1 Make your benefit elections by Nov. 15, Enter your beneficiaries. Welcome to Open Enrollment Saint Mary s Hospital!

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1 Welcome to Open Enrollment Saint Mary s Hospital! Trinity Health and Saint Mary s Hospital are pleased to provide you with the information you will need to enroll in benefits for next year. Throughout the rest of this communication, you will see Trinity Health and Saint Mary s Hospital referred to as simply Trinity Health. If you have more questions after reviewing this guide, refer to the For More Information section to learn where you can get answers. What s Inside What s New for How to Enroll 3 About the Medical Plans 4 Medical Coverage 5 Your Top Three Tasks for Open Enrollment 1 Make your benefit elections by Nov. 15, Enter your beneficiaries. Medical and Pharmacy Plan Highlights 6 3 Submit your Personal Health Application for supplemental life insurance to The Hartford, if applicable. Paying for Medical and Pharmacy Coverage 7 More About the Health Savings PPO 8 Live Your Whole Life 9 More About the Medical Plans 10 Dental Coverage 11 Vision Care Coverage 12 Flexible Spending Accounts 13 Life Insurance 14 Time Away from Work 15 Legal Plan and Voluntary Benefits 16 It s also a good time of year to: Check the eligibility rules if you, your spouse/eligible adult and/or dependent child both work at Trinity Health at Review the Live Your Whole Life section of this guide to learn about resources that will help you maintain your health and incentives on your medical contributions throughout the year. Print copies of your benefit elections for proof of enrollment. Open Enrollment is Mandatory for You must enroll by Nov. 15, 2017 in order to have benefits in If you want to participate in the Essential PPO Assist Plan for 2018, you must apply each year and meet specific income and eligibility guidelines. For more information on the Essential PPO Assist Plan, refer to page 7. Open enrollment is mandatory for medical coverage for 2018 This means that you must enroll in medical coverage by Nov. 15, Even if you are going to waive medical coverage, you still need to complete your open enrollment medical coverage election and select Waive. Who is Eligible 17 For More Information 18 Important Reminders 19 Additional Notices Saint Mary s Waterbury 1

2 What s New for 2018 You have the opportunity to choose from three all new Medical plan options for 2018: 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. Keep in mind, because these medical plan options are all new for 2018, you must make a medical plan election, including if you want to waive coverage. If you don t make a medical election, you will not have medical coverage. As part of the medical plan designs for 2018, you will now share in the cost of services when you utilize Tier 1 providers: Trinity Health facilities and aligned providers. Keep in mind, even with the new cost-sharing structure, you will have a lower deductible, coinsurance and out-of-pocket maximum when you use Trinity Health facilities and aligned providers. 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. If you enroll in benefits this year, you will receive a new medical ID card through Aetna and a new pharmacy card through CVS/Caremark. Beginning January 1, 2018, we are transitioning our Employee Wellness program to the Live Your Whole Life well-being program through Trinity Health. Participation in this program will help you maintain your 2018 medical insurance premiums. Beginning January 1, 2018, colleagues can now receive financial assistance for adoption expenses. We are continuing to harmonize who is covered under Trinity Health benefits and programs. For 2018, An Eligible Adult may now be covered. See the Who is Eligible section for more information. Complete your benefits enrollment online using Farmington, the new benefits enrollment web-based tool. Follow the step-by-step instructions provided in this guide to help you navigate your benefit options for This year, certain vaccinations will be covered through the pharmacy benefit as well as the medical benefit with a $0 copay. Under the pharmacy benefit, you must use your prescription card at a participating CVS network pharmacy that offers the specific vaccine. These vaccines may include: seasonal flu vaccine, shingles vaccine and the pneumonia vaccine. We are pleased to introduce the Trinity Health MyBenefits internet site for You can log on at to find information about the 2018 Open Enrollment process and to learn more about your Trinity Health benefits. You will have the opportunity to contribute $50 more per year to your HSA, up to a maximum of $2,800 in 2018, if you have colleague only coverage. The IRS HSA contribution limit for all other coverage levels has increased to $5,600. Beginning Jan. 1, 2018, you and your covered dependents are required to select a primary care physician (PCP) online. If an eligible adult qualifies as a tax dependent, you must complete the Non-Spouse Eligible Adult Dependent Certification form posted on MyBenefits each year in order to receive pre-tax deductions. Starting in 2018, you may elect to cash-out up to 80 hours of PTO. Keep in mind you must maintain a minimum of 40 hours in your PTO bank at the time of the cash-out in PTO cash-out payments will be included in your first pay in November Trinity Health is updating its pharmacy formulary with Caremark effective Jan. 1, A drug formulary is a list of prescription drugs both generic and brand name that offer the greatest overall value for both colleagues and the plan. To learn more about the new pharmacy formulary, please visit MyBenefits or contact Caremark. Beginning in 2018, you have new vendors for dental and vision. You will not receive an insurance card for these plans. Your Enrollment Requirements Open enrollment is mandatory for This means you will not have coverage if you do not choose your own benefit options between Oct Nov. 15, If you wish to participate next year you must complete your enrollment by Nov. 15, 2017 at 11:59 p.m. EST. 2 Saint Mary s Waterbury

