2016 Benefits ENROLLMENT GUIDE

Transcription

1 2016 Benefits ENROLLMENT GUIDE

2 Choices Emory Healthcare is proud to be a vital part of the Atlanta community. One of the reasons we are an employer of choice is the rich benefits package that we offer our employees. As a part of Emory Healthcare, you have numerous benefits available to you. You have a choice of two medical plans for 2016, each with unique plan design features. In addition, there are plans that provide coverage for dental, vision, disability, retirement, long-term care, legal services and more. We encourage you to take a close look at all of the benefits information provided in this guide. Our benefit plans are just one of the many ways Emory Healthcare helps you take care of yourself and your family. The Summary of Benefits and Coverage (SBC) for each health plan and the individual health insurance marketplace exchange notice can be accessed at Click on Employee Resources and then Your Benefits. What s Inside Benefits Enrollment 2016 Your Benefits Benefits Eligibility How to Enroll Change In Your Coverage Mid-Year Health Benefits Medical Plans Plan 1: HSA Plan Plan 2: POS Plan Medical Plan Rates Medical Plan Comparison Quick Guide Wellness Incentives Flexible Spending Accounts Dental Benefits Vision Benefits Additional Benefits Short-Term & Long-Term Disability Life and Accident Insurance Long-Term Care, Home & Auto, Aflac and Prepaid Legal (b) Retirement Plan Additional Resources More Medical Plan Information Important Numbers and Websites This guide is meant to provide basic benefit plan information. For additional details and specific information, please contact the vendor or review the Summary Plan Description (SPD) for each plan. SPDs are available on the Your Benefits website (go to and select Employee Resources) or by contacting the Employee Resource Center at or EHC.HR/Benefits@emoryhealthcare.org for a printed version. DISCLAIMER: Emory Healthcare reserves the right to terminate or amend its plans and leave policies in whole or in part at any time, including the right to terminate or modify coverage, and the cost of coverage, for any group of employees, whether active, on leave or retired, and/or dependents at any time, even during a leave or after retirement. The welfare plans do not provide vested benefits.

3 Your Benefits As an Emory Healthcare employee, you are fortunate to have a wide range of benefit programs available to you. Benefit programs give you important financial protection when you need it most. Enrolling in your benefits is quick and easy. Spend a few minutes and review the benefit programs that Emory Healthcare offers to make the choices that are right for you and your family. Some benefits Emory Healthcare offers are employer provided, and coverage is automatic if you are eligible. Other benefits give you choices and require you to enroll. Employer-Provided Benefits As an eligible employee, Emory Healthcare automatically provides you with several benefits. Emory Healthcare pays the full cost for basic life insurance and long-term disability coverage and provides a basic employer contribution to the 403(b) retirement plan for eligible employees. For more information on retirement plan options, view the Discover Your Retirement Options Guide located on the Employee Resources site on Optional Benefits In addition to employer-provided benefits, eligible employees may enroll in optional benefits, including medical, dental, vision, supplemental life insurance, accidental death and dismemberment, disability, flexible spending accounts, 403(b) retirement plans and other voluntary plans. You contribute toward the cost of the optional benefits that you elect. When Coverage Begins For most benefits, coverage begins on an employee s date of hire. New Hires: If you are benefits-eligible, you must enroll during your first 31 days of employment with Emory Healthcare. For optional benefits other than the 403(b) and supplemental long-term disability, if you do not enroll during your first 31 days of employment, you will not receive coverage. Your next opportunity to enroll in optional benefits will be during the annual benefits enrollment period, typically held in the fall of each year for the upcoming year, or if you experience a qualified family status change (see page 4 for more information). Life and long-term care benefits require Evidence of Insurability (EOI) for late enrollees. Current Employees: If you are a current, benefitseligible Emory Healthcare employee, each year you have an opportunity to review your benefit elections during the annual benefits enrollment period and make changes for the upcoming plan year. When Coverage Ends For most benefits, coverage will end on the last day of the month in which: Your regular work schedule is reduced to fewer than 20 hours per week; Your employment with Emory Healthcare ends due to resignation, termination or death; or You stop paying your share of the coverage. Your dependent(s) coverage ends: When your coverage ends, or The last day of the month the dependent is no longer eligible: For Dependent Child(ren) (up to age 26): End of the month in which they turn / Benefits Enrollment Guide 1

