2017 RUSH BENEFITS EMPLOYEE CONTRIBUTIONS BOOKLET. for Employees of Rush University Medical Center

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1 2017 RUSH BENEFITS EMPLOYEE CONTRIBUTIONS BOOKLET for Employees of Rush University Medical Center

2 2017 RUSH BENEFITS EMPLOYEE CONTRIBUTIONS BOOKLET This booklet provides detailed information about how much you will pay for your Rush benefits in To learn more about your benefit options and to enroll, log into Remember, your base cost of benefits is determined by your pay (for medical, supplemental life insurance and disability buy-up benefits), and the level of coverage you choose. The following benefit cost information is included in this booklet: 2017 FULL-TIME RATES FOR MEDICAL BENEFITS PART-TIME RATES FOR MEDICAL BENEFITS RATES FOR DENTAL AND VISION BENEFITS Dental Plan Vision Plan 2017 RATES FOR LIFE INSURANCE Employee Supplemental Life Insurance Spouse/Civil Union Partner Supplemental Life Insurance Child(ren) Supplemental Life Insurance 2017 RATES FOR DISABILITY BENEFITS Short-Term Disability Buy-Up Long-Term Disability Buy-Up 2017 RATES FOR ACCIDENT AND CRITICAL ILLNESS COVERAGE Voluntary Accident Plan Voluntary Critical Illness Plan Child Critical Illness Coverage QUESTIONS? Contact the Rush Benefits Center Monday through Friday, 7:00 a.m. to 7:00 p.m. (312) or (855) rushbenefits@benefitfocus.com 1

3 FULL-TIME EMPLOYEES 2017 RATES FOR NON-UNION MEDICAL BENEFITS Rates per pay period (24 x a year) EMPLOYEE HOURLY RATE BASIC PLAN <$22 $22-$27.99 $28-$46.15 $46.16 AND ABOVE Employee only $42.75 $45.00 $47.50 $54.75 Employee + spouse $79.25 $84.50 $91.25 $ Employee + children $73.75 $78.00 $87.00 $ Family $96.50 $ $ $ PREMIER PLAN Employee only $66.50 $70.00 $75.75 $91.00 Employee + spouse $ $ $ $ Employee + children $ $ $ $ Family $ $ $ $ HEALTH SAVINGS ADVANTAGE PLAN Employee only $51.00 $54.00 $57.75 $69.25 Employee + spouse $ $ $ $ Employee + children $95.25 $ $ $ Family $ $ $ $ SELECT EPO PLAN Employee only $87.50 $94.00 $ $ Employee + spouse $ $ $ $ Employee + children $ $ $ $ Family $ $ $ $ PART-TIME EMPLOYEES 2017 RATES FOR NON-UNION MEDICAL BENEFITS Rates per pay period (24 x a year) EMPLOYEE HOURLY RATE BASIC PLAN PREMIER PLAN HEALTH SAVINGS ADVANTAGE PLAN SELECT EPO PLAN <$22 $22-$27.99 $28-$46.15 $46.16 AND ABOVE Employee only $52.25 $55.50 $59.25 $69.50 Employee + spouse $ $ $ $ Employee + children $95.00 $ $ $ Family $ $ $ $ Employee only $86.75 $92.00 $99.50 $ Employee + spouse $ $ $ $ Employee + children $ $ $ $ Family $ $ $ $ Employee only $66.00 $70.25 $76.00 $91.50 Employee + spouse $ $ $ $ Employee + children $ $ $ $ Family $ $ $ $ Employee only $ $ $ $ Employee + spouse $ $ $ $ Employee + children $ $ $ $ Family $ $ $ $

4 2017 RATES FOR DENTAL AND VISION BENEFITS DENTAL PLAN Rates per pay period (24 x a year) FULL-TIME EMPLOYEES GUARDIAN: FIRST COMMONWEALTH DHMO Employee only $5.74 Employee + spouse $10.62 Employee + children $12.12 Family $13.74 DELTA DENTAL PPO Employee only $10.10 Employee + spouse $20.20 Employee + children $17.18 Family $25.26 PART-TIME EMPLOYEES GUARDIAN: FIRST COMMONWEALTH DHMO Employee only $6.08 Employee + spouse $11.37 Employee + children $12.85 Family $14.57 DELTA DENTAL PPO Employee only $10.71 Employee + spouse $21.62 Employee + children $18.21 Family $26.78 VISION PLAN Rates per pay period (24 x a year) VISION PLAN Employee only $4.07 Employee + spouse $6.32 Employee + child(ren) $6.00 Family coverage $