3 How to Enroll Step-by-step instructions To protect personal information, the benefit enrollment system requires colleagues to register their account prior to making their benefit elections. An address is required to register and serves as the username for logging in. To register as a first time user: 1. Open a web browser to 2. Click the "Register Now" button 3. Colleague s must provide the following information: Their last name The last 4 digits of their social security number Their birth date 4. When the system matches the colleague s information, they will be prompted to provide an address where a registration link will be sent. This address will be their username for any future visits. 5. The colleague will receive a registration with a link to click to complete their login. The registration link is only valid for 30 minutes. 6. Click the link inside the and the colleague will be brought to the Change Password screen. At this point they must provide a password for their login to the enrollment system. The requirementsfor the password are: The password must be at least 8 characters long. The password must contain at least 1 upper case character. The password must contain at least 1 lower case character. The password must contain at least 1 number. The password cannot contain the word password. If you are unable to register or have other technical difficulties, please call Open Enrollment is mandatory for 2018 This means that you must enroll by Nov. 15, 2017 if you want to choose your own benefit options for Even if you are going to waive coverage, you still need to complete your open enrollment elections and select Waive. Adding Family Members If you re adding family members to your benefit plan 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. 17, If you don t submit the required documentation by the deadline, your dependents will not be enrolled in coverage for 2018, 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 documentation verifying their dependent status at that time. To see who is eligible to be added to coverage, please see the Who is Eligible section on page 17. 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 note, you have the option to purchase coverage for your spouse/eligible adult and dependents. If you and your spouse/eligible adult or dependent(s) both work for Trinity Health, and are benefits eligible, you cannot elect dual coverage (enrolled as a colleague and a dependent). In addition, only one of you will be able to elect coverage for your child(ren). Saint Mary s Waterbury 3

4 About the Medical Plans Introducing the Clinically Integrated Network (CIN) in 2018 Trinity Health is pleased to introduce our Clinically Integrated Network (CIN) structure for our medical plan options in A CIN joins local physicians and health care providers that have made a decision to partner with a Regional Health Ministry (RHM) to deliver services focused on high quality and cost-efficient care designed to improve the health of those we serve. Seeking care within the CIN can help you and your physician make health care decisions that ensure that you are accessing the right care, at the right time, in the right setting. In addition, by utilizing our CIN you will pay less out-of-pocket for the care you receive, because all of the CIN providers are in our Tier 1 network. Choose your Primary Care Physician (PCP) 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. Trinity Health encourages you to select a PCP and develop a relationship with them. Therefore, beginning January 1, 2018, you and your covered dependents will be required to have a PCP on record. Be sure to indicate your PCP through the medical vendor s online portal. If no PCP is indicated, the Plan will auto-assign based on: 1. Claim history 2. Tier 1 physician within 10 mile radius of your home 3. Tier 2 physician within 10 mile radius of your home To find an in-network physician or provider, visit select the My Service Providers tab. Understanding your out-of-pocket medical costs You may be wondering how Trinity Health and you share medical and pharmacy costs each year. The graphic below shows how costs are shared for both premiums and coverage. Keep in mind, your costs will vary depending on the plan and the network you access at the time of service. How Trinity Health & You Share Medical & Pharmacy Costs Trinity Health and you pay for your Medical and Pharmacy premiums throughout the year. Trinity Health & You Trinity Health and you pay costs as you receive care throughout the year. Your Cost Shared Cost Plan Cost Employee Premium Contributions Copays 100% of Medical Costs up to the deductible You pay 10%/20%*Coinsurance Plan pays 90%/80%* of costs Plan pays 100% of Medical Costs once out-of-pocket is met * Dependent on the Trinity Health Medical Plan selected and the cost share for Tier 1 facilities or physicians. 4 Saint Mary s Waterbury