4 Who Can Enroll (Benefits Eligibility) You are eligible for benefits if you are a regular full-time or part-time employee scheduled to work 20 hours or more per week. If you elect coverage, your dependents are also eligible for medical, dental, vision and life insurance coverage. Eligible dependents include: Your legal spouse. Same-Sex Domestic Partner (SSDP): Another adult of the same sex who is engaged with you in a spouselike relationship characterized by mutual dependency. Have residence in the same household. Financially responsible for each other s well-being and debts to third parties. This means that you have entered into a contractual commitment for that financial responsibility or have joint ownership of significant assets (such as home, car, bank accounts) and joint liability for debts (such as mortgages and major credit cards). Neither partner is married to anyone else nor has another domestic partner receiving benefits. Partners are not related by blood closer than would bar marriage in the state of their residence. If you choose to cover a same-sex domestic partner, you will pay the same cost and receive the same coverage as you would for a spouse. Covering an SSDP will result in additional tax liability (imputed income). If your relationship ends, you will need to notify the Employee Resource Center. Your legal child(ren): Includes your natural, adopted or foster child(ren), stepchild(ren), your SSDP s child(ren) or any child for whom you have legal custody. They are eligible: Up to age 26. Regardless of age, if fully disabled and unmarried, provided he/she became fully disabled prior to age 19 or between the ages of 19 and 26, if the child was covered by the plan when the disability occurred. Dependent Verification of Eligibility When you first enroll, or if you change coverage midyear due to a qualified IRS family status change, you are required to provide documentation substantiating the eligibility of your dependent(s) within 31 days of the change or enrollment. If documentation is not received within 31 days, a letter will be mailed to you requesting the documentation within a given deadline. Events that require documentation to support the change include: Spouse with a last name different than yours Document(s): Marriage certificate OR joint tax return (current or previous year only). Child with a last name different than yours Document(s): Birth certificate or a court document awarding custody or requiring coverage. Dependent child over age 26 Document(s): Birth certificate AND a Social Security Disability Award or letter from a physician AND the parent s tax return claiming the child (current or previous year only). Same-Sex Domestic Partner (SSDP) Document(s): Affidavit of Domestic Partnership and a document validating the partnership, such as a joint bank account statement, utility bill or mortgage/lease/rental agreement. Employee with five dependents who adds a sixth or more dependents Document(s): Birth certificate AND either a court document or the tax return from the parent claiming the child must be submitted (current or previous year only). Employee with a 50+ age difference with dependent(s) Document(s): Birth certificate AND either a court document or the tax return from the parent claiming the child must be submitted (current or previous year only). REMINDER: You must provide the documents listed above to the Employee Resource Center within 31 days from your initial election or mid-year family status change if one of the above situations applies to you and your family. If documentation is not received in a timely manner, the election/change requested will not be processed and the affected dependents will not be covered under Emory Healthcare s plans. Legible copies of required documents are acceptable Benefits Enrollment Guide 12/15

5 How to Enroll Enroll Online Enrolling is easy and available 24 hours a day through e-vantage on and Self Service. You can enroll online at any public access computer that has Internet connectivity. To access e-vantage, you will need your network ID and password. If you do not know your network ID or password, call 8-HELP at Steps to Enrolling Online 1. Once logged in to e-vantage, click on Self Service, then Benefits and then Benefits Enrollment. 2. Choose Select to view your current elections and the new election options. 4. After selecting your elections and covered dependents, if any, your payroll deductions will be displayed. 5. You will be prompted at the bottom of the page to Continue to finalize your elections. 6. Click Submit after reading the Authorize Elections Statement. Note: You have not enrolled until you click Submit. 7. Click View/Print to bring up a printable pdf confirmation page. Make sure to save a copy of your confirmation page and carefully review it for accuracy. 3. Complete the certifications for the Spouse/SSDP medical charge and the tobacco surcharge. Don t have access to a computer? No need to worry! The locations listed below have computers available Monday through Friday. For times, go to Employee Resources and select Contact HR under Need Help. Emory University Hospital - Learning Resource Center (2nd Floor, Room E214) - Human Resources (2nd Floor, Room D201) Emory University Hospital Midtown - Learning Resource Center (Glenn Bldg, 2nd Floor, Room 4709) - Human Resources (W.W. Orr Bldg, 5th Floor) Emory University Orthopaedics & Spine Hospital - Human Resources Emory Johns Creek Hospital - Human Resources Emory Saint Joseph s Hospital - Human Resources Emory Wesley Woods Center - Houston Building Main Lobby 12/ Benefits Enrollment Guide 3

6 Change in Your Coverage Mid-Year The IRS provides strict regulations about changes to pretax elections during the plan year. If you experience a qualified IRS family status change mid-year, you are permitted to make a change within 31 days of the event. If the change request is not completed within 31 days of the event, you will not be able to change your elections until the following year s annual benefits enrollment period, which means the change will not be effective until January 1 of the following year. Below is a list of some of the more commonly known qualified family status changes: Marriage, divorce or annulment, or permanent separation from a same-sex domestic partner Birth of a child Placement of a foster child or child for adoption with you, or assumption of legal guardianship of a child Change in your spouse s/ssdp s or dependent s employment status that affects benefits eligibility, including termination or commencement of employment or change in worksite You or your spouse/ssdp returns from unpaid leave of absence You or your dependent becomes eligible or loses eligibility for Medicare or Medicaid The death of your spouse/ssdp or dependent Court ordered coverage of your child by you or your spouse/ssdp, allowing you to add or drop the child s coverage Change in your employment that affects benefits eligibility (working at least 20 hours per week) Loss of eligibility for a dependent Change in dependent care provider or cost for Dependent Day Care Flexible Spending Account The change you request must be consistent with the qualifying event. To make a family status change, go to log in to e-vantage and go to Self Service. In most cases, when you enter your family status change through Self Service and make your elections, the process is complete. However, some mid-year changes also require documentation to be submitted within 31 days of the event. Please refer to the below section for a list of events that require documentation. Family Status Change Event Dependent loss of the state s CHIP plan Judgment, Decree or Court Order to add coverage for a dependent child Documentation to Submit A copy of the Certificate of Creditable Coverage or a termination letter that lists the date your coverage ended A copy of the court order awarding custody or requiring coverage Legally married couples with different last names Proof of marriage such as marriage certificate or jointly filed tax return Dependent child with a last name different than yours Beginning Same-Sex Domestic Partner Relationship Ending Same-Sex Domestic Partner Relationship A copy of the birth certificate or a court document awarding custody or requiring coverage Statement of Same-Sex Domestic Partnership or a civil union certificate from a state or governmental agency that recognizes civil unions Complete the Same-Sex Domestic Partnership Termination form Change of residence that is inside or outside of the plan area A copy of your visa and/or passport that shows the date of entry or exit from the plan area Please contact the Employee Resource Center at for more details Benefits Enrollment Guide 12/15

