100%, within plan limits. Preventive care can help detect potential health risks early, avoiding costly medical bills down the road. Check with your medical provider before receiving care to find out what services will be covered at no cost. When you enroll in a medical plan, you will automatically receive behavioral health benefits, provided through Penn Behavioral Health. You do not have to get a referral from your primary care physician before receiving care. Behavioral Health benefits include: Individual, group and family therapies, Medical evaluations, Crisis intervention, and Inpatient and outpatient care for the treatment of emergent and acute cases. Autism benefits have been added to Penn Behavioral Health coverage. Your Penn Behavioral Health includes a deductible and out-of-pocket maximum. Any amount you pay out of pocket will count toward your medical deductible and out-of-pocket maximum. For complete plan details about Penn Behavioral Health coverage visit Treatment facilities are conveniently located throughout the Delaware Valley and your health information is strictly confidential. You may call for assistance and a qualified counselor will provide you with all of the options available for you and your dependents. 7

9 PennCare PPO Plan PennCare PPO PennCare PPO IBC In-Network Out-of-Network How to Access Care Go to any Go to any IBC Go to any provider PennCare provider in-network provider Referrals Needed No No No Deductible Employee Employee + Spouse/Child(ren) Family None $250 $500 $750 $750 $1,500 $2,000 Coinsurance 100% 80% 60% Office Visit $20 copay $35 copay/$50 copay 60% after deductible Out-of-Pocket Maximum Employee Employee + Spouse/Child(ren) Family Emergency Room Fee (waived if admitted) Inpatient Hospital* Outpatient Hospital* Advanced Radiology $1,000 $1,500 $2,000 $3,000 $5,000 $7,000 $6,350 $9,500 $12,700 $150 copay $150 copay $150 copay 100% 100% $1,000 copay; no deductible or coinsurance. Physician Services: 80% coinsurance after deductible. Maternity: $750 copay (no deductible or coinsurance) $500 copay; no deductible or coinsurance. Physician Services: 80% coinsurance after deductible. $250 copay; then 80% 60% after deductible 60% after deductible $250 copay; then 60% after deductible 100% after deductible * If you do not see a provider for certain services in the Centers of Excellence of UPHS for oncology, cardiology, neuroscience or orthopaedics, you will pay an additional $1,000 copay (copay will be waived for emergency care) 8

10 IBX.com You can use the IBC site to: Manage your account, request an ID card and check the status of your claims Identify doctors and hospitals within IBC s network by using the Provider Directory Access and register for Healthy Lifestyle programs and incentives And download the free IBX app for easy access to your health care information and helpful resources while on the go. The site is secure, confidential and convenient. 9

11 Earn $150 with Wellfocused Healthy Rewards Wellfocused is our healthy workforce program that provides you with free programs, tools and resources that help you: 1. Be more aware of your current health status, and 2. Improve your health or maintain your good health. As part of Wellfocused, we are offering the Healthy Rewards program an online program that makes it easier for you to manage your health and well-being while being rewarded for your actions. To be eligible to receive the Healthy Rewards Credit, you must be enrolled in the PennCare PPO Plan. How Healthy Rewards Works 1. You earn points for completing healthy actions, healthy activities, and challenges. 2. You reach levels when you earn a set number of points. 3. You are eligible for rewards when you reach each level. It s easy to earn points using the Healthy Rewards online too! Visit and select Healthy Rewards. Then enter your user name and password (same information you use when you log in to your UPHS computer). To earn the $150 Healthy Reward Credit, you must Take the Well-Being Assessment and Know Your Numbers, and Achieve healthy numbers as shown in Jog Forward below AND complete Healthy Activities. Once your total points equal 1,500 you will receive the $150 Healthy Reward Credit. Sign up for Healthy Activities at First Steps: 300 points Take the online Well-Being Assessment and Know Your Numbers Once you complete both actions, enter your biometric numbers into the Healthy Rewards online tool. If you complete the Well-Being Assessment by June 30, 2014 you will earn 100 bonus points. You must enter these biometric numbers into the Healthy Rewards tool: Blood pressure Body Mass Index (BMI) Fasting Blood Sugar HDL Cholesterol LDL Cholesterol Total Cholesterol 10