5 Watch this Video to Learn More Scan the tag with your smartphone to download and view a video about your 2018 medical plan choices. Get the free mobile application at If you don t have a smartphone, visit the MyBenefitswebsitetoview the video. Medical Coverage Trinity Health is offering you three new medical plan choices for 2018 which support our efforts to provide a common experience for all colleagues and provide meaningful choices. The three new plans are administered by Aetna and support our new clinically integrated network structure. The PPO plans - Traditional, Health Savings and Essential - offer these three tiers so you can pay less by receiving care from network providers. Tier 1, or the Trinity Health network providers, are facilities or physicians aligned with our organization that provide you with the most cost-effective care. For services unavailable through Trinity Health 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. How the medical plan works 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 With the Health Savings PPO, you pay less per pay period for coverage leaving more money in your paycheck and you have access to a Health Savings Account (HSA) to help pay for current and future medical expenses. Here s how it works: First Second Third You pay the full cost of medical and prescription expenses until you reach the annual deductible (Note: preventive care services and certain preventive 90-day generic prescriptions do not require you to meet the deductible). Once you meet the deductible, you pay coinsurance until you reach the out-of-pocket maximum. Once you reach the out-of-pocket maximum, Trinity Health pays 100% of all remaining eligible expenses during the year. To learn more about the Health Savings PPO, see page 8 of this enrollment guide. If you enroll in the Health Savings PPO, you will automatically have an HSA. Trinity Health and Saint Mary s Hospital 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. We encourage you to consult with a tax advisor for IRS rules and tax implications related to HSAs. Essential PPO The Essential PPO works the same as the Traditional PPO where you pay for 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. Saint Mary s Waterbury 5

6 Medical and Pharmacy Plan Highlights For more information about your medical and pharmacy plan options, visit Medical Plan Network Tier Traditional PPO Health Savings PPO 1 Essential PPO 1 Highlights Trinity Healthfunded account All Tiers N/A HSA: $650 / $1,300 HRA: $850 / $1,700 (Individual / Family) If you qualify during open enrollment Tier 1 $250 / $500 $1,500 / $3,000 $1,000 / $2,000 Annual deductible Tier 2 $750 / $1,500 $2,500 / $5,000 $2,500 / $5,000 (Individual / Family) Tier 3 $1,500 / $3,000 $3,500 / $7,000 $4,000 / $8,000 Tier 1 10%* 10%* 20%* Coinsurance Tier 2 20%* 20%* 30%* Tier 3 40% R&C* 40% R&C* 40% R&C* Tier 1 0% no deductible 0% no deductible 0% no deductible Preventive care Tier 2 0% no deductible 0% no deductible 0% no deductible Tier 3 40% R&C* 40% R&C* 40% R&C* Tier 1 $20 / $30 10%* 20%* Office visit Tier 2 $30 / $40 20%* 30%* (PCP / Specialist) Tier 3 40% R&C* 40% R&C* 40% R&C* Urgent care visit All Tiers 0% after $35 copay 10%* 20%* Emergency room All Tiers 0% after $100 copay 10%* 0% after $100 copay Tier 1 None** None** None** Inpatient Tier 2 $500** $500** $750** admission Tier 3 $1,000** $1,000** $1,000** Tier 1 $50** None** $50** Outpatient Tier 2 $100** $100** $100** surgical services Tier 3 $200** $200** $200** Tier 1 $2,500 / $5,000 $2,600 / $5,200 $3,500 / $7,000 Out-of-pocket maximum Tier 2 $4,750 / $9,500 $5,000 / $10,000 $5,500 / $11,000 (Individual / Family) Tier 3 $9,500 / $19,000 $7,000 / $14,000 $9,000 / $18,000 Retail Pharmacy Retail Pharmacy Retail Pharmacy Generic $10 $10 Prescription drug Brand formulary 20% ($30 min, $80 max) 20% after deductible, 0% after 25% ($30 min, $80 max) 34 day supply out-of-pocket max Brand 40% ($60 min, $100 max) 50% ($60 min, $120 max) non-formulary CVS Caremark Mail or Retail CVS Caremark Mail or Retail CVS Caremark Mail or Retail Generic $25 $25 90 day supply Brand formulary 20% ($75 min, $200 max) 20% after deductible, 0% after 25% ($75 min, $200 max) out-of-pocket max Brand 40% ($150 min, $250 max) 50% ($150 min, $300 max) non-formulary Out-of-pocket maximum Deductible and out-of-pocket Out-of-pocket maximum based on Tier 2 based on Tier 1 based on Tier 2 1 The individual deductible only applies to those enrolled in colleague-only coverage for the Health Savings PPO and Essential PPO Assist Plans. For all other coverage levels, the full family deductible must be met even if only one person in the family is receiving care. * Reasonable and Customary (R&C), subject to deductible. ** Subject to deductible and coinsurance. Select, generic preventive drugs are covered at 100% and are not subject to the annual deductible. See the MyBenefits website for the complete list of eligible drugs. 6 Saint Mary s Waterbury

