Benefit Highlights for 2017

Transcription

1 Benefit Highlights for CARE LVHN.org

2 September 2016 Dear Valued Colleague, It s time to select your 2017 benefits. This year, the Open Enrollment period runs from Friday, Oct. 7, through Friday, Oct. 28. You must enroll during this time if you wish to receive benefits in Please review the Open Enrollment brochure and select the benefits that best meet the needs of you and your family. While the health care environment continues to present challenges due to the Affordable Care Act, Lehigh Valley Health Network (LVHN) is committed to providing a comprehensive and cost-effective colleague benefit program. In FY16, the network s health care claims costs totaled $124 million in support of employees and their dependents health and wellness care. Each year we review our plan coverage and market data to ensure we are managing our health plan claims costs as effectively as possible, which enables us to continue to provide a comprehensive medical plan to our colleagues. Among the ways LVHN does this is by helping colleagues become better health care consumers and encouraging use of LVHN facilities, hospitals and physicians. One important change you will notice this year is that we ve changed our plan name from Choice Plus to LVHN Health Plan. This change was made to make it easier for organizations to be able to identify our colleague health plan. For the first time, we ve also added a free health coaching benefit for all colleagues to help keep you and your LVHN Health Plan dependents (age 18 and over) at your best. And we introduced the My Total Rewards tool that makes it easy for you to see and understand your compre hensive benefit package. My Total Rewards offers a summary of your compensation including base and incentive pay, retirement benefits, paid time off, sick time and other benefits you are entitled to as a colleague of the network. Please review the enrollment materials to learn about your 2017 benefits and changes. If you have any questions, please contact the human resources benefits team at If you are a Health Network Laboratories (HNL) colleague, please call HNL s HR department at As always, the well-being of our colleagues continues to be a priority. Thank you for making your health and wellness a priority and for all you do to make a difference at LVHN. Sincerely, Deborah A. Patrick Senior vice president, human resources David Burrack Administrator, total rewards Open Enrollment Benefit Highlights

3 Your Medical Plan for 2017 LVHN will continue to offer two medical options the LVHN PPO Plan and the LVHN HSA Plan. For more detailed information, please see the enclosed 2017 LVHN Health Plan brochure or Summary of Material Modifications. Health Care Reform and You Enrolling in the LVHN medical plan will satisfy your obligation under Health Care Reform legislation to have medical coverage in However, you and your dependents also have other options for coverage and can enroll in: Your spouse s plan, if applicable A parent s plan, if applicable Medicaid or Medicare, if eligible Medical coverage available through a Public Exchange* * A Public Exchange is a state- or federally run shopping website where individuals can buy health care coverage. Although anyone may purchase coverage through a Public Exchange, it is primarily intended for individuals, families and small business owners who are uninsured or buy insurance on their own. Please note that because LVHN s medical plan meets Health Care Reform affordability and minimum value requirements, you will not be eligible for a government subsidy if you buy coverage through a Public Exchange. LVHN Dental Plan You have a choice of two dental options. The Basic Plan covers preventive and basic services. The Comprehensive Plan covers preventive, basic major and orthodontic services. Annual deductible $50 per individual; maximum not to exceed $150 per family PREVENTIVE 100% of Usual and Customary Charge, No Deductible Preventive and Diagnostic (6 months apart) Prophylaxis Fluoride for children Routine examinations Bitewing and full mouth X-rays (full mouth X-rays limited to once every 3 years) Sealants (limited to once per tooth every 6 years) Basic Dental Plan Basic Restoration Other X-rays Fillings Extractions** Oral surgery** BASIC 80% of Usual and Customary Charge After Annual Deductible Met General anesthesia* Endodontics Periodontics* Root canal therapy PREVENTIVE 100% of Usual and Customary Charge, No Deductible Preventive and Diagnostic (6 months apart) Prophylaxis Fluoride for children Routine examinations Bitewing and full mouth X-rays (full mouth X-rays limited to once every 3 years) Sealants (limited to once per tooth every 6 years) 20% co-payment by the employee Calendar year maximum $1,500 per individual BASIC 80% of Usual and Customary Charge After Annual Deductible Met Basic Restoration Other X-rays Fillings Extractions** Oral surgery** General anesthesia* Endodontics Periodontics* Root canal therapy Comprehensive Dental Plan MAJOR 50% of Usual and Customary Charge After Annual Deductible Met Major Restorative*** Full dentures Partial dentures Fixed bridgework Crowns Inlays Repairs and replacements of all above services ORTHODONTICS 50% of Usual and Customary Charge, No Deductible Teeth Straightening Any service that attempts to alter occlusion or alignment of the teeth Night guard Treatment for bruxism 20% co-payment by the employee Calendar year maximum $1,500 per individual 50% co-payment by the employee 50% co-payment by the employee $1,500 individual lifetime maximum *** Limited benefit *** Some services may be payable under medical plan. Please refer to the Dental Summary Plan Description for additional service limitations. *** Reimbursement level could be dependent on pre-existing condition Open Enrollment Benefit Highlights 3