7 Medical Plans Everyone s health care needs are different. That s why it s important to carefully decide which medical plan will work best for you. In this section, you will find information on the two medical plans that Emory Healthcare offers. You have a choice of two medical plans: Plan 1 HSA Plan Plan 2 POS Plan Both plans use the same provider networks; however, there are key differences in how each plan works, including s, co-pays and co-insurance. Network Options Both plans have three Network options: Emory Healthcare Network (EHN): Providers and facilities that are owned by and affiliated with Emory Healthcare give you the maximum benefit available under the plans, with lower co-pays, co-insurance and s. For a list of EHN providers, go to page 24. Aetna National (In-Network): Providers and facilities are part of both medical plans through Aetna. Copays, co-insurance and s are higher than with the EHN. Out-of-Core-Network: Providers and facilities that are not participating with Aetna are considered Out-of-Core-Network. Costs are the highest. To locate an EHN or Aetna National (In-Network) physician or facility, go to custom/emory or call Preventive Care Routine preventive care is covered at 100% under both medical plans. Preventive care can help you identify potential health risks before they become real health problems. These services include annual physicals, well-child visits, immunizations, health screenings and more. (See and click on Employee Resources and Your Benefits for a list of services.) Tier Zero Both plans offer Tier Zero for prescription drugs. With Tier Zero, generic forms of birth control and prescription medications used to prevent and treat chronic health conditions, such as congestive heart failure (CHF), diabetes, high blood pressure, high cholesterol, tobacco addiction and more, are covered at 100%. For Tier Zero medications, you pay $0 for a 30- or 90-day supply. For a complete list of Tier Zero medications, go to www. ourehc.org and click on Employee Resources and Your Benefits. Please note that, from time to time, this list will change as medications will be moved off patent protection (brand) and placed in a generic status. It is also possible for generic medications to fall off the list as they become available over-the-counter. For the most up-to-date information or to request an updated listing, please contact CVS/caremark at What Is the Same in Both Medical Plans? Same broad network of physicians in Georgia and nationally (EHN and Aetna National [In-Network]). Routine preventive care is $0 when service is received within the EHN or Aetna National (In-Network). Tier Zero (you pay $0 for certain generic prescription drugs). Neither plan requires you to select a primary care physician or get a referral to see a specialist. Unlimited lifetime maximum applied across both plans and networks. The opportunity to earn incentives for wellness activities (see page 12 for more details). Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. For additional information, go to Employee Resources and Your Benefits. Information can be found under the heading Notices, Summaries, Reports & Resources. 12/ Benefits Enrollment Guide 5

8 Medical Plans HSA Plan Deductible All eligible expenses incurred by you or your covered dependents throughout the plan year apply toward meeting the annual : $1,350 (Employee Only) or $2,700 (Employee + Spouse/SSDP, Employee + Children or Family) within the EHN or $1,500 (Employee Only) or $3,000 (Employee + Spouse/SSDP, Employee + Children or Family) for In-Network. As expenses are incurred, including ER visits and prescription drugs, you can use funds that have accumulated in your HSA to cover these costs. Once your HSA balance is exhausted, any remaining portion of your that needs to be met for the year will be an out-of-pocket expense and your financial responsibility. The annual must be satisfied before any plan expenses are paid by co-insurance, with the exception of preventive care and Tier Zero prescriptions, which are covered at 100%. If you enroll and elect employee and dependent coverage, any covered expenses incurred will apply toward meeting the family of $2,700 (EHN) or $3,000 (In-Network) before any expenses are covered under co-insurance. Co-Insurance Once the annual is satisfied, the HSA Plan works like a traditional plan by paying the majority of expenses through co-insurance. EHN care is covered at 90% (you pay 10%); In-Network care is covered at 80% (you pay 20%) and Out-of-Core-Network care is covered at 60% (you pay 40%). Plan 1 HSA Plan The HSA Plan, a consumer-driven medical plan with a Health Savings Account, puts you in charge of how your health care dollars are spent. Features of this plan include: The same covered services and network of providers as the POS Plan with a different way to pay and save for health care expenses. A Health Savings Account (HSA) with tax advantages, funded in part by Emory Healthcare. The HSA gives you the flexibility to choose how to spend your health care dollars. 100% coverage for all preventive care when services are in the Emory Healthcare Network (EHN) or Aetna National Network (In-Network). Like the POS Plan, the HSA Plan has s, co-insurance and an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year. Learn more about this plan by viewing the HSA Plan Quick Guide posted on the intranet. Go to and click on Employee Resources and Your Benefits. Out-of-Pocket Maximum Like a traditional plan, there is a maximum amount that you are financially responsible for under the plan each year. Once your out-of-pocket eligible expenses reach the annual maximum of $3,200 (Employee Only) or $6,400 (Employee + Spouse/SSDP, Employee + Children or Family) within the EHN or In-Network, the plan pays 100% of eligible expenses for you and your covered dependents for the remainder of the plan year. The individual out-ofpocket maximum of $3,200 within the EHN and In- Network will be applied to a covered family member who incurs medical expenses after the Family of $2,700 within the EHN or $3,000 within the In-Network is completed. This eliminates the need for the full Family out-of-pocket maximum to be satisfied if only one family member needs medical care. However, the combined medical charges incurred by additional family members will satisfy the full Family out-of-pocket maximum. When the Family out-of-pocket maximum is satisfied, eligible expenses for all family members will be covered at 100% for the remainder of the plan year. It is important to note that, other than preventive care, you have to pay 100% of your eligible medical expenses, including prescription drugs, until your annual is met.* Once met, the plan provides coverage through co-insurance. You need to carefully consider the balance in your HSA and your ability to meet these financial obligations in the event of an illness, injury or accident. * If you elect Employee+Spouse, Employee+Children or Family level coverage, you must meet the family before the plan pays Benefits Enrollment Guide 12/15