7 Paying for Medical and Pharmacy Coverage Contribution levels for the medical and pharmacy plans are based on the Social Security taxable wage base ($127,200 for 2017, indexed annually) to ensure our benefit plan cost-sharing model is appropriately aligned with our colleagues income levels. The amount you pay for medical and pharmacy coverage is based on your annual base salary (your base rate of pay times your budgeted hours) and your participation in the Well-Being programs. If at any time during the 2018 plan year, you earn $127,200 or more, you will pay a higher premium contribution per pay period for your medical insurance. Full Time Traditional PPO Health Savings PPO Essential PPO Full 1-Person No Full 1-Person No Full 1-Person No Your per pay period cost Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Colleague only Colleague plus spouse/ bug eligible adult Please contact your Human Resources representative for medical plan rates. Colleague plus child(ren) Colleague plus family Part Time Traditional PPO Health Savings PPO Essential PPO Full 1-Person No Full 1-Person No Full 1-Person No Your per pay period cost Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Colleague only Colleague plus spouse/ bug eligible adult Please contact your Human Resources representative for medical plan rates. Colleague plus child(ren) Colleague plus family Need help with your health care costs? You may be eligible for the Essential PPO Assist plan ( Assist Plan ) if you meet certain income requirements. It is the same as the Essential PPO, but includes a Trinity Health-funded Health Reimbursement Account (HRA) to help you pay for your health care costs at the time of service. To participate in the Assist Plan, you must apply and meet specific income and eligibility guidelines. To learn more, see the application form on the MyBenefits website or Apply by submitting a completed application form with a copy of your most recent Federal Income Tax Form 1040 or 1040EZ to Human Resources by Nov. 17, NOTE: If you think you qualify for the Assist Plan, you should elect the medical plan you think will be best for you which could be the Traditional PPO, the Health Savings PPO, or the Essential PPO. If you qualify for the Assist Plan, you will be moved to the Assist Plan. Otherwise, you will remain in the plan you elected during open enrollment. How do the Incentives work? For more information on how to achieve Full and 1-Person incentives, see the Live Your Whole Life section on page 9. Saint Mary s Waterbury 7

8 More about the Health Savings PPO TheHealthSavingsPPO is a consumer-driven health plan which gives you the opportunity to participate in a plan where your health care costs are more closely determined by your decisions. Here are some reasons to consider choosing the Health Savings PPO in 2018: IlikedthatIsaved money in premium contributions spending money only when I used medical care. I can really save for my health care expenses when I use the HSA. It s great that Trinity Health makes its full contribution to my HSA in January. For certain generic preventive drugs and diabetes and asthma drug classes, I didn t have to pay my deductible before the plan started paying those expenses. How the deductible works TheHealthSavings PPO Plan includes a combined deductible. A combined deductible means the full family deductible must be met even if only one person in the family is receiving care. Coinsurance begins once the combined deductible has been met. 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 will make a full contribution to your account in January based on the coverage level you elect. In addition, you can also contribute to this account up to IRS limits: Coverage Level Trinity Health Your Voluntary Total IRS Allowed Contributions Contributions* HSA Contributions Colleague only $650 $2,800 $3,450 All other coverage levels $1,300 $5,600 $6,900 *If you are 55 or older, you can contribute an additional $1,000 in catch-up contributions to your HSA. May be subject to state taxation. Questions about the HSA How do I get an HSA? To be eligible for the HSA, you must enroll in the Health Savings PPO. In addition, you cannot have coverage under another non-high deductible health plan, such as Medicare, TRICARE, or coverage through a spouse s health plan. Who can use funds in my HSA? You and your dependents can pay for medical, dental and vision expenses with funds in your HSA. Dependents must be claimed on your tax return. Why would I contribute to my HSA? Contributions to the HSA are a great way to save on taxes. 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). Keep in mind that you can change the amount you contribute to your HSA at any time during the plan year. How can I use the money in my HSA? You may use the HSA to pay for qualified medical expenses now and during retirement for you and your qualified dependents. How do I pay for medical expenses with my HSA? 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. What happens if I don t use all the money in my HSA each year? Any money you do not use during the year is carried over, without any limits. Remember, you own the money in your HSA and it is yours to keep even when you change jobs or retire. Can I enroll in the Health Care Flexible Spending Account (HCFSA) if I have an HSA? When you enroll in the Health Savings PPO which includes the HSA, you will not have access to the health care flexible spending account (HCFSA). However, the HSA may be seen as having more advantages over the HCFSA including: The opportunity to carry over savings from year to year you do not forfeit any amount in your HSA at the end of the plan year (if you are currently enrolled in the HCFSA for 2017 and you elect the HSA for 2018, you must utilize your HCFSA funds by Dec. 31, 2017); Contributions of up to $6,900 in tax-free HSA dollars each year (the HCFSA maximum is $2,600); 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, may be right for me? Your medical plan choice depends on your personal situation. If you answer yes to some of these questions, the Health Savings PPO plan may be 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? For more information about the Health Savings PPO, including the Health Can you see your HSA balance growing as you keep Savings Account (HSA), visit making contributions each year? We encourage you to consult with a tax advisor for IRS or rules and tax implications related to an HSA. May be subject to state taxation. 8 Saint Mary s Waterbury

