OPEN ENROLLMENT April 25 May 8, 2016

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1 OPEN ENROLLMENT April 25 May 8, 2016 Make Your Elections Online by May 8! Open Enrollment is just around the corner. Now is the time to understand the benefits available to you and what s changing. You must take action by 11:59 p.m. on Sunday, May 8, 2016, to confirm your benefit elections. HIGHLIGHTS Wellfocused Program We have refreshed our Wellfocused program with a new look and have moved to three levels, rather than the previous four-level program. The Wellfocused program will continue to reward you for taking steps to learn about your health status, participating in health and well-being activities throughout the year, and improving or maintaining your health. Learn more on pages Dental Plans Dental coverage will be offered through Penn Faculty Practice as well as two new Delta Dental plans Delta Dental Standard and Delta Dental Premium. Learn more on page 8. 1

2 WELCOME TO OPEN ENROLLMENT Open Enrollment is your annual opportunity to review your benefits and ensure your coverage meets your needs. Our benefit programs help you and your family stay well and protect you when you re not well while managing the rising costs of health care for us all. Participate in the Wellfocused Program and Earn Rewards Through Wellfocused, our healthy workforce program, you have the opportunity to earn rewards for completing certain actions, participating in the many different health and well-being challenges, and meeting healthy requirements. If you re enrolled in the PennCare PPO plan, you can receive a $200 Wellfocused reward plus entry into a drawing to win an additional $500 by participating in the program. See program details on pages Tobacco Earned Premium Discount If you were not tobacco-free during the plan year, but you have completed the Health Advocate or another tobacco cessation program or you are tobacco-free now, then you are eligible to receive the earned premium discount. During Open Enrollment, you must go online and certify your new non-tobacco user status. If you are not tobacco-free, you can take advantage of the free tobacco cessation program provided by Health Advocate. Remember, your covered spouse/domestic partner and covered dependents (ages 18 26) must also be tobacco-free to receive the earned premium discount adding up to a savings of more than $650 per year! CONTENTS What's Changing for Open Enrollment Is April 25 May 8, Medical 5 The PennCare PPO Plan at a Glance 6 Dental 8 Vision 9 Additional Benefits 9 A Note About Legal Notices Legal notices summarize the legal protections, rights and responsibilities related to your participation in UPHS benefit offerings. Beginning April 25, UPHS will make these notices available to you on our HR&You website. Visit and click Legal Notices in the Get There Fast section. Earn Rewards Through Wellfocused Employee Contributions 11 How to Enroll 12 2

3 What's Changing for Here are the changes that will go into effect on July 1, Wellfocused Program The Wellfocused program is moving to three levels rather than the previous four-level program. The program offers you the opportunity to earn up to $200 PLUS the opportunity to win $500 when you complete all three levels. Learn more on pages Dental UPHS will offer the Penn Faculty Practice dental plan and two new Delta Dental plans: Delta Dental Standard and Delta Dental Premium. The two Delta Dental plans replace the current Delta Dental plan and the Aetna DMO dental plan, which will no longer be offered. Learn more on page 8. Vision Vision coverage will continue to be offered through the the Davis Standard plan or the Davis Premium plan. The Vision Benefits of America (VBA) plan will no longer be offered. Learn more on page 9. HEALTH ADVOCATE We want you to feel supported as you navigate the complex world of health care. Health Advocate is a free, confidential service available to you, your spouse, your dependent children, and your parents and parents-in-law. Contact Health Advocate to get help using and managing your health care benefits. You also have the opportunity to participate in the free tobacco cessation program through Health Advocate. Call Health Advocate at or visit to get started with any of these services. You can also access Health Advocate from the home page of the HR&You website. 3