9 Medical Plans HSA Plan Continued Prescription Drugs If you are enrolled in the HSA Plan, you must pay all out-ofpocket costs for prescription drugs until you meet your annual under the EHN, which is $1,350 (Employee Only) or $2,700 (Employee + Spouse/SSDP, Employee + Children or Family), or In-Network, which is $1,500 (Employee Only) or $3,000 (Employee + Spouse/ SSDP, Employee + Children or Family). You can use your HSA to pay for prescription drugs. After you meet the, you will pay the applicable co-insurance amount under the HSA Plan, up to the 30-day retail maximum. The table below shows what your responsibility is once your is satisfied. For example, if the table shows co-insurance is 20%, the plan will pay 80% of the cost of the prescription drug and you are responsible for the other 20%. However, there is financial protection built into the prescription drug benefit in that you will never pay more than the 30-day retail maximum, outlined in the table below: Preventive Prescription Drugs (Not Subject to Deductible) and Non-Preventive Prescription Drugs (After Meeting Deductible) Tier Coinsurance 30-day Retail Maximum Co-pay 90-day Mail Order Maximum Co-pay Zero 0% $0 $0 1 10% $25 $ % $75 $ % $120 $ % $150 $375 Prescription drug coverage is administered through CVS/caremark. To determine your coverage tier, call Mandatory Mail Order If you take any maintenance prescription medications to treat certain ongoing medical conditions, you will need to fill your prescriptions in one of three ways: through CVS/caremark s mail order service, at a CVS retail pharmacy location (at the mail-service cost) or at an Emory pharmacy. Please be aware that if you attempt to fill a maintenance drug at a pharmacy other than CVS or Emory, you will be charged the full retail cost on your third attempt to refill. Prior Authorizations and Quantity Limits Medications within certain drug categories require prior authorizations and quantity limits as part of CVS/ caremark s clinical review program. These clinical review programs help ensure patient safety by implementing quantity, dose and effectiveness reviews prior to medications being prescribed. For a list of drug categories requiring prior authorization and medications subject to the clinical review program, contact CVS/caremark at Health Savings Account (HSA) The HSA is funded in three ways by Emory Healthcare s annual contribution, your participation in various wellness activities (incentives) and through optional pretax contributions you make to the HSA. 1. Emory Healthcare s Annual Contribution. If you enroll in: Employee-Only coverage Emory Healthcare contributes $300 to your HSA. Employee + Spouse/SSDP, Employee + Child(ren) or Employee + Family level coverage Emory Healthcare contributes $600 to your HSA. Note: Emory Healthcare s contribution is prorated based on your enrollment date if enrolled after January 1. Your HSA begins on the first of the month following your election. 2. Incentives. In addition to Emory Healthcare s annual contribution to your HSA, you and your spouse/ssdp can each earn up to $500 in incentives toward your HSA balance each year by completing various wellness activities. See page 12 for details on earning incentives. 3. Your Contributions. Finally, if you want a way to save tax-free for current or future eligible medical expenses, you can also contribute to your HSA. Contributions to your HSA have no expiration date they remain in the account until you decide to access them or reimburse yourself for an eligible expense you already paid out-ofpocket. You decide when and how to pay. To Qualify for a Health Savings Account: 1. You must be enrolled in the HSA Plan. 2. You cannot be claimed as a dependent on someone else s tax return. 3. You cannot be covered by a spouse s FSA. 4. You cannot be covered by any other medical plan, including Medicare A and/or B. 5. While you may cover a child up to age 26 or an SSDP under the HSA Plan, qualified medical expenses are those incurred by you, your spouse and all dependents you claim on your tax return. Refer to IRS Publication 969 for details. 6. Your 2015 FSA balance must be $0 as of December 31, / Benefits Enrollment Guide 7