12 Jog Forward: 1500 points Take Healthy Actions To earn these points, you need to have earned the 300 points in First Steps AND have your biometric numbers fall within the healthy ranges in the chart below. If your numbers fall outside of the range, take action by participating in a Healthy Rewards program. When you earn a total of 1500 points, you receive a $150 Healthy Credit (paid in a lump sum). Wellfocused Healthy Rewards Program Earn Points When Your Number is in this Healthy Range Blood Pressure 120/80 Blood Sugar Between HDL Cholesterol Above 60 LDL Cholesterol Below Total Cholesterol Less than 200 Body mass Index (BMI) Between Number not within a Healthy Range? You can still receive the Healthy Reward Credit anytime during the year by taking Healthy Actions through the program. To get started earning points visit Sprint Ahead: 3000 points Complete Healthy Activities and Challenges Once you earn 3000 points, your name will go into a quarterly drawing for a $50 Amazon gift card. There will be 100 winners throughout the year. Lead the Way: 6000 points Complete Healthy Activities and Challenges Once you earn 6000 points, your name will go into a raffle to attend a Leadership Event. There will be 25 lucky winners! 11

13 Prescription Drugs When you enroll for medical benefits, you automatically receive prescription drug coverage through Caremark. Benefits include coverage for prescriptions purchased at UPHS pharmacies, retail pharmacies and through the UPHS or Caremark mail order program. Your out-of-pocket costs will be lower if you use an in-house UPHS Pharmacy. Mail Order You are required to fill your maintenance medications at a UPHS Pharmacy, Penn Medicine at Radnor or through Caremark mail order. Mail order allows you to receive a 90- day supply of your maintenance medication for one copay. Prescriptions will be mailed to the address of your choice. Retail Pharmacies You can fill your prescriptions for a 30-day or 90- day supply at any of the UPHS Pharmacies for a lower copayment. You can also fill your 30-day prescription at any retail pharmacy. Participating UPHS Pharmacies Chart Hospital of the University of Pennsylvania 3400 Spruce Street 1 Ravdin Pennsylvania Hospital Outpatient Pharmacy 800 Spruce Street Spruce Building First Floor PENN Presbyterian Medical Center Outpatient Pharmacy 39 th and Market Streets Medical Office Building (MOB) PENN Medicine at Radnor PENN Presbyterian Apothecary Penn Home Infusion Outpatient Pharmacy and 51 North 39 th Street Mail Order Services (3910 Building) 250 King of Prussia Road 2 nd Floor Radnor Retail/Mail Order Chart 30-day Supply 90-day Supply UPHS Pharmacy Retail Pharmacy UPHS Pharmacy/ Mail Order Caremark Mail Order Out-of-Pocket Maximum $1,000 per member / $3,000 per family Generic $5 $15 $10 $30 Preferred $15 $45 $30 $90 Non-Preferred $30 $75 $60 $150 Specialty Drugs Copay will match 30-day supply for UPHS Pharmacy 80% coinsurance; $100 per prescription maximum Not Covered Not Covered 12

14 Go Generic and Save! Generic drugs have proven to be just as helpful in treating symptoms as their brand-name drug competitors. Here s why. Generic drugs are available in the market after the patent on the brand-name drug has expired (usually between 10 and 20 years). Once the patent expires, competing drug manufacturers can make an almost identical drug but call it something different. Generic-equivalent drugs, therefore, have virtually the same active chemical makeup as their brand-name counterparts, but there is an added bonus they cost less. Here are a couple of questions you can ask your doctor or pharmacist about your current medications to see if switching to a generic drug may be right for you: Is there a generic-equivalent drug available for any medication I am currently taking? If not, is there a generic-alternative drug that would work just as well as the medication I am currently taking? Preventive Medication Covered at 100% As part of the Affordable Care Act, preventive care medications are covered at 100% with a written prescription from your physician. Covered prescriptions include: Aspirin (prescribed, not OTC) Colonoscopy Medications (for ages 50-74) Contraceptives Fluoride Folic Acid Immunizations Iron Supplements Smoking cessation medications Vitamin D Specialty Drugs Specialty drugs will be covered separately. Any out-of-pocket costs, including copays, will count toward the prescription drug out-of-pocket maximum. The cost for specialty drugs depends on where your prescription is filled. UPHS Pharmacy: You will pay a copay for specialty drugs. The cost will depend on the type of drug (generic, preferred, or non-preferred) you receive. Caremark: You will pay 30% coinsurance up to a $100 maximum per prescription. Please note that only 30-day supply prescriptions will be covered. 13