4 Open Enrollment Is April 25 May 8, 2016 Take action during Open Enrollment if you want to: Make changes to your current benefit elections for Add a dependent to, or drop a dependent from, your benefits coverage. Contribute to a Health Care or Dependent Care Flexible Spending Account (FSA) in Update your life insurance beneficiary information, if needed. Enroll for coverage in a dental and/or vision plan other than the default coverage listed below. Receive the lower Non-Tobacco Medical payroll deduction for your medical coverage. What Happens If You Don t Take Any Action? If you do not take action during Open Enrollment: Medical If you waive coverage You will keep your current coverage level and same tobacco/non-tobacco user medical rate. You will continue to waive coverage. You will keep your current coverage, if you are enrolled in the Penn Faculty Practice plan. Dental You will default to the Delta Dental Premium plan, if you are enrolled in the Delta Dental plan. You will default to the Delta Dental Standard plan, if you are enrolled in the Aetna DMO plan. Vision Flexible Spending Accounts Supplemental Life and AD&D Insurance (Employee and Dependent Coverage) Short-Term Disability You will keep your current coverage, if you are enrolled in the Davis Standard or Davis Premium plan. You will default to the Davis Premium plan, if you are enrolled in the Vision Benefits of America (VBA) plan. You must enroll each year to participate. You will keep your current coverage. You will keep your current coverage. Benefits You Receive Automatically Life Insurance is a core benefit paid for by UPHS and automatically provided to you for a death benefit equal to your salary. After one year of continuous service, full-time employees will be automatically enrolled for long-term disability coverage and UPHS will pay the full cost of coverage. Visit for more information. Open Enrollment Resources EnrollOne You will make your benefit elections through our secure, online benefits enrollment website EnrollOne. Before Open Enrollment, review your benefit options and learn about the new dental plan offerings. Beginning April 25, log on to to make your benefit elections for coverage effective July 1, UPHS Enrollment Call Center The UPHS Enrollment Call Center is available to you during Open Enrollment to answer any questions about your benefits, help you choose the best coverage for you and your family, and assist with enrollment. Call to speak to a representative. The UPHS Enrollment Call Center will be available Monday to Friday, 9:00 a.m. to 5:00 p.m. (ET), during the Open Enrollment period. HR&You Website During Open Enrollment, visit the HR&You website at and click on EnrollOne to learn about all of your benefits, find providers, complete your enrollment and much more! 4

5 Medical The PennCare PPO Plan As a full-time or part-time employee, you have the opportunity to enroll in the PennCare PPO Plan, administered by Independence Blue Cross (IBC). The PennCare PPO Plan offers three networks of providers with different levels of coverage. You receive the highest level of benefits when you visit a PennCare Network provider, facility and pharmacy. The plan also includes prescription drug coverage through Caremark. Network Your Cost Share For More Information About... PennCare PPO Network Provides access to best-in-class providers in many convenient locations even outside of the Philadelphia metropolitan area. When you use this network, you save on everything from doctor office visits and prescription drugs to X-rays and hospital care. IBC In-Network If you choose a provider that's not in the PennCare Network, you should consider using an in-network provider. You will have to pay more out of pocket than you would if you used a PennCare Network provider, since you will have to meet a deductible for some services before the plan begins to pay for coverage. Out-of-Network This includes any providers outside the PennCare and IBC networks. You will pay more when you visit an out-of-network provider. $ $$ $$$ Providers Visit and click on Penn Providers from the Get There Fast section on the home page. Providers Visit Coverage Visit or use the IBX app to access your information wherever you are. Centers of Excellence Remember, certain services require you to receive care from a PennCare provider under the Centers of Excellence. The benefit plan offers best-in-class services provided by the following UPHS departments: Oncology Cardiology Neuroscience Orthopaedics If you do not receive the service from a provider in the Centers of Excellence of UPHS, you will pay a $1,000 copay in addition to the regular cost share of the service (does not apply to emergency services). If you or a covered dependent lives more than 50 miles from Philadelphia, you will be eligible for consideration of waiver of the $1,000 copay if you receive the service from a provider outside of the Centers of Excellence of UPHS. Penn Primary Care Connection Concierge Service Penn Primary Care Connection is a concierge service that can help you or a family member schedule a new patient primary care or ophthalmology appointment. In addition, employees may call to schedule new patient dermatology appointments. Call the Penn Primary Care Connection at to schedule an appointment with a PennCare Network physician right away. Autism Benefits Through Penn Behavioral Health s Preferred Network, the diagnosis, care and support for autism is covered in full for most services. Outpatient office visits require a $20 copay. Care received through the Penn Behavioral Health Regional Network or outside of the network requires the payment of a deductible and coinsurance. For more information, please call For a complete list of services available through the Centers of Excellence of UPHS, visit and click the link for Centers of Excellence under UPHS Resources. If you have questions about these services, or about when to use a Center of Excellence, call Health Advocate at