10 Medical Plans HSA Plan Continued WHAT S DIFFERENT ABOUT A HEALTH SAVINGS ACCOUNT? 1. The Health Savings Account (HSA) is only available if you participate in the HSA Plan. The money is yours, is held in an investment account and is portable it goes with you to be used for qualified medical expenses if you leave Emory Healthcare or when you retire. 2. If you are enrolled in the HSA Plan, you may not participate in a general Healthcare Flexible Spending Account (FSA). However, you can participate in the Limited Aetna Healthcare FSA for dental and vision, and then for medical expenses once you have met your. 3. If you are enrolled in the HSA Plan, you may still participate in the Dependent Day Care Flexible Spending Account (FSA). Additional HSA Features Once your HSA account is open, you will receive a welcome kit from Aetna/PayFlex. The kit will include an Aetna/PayFlex MasterCard debit card to pay eligible expenses. Withdrawals from HSAs for qualified medical expenses are tax-free. If you withdraw money for any reason other than qualified medical expenses, you must pay income tax and a 20% IRS tax penalty. You must have a balance in your account to make a withdrawal. Money in the HSA will be invested in a money market fund. The maximum you can contribute to an HSA in one year is set by the IRS (in 2016, $3,350 for single coverage and $6,750 for family coverage). If you are age 55 or older, you can contribute additional catchup contributions. It is your responsibility to make sure your HSA contributions, including any employer or incentive contributions, do not go over the IRS maximum. The minimum you can contribute is $ HOW THE HSA PLAN WORKS GET PREVENTIVE CARE FREE EHN and In-Network preventive care is covered at 100% with no. You pay $0 out-of-pocket for your annual physical, well-woman visit, mammogram, colonoscopy, routine immunizations and other eligible services. PAY FOR OTHER MEDICAL EXPENSES You pay for additional medical and prescription drug expenses as you incur them until your annual is met. Your amount depends on your coverage level. USE YOUR HSA Your HSA helps you cover your and pay for other medical costs. Emory Healthcare will HSA Debit Card HSA contribute $300 (employee only) or $600 (dependent or family coverage) to your HSA. You can also earn additional HSA monies through wellness incentives. Unused funds from your HSA roll over to the next year, and your account balance earns interest (tax-free) over time Benefits Enrollment Guide 12/15

11 Medical Plans POS Plan Plan 2 POS Plan The POS Plan works more like a conventional medical plan where members pay co-pays for some services (copays are fixed-fee amounts that you pay at the time you receive services and are not subject to the ). The POS Plan also uses co-insurance for some services (co-insurance is the portion of expense you must pay for care, in most cases, after meeting your ). The is a set amount that typically you must pay before co-insurance starts. See page 11 for amounts. The POS Plan allows members to receive services from a national network of providers and facilities. It is an open access plan that: Provides the flexibility to choose any provider Does not require that a Primary Care Physician (PCP) be identified or selected Does not require a PCP referral to see a specialist With the POS Plan, your biweekly contribution is higher than with the HSA Plan, but your annual is lower. You cannot open a Health Savings Account (HSA) or receive HSA contributions from Emory Healthcare. You do have the option of enrolling in a Healthcare Flexible Spending Account (FSA) which allows you to set aside up to $2,550 pretax dollars to help pay for medical expenses. See page 13 for more information about the FSA. EHN and In-Network preventive care is covered at 100% and is not subject to the. For all other medical services, the plan pays a portion of your covered expenses - 90% for Emory Healthcare Network (EHN), 80% In- Network (Aetna National) and 60% (Out-of-Core- Network) - after you pay the annual. Office visits are covered with a co-payment. Prescription drugs are covered through co-insurance. The POS Plan also has an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year. Co-payments, s and co-insurance count toward the out-of-pocket maximum. Save on Prescription Drug Costs If you take prescription medication on an ongoing basis, you will save money and time by using CVS/caremark mail orders. No extra charge for shipping. Another great way to save on drug costs is to buy generic. Always ask your pharmacist if a generic version is available. Prescription Drugs Prescription drug coverage is administered through CVS/ caremark. Emory Healthcare s prescription drug benefits for the POS Plan are based on the five-tier co-pay structure below. You will pay the applicable co-insurance amount subject to the retail minimum and maximum cost. You do not have to meet your first. Prior Authorization & Quantity Limits Medications within certain drug categories require prior authorizations and quantity limits as part of CVS/ caremarks clinical review program. These clinical review programs help ensure patient safety by implementing quantity, dose and effectiveness reviews prior to medications being prescribed. For a list of drug categories requiring prior authorization and medications subject to the clinical review program, call for more information. Mandatory Mail Order If you take any maintenance prescription medications to treat certain ongoing medical conditions, you will need to fill your prescriptions in one of three ways: through CVS/ caremark s mail order service, at a CVS retail pharmacy location (at the mail-service cost) or at an Emory pharmacy. Please be aware that if you attempt to fill a maintenance drug at a pharmacy other than CVS or Emory, you will be charged the full retail cost on your third attempt to refill. Tier Coinsurance 30-Day Retail Minimum 30-Day Retail Maximum Mail Minimum (up to 90 days) Mail Maximum (up to 90 days) Zero 0% $0 $0 $0 $0 1 10% $10 $25 $25 $ % $30 $75 $75 $ % $60 $120 $150 $ % $90 $150 $225 $375 12/ Benefits Enrollment Guide 9