9 Live Your Whole Life Staying healthy all the way around - in body, mind, and spirit - makes us happier and more productive at home and on the job. At Trinity Health, we believe that an annual Health Assessment and healthy activities are essential steps in understanding your well-being. It s so important that we provide an incentive when you and your covered spouse or eligible adult complete these steps. New for 2018, incentives are no longer earned as contributions to your HSA, but as a lower medical contribution. Here s how this year s program will work: All colleagues start with the Full Incentive amounts. Note: See the box to the right to understand the new options for Full and 1-Person Incentives. There are two Periods where you can earn LifePoints to maintain your Full Incentive amounts. To maintain these incentives throughout the year, you need to earn 100 LifePoints in each Period by completing the outlined activities. Incentive Structure There are separate incentive amounts for colleagues and spouses/eligible adults. If both you and your spouse/eligible adult complete the activities in each period, you will maintain the Full Incentive amounts. If only one of you completes the activities in each period, you will only maintain a 1-Person Incentive amount. (See the section Paying for Medical Coverage for contribution rates with Full and 1-Person Incentives.) Period 1 Earn 100 LifePoints by March 30, 2018 Complete your Health Assessment The Health Assessment is an online questionnaire about your health habits. Your answers are kept secure and confidential; summary data is used to identify areas for future well-being and prevention programs. Note: To maintain your Full Incentive amount, the health assessment must be completed by you and your covered spouse or eligible adult in Period 1 (Oct. 1, March 30, 2018.) If you (and your spouse/eligible adult, if applicable) do not complete your health assessment by March 30, 2018, you will not maintain the incentive of a lower per pay period cost for medical coverage, beginning with the pay that includes May 1, Period 2 Earn 100 LifePoints between April 1 and June 29, 2018 To continue receiving the incentive throughout the year, you and your covered spouse or eligible adult need to earn 100 LifePoints by participating in a Meaningful Choice activity that interests you within Period 2. You can choose from a variety of Meaningful Choice Activities that fit your lifestyle. Some examples include talking with a health coach, completing a stage of an online journey module, tracking well-being items such as hours of sleep or time spent volunteering. If you (and your spouse/eligible adult, if applicable) do not earn 100 LifePoints by June 29, 2018, you will not maintain the incentive of a lower per pay period cost for medical coverage, beginning with the pay that includes August 1, Need another chance to earn your Full Incentives? If you did not complete the required activities by the Period 1 deadline, you still have one more chance to regain your Full Incentive amounts. If you complete both the Period 1 and Period 2 activities by June 29, 2018, you will regain the Incentive (Full or 1-Person, depending on if your spouse/eligible adult completes the activities), beginning with the pay that includes August 1, If you feel that you are unable to complete the Live Your Whole Life incentive activities by the deadline due to extenuating circumstances (e.g., medical hardship, military deployment), you may request an exception. For your exception request to be reviewed, the form must be completed and returned prior to the end of each Period. Exception forms can be found at or by calling For more information on dates and activities, please visit the Live Your Whole Life website at mybenefits. trinity-health.org/lywl or call Saint Mary s Waterbury 9

10 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. Maintenance Choice program for your maintenance medications Our prescription drug plan requires that you receive your maintenance medications* in 90-day supplies through the CVS Caremark Mail Service Pharmacy or a local CVS Pharmacy. Once you reach your plan limit (initial fill and 2 refills) for filling 30-day supplies at a retail pharmacy, you will pay the full cost of your medications if you do not move your prescription to one of the long-term options listed above. *A maintenance medication is a long-term medication taken regularly for chronic conditions or long-term therapy. 10 Saint Mary s Waterbury