15 Dental Benefits You can choose from three dental plan options; the Penn Dental, Delta Dental, or the Aetna DMO. All three plans cover many preventive, basic, and major dental treatments, including orthodontia. Dental Plan Highlights Chart Dental Chart How to Access Care Penn Dental Delta Dental* Aetna DMO Go to any Penn Dental network provider Go to any dental care provider (benefits may be greater with a Delta Dental provider) Referrals Needed No No Yes Annual Deductible $50/person, $150/family (on basic, major and ortho) $50/person, $150/family (on basic, major and ortho) None Coinsurance Preventive Plan pays: 100% Plan pays: 100% of Delta s allowance Care must be coordinated by your Primary Care dentist Plan pays: 100% Basic 80% 80% of Delta s allowance 100% Major 50% 50% of Delta s allowance 50% Implants Orthodontic 50% ($1,500 annual maximum per individual) 50% (for adults and dependent children); up to $1,500 lifetime orthodontic maximum 50% (up to the annual maximum) 50% of Delta Dental s allowance (for adults and dependent children); up to a $1,500 lifetime orthodontic maximum Not covered 50% (for adults and dependent children); no lifetime orthodontic maximum - Invisaline In-Office Whitening 50% coverage up to $2,000 maximum (Full case: $2,000 coverage Express case: limited to $1,000) $325 copay Take-Home Whitening $200 copay Annual Maximum Benefit $3,000/person Premier $1,500/person PPO $2,000/person None * The Dental Plan contains a provision that coordinates the benefits it pays on behalf of an individual with payments that may be made under other plans covering the individual, so that the total benefits available will not exceed 100% of the allowable expenses. Please see your Summary Plan Description for more information. 14

16 Penn Dental If you choose the Penn Dental Plan, there are three locations you can go to for dental services: The Dental Care Center 4003 Locust Street Philadelphia Penn Dental 3401 Market Street Philadelphia Penn Dental Center At Bryn Mawr 711 Lancaster Avenue Bryn Mawr For questions or to find a network provider, refer to one of these Provider Contacts: Provider Phone Number Website Penn Dental Delta Dental Aetna DMO

17 Vision Benefits UPHSflex benefits offers three options for vision coverage. You can choose from the IBC Davis Vision Premium Plan, IBC Davis Vision Standard Plan, or Vision Benefits of America (VBA) Plan. All three plans cover eye exams, standard lenses and frames, or contacts. You can also save money if you receive eye care from UPHS Eye Care Centers: PENN Presbyterian Medical Center Scheie Eye Institute 51 N. 39th St Philadelphia, PA Hospital of the University of Pennsylvania 2 Gates 3400 Spruce St Philadelphia, PA PENN Medicine at Radnor 250 King of Prussia Rd Radnor, PA Mercy Fitzgerald Medical Office Building 1501 Lansdowne Ave Suite 2058 Darby, PA PENN Eye Care at Media 601 West State Street Media, PA Low Vision Research and Rehabilitation Center at Ralston House 3615 Chestnut St Philadelphia, PA Penn Eye Care at the Perelman Center for Advanced Medicine 3400 Civic Center Blvd West Pavilion 3 rd Floor Suite 3-013W Philadelphia, PA Scheie Eye is a participating provider with both IBC Vision Plans and VBA for your routine vision care. However, if you elect the IBC Davis Vision Premium Plan and use Scheie providers, you will receive some enhanced vision care benefits at a reduced cost for services. IBC Davis Vision Premium Plan IBC Davis Vision Premium Plan How to Access Care Scheie Provider All Other Participating Providers Eye Exam (once per contract year) Standard Lenses (once per contract year) Frames Medically necessary contact lenses (in lieu of eyeglasses) and evaluation and fitting, with prior approval Non-Participating Providers Covered at 100% Covered after $10 copay Reimbursement of up to $32 Covered at 100% for all ranges of prescriptions Participating provider's frame collection: $100 allowance OR Davis' Fashion selection: 100% Designer selection: 100% Premier selection: $20 Covered at 100% for all ranges of prescriptions Participating provider's frame collection: $65 allowance OR Davis' Fashion selection: 100% Designer selection: 100% Premier selection: $20 Reimbursement of up to: Single vision: $30 Bifocal: $36 Trifocal: $50 Lenticular: $72 Reimbursement of up to $30 Covered up to $200 Covered up to $200 Reimbursement of up to $200 16