12 Medical Plan Rates (Biweekly)* Plan HSA POS Full-time** Part-time*** Full-time** Part-time*** Single $14.50 $22.00 $40.50 $61.00 Employee+Child(ren) $68.50 $ $ $ Employee+Spouse/SSDP $77.00 $ $ $ Family $ $ $ $ *Rates do not reflect the Spouse/SSDP Medical Charge and Tobacco Use Surcharge. ** Full-time rates apply for employees scheduled to work 31 or more hours per week. *** Part-time rates apply for employees scheduled to work hours per week. Spouse/SSDP Medical Charge - $50 An additional $50 per month medical charge will be added to your medical plan contribution if your covered spouse/ssdp has access to group health insurance coverage through his/her employer. If you cover a spouse/ssdp, you must certify ANNUALLY online in e-vantage whether your spouse/ssdp does or does not have access to group health insurance coverage through his/her employer. Tobacco Use Surcharge - $50 per person To support the health and wellness of our staff and set a positive example for our patients and the community, Emory Healthcare has implemented a $50 per person monthly tobacco use surcharge on medical contributions for employees and their spouses/ssdps who use tobacco products. Important Notice: Don t forget that false statements on the spouse and tobacco certifications, as well as enrollment and claims documents, are a violation of Emory Heathcare s Standards of Conduct policy as falsification of forms, records and documents and could lead to disciplinary action, up to and including an unpaid suspension or termination of employment without prior warning, at the sole discretion of Emory Healthcare. Important Reminder! If the spouse/ssdp medical certification is not completed, you will automatically incur the $50 monthly charge for the spouse/ssdp medical charge. Don t forget to certify! Need Help Quitting Tobacco? Emory Healthcare offers several tobacco cessation resources at no cost to employees. For a listing of resources, go to Benefits Enrollment Guide 12/15

13 Medical Plan Comparison Quick Guide PLANS HSA PLAN POS PLAN EHC Contribution $300/$600 1 None Earned Incentives $500/$1,000 2 $500/$1,000 2 Health Savings Account (HSA) Yes No Annual Deductible Emory Healthcare Network (EHN) Aetna National (In-Network) Out-of-Core- Network 3 Emory Healthcare Network (EHN) Aetna National (In-Network) Out-of-Core- Network 3 Single $1,350 $1,500 $2,500 $850 $1,000 $2,000 Family $2,700 4 $3,000 4 $5,000 4 $2,550 $3,000 $6,000 Out-of-Pocket Maximum Single $3,200 $3,200 $6,500 $2,500 $2,700 $6,500 Family $6,400 $6,400 4 $13,000 4 $5,000 $5,400 $13,000 Aggregate Yes Yes Yes Yes Yes Yes Primary Care Physician Office Visits 5 Pediatrician or Mental Health Physician Visits Specialist Office Visits Diagnostic Labs and X-Ray Durable Medical Equipment (DME) 10% after 10% after 10% after 10% after 10% after 20% after 20% after 20% after 20% after 20% after $25 co-pay $35 co-pay $25 co-pay $25 co-pay $35 co-pay $50 co-pay 10% after 10% co-insurance (no ) 20% after 20% co-insurance (no ) Routine Preventive Care 6 (Eye Exam, Annual Physical, Flu Shots, GYN Annual) Plan Pays 100% Plan Pays 100% $0 co-pay $0 co-pay Emergency Room Visits 10% after 20% after 20% after $150 co-pay 7 $150 co-pay 7 $150 co-pay Hospitalizations Inpatient/Outpatient Coverage 10% after 20% after 10% after 20% after Behavioral Health Benefits Inpatient Treatment 10% after 20% after 10% after 20% after Outpatient Treatment 10% after 20% after $25 co-pay $25 co-pay 1. $600 is contributed annually to the HSA by Emory Healthcare when Employee+Spouse/SSDP, Employee+Children or Family level coverage is elected. 2. An annual maximum of $1,000 in incentives can be earned when Employee+Spouse/SSDP or Family level coverage is elected. 3. Amounts applied to and out-of-pocket maximums are limited to the Reasonable and Customary charges. 4. Family applies in the HSA plan when Employee+Spouse/SSDP, Employee+Children or Family level coverage is elected. 5. Includes services of an internist, general physician, family practitioner, dermatologist and allergist. 6. Routine preventive care services ONLY are covered at 100% under the plan. Diagnostic services are subject to the and co-insurance. 7. Co-pay waived if admitted. DISCLAIMER: Every attempt has been made to ensure the chart and information above accurately reflect the details of the plan. Should there be any errors, the terms and conditions of the Summary Plan Description (SPD) prevail. 12/ Benefits Enrollment Guide 11