6 The PennCare PPO Plan at a Glance Preventive Care Covered at 100% Get regular preventive care. Annual exams, age-appropriate screenings, well-woman care and immunizations are covered at 100%, within the plan limits. Preventive care can help detect potential health risks early, helping you stay healthy and avoid costly medical bills down the road. How to Access Care PennCare Network IBC In-Network Out-of-Network Go to any PennCare provider Go to any IBC in-network provider Go to any out-of-network provider Deductible - Individual - Individual + Spouse/Child(ren) - Family None $250 $500 $750 $750 $1,500 $2,250 Preventive Care (The Plan pays) 100% 100% 60% after deductible Coinsurance (The Plan pays) 100% 80% 60% Office Visit (You pay) - Primary Care/Specialist Medical Out-of-Pocket Maximum (Includes deductible, coinsurance and medical copays) - Individual - Individual + Spouse/Child(ren) - Family Emergency Room Fee (You pay; waived if admitted) Inpatient Hospital* (You pay) Outpatient Facility* (You pay) Advanced Radiology (You pay) Penn Behavioral Health Inpatient Mental Health and Substance Abuse (You pay) Outpatient Mental Health and Substance Abuse (You pay) $20 copay $1,000 $1,500 $2,000 $35 copay/ $50 copay $3,000 $5,000 $7,000 40% after deductible $6,350 $9,500 $12,700 $150 copay $150 copay $150 copay $0 $0 $1,000 copay; no deductible or coinsurance (Physician services: 20% coinsurance after deductible) Maternity: $750 copay (No deductible or coinsurance) $500 copay; no deductible or coinsurance (Physician services: 20% coinsurance after deductible) $0 $250 copay In-Network (PBH Preferred) $0 In-Network (PBH Regional Network) $1,000 copay; no deductible or coinsurance (Physician services: 20% coinsurance after deductible) 40% after deductible 40% after deductible $250 copay; then 40% after deductible Out-of-Network 40% after deductible $20 copay $35 copay 40% after deductible *If you do not receive care from a provider for certain services in the Centers of Excellence of UPHS for oncology, cardiology, neuroscience or orthopaedics, you may be required to pay an additional $1,000 copay (copay will be waived for emergency care). 6

7 Prescription Drug When you enroll in medical coverage, you automatically receive prescription drug benefits through Caremark. Any out-of-pocket costs, including copays, will count toward the prescription drug out-of-pocket maximum. For more information on your prescription drug benefits, visit the HR&You website: You save on prescription drug copays when you visit a UPHS pharmacy. You also have the option to fill your prescriptions through a retail pharmacy or out of network. UPHS pharmacies include: Hospital of the University of Pennsylvania, Pennsylvania Hospital, Penn Medicine University City Apothecary, Penn Presbyterian Medical Center, Penn Presbyterian Apothecary, Hospital of the University of Pennsylvania Radnor Pharmacy,* Penn Home Infusion Therapy, New! Perelman Center for Advanced Medicine Outpatient Pharmacy, *Radnor Pharmacy provides the option to receive prescription drugs through mail order. Prescription Drug Coverage Out-of-Network 30-Day Supply UPHS Pharmacy Retail Generic $5 $15 Preferred $15 $45 Non-preferred $30 $75 90-Day Supply UPHS Mail Order* Caremark Mail Order Generic $10 $30 Preferred $30 $90 Non-preferred $60 $150 Specialty Drugs (30-day supply only) Out-of-Pocket Maximum No cost 80% coinsurance (Plan pays); $100 per prescription maximum No coverage $1,000 per member/$2,000 per family No maximum *You may access a 90-day supply through the outpatient pharmacies at UPHS pharmacy locations. Use UPHS Pharmacies for Specialty Drugs or Penn Home Infusion Therapy Specialty drugs filled at a UPHS pharmacy are covered at no cost to you! You can also have your specialty drugs mailed or delivered to your home by Penn Home Infusion Therapy. For more information about the program or to transfer your remaining specialty fills, please call