18 IBC Davis Vision Premium Plan How to Access Care Scheie Provider All Other Participating Providers Contact lenses (in lieu of eyeglasses) including standard, specialty and disposable lenses Allowance of up to: Standard/Specialty: $110 Disposable: $80 Allowance of up to $75 Non-Participating Providers Reimbursement of up to: Standard/Specialty: $60 Disposable: $75 IBC Davis Vision Standard Plan IBC Davis Vision Standard Plan How to Access Care Participating Providers Non-Participating Providers Eye Exam (once per contract year) Covered after $10 copay Reimbursement of up to $30 Standard Lenses (once per contract year) Frames Medically necessary contact lenses (in lieu of eyeglasses) and evaluation and fitting, with prior approval Contact lenses (in lieu of eyeglasses) including standard, specialty and disposable lenses Covered at 100% for all ranges of prescriptions Participating provider's frame collection: $15 allowance OR Davis' Fashion selection: 100% Designer selection: $16 Premier selection: $35 Participating provider's frame collection: Single vision: $20 Bifocal: $20 Trifocal: $30 Lenticular: $50 Reimbursement of up to $15 Allowance of up to $100 Reimbursement of up to $200 Not Covered Not Covered Vision Benefits of America (VBA) Plan Vision Benefits of America (VBA) Plan How to Access Care VBA Provider Non-VBA Provider Eye Exam (once per contract year) Covered at 100% Reimbursed up to $40 Standard Lenses (once per contract year) Covered at 100% Reimbursed up to $30-$80 Frames Reimbursed up to $100 Reimbursed up to $30 Medically necessary contact lenses (in lieu of eyeglasses) and evaluation and fitting, with prior approval Based on UCR Reimbursed up to $200 Contact lenses (in lieu of eyeglasses) including standard, specialty and disposable lenses $140 max paid in lieu of exam and glasses $140 max paid in lieu of exam and glasses 17

19 Your Flexible Spending Accounts (FSAs) Flexible Spending Accounts allow you to pay for eligible health care and/or dependent care expenses with tax-free money. When you enroll in a Health Care and/or Dependent Care FSA, the dollars you designate will be deducted from your paycheck on a before-tax basis and credited to your FSA. You pay no federal or Social Security taxes on money in these accounts. UPHS offers two types of Flexible Spending Accounts (FSAs) a Health Care FSA and a Dependent Care FSA. When you enroll in an FSA you must elect your annual contribution amount for the entire plan year. Annual Contribution Amount If you are enrolling in an FSA as a new hire, your election is in effect for the remainder of the plan year. FSA elections do not carry over from year to year. You must enroll in the FSA each year if you wish to continue to participate. If you currently contribute to an FSA, you must re-enroll each year during Open Enrollment if you wish to contribute to your FSA for the next calendar year. Remember, elections do not roll over from year to year. Any unused funds in your account will be forfeited. Here s How the Health Care Flexible Spending Account Works: Step One: Contribute to your account through convenient pre-tax payroll deductions. Step Two: Use your Health Care Flexible Spending Account card to pay for eligible health care expenses. Or, you can submit a claim form with proof of payment and a dated receipt of services for reimbursement. Please remember, if you wish to participate in the Health Care Flexible Spending Account and are enrolling as a new hire, select your contribution amount for the remainder of the plan year. If you are enrolling during annual Open Enrollment, select your contribution amount for the following plan year. Keep in mind that elections do not carry over from year to year. If you do not enroll during the annual Open Enrollment period, you will not be able to contribute to the FSA until the following calendar year. Here s how the Dependent Care Flexible Spending Account works: Step One: Contribute to your account through convenient pre-tax payroll contributions. Step Two: Incur eligible dependent care expenses for services provided to qualified individuals including your children up to their 13 th birthday, or other family or household members who meet certain dependent eligibility requirements. Step Three: Submit proof of those expenses with a claim form. You can only be reimbursed up to the total amount deposited into your account at the time you submit the claim. Please remember, if you wish to participate in the Dependent Care Flexible Spending Account and are enrolling as a new hire, select your contribution amount for the remainder of the plan year. If you are enrolling during annual Open Enrollment, select your contribution amount for the following plan year. Keep in mind that elections do not carry over from year to year. If you do not enroll during the annual Open Enrollment period, you will not be able to elect to contribute to the FSA until the following plan year. 18