11 Dental Coverage You have a choice between two Delta Dental of Michigan plan options: the High plan and the Standard plan. Our plans utilize the Delta Premier and PPO networks. Visit for providers in your area. Your dental elections for 2017 will NOT carry over. Dental Plan Highlights High Plan Standard Plan Participating Dentist Nonparticipating Dentist Participating Dentist Nonparticipating Dentist Annual deductible Individual/Family $25/$50 $50/$100 $50/$100 $100/$150 Class I - Preventive services 100% covered 100% covered 100% covered 100% covered ($0 colleague cost) (Usual and Customary ($0 colleague cost) (Usual and Customary rates apply) rates apply) Class II - Basic services 20% after deductible 20% after deductible 40% after deductible 40% after deductible Class III - Major restorative services 40% after deductible 40% after deductible 50% after deductible 50% after deductible Class IV - Orthodontics 50% after deductible 50% after deductible Not covered Maximums Per person annual (non-orthodontics) $1,750 $1,250 $1,500 $1,000 Per person lifetime (orthodontics) $1,500 $1,500 Not applicable Not applicable Your per pay period cost Full-time Part-time Full-time Part-time Colleague only Colleague plus spouse/eligible adult Please contact your Human Resources representative for dental plan rates. Colleague plus child(ren) Colleague plus family NOTES: When you receive services from a non-participating dentist, you will be responsible for the difference between what your dentist charges and the Delta Dental non-participating dentist fee. Fluoride treatments are covered once every 12 months up to age 19. Bitewing x-rays are covered once every 12 months. For more information about your dental plan options or about Delta Dental, visit Saint Mary s Waterbury 11

12 Vision Care Coverage You have a choice between two United Health Care vision plan options: the High plan and the Standard plan. Visit for providers in your area. UHC Vision Plan Highlights High Plan Standard Plan In-network Out-of-network In-network Out-of-network (reimbursement schedule) (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 Up to $40 Up to $40 Bifocal $0 copayment Up to $60 $0 copayment Up to $60 Trifocal Up to $80 Up to $80 Lenticular Up to $80 Up to $80 Frames $150 retail allowance Up to $45 $150 retail allowance Up to $45 Covered frame at retail locations at retail locations 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 Contact lens coverage is provided under the plan and may vary dependent on the type of contact lenses prescribed. Please see the benefit summary on My Benefits for additional information. 20% discount 20% discount 20% discount 20% discount The following lens options are covered in full: standard scratchresistant coating, standard basic and high-end progressive lenses, standard polycarbonate lenses, standard antireflective coating, UV, tints, photochromic, Transitions, edge coating The following lens options are covered in full: standard scratch-resistant coating, standard polycarbonate lenses Colleague only Colleague plus spouse/eligible adult Colleague plus child(ren) Colleague plus family Please contact your Human Resources representative for vision plan rates. For more information about your vision care plan options, visit 12 Saint Mary s Waterbury

13 Health Care and Dependent Care Flexible Spending Accounts You have the opportunity to set aside before-tax money to offset eligible health care or dependent care expenses. There are two different types of Flexible Spending Accounts a Health Care Flexible Spending Account (HCFSA) and a Dependent Care Flexible Spending Account (DCFSA). How much can I contribute? What expenses will it cover? When do I have to spend the money? How do I access my FSA savings? Health Care Flexible Spending Account (HCFSA) Before-tax dollars in any amount between $130 and $2,600 Eligible health care products and services used by you and/or your eligible dependents. Examples include: 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 For a list of expenses that are eligible for HCFSA reimbursement, visit Contributions made to the HCFSA during the 2018 calendar year can be used for claims with dates of service between Jan. 1, 2018 and Mar. 15, 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. Dependent Care Flexible Spending Account (DCFSA) Before-tax dollars in any amount between $130 and $5,000 Expenses for the care of 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 DCFSA during the 2018 calendar year can be used for claims with dates of services between Jan. 1 and Dec. 31, You can use a variety of payment options to access your FSA savings. These include the Pay my Provider, Pay me Back, or by using the Mobile application. Reminders: If you choose to enroll in the Health Savings PPO medical plan option, you cannot enroll in the HCFSA. The Health Savings Account works just like the HCFSA but offers additional benefits, such as the opportunity to carry over unused funds, contribute up to $2,800/individual ($5,600/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 HCFSA and/or DCFSA elections for 2018 during open enrollment. Your prior year elections will NOT carry forward. HCFSA and DCFSA claims for the 2018 plan year must be postmarked on or before Mar. 31, If you choose to contribute to the HCFSA a new WageWorks Health Card will be mailed to your home. For more information about your FSA benefits and to obtain a list of eligible expenses, visit How to use your remaining 2017 HCFSA funds If you contributed to the HCFSA in 2017 and have funds remaining on Dec. 31, 2017, you can use the funds for claims incurred between Jan. 1, 2018 and Mar. 15, Claims must be submitted by Mar. 31, To ensure you use your remaining 2017 funds, you must pay for the claim at the time of service and submit your claims to WageWorks. Do not use your WageWorks debit card to pay for claims during this period because the card will access 2018 funds. Saint Mary s Waterbury 13