4 LVHN Vision Plan You have a choice of two vision plans through National Vision Administrators (NVA) the Base Plan and the Buy-Up Plan. Both plans offer coverage for exams, lenses, frames and contact lenses. The Buy-Up Plan offers frames every 12 months instead of 24 months and enhanced contact lens coverage. See NVA vision flier on the HR intranet for more information. Plan Highlights Base Plan Buy-Up Plan Benefit Frequency Examinations One every 12 months One every 12 months Lenses One every 12 months One every 12 months Frames One every 24 months One every 12 months* Contacts One every 12 months One every 12 months Examination In Network Out of Network In Network Out of Network Examination Covered 100% Reimbursed up to $40 Covered 100% Reimbursed up to $40 * The Buy-Up Plan allows for new frames every 12 months as well as contacts and eyeglasses in the same benefit period. Please access the HR intranet for more vision plan information. Contact Information for Populytics: Please visit MyPopulytics.com to: Submit a question 24/7. Update or make any changes to your personal address. Important Reminders How Coordination of Benefits Works As in prior years, you will be asked to complete a coordination of benefits form online during open enrollment. If the employee or his or her dependents are covered under both this plan and another health care plan, they cannot receive benefits totaling more than the amount they are entitled to under this plan or the other plan, whichever is greater. The maximum this plan will pay when there is an other source of coverage is the total amount it would pay if there were no other coverage. For example, if you have an orthodontic claim and the primary plan pays 50 percent, this plan will not make any additional payments as the LVHN Health Plan also pays 50 percent. If the primary plan pays a benefit at 80 percent and this plan reimburses at 80 percent, this plan will not make any additional payments. Therefore, if a member has another source of coverage, it is important to know which plan will pay first and thus what benefits, if any, may be payable under the plan. Important Flexible Spending Account (FSA) Information If you chose a Health Care FSA in 2016, you received a Benefits (debit) Card to use to pay for any out-of-pocket health care expenses. If you elect a Health Care FSA in 2017, you should not destroy your current debit card, but continue to use it. You will have until March 31, 2017, to submit your 2016 claims for reimbursement, and you will forfeit any amounts remaining in your 2016 Health Care FSA that you don t use for 2016 expenses. In order to be reimbursed, you must either use your debit card through Dec. 31, 2016, or manually submit claims for reimbursement until March 31, Estimate what you will be spending in health care and child/ elder care expenses in 2017 and consider electing an FSA. The maximums for the FSA will remain the same for 2017: $2,500 for Health Care FSA and $5,000 for Child/Elder Care FSA, subject to any necessary non-discrimination testing adjustments. You can see the list of allowable expenses and the FSA calculator at MyPopulytics.com under FSA/HSA. Tobacco Surcharge When you enroll in medical coverage during Open Enrollment, once again you will be required to complete an online certification regarding your tobacco usage. If you certify at Open Enrollment that you have used tobacco products in the last three months, you will be assessed a $25 per pay period surcharge on your 2017 medical premiums. Tobacco use includes cigarettes, pipes, cigars, chewing tobacco, snuff, e-cigarettes, or any other type of smoking or smokeless tobacco. There will be random tobacco testing that will occur for Open Enrollment Benefit Highlights