20 Is a Flexible Spending Account right for you? There are a few things to consider when deciding if a Flexible Spending Account makes sense for you. How Much Should I Contribute? Before making your spending account election, you need to estimate your out-of-pocket costs for health care and dependent care in the coming year, because any contributions you make during the year, but don t use by September 15, 2015 for the Health Care FSA and June 30, 2015 for the Dependent Care FSA, are forfeited. Calculating your current year s costs can be your best gauge. Access the E-Book to use both the Health Care FSA Calculator and the Dependent Care FSA Calculator: If you are married and filing a joint tax return, your contributions combined with your spouse s contributions to a Dependent Care FSA, cannot exceed $5,000* for the calendar year (January 1 through December 31), regardless of your or your spouse s plan year. Contribution Limits For the plan year, you can contribute from $60 up to $2,500 in pre-tax earnings to the Health Care FSA, or from $260 up to $5,000* in pre-tax earnings to the Dependent Care FSA. If you are married and filing a joint tax return, your contributions combined with your spouse s contributions to a Dependent Care FSA, cannot exceed $5,000* for the calendar year (January 1 through December 31), regardless of your or your spouse s plan year. *Employees making $115,000 or more will only be able to contribute a maximum of $1,700 this plan year to a Dependent Care FSA to meet IRS regulations. Important Rules You must re-enroll every year in order to participate in an FSA. If you participate in the Health Care FSA, any unused funds left after September 15, 2015 will be forfeited. You can submit expenses until December 31 after the end of the plan year. If you participate in the Dependent Care FSA, any unused funds left after June 30, 2015 will be forfeited. You can submit expenses until September 30 after the end of the plan year. Expenses paid through the Spending Account can t be claimed as a tax deduction on your federal income tax return. 19

21 Hold on to your receipts. The administrator has the right to request receipts for the money spent using your Health Care Flexible Spending Account Card. Eligible Health Care Expenses You can use your Health Care FSA to be reimbursed for: Medical and dental deductibles and copays, Out-of-pocket costs for hospital or physician care, Non-reimbursed prescriptions and copays, Dental care, including orthodontia, Vision care, including exams, eyeglasses and contact lenses, Hearing aids, and Other expenses considered eligible by the IRS. Over-the-counter medications and drugs (such as pain relievers, antacids and allergy and cold medicines) are only eligible for reimbursement if you have a prescription from your doctor. Expenses that are not eligible for reimbursement include: Health insurance contributions, Health insurance premiums under your spouse s plan, Most cosmetic surgery procedures, and Dietary supplements/vitamins, cosmetics, toiletries and sundry items. For a complete list of eligible expenses, visit You can be reimbursed for up to the amount you elected to deposit for the plan year, even if you have not yet made the full contribution for your FSA. Eligible Dependent Care Expenses You can use your Dependent Care FSA to be reimbursed for child or elder care expenses which enable you to work. This includes costs you incur for child care for dependent children under age 13 and/or an adult living with you whom you claim as a tax dependent and who is physically or mentally incapable of self-care (e.g., disabled spouse, elderly parent). You can only be reimbursed for up to the amount that has been deposited into your FSA at the time you request reimbursement. Vision Expenses Vision care services not covered by your vision plan, such as an extra eye exam, contact lenses and glasses, and other services, such as laser vision correction (LASIK) or even contact lens solution, are eligible for reimbursement. 20

22 Life, Disability and EAP As a UPHS employee, a range of benefits are available that safeguard you and your family in the event of an illness, injury or death. Some of these you are enrolled in automatically and are fully paid for by UPHS, and some you must decide if you want to enroll in and are paid for by you. Employee and Dependent Life Insurance UPHS offers you the options of Core and Supplemental Life Insurance for yourself and Dependent Life Insurance for your spouse and children. If you leave UPHS, you may convert your coverage to an individual policy within 30 days of your termination date. Core Coverage All UPHS benefit-eligible employees will receive core life insurance equal to one times their base salary at no cost. If your annual base salary is greater than $50,000, you will have the option to cap your coverage at $50,000. You cannot opt out of Core Coverage. Imputed Income Under IRS rules, you must pay taxes on the premium value of UPHS-paid Core Coverage over $50,000. This is called imputed income and will be shown on your pay stub. The IRS determines the amount of this tax. Supplemental Coverage You can also choose employee-paid Supplemental Coverage of 1x, 2x, or 3x your base pay. The cost of Supplemental Coverage is based on your coverage option, base pay and your age. Premiums will be deducted from your paycheck on an after-tax basis. The combined maximum employee life insurance coverage amount (UPHS-provided Core Coverage plus Supplemental Coverage) is $1,000,000. Naming a Beneficiary Be sure to name a beneficiary when you first become insured. You may name anyone as your beneficiary; however, minors will not be entitled to benefits until they reach legal adult age. You may change your beneficiary at any time. Dependent Life Insurance Dependent life insurance provides benefits to you, as the beneficiary, in the event of the death of your spouse/partner and/or child(ren). If you choose any of the dependent life insurance options, deductions for the coverage are made with after-tax dollars. If your spouse works for UPHS, only one of you can elect dependent life insurance. Coverage options available: Spouse/Partner Child(ren) $2,000 for your spouse/partner $1,000 for your child(ren) $5,000 for your spouse/partner $2,000 for your child(ren) $10,000 for your spouse/partner $5,000 for your child(ren) 21