8 Dental UPHS helps you maintain good dental health by providing you with three dental plan options: Penn Faculty Practice, Delta Dental Standard and Delta Dental Premium. The Aetna DMO plan is being eliminated. If you are currently enrolled in the Delta Dental plan, you will default to the new Delta Dental Premium plan with the same coverage level unless you make an alternate election. If you are currently enrolled in the Aetna DMO plan, you will default to the new Delta Dental Standard plan with the same coverage level unless you make an alternate election. Here is a side-by-side comparison of the plans: Deductible - Individual - Family Annual Benefit Maximum Diagnostic and Preventive Services Exams, cleanings, X-rays and sealants (Plan pays) Basic Services Fillings and posterior composite restorations* (Plan pays) Endodontics Root canals (Plan pays) Oral Surgery (Plan pays) Major Services Crowns, inlays, onlays and cast restorations (Plan pays) Prosthodontics Bridges, dentures and implants (Plan pays) Orthodontia Adults and dependent children (Plan pays) Orthodontia Lifetime Maximum (Plan pays) Out-of-Network Reimbursement Penn Faculty Practice $50 $150 Delta Dental Standard Premier and PPO Network Out-of-Network $50 $150 Delta Dental Premium Premier and PPO Network Out-of-Network $25 $75 $3,000 $1,500 $2, % with no deductible 100% with no deductible 100% with no deductible 100% 80% 60% 80% 70% 80% 80% 60% 80% 70% 100% 80% 60% 80% 70% 50% 50% 80% 70% 50% 50% 60% 50% Not covered 50% $2,000 $2,000 N/A N/A Premier level N/A Premier level * Tooth color (composite restorations) for posterior fillings has a $35 to $55 copay depending on the size of the filling; amalgam (silver) fillings remain covered at 100%. Save Money by Knowing Your Provider's Network You can use any dentist you choose. However, the amount you pay for dental services will depend on your plan option and whether your provider participates in the Delta Dental PPO network or the Delta Dental Premier network or is a nonparticipating provider. The highest benefit level will be paid when you visit a PPO network provider. These providers offer the highest discount, so your cost is lowest when you receive services from them. PENN FACULTY PRACTICE Penn Faculty Practice offers services at three locations: The Dental Care Center 4003 Locust Street Philadelphia, PA PENN Dental 3401 Market Street Philadelphia, PA PENN Dental Center at Bryn Mawr 711 Lancaster Ave Bryn Mawr, PA

9 Vision UPHS will offer two vision plans that allow you to select the coverage level and cost that best meet your needs. You may choose either the Davis Standard plan or the Davis Premium plan. The Vision Benefits of America (VBA) plan is being eliminated. If you are currently enrolled in this plan, you will default to the Davis Premium plan with the same coverage level. Here is a side-by-side comparison of the plans: Annual Eye Exams Lenses (1 set per year) Frames Contact Lenses and Fittings Davis Standard Davis Premium In-Network Out-of-Network Scheie* In-Network Out-of-Network $10 copay Plan pays up to $30 No cost $10 copay Plan pays up to $32 No cost Participating provider s frame collection: $15 retail allowance** Not covered Plan pays benefits for lenses and frames once every year Allowances: Single: $20 Bifocal: $20 No cost No cost Trifocal: $30 Lenticular: $50 Plan pays up to $15 Participating provider s frame collection: $100 allowance** Allowance of up to: standard/specialty $110; disposable $80 Participating provider s frame collection: $65 allowance** $75 allowance Allowances: Single: $30 Bifocal: $36 Trifocal: $50 Lenticular: $72 $30 allowance Reimbursement of up to: standard/specialty $60; disposable $75; fitting $20 daily wear, $30 extended wear, $75 disposable * Scheie Eye is a participating provider with both vision plans; however, if you elect the Davis Premium plan and use Scheie providers, you will receive the enhanced vision care benefits described here at a reduced cost for services. ** You may select frames from a participating provider OR you may receive an allowance for Davis line of Fashion, Designer and Premier frames. To learn more, visit Additional Benefits Flexible Spending Accounts (FSAs) FSAs allow you to contribute money on a pre-tax basis to help pay for eligible health care and/or dependent care expenses. For the plan year, you can contribute from $60 to $2,550 in pre-tax earnings to the Health Care FSA or from $260 up to $5,000* in pre-tax earnings to the Dependent Care FSA. For the Health Care FSA, any unused funds left after September 15, 2017, will be forfeited. You can submit expenses until December 31 after the end of the plan year. *Employees making $115,000 or more will be able to contribute a maximum of only $1,700 this plan year to a Dependent Care FSA to meet IRS regulations. Life Insurance and AD&D Insurance Life insurance is a core benefit, automatically provided to you at one times your annual base salary. You have the opportunity during Open Enrollment to purchase supplemental life and AD&D coverage for yourself or your dependents. Disability Disability benefits can replace a portion of your base pay if you are unable to work because of illness or injury. In most cases, you pay for short-term disability benefits, while UPHS pays for long-term coverage. Transit and Commuter Benefits The IRS sets annual limits for transit and commuter benefits. You may elect pre-tax deductions up to $255 per month for both the Parking Program and the Public Transit Program. Learn More About Your Options For complete plan details about your coverage options, visit the HR&You website at 9