5 employees. Any employee who falsifies information will be subject to disciplinary action. You may have the surcharge removed and all 2017 surcharge payments refunded if you complete the LVHN Tobacco Treatment Program in This is a six-month program that offers a comprehensive approach to nicotine (tobacco) dependence by combining behavioral modification, psycho-social support and pharmacologic therapy. An individualized plan of care is developed that incorporates nicotine dependence assessment, education, cessation/relapse prevention strategies and ongoing support. To enroll in the program, contact If your physician determines that it is not medically appropriate for you to achieve tobacco-free status, you can obtain a reasonable alternative as recommended by your physician. You will need to submit a Physician Tobacco Alternative Form by Nov. 30, 2016, to receive the lower tobacco-free medical plan premiums for The form is available on the human resources intranet (hr.content.lvh.com). Working Spouse Surcharge Enrolling a working spouse who has access to medical coverage through his or her employer generally increases LVHN s cost of providing medical coverage to all employees. In addition, some of the fees imposed on the plan under Health Care Reform are based on the number of people covered. If you enroll a spouse for medical coverage who is eligible for benefits through his or her employer, other than LVHN or HNL (not including Medicare, TRICARE, COBRA and retiree coverage), you will pay an additional $50 per pay period in 2017 medical plan premiums. This surcharge will not apply if you certify that your spouse is not eligible for coverage elsewhere. At enrollment, you will be asked to certify whether your enrolled spouse is eligible for medical coverage through his or her employer and to identify the name of the employer. If your spouse works at LVHN or HNL, you will not be assessed a surcharge and should answer no to the working spouse question. Any employee who falsifies information will be subject to disciplinary action. Health Coaching For the first time, LVHN is offering a free health coaching benefit to all colleagues. The free benefit is also available to LVHN Health Plan dependents age 18 and over. Health coaches are certified professionals who can provide confidential phone-based assistance to help you reach your self-identified health and wellness goals. Whether you want to minimize stress, improve work/life balance, eat healthier, stop smoking or improve your fitness, a health coach can help you develop a wellness vision and support you along the way to achieve your goals. Visit MyPopulytics.com and go to Health and Wellness for more information. Preventive Care Part of a healthy lifestyle is making sure to get the necessary preventive care; that s why the LVHN medical plan covers preventive care at 100 percent when you use a Tier 1 or Tier 2 provider. Covered services include annual physicals, flu shots, mammogram screenings, well-child care and wellwoman care, according to plan provisions. Preventive care is not covered under Tier 3. Please visit the human resources intranet (hr.content.lvh.com) for a complete list of coverages. Your Culture of Wellness As a health care organization, LVHN is committed to providing you with the resources you need to maintain a healthy lifestyle. Through Culture of Wellness, our comprehensive em ployee wellness program, LVHN families covered through the medical plan can be reimbursed up to $700 for approved wellness programs each year. Whether you want to manage your weight, reduce your stress level or improve your diet, Culture of Wellness offers a variety of tools and programs to help you reach your wellness goals. Learn more about Culture of Wellness on the HR intranet (hr.content.lvh.com) or MyPopulytics.com and call CARE to enroll in a program. You also may look at the Culture of Wellness booklet, which has topic area icons linked to the Health and Wellness Assessment categories. This enables you to easily find a program that would work best for you. You will be reimbursed after you complete a program. Supplemental Life Insurance You can elect Supplemental Life with Accidental Death and Dismemberment (AD&D) insurance in increments of $25,000, up to the lesser of five times your annual salary or $500,000. During open enrollment, you can increase your existing supplemental life coverage by $25,000 or newly enroll for $25,000 without Evidence of Insurability (EOI). If you elect coverage beyond an increment of $25,000, you will have to provide EOI. You may elect spouse life insurance coverage of either $25,000 or $50,000, provided you elect employee supplemental life coverage. You can increase spouse coverage by a $25,000 increment without EOI. Dependent life coverage of $15,000 for each child, up to age 26, can be elected without EOI provided you elect employee supplemental life coverage. If you elected or increased Supplemental Life or Spousal Life insurance by an amount greater than $25,000, you must complete the Evidence of Insurability form (EOI). An individualized form will be presented to you on the confir mation screen at the end of online Open Enrollment Open Enrollment Benefit Highlights 5