23 Accidental Death & Dismemberment Insurance AD&D coverage pays benefits in addition to any life insurance benefits you receive if you die or are dismembered as the result of an accident. You may also elect family coverage for your spouse/partner and any eligible dependent children. If you choose any of the family coverage options, deductions for the coverage are made with after-tax dollars. Employee-Paid AD&D Coverage Your choices for employee-paid AD&D coverage are 1x, 2x, 3x, 4x base pay, or no coverage. The maximum available AD&D coverage amount is $500,000. Required premiums for coverage will be deducted pre-tax from your paycheck. Family AD&D Coverage Coverage for your spouse will equal 50% of the amount you choose for yourself. Coverage for each dependent child will equal 15% of the amount you choose, to a maximum of $25,000. If you elect family AD&D coverage, you are automatically the beneficiary for any benefits that may be payable. Naming a Beneficiary Be sure to name a beneficiary when you first become insured. You may name anyone as your beneficiary; however, minors will not be entitled to benefits until they reach legal adult age. You may change your beneficiary at any time. Short-Term Disability Short-Term Disability (STD) provides you with income if you are not able to work due to a nonwork-related illness or injury. For most of the Health System, the waiting period for STD is 30 days or the end of your accrued sick time, whichever is greater. For CCA, the waiting period is 14 days. The voluntary plan provides 60% of your base pay to a maximum of $1,000 per week for up to 180 days following the start of your disability payments. The cost of STD coverage is based on your age and base pay. Employees who work in New Jersey can elect coverage through the UPHSflex STD option. However, this coverage will be offset by any STD benefit you receive from the New Jersey state plan. Applying for Benefits You can file a short-term disability claim over the phone by calling UnumProvident at , at which time a representative will begin the claim process. You will be asked to sign an authorization allowing UnumProvident to obtain information directly from your medical provider. For more information, call the Disability Management Office at Long-Term Disability 22

24 The Long Term Disability Program provides you with income if you are not able to work due to a non-work-related illness or injury. Full-time employees are eligible after one full year of continuous employment. UPHS pays for the full cost of this coverage. The monthly benefit is equal to 60% of your monthly base pay, up to a maximum of $10,000 per month. Since LTD is provided to you automatically, and is a non-flex benefit, it will not appear as an option for enrollment on the EnrollOne website. Employee Assistance Program All UPHS employees are eligible for the EAP which is 100% paid by UPHS. The EAP is administered by PENN Behavioral Health. The EAP, available to you 24-hours a day, 7 days a week, offers confidential assistance available to all employees and dependents to help with a variety of problems, such as anxiety, depression and stress. You can receive up to eight free annual counseling sessions for you and your dependents. For more information, contact PENN Behavioral Health at

25 Other Valuable Benefits UPHS offers a variety of additional benefits to complete our comprehensive benefits program: UPHS Retirement Contribution and 403(b) Matching Plan Retirement benefits provided by UPHS are designed to assist with your financial security in your retirement years. For more information on your retirement benefits at UPHS, including eligibility criteria, visit Professional Development Program The Professional Development Program is offered on a fund-available basis for improving professional practice and/or acquiring skills and knowledge supporting organization-wide improvement initiatives. You are eligible for this program after 90 days of employment. Full-time employees can receive up to $600 per fiscal year (July 1 to June 30) and part-time employees can receive up to $300 per fiscal year. Reimbursement is ONLY for NON-CREDIT skill development courses, as approved by your Manager, such as: Job-related training programs Seminars which grant CEU credits Preparation seminars for certifications The Professional Development Program does NOT cover: Licensing fees or renewals Any expenses associated with conditions of employment (e.g., required certifications, such as BLS and ACLS training) Education unrelated to one s current profession or organizational mission You can use this program along with the Employee Tuition Assistance benefit. Employee Tuition Assistance Program The Employee Tuition Assistance Program allows you to pursue degree programs that are related to your current job or a future career opportunity within Penn Medicine. You are eligible to start your first semester after 180 days of employment. You can receive up to $8,000 per calendar year if you are a full-time benefit-eligible employee budgeted to work 35 or more hours per week. You can receive up to $4,000 per calendar year if you are a part-time benefit-eligible employee budgeted to work hours per week. The benefit covers tuition expenses and course-related fees. For all other programs of study and non-degree credit bearing coursework, a maximum of $5,250 per year for full-time employees and $2,625 for part-time employees is available. Tuition Benefits are subject to city, state and federal taxes based on IRS regulations. Employee Dependent Tuition Program After three years of full-time employment, you are able to enroll your eligible dependent children in the employee dependent tuition program. Upon acceptance, the Employee Dependent Tuition 24