14 Wellness Incentives Earning your wellness incentives can help lower your overall medical costs. If you enroll in the HSA Plan, your incentives will be a contribution to your HSA. If you enroll in the POS Plan, your incentives will be a credit against your or co-insurance. Refer to the chart below for incentive amounts. Each enrolled employee and spouse/ssdp is eligible for the same amounts. All incentives must be completed between January 1, 2016, and November 15, 2016, to be eligible for 2016 incentives. Incentive Opportunities Compass Online Health Risk Assessment (HRA) Complete Aetna s Compass Online Health Risk Assessment (HRA) first and open the gate to your 2016 incentives. The HRA takes only minutes to complete and provides feedback, support and guidance on your health strengths and risks. The HRA must be completed before any other incentives can be received. For example, if you get your annual checkup, but don t complete the HRA, you will not receive your checkup incentive until after you complete your HRA. Complete the HRA early in 2016, so you can get credit for all of your incentives. Go to Aetna s homepage at log in and click Take a Health Assessment in the box on the left-hand side of the page. On the next page (your Health Dashboard ), click Launch My Health Assessment in the Health Assessment box. Journeys Online Programs Immediately after you complete the HRA, you have an opportunity to start an online health improvement program or Journey. Select from a wide variety of Journeys, including Get Active, Eat Healthier, Stress Less, Blood Pressure in Check, Diabetes Life: Type 2, Heart- Healthy Cholesterol, Sleep Well and Weigh Less. Complete the last stage of two Journeys to earn your incentive. To get started, log in to and click on Health Programs, Health Dashboard, Launch My Programs and Embark on a Journey. Annual Checkup One of the most important things you can do for your health is to schedule an annual checkup (or wellness/ preventive exam). With a focus on preventive care, an annual checkup includes an age- and gender-appropriate history, an examination, a review of risk factors and plans to reduce them, and appropriate immunizations and screenings. For women, a well-adult (or well-woman) visit will count for this incentive. If you don t have a primary care physician, call Emory HealthConnection at or go to Colorectal Cancer Screening Colorectal cancer affects men and women of all racial and ethnic groups and is most often found in people age 50 years or older. Talk with your doctor if you are age 50 or older and haven t been screened, or if you think you may be at higher than average risk for colorectal cancer. If you and your doctor decide that a colorectal cancer screening is right for you and you complete it by November 15, 2016, you can receive the incentive. Healthy Lifestyle Coaching Access your own personal, telephonic health coach from Aetna to help you reach your health-related goals. Work on one or more of the following: weight management, tobacco cessation, stress management, nutrition, fitness and preventive health. You can receive the incentive after completing the third coaching session. Enroll by (a) completing Aetna s Compass Online Health Risk Assessment; (b) self-referring by telephone; or (c) receiving a referral from other Aetna programs. To self-refer by telephone, call In Touch Care (formerly Disease Management) If you have a chronic or acute health challenge, Aetna s In Touch Care (ITC) is a great resource. The program provides support you need, and, in the most urgent circumstances, Aetna connects you to one-on-one nurse support. You will have direct phone access to a highly experienced registered nurse, who you ll work with for all your needs. Complete two phone calls with your nurse to qualify for the incentive. Enroll at Log in, click Health Management in the top bar and then click Enroll Now. You can also call Aetna at Incentive Amounts (For Employee and Spouse/SSDP) Compass Health Risk Assessment N/A Journeys Online Programs $ Colorectal Cancer Screening $ Healthy Lifestyle Coaching $ Annual Checkup (preventive exam) $ In Touch Care $ Maximum Incentive... $ Benefits Enrollment Guide 12/15

15 Flexible Spending Accounts (FSAs) A Flexible Spending Account (FSA) is funded with money you contribute on a pretax basis. You can use FSA funds to pay for qualified out-of-pocket health care costs for yourself and eligible dependents or dependent day care charges. According to IRS regulations, each year you must enroll during your annual benefits enrollment period if you want to participate in either a Healthcare FSA or a Dependent Day Care FSA. Aetna/PayFlex is Emory Healthcare s Flexible Spending Account Administrator. Check your FSA balance online and locate more information at aetnanavigator.com. Healthcare FSA for POS Plan You can contribute between $200 and $2,550 pretax annually into the Healthcare FSA. All money you elect to contribute is accessible immediately. The money you contribute can be used to cover out-of-pocket costs, such as: Medical expenses: co-pays, s, coinsurance Dental expenses: s and co-insurance Vision expenses: prescription glasses, contact lenses, co-pays Prescription drug costs Over-the-counter drugs with a prescription Limited Healthcare FSA for HSA Plan HSA Plan members are not eligible for the Healthcare FSA but do have access to a special Limited Healthcare FSA administered through Aetna/PayFlex. You may use the Limited FSA to pay for dental and vision expenses and then for medical expenses once your has been met. Dependent Day Care FSA Money you contribute into a Dependent Day Care FSA can be used toward care for a child under age 13, a physically or mentally disabled parent or child, or elder care for tax-qualified dependents. If you re single or married and filing a joint tax return, you can contribute up to $5,000 into this FSA. If you re married and file separately, you can contribute up to $2,500. If you are a highly compensated employee under the IRS definition, you are restricted to an annual contribution of no more than $2,400. Unlike the Healthcare FSA, you can only access the money that is currently in your account. To qualify for reimbursement, t hese expenses must be incurred so that you (and/or your spouse/ssdp) can work or go to school. HSA Plan members can also participate in the Dependent Day Care FSA. Aetna/PayFlex Card New FSA participants will automatically receive an Aetna/ PayFlex Card in the mail for Please activate the card when you receive it. The use of the Aetna/PayFlex Card is for convenience only. IRS guidelines still require you to retain receipts for any eligible expense for which you receive reimbursement. On occasion, Aetna/PayFlex may request verification of expenses and you will need to submit appropriate documentation for the expense. If not received, the card will be deactivated until the expense can be substantiated as eligible under IRS definitions. Check with Aetna/PayFlex to determine what supporting documentation is required. Use It Don t Lose It The risk of forfeiting money from your Healthcare FSA has been reduced by a grace period (extra time in the following year to use your FSA money). You will be able to use any remaining balance in your Healthcare FSA at the end of 2016 to pay for expenses incurred through March 15, Any 2016 Healthcare FSA funds not used by March 15, 2017, will be forfeited. To avoid forfeiture, purchase items such as prescriptions, eyeglasses, contact lenses and other approved Healthcare FSA expenditures. Reimbursement requests using your previous year s remaining Healthcare FSA balance must be filed by May 15, Please remember to keep all of your receipts, as they are required for verification of expenses. If you have a Dependent Day Care FSA, you do NOT have a grace period in which to use remaining previous year balances. All expenses must occur before December 31, 2016, and claims for the 2016 Dependent Day Care FSA must be filed no later than May 15, 2017, to receive reimbursement. 12/ Benefits Enrollment Guide 13