14 Life Insurance Colleague life insurance options If eligible, 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. You will be eligible for will preparation services through The Hartford s EstateGuidance Will Services at no charge. To get started, access The Hartford s EstateGuidance Will Services online at and enter the Trinity Health Web ID WILLHLF in the Promotional Code box. Basic life/ad&d (employer-paid) Supplemental life Supplemental AD&D Maximum amounts Personal Health Applications Colleague Life Insurance Plan Highlights (full- and part-time) One times annual base salary One to eight times annual base salary One to eight times annual base salary Basic life: $1.5 million Supplemental life: $1.5 million (Combined: $3 million) Any election of more than three times annual base salary or $1.5 million in colleague Supplemental life coverage will require you to complete a Personal Health Application form. Costs for colleague supplemental life insurance coverage are based on your age as of Jan. 1, 2018, and will be available when you enroll online. Dependent life insurance options You have the option to purchase coverage for your dependents (including your spouse, eligible adult or eligible children). You may elect coverage for your dependents without electing coverage for yourself. If you and your spouse or eligible adult both work for Trinity Health and are benefit eligible, you cannot elect spouse/eligible adult coverage for that individual. Also, only one of you will be able to elect coverage for your child(ren). If your dependent child also works at Trinity Health and is benefit eligible, you cannot elect child life coverage for that individual. Are your beneficiaries up-to-date? You may want to take a moment to review the beneficiary(ies) you have on file for your life coverage. If you haven t yet designated beneficiary(ies), your life insurance benefits will be paid according to the plan provisions as outlined in the Summary Plan Description. You may change your beneficiary(ies) during the Open Enrollment process or anytime throughout the year. Beneficiary(ies) designated for Basic Life Insurance apply to any Employee Supplemental Life Insurance elections. For more information about your life insurance benefits or to obtain a Personal Health Application form, visit Personal Health Application Dependent Life Insurance Plan Highlights (full- and part-time) Spouse/Eligible Adult life 1 Child(ren) life 2 Coverage amount Coverage amount $10,000 $20,000 $50,000 $80,000 $100,000 $5,000 $10,000 $20,000 Any election more than $20,000 in spouse/eligible adult supplemental life coverage will require your spouse/eligible adult to complete a Personal Health Application form. 1 Costs for spouse/eligible adult life insurance coverage are based on your age as of Jan. 1, 2018, and will be available when you enroll online. 2 Child(ren) life insurance costs cover all of your eligible children, and will be available when you enroll online. 14 Saint Mary s Waterbury

15 Time Away From Work At Trinity Health, we are working to harmonize time off benefits across our Ministry. Our goal is to help strengthen and enhance our people-centered health system and provide our colleagues with meaningful benefits that are competitive and sustainable. Here are some of the benefits you receive as youneedtimeawayfromwork. Short-term disability Short-term disability (STD) pays a benefit if you are unable to work because of a qualified injury or illness. NOTE: this is an employer provided benefit. No election is required to receive this benefit. Amount of benefit When benefits begin How long benefits continue 60% of base pay 100% if covered under MTO After an elimination period following an injury or illness Up to 11 weeks Long-term disability Long-term disability (LTD) pays a benefit if you are unable to work for a long period of time because of a qualified injury or illness. Amount of employer-provided benefit When benefits may begin How long benefits continue 60% of base pay After Minimum of 90 days or the end of short-term days of disability Benefits continue until you are able to return to work, are deemed no longer disabled, or until age 65 or older, depending on when the disability begins. PTO cash-out Under the PTO program, hourly colleagues earn PTO based on your hours paid. You are able to cash-out a certain amount of your unused PTO each year. Howmuchtimecan you cash-out Electing to cash-out Payment date for cash-out You can cash-out up to 80 hours.you must maintain a minimum PTO bank of 40 hours Election for 2018 may only be made during open enrollment to avoid taxation on the value of your PTO bank. Your election is irrevocable and cannot be changed. You will receive your cash-out in the first pay in November You may cash-out only hours you will accrue during the calendar year in which you plan to receive payment. Consequently, you may not cash-out PTO hours carried over from previous years. For example, Jane has a PTO balance of 100 hours as of Dec. 31, During open enrollment, she elects to cash-out 40 hours in Jane cannot cash-out any of the 100 hours she earned in 2017 or earlier. She must plan her 2018 cash-out amount on only the hours she will accrue in REMINDER: If you want to cash-out PTO in 2018, you must make a new PTO cash-out election. For more information about the program, visit For more information about your disability benefits, visit Saint Mary s Waterbury 15