26 Program will support tuition for undergraduate courses at the University of Pennsylvania for up to eight semesters. The program does not cover support at other colleges/universities. Adoption Reimbursement The financial cost of adopting an infant or child can be significant. While becoming a parent is not free of expenses, adoptive parents often are faced with initial costs that create additional stress and burdens. UPHS knows that adoption can be a wonderful experience, that s why we offer eligible employees (full-time employees working 35 hours or more per week) reimbursement benefits for child adoption. Through the program, you are eligible to be reimbursed up to $5,000 for qualified expenses, which may include: Attorney s fees and court costs, Travel expenses, and Other adoption-related expenses. Certain restrictions and limitations apply. For more information on the adoption benefit, log on to the UPHS Intranet or contact the UPHS Benefits Office at Work Life Benefit All UPHS employees are eligible for the Work Life Benefit, which is 100% paid by UPHS. The Work Life Benefit, administered by PENN Behavioral Health, helps you balance your personal and professional life. It offers child care and eldercare resources, summer programs, etc. To access the Work Life Benefit, contact PENN Behavioral Health at T.R.I.P. Commuter Program The Transportation Reimbursement Incentive Program (or TRIP) is a tax incentive program for commuting costs (parking and transit), which is deducted from your paycheck on a pre-tax basis. There are three different types of options under the TRIP program: The Parking Program is for direct payment to a non-university Parking Lot vendor. You can elect pre-tax deductions of up to $245 per month. The Public Transit Program is for your Monthly Transit or Trailpass and/or tickets, which will be mailed directly to your home. You can elect pre-tax deductions of up to $245 per month. This includes employees that purchase tickets or passes on a monthly basis for SEPTA, PATCO, New Jersey Transit or DART. Employees who purchase SEPTA Monthly passes through the ComPASS program are given a 10% discount. You are only permitted to purchase one SEPTA pass per month. The SEPTA pass must be for yourself because passes are genderspecific. The Pay-Me-Back Program is for the reimbursement of tokens and parking meters of up to $245 per month for public transit and parking. You can enroll or change elections anytime throughout the year by visiting and selecting Transportation, or you can call and select the prompt for the TRIP program. 25

27 Elections made before the tenth of the current month will be applied to the benefit for the following month. Elections made after the tenth of the current month will be applied to the benefit for the month after the following month. Your payment will be deducted on a monthly basis from the last paycheck of each month for the following month s benefit. For example, your payment for February would be deducted from your last paycheck in January. Health Advocate Health Advocate is available to you and your family (including covered dependents, parents and inlaws) to help you navigate the health care system. Health Advocate can also help you save money on your out-of-pocket medical expenses by comparing the cost of visiting a PennCare Network provider against another provider. Other Health Advocate services include: working with providers and insurance companies on your behalf to help resolve claims and billing issues, locating eldercare and additional support services, and getting reliable second opinions. Quit Tobacco with Health Advocate Health Advocate offers a free tobacco cessation program. This program allows you and your covered dependents 13 weeks of telephonic counseling with a trained coach, FREE nicotine replacement therapy (NRT) (patch, gum, lozenge), and a $0 copay for over-the-counter NRT and prescription smoking cessation medications. You will receive the earned premium discount on your medical contributions when you and your dependents are tobacco free or have enrolled in the tobacco cessation program by June 30, Call Health Advocate at or visit to get started with any of the services. You can also access Health Advocate from the home page of the HR&You Website. Penn Primary Care Connection Concierge Service The Penn Primary Care Connection service can help you get an appointment as a new patient through a PennCare facility. If you or a family member would like to make an appointment with a primary care physician, contact Penn Primary Care Connection at to schedule an appointment and see a PennCare Network physician right away. Please note that this service is only used to assist you in making the initial appointment. 26