5 2017 RATES FOR LIFE INSURANCE EMPLOYEE SUPPLEMENTAL LIFE INSURANCE Monthly Rates Supplemental life and AD&D insurance premiums are calculated based on your age, current base annual salary, and amount of coverage you desire. Rates are based on your age as of January 1 of the current year as shown in the table below. AGE UNDER RATE PER $.06 $.08 $.09 $.10 $.14 $.21 $.30 $.54 $1.14 $1.58 $1,000 How to calculate your supplemental life insurance premium Example: To calculate the monthly premium for a 30-year-old employee whose annual salary is $25,000 per year, and who elected supplemental coverage for twice their annual salary: $50,000 x.08 (per rate table above) = $4,000 1,000 = $4.00 monthly payroll deduction SPOUSE SUPPLEMENTAL LIFE INSURANCE Monthly Rates Employees may elect supplemental coverage for a spouse. Rates are based on your spouse s age as of January 1 of the current year as shown in the table below. AGE UNDER RATE PER $.06 $.08 $.09 $.11 $.12 $.19 $.35 $.57 $1.04 $1.77 $1,000 CHILD(REN) SUPPLEMENTAL LIFE INSURANCE Monthly Rates Child(ren) life coverage monthly cost (covers all eligible children) $10,000 = $1.54 per month for one or more children How to calculate the premium for dependent supplemental life insurance Example: You are electing $30,000 for your 37-year-old spouse and $10,000 of coverage for each of your two children. 1) Enter the rate from the table $0.11 2) Enter the amount of insurance coverage $30,000 3) Divide line 2 by $1, ) Spouse coverage monthly premium (Multiply line 1 by line 3) $3.30 5) $10,000 of child coverage for two children +$1.54 6) Total monthly cost (add line 4 plus line 5) $4.84 4

6 2017 RATES FOR DISABILITY BENEFITS SHORT-TERM DISABILITY BUY-UP Semi-Monthly Rates Short-term disability buy-up premiums are calculated based on your age as of January 1 of the current year as shown in the table below. (Your annual salary must be at least $104,000 to be eligible for this buy up option.) RATE TABLE FOR BUY-UP OPTION AGE UNDER MONTHLY RATE Premium rates represent the cost of each $10 of weekly salary (up to $500) above the weekly salary paid by the core STD benefit (up to $1,500). Rush employees not paid through the time and attendance system should refer to the appropriate sick leave policy for more information. How to calculate your STD buy-up premium Example: To calculate the semi-monthly premium for a 32-year-old employee whose annual salary is $115,000 at the 75 percent benefit: Step One: $115, = $2, (weekly salary) times.75 equals $1, Step Two: $1, $1,500 (core STD benefit) = $ Step Three: $ = $15.87 $15.87 x.693 (from rate table above) = $10.99 $ = $5.50 semi-monthly payroll deduction LONG-TERM DISABILITY BUY-UP Semi-Monthly Rates Long-term disability buy-up premiums are calculated based on a common rate for all employees: $0.236 per $100 of annual salary. BUY-UP PREMIUM CALCULATION FOR 60% BUY-UP OPTION Annual salary 100 x = annual cost Annual cost 24 pay periods = semi-monthly deduction Example: annual salary $50,000 $50, x = $118 annual cost $ = $4.92 per pay period deduction from your paycheck 5

7 2017 RATES FOR ACCIDENT AND CRITICAL ILLNESS COVERAGE VOLUNTARY ACCIDENT PLAN Rates per pay period (24 x per year) Employee $6.15 Employee + Spouse $10.34 Employee + Children $11.85 Employee + Family $18.93 VOLUNTARY CRITICAL ILLNESS PLAN Rates per pay period (24 x per year) COVERAGE AMOUNT: $10,000 $20,000 $30,000 EMPLOYEE AGE Employee Plus spouse Employee Plus spouse Employee Plus spouse < 25 $1.24 $1.06 $2.47 $2.12 $3.71 $ $1.66 $1.40 $3.32 $2.79 $4.98 $ $2.31 $2.00 $4.61 $4.00 $6.92 $ $3.53 $3.12 $7.05 $6.24 $10.58 $ $5.67 $5.23 $11.33 $10.45 $17.00 $ $8.72 $8.63 $17.44 $17.26 $26.16 $ $12.69 $13.36 $25.38 $26.72 $38.07 $ $17.82 $19.82 $35.63 $39.64 $53.45 $ $26.03 $29.76 $52.06 $59.52 $78.09 $ $36.79 $73.58 $ $52.11 $ $ $69.91 $ $ $83.80 $ $ $92.27 $ $ CHILD CRITICAL ILLNESS COVERAGE Rates per pay period (24 x per year) Critical Illness coverage for your children is available in increments of $2,500 up to $15,000. AMOUNT OF COVERAGE $2,500 $5,000 $7,500 $10,000 $12,500 $15,000 PAY PERIOD COST $0.22 $0.43 $0.65 $0.86 $1.08 $1.29 Please note: These rates apply ONLY to non-union and ISSSA-represented employees. Teamsters-represented employee rates may be different from those listed in this booklet, and these employees are advised to consult their contract for rates. These rates do not apply to house staff. Your cost for 2017 is based on your salary (hourly rate equivalent) that is in effect on October 30, This guide contains a summary of 2017 benefits contribution rates for medical and other benefit options available to you. For more information about any Rush benefit plan, please refer to the applicable summary plan description. Although every effort has been made to ensure that the information in this guide is accurate, if there is any conflict between this guide and the terms of a benefit plan as described in the summary plan description, the latter must control. Summary plan descriptions are available in human resources and online at 6