16 Legal Plan You re eligible for the legal plan if you are a regularly scheduled full- or part-time colleague with 20 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. Hyatt Legal Plan Highlights In-network All covered services are paid in full No waiting periods No deductibles or copayments No claim forms 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) 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 Civil litigation defense Your per pay period cost Colleague only: $5.12 Colleague plus family: $6.97 For more information about the legal plan, visit Voluntary Benefits In addition to your group benefits, Trinity Health has partnered with The Farmington Company to provide eligible colleagues the opportunity to elect personal insurance plans. 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 Hospital Indemnity Accident insurance For more information and to enroll, call Be sure to tell the representative that you are a member of Trinity Health and Saint Mary s Hospital. 16 Saint Mary s Waterbury

17 Who Is Eligible Eligible Individual Colleague Spouse/Eligible Adult Definition Regularly scheduled full- or part-time colleague with 20 or more budgeted hours per pay period (20 or more budgeted hours per pay period for short-term disability and 30 or more budgeted hours per pay period for long-term disability.) You may cover your spouse or Eligible Adult. An Eligible Adult is an adult who resides and has financial interdependence with the colleague, and is not a tax qualified dependent or related by blood, adoption or marriage to the colleague. If an eligible adult qualifies as a tax dependent, you must complete the Non-Spouse Eligible Adult Dependent Certification form posted on MyBenefits each year in order to receive pre-tax deductions. For 2018, you must submit the form by Nov. 17, Dependent Children Dependent children are eligible for coverage through the end of the Plan Year in which they turn age 26, regardless of marital status, student status, residency, financial dependency or other requirements provided they meet all of the following criteria: They are: Your or your spouse/eligible adult s natural children; Your or your spouse/eligible adult s legally adopted children or children placed with you or your eligible adult for adoption; or Children for whom you or your spouse/eligible adult are the court-appointed legal guardian. Not otherwise covered under the Plan or any other group health plan offered by the Employer. Note: Children of eligible adults may be covered only if their eligible adult is covered. New Hires New hires are eligible for benefits on the first day of the month following 30 days of employment. To view the complete eligibility rules and documentation requirements for you and your family visit trinity-health.org Saint Mary s Waterbury 17

18 For More Information We hope this enrollment guide has provided you and your family with all of the information you need to make your benefit elections for In addition to completing your Open Enrollment, please remember to review and update your personal information, such as your address, phone number, marital status and emergency contacts as necessary. You may update your personal information at any time throughout the year. If you still have questions about your options or the open enrollment process, you can: Attend a benefits meeting, where you ll receive additional information and have an opportunity to ask questions regarding your benefit options. Day Time Campus Room Thursday, Oct. 12 8:00 a.m. 9:00 a.m. St. Mary s Hospital Auditorium 11:00 a.m. 12:00 p.m. 2:00 p.m. 3:00 p.m. 5:00 p.m. 6:00 p.m. Monday, Oct :00 a.m. 11:00 a.m. St. Mary s Hospital Auditorium 4:00 p.m. 5:00 p.m. Wednesday, Oct. 18 7:00 a.m. 8:00 a.m. St. Mary s Hospital Auditorium 11:00 a.m. 12:00 p.m. Thursday, Oct. 19 8:00 a.m. 9:00 a.m. St. Mary s Hospital Auditorium 10:00 a.m. 11:00 a.m. 4:00 p.m. 5:00 p.m. Monday, Oct :00 p.m. 1:00 p.m. St. Mary s Hospital Auditorium 2:00 p.m. 3:00 p.m. 6:00 p.m. 7:00 p.m. Tuesday, Oct. 24 7:00 a.m. 8:00 a.m. St. Mary s Hospital Auditorium 12:00 p.m. 1:00 p.m. 4:00 p.m. 5:00 p.m. If you have any questions about the material in this guide, please contact The Trinity Health Of New England Benefits Resource Center at or BenefitsResourceCenter@TrinityHealthOfNE.org 18 Saint Mary s Waterbury