10 Earn Rewards Through Wellfocused The Wellfocused program allows you to receive rewards for participating in health and well-being challenges and activities and improving or maintaining your good health. For each activity or action you complete, you earn points that allow you to move through the levels and earn up to $200. This year, you will have the opportunity to enter into a raffle to win $500 if you make your way through all three levels of the program. How Wellfocused Works Level 1: Seek 1,000 Points Earn $50 Take the Well-Being Assessment and Know Your Numbers Level 2: Achieve 3,000 Points Earn $150 Participate in health challenges and activities Level 3: Grow 5,000 Points Enter into raffle to win $500 Participate in health challenges and activities (30 winners annually) Get a Biometric Screening to Know Your Numbers There are two ways you can receive a biometric screening: 1. Attend an on-site biometric screening. UPHS will host on-site health screenings at some UPHS locations. You can schedule a biometric screening online today at 2. Visit your doctor and submit a Health Provider Screening Form. You will need to bring the Health Provider Screening Form to your appointment. To download the form, visit and select the Health Provider Screening Form link under Wellfocused Guides on the Wellfocused home page. Your physician must fax your completed form to A Note About Confidentiality Your medical information is personal and confidential. Just as we take steps to ensure the privacy of our patient s information, we do the same for our employees. Your protected health information (PHI) is always private. UPHS is required by the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to maintain privacy of PHI. 10

11 How to Earn Wellfocused Rewards Seek Achieve Grow Activities Points Earned Cumulative Points Reward Get a biometric screening to Know Your Numbers 450 Well-Being Assessment 450 Join first challenge 100 Achieve healthy numbers: - BMI (between 18.5 and 25) - Blood pressure (diastolic < 80 mmhg and systolic < 120 mmhg) - Fasting blood glucose (between 70 and 99) - Total cholesterol (< 200) - LDL cholesterol (100 < = LDL < 130) - HDL cholesterol (< 200) Healthy Activities ( points per activity) Bonus: If you complete the Well-Being Assessment by June 30, 2016 Healthy Activities ( points per activity) 100 points per healthy number 600 points total (Depends on points achieved for items above) 100 points 2,000 points total 5,000 1,000 Earn $50 3,000 Earn $150 Enter into raffle to win $500 (30 winners) Employee Contributions To be eligible for the tobacco earned premium discount on your medical contributions, you and your covered spouse/domestic partner and any covered dependents ages must be tobacco-free or enrolled in a tobacco cessation program by June 30, The rates listed below for the PennCare PPO Plan include prescription drug coverage. Full-Time Employee Bi-Weekly Contributions Plan Option Self Only PennCare PPO Self + Children Self + Spouse* Self + Family Tobacco User $85.85 $ $ $ Tobacco-Free $58.62 $ $ $ No Coverage $0 $0 $0 $0 Part-Time Employee Bi-Weekly Contributions Plan Option Self Only PennCare PPO Self + Children Self + Spouse* Self + Family Tobacco User $ $ $ $ Tobacco-Free $98.80 $ $ $ No Coverage $0 $0 $0 $0 Dental Plans Dental Plans Delta Dental Standard $4.49 $9.68 $10.13 $15.57 Delta Dental Standard $9.97 $21.52 $22.52 $34.59 Delta Dental Premium $5.35 $12.65 $12.02 $19.74 Delta Dental Premium $11.89 $28.10 $26.71 $43.86 Penn Faculty Practice $9.19 $19.52 $18.37 $26.41 Penn Faculty Practice $20.42 $43.38 $40.83 $58.69 Vision Plans Vision Plans Davis Standard $0.66 $1.14 $1.51 $1.93 Davis Premium $2.03 $3.50 $4.68 $5.96 * Includes domestic partners. Davis Standard $0.66 $1.14 $1.51 $1.93 Davis Premium $2.03 $3.50 $4.68 $5.96 * Includes domestic partners. 11

12 How to Enroll To enroll for benefits, visit the EnrollOne website at starting April 25. Log on to our secure site using your network username and password the same information you use when logging in to your work computer. Once you are logged on to EnrollOne, you can: Enroll for benefits. During the Open Enrollment window, April 25 May 8, 2016, you may enroll for benefits 24 hours a day, seven days per week. Your elections will be in effect for July 1, 2016, through June 30, Print your online confirmation statement. If you want a copy of your elections, you must print your confirmation page after you complete your enrollment. View your benefits profile page. Your profile will show your benefit elections for the plan year. Update Your Beneficiary Information During Open Enrollment, please review your beneficiary information for your life insurance benefits and make any necessary changes. A beneficiary is the person(s) who receives your life insurance benefits if you die. FOR THE UPHS 403(b) PLAN If you are married, your spouse is automatically your beneficiary. To choose a beneficiary other than your spouse, you must obtain your spouse s consent in writing. Visit and click the link to your plan vendor (Vanguard or TIAA-CREF) to get further information. UPHS Enrollment Call Center If you have questions about your benefit options, call the UPHS Enrollment Call Center between April 25 and May 8, 2016, at for support around understanding and selecting the best benefits for you and your family. 12