28 Important Considerations for the UPHSflex Benefits Program Your Benefits; Your Decisions You must take action to confirm your benefit elections and take advantage of the premium discount for non-tobacco use. If you do not make an election by April 27, 2014, you will miss your opportunity to make any changes to your benefits, add or drop dependents or enroll in a Health Care and/or Dependent Care Flexible Spending Account (FSA) for the plan year. If you are enrolling as a new hire, you must make your elections within 30 days of your benefits eligibility date. Otherwise, you will receive the default benefits. Consider enrolling in the FSAs to save by using pre-tax money for health care or dependent day care expenses. Compare the total out-of-pocket costs for each of your health care options. Newly married or a parent of small children? Consider adding Supplemental Life and Accidental Death & Dismemberment (AD&D) insurance. Any elections you make during Open Enrollment will be effective July 1, 2014 through June 30, If you are a new hire, your elections will be effective from your benefits effective date through June 30, Medical Coverage Use your health care benefits wisely to keep costs to a minimum: Take good care of yourself and your family. The healthier you are, the less medical care you ll need. Avoid using tobacco products so you can earn the premium discount on your medical contributions. Know the rules before you seek treatment: Choose PennCare Network providers whenever possible to keep out-of-pocket expenses to a minimum. You will pay less out-of-pocket when using a Penn Medicine facility. We all benefit when you use the health system for your health care. Know when to visit an emergency room and when to visit an urgent care center or retail health clinic. Use your wellness visits and screenings to help detect or prevent health issues in the future, and ensure good health through check-ups, immunizations, well-woman care, colorectal cancer screenings and more. These preventive services are covered at 100% without a copay. Feeling stressed? Reach out to the Employee Assistance Program through Penn Behavioral Health at

29 Prescription Drugs The U.S. Food and Drug Administration recommends these six tips to ensure healthy use of prescription drugs: Find out the name of your medication Ask questions about the proper use of your medication Know what your medication is for Read medicine labels and follow directions Keep all of your health care providers informed about your medications and dietary supplements (including vitamins and herbals) For emergencies, keep a list of your medications with you at all times and let a loved one know your medications Keep in mind, you are automatically enrolled in prescription drug coverage through Caremark when you enroll in a medical plan. Remember, using a UPHS Pharmacy is the most cost-effective way for you to fill your prescription. Maintenance medications: You must use the mail-order program and have the prescription filled as a 90-day prescription. Dental Benefits Get your teeth cleaned twice a year. Scientific research suggests a connection between oral health and general health, particularly the association between oral infections and adverse pregnancy outcomes. Common risk factors also exist between oral and chronic diseases, such as diabetes, heart disease and stroke. Review the different plan options carefully to determine which plan benefits fit the needs of you and your family. If you choose the Penn Dental Plan, you must use one of the three specific PENN locations. Vision Benefits An annual eye exam is an important part of keeping you and your family in good health. Annual eye exams not only detect diseases of the eye like cataracts and glaucoma, but also enable early detection of other diseases like diabetes, multiple sclerosis and high blood pressure. You will save money if you receive eye care from one of the UPHS Eye Care Centers. Keep in mind, exams are paid at 100% with a $10 copay if you are enrolled in the IBC Davis Vision Plan or 100% if you are enrolled in the Vision Benefits of America Plan. Choose in-network providers whenever possible to keep out-of-pocket expenses to a minimum. 28

30 Income Protection Are you ready for a What if? A disability for six months can wipe out years of savings. And when people are disabled and can t work, they lose more than just their current income they lose their ability to save money. Disability coverage is more important than ever because people with chronic conditions are living longer. That s why UPHS offers you the option to purchase Short-Term Disability coverage and provides you with Company-paid Long-Term Disability Insurance if you meet the eligibility requirements. Wellness Resources Don t forget to manage your well-being. Participate in the Wellfocused programs. Access these programs and resources from the HR & You Website at Take advantage of the services available from Carewise Health Programs. Take the Personal Health Assessment (PHA) and certify that you participated in two healthy behaviors to receive a $5 healthy reward credit per paycheck! 29

31 How to Enroll Enrolling for benefits is simple using our online enrollment system. If you are enrolling as a new hire, be sure to complete your enrollment within 30 days of your hire date. If you are enrolling during annual Open Enrollment, you need to enroll from April 14 through April 27, 2014 for coverage in the plan year. Enrolling for benefits is easy, whether you are a new hire or during annual Open Enrollment, through our online enrollment system, EnrollOne. EnrollOne allows you to elect or change your benefits in four easy steps: Logging On and Enrolling Online Whether you are a new hire or it is Open Enrollment, enrolling for benefits is easy through EnrollOne our online enrollment system. EnrollOne allows you to elect or change your benefits in a few simple steps: Step 1: Go to and then select EnrollOne, which will take you to the login page. Step 2: Log in using your Social Security number and PIN, which is the last four digits of your Social Security number. Step 3: Review your benefit options and make your elections. Be sure to print your Benefits Profile page after completing your enrollment. If You Have Questions If you have any questions about the PennCare PPO Plan, call Health Advocate at or visit Representatives are available to help you and your family understand your UPHS medical plan benefits. 30