16 Dental You can choose from two types of dental plans: the Aetna Traditional Dental (PPO) Plan or the Aetna Dental Maintenance Organization (DMO) Plan. Aetna does not issue dental cards, as it is not required by the provider. However, you can log on to if you wish to print a card. Plan 1- Aetna Traditional Dental (PPO) Plan This plan is a traditional dental plan that allows you to see any dental provider. Some services require you to pay the and applicable co-insurance. The is a set amount that typically you pay before co-insurance starts. Co-insurance is the portion you must pay for services, in most cases, after meeting your. Features of this plan include: Flexibility to choose any provider. This plan has a large number of In-Network providers. Reimbursements for most Out-of-Network claims. Preventive services received by either In-Network or Out-of-Network providers are covered at 100% up to reasonable and customary levels. Some examples of routine preventive services include: Oral examinations Routine, deep cleanings and polishing (Deep cleanings, or full mouth debridement, CPT 4355, are covered under preventive services as a replacement for one of your routine cleanings once in a 24-month period of time.) PLANS Preventive Services (routine and deep cleanings, X-rays, etc.) Fluoride Sealants (permanent molars only) Bitewing X-rays Full Mouth Series X-rays Space Maintainers Plan 2- Aetna DMO Plan The Dental Maintenance Organization (DMO) Plan is a managed care plan that contracts with a list of providers at a set fee schedule. Participants pay copays and do not have to pay co-insurance. This plan offers a limited network of dentists with low member contributions, no and low out-of-pocket co-pays. Out-of-Network coverage is not available. A Primary Care Dentist (PCD) must be selected and a referral is required for specialist care. Make sure to contact the dental provider you select to find out if they are accepting new patients. For a list of scheduled services, network providers and to see what the plan pays, go to custom/emory. Aetna Traditional Dental (PPO) Aetna DMO* In-Network Out-of-Network 1 In-Network Only $0 $0 $0 Basic Services (filling, root canal, etc.) 10% 2 20% 2 Scheduled Major Restorative (crown, bridge, etc.) 50% 2 50% 2 Scheduled Calendar Year Deductible 3 $50/person $150/family $50/person $150/family Annual Plan Payment Maximums $1,500/person $1,500/person None Orthodontia Deductible None None Co-insurance 50% 50% Lifetime Maximum $1,500 $1,500 1 Amounts applied to are limited to the Reasonable and Customary charges 2 After 3 Waived for preventive services * There is no Out-of-Network coverage in the Aetna DMO plan For the 2016 dental plan rates, go to page 15. None $2,000 co-pay, limited to one treatment per lifetime DISCLAIMER: Every attempt has been made to ensure the chart and information above accurately reflect the details of the plan. Should there be any errors, the terms and conditions of the Summary Plan Description (SPD) prevail Benefits Enrollment Guide 12/15

17 Dental Continued Dental Plan Rates (Biweekly) Plan Aetna Traditional Dental (PPO) Aetna DMO Full-time* Part-time** Full-time* Part-time** Employee Only $11.50 $15.71 $8.50 $ Person $23.50 $31.91 $15.50 $21.66 Family $36.50 $50.25 $26.50 $34.21 * Full-time rates apply for employees scheduled to work 31 or more hours per week. ** Part-time rates apply for employees scheduled to work hours per week. Vision Emory Healthcare offers an optional vision plan through EyeMed Vision Care. Features of this plan include: Routine annual eye exam $0 co-pay. Single, bifocal, trifocal, lenticular lenses $0 co-pay. Progressive lenses $65 co-pay. Frames Up to $150 allowance, 20% off balance over $150. Contact lenses (conventional and disposable) $0 co-pay up to $200 allowance, 15% off balance over $200 on conventional lenses. Benefits provided once every 12 months for lenses or contact lenses. Contact lens and frame allowance is a one-timeuse benefit. Members are encouraged to use their full allowance at the time of initial service. Unused balances are not available for future visits during the same plan year in which the initial service was utilized. 40% off unlimited additional prescription eyewear purchases. 20% off nonprescription sunglasses. For a complete list of plan details, go to Providers EyeMed Vision Care offers a large network of providers, including the Emory Eye Center, LensCrafters, Pearle Vision and more. For a complete list of providers, call or go to (click Locate a Provider, then Select Your Network dropdown menu and choose Select, then enter your zip code and click Submit). The group number is Vision Coverage Through Your Medical Plan Employees enrolled in one of Emory Healthcare s medical plans receive one vision exam per calendar year at an optometrist or ophthalmologist. Because an annual vision exam is considered preventive care, it is covered at 100%. Locate a participating vision provider at Vision Plan Rates (Biweekly) Full-time & Part-time (rates are the same) Employee Only $5.08 Employee+Child(ren) $10.15 Employee+Spouse/SSDP $9.64 Family $14.94 Discounts at the Emory Eye Center All Emory Healthcare employees and their immediate family members are eligible to receive services and discounts at the Emory Eye Center. For a complete list, visit To schedule an appointment, call / Benefits Enrollment Guide 15