6 2017 LVHN Health Plan Medical, Dental and Vision Premiums Your premium will be based on your coverage tier (Employee, Employee + Spouse, Employee + Child(ren), Employee + Family) and which option you select. For full-time employees, your premium also will be based on your annual salary (see chart below) Benefit Premiums Costs are based per pay on pre-tax payroll deductions over 26 pay periods per year unless otherwise noted. LVHN PPO Plan Full-time Employees Base Earnings Employee Employee + Spouse Employee + Child(ren) Employee + Family $200,000 + $71.00 $ $ $ $100,000 - $199,999 $63.67 $ $ $ $75,000 - $99,999 $46.28 $91.22 $91.22 $ $50,000 - $74,999 $39.32 $79.72 $79.72 $ $40,000 - $49,999 $33.44 $67.14 $67.14 $99.51 $30,000 - $39,999 $27.82 $55.64 $55.64 $81.05 Under $30,000 $20.87 $42.80 $42.80 $63.67 Part-time (for all earnings) Part-time Employees Employee Employee + Spouse Employee + Child(ren) Employee + Family $83 $163 $163 $243 LVHN HSA Plan Full-time Employees Base Earnings Employee Employee + Spouse Employee + Child(ren) Employee + Family $200,000 + $0 $55 $55 $100 $100,000 - $199,999 $0 $38 $38 $76 $75,000 - $99,999 $0 $23 $23 $46 $50,000 - $74,999 $0 $17 $17 $34 $40,000 - $49,999 $0 $12 $12 $24 $30,000 - $39,999 $0 $8 $8 $16 Under $30,000 $0 $5 $5 $10 Part-time (for all earnings) Part-time Employees Employee Employee + Spouse Employee + Child(ren) Employee + Family $40 $78 $78 $135 If applicable, the $25-per-pay-period tobacco surcharge and/or $50-per-pay-period working spouse surcharge will apply in addition to the medical premiums listed above Open Enrollment Benefit Highlights

7 LVHN Dental Plan Employment Status Dependents on Plan Basic Dental Comprehensive Dental Full-time and Part-time Employee $15 $18 Employee + Spouse $25 $32 Employee + Child(ren) $25 $36 Employee + Family $37 $52 LVHN Vision Plan Employment Status Dependents on Plan Base Plan Buy-Up Plan Full-time and Part-time Employee $3.08 $4.06 Employee + Spouse $5.69 $7.47 Employee + Child(ren) $5.39 $7.09 Employee + Family $7.68 $10.09 Reminder: Open Enrollment Oct. 7 28, 2016 Resources to Help You Open Enrollment Help Sessions At LVH Cedar Crest, Computer Lab 1 Tuesday, Oct. 11, noon 4 p.m. Thursday, Oct. 20, 3 7 p.m. Tuesday, Oct. 25, 7 11 a.m. At LVH Muhlenberg Tuesday, Oct. 18, noon 4 p.m., ECC B Wednesday, Oct. 26, 7 11 a.m., ECC A At LVH 17th Street Auditorium Wednesday, Oct. 12, noon 4 p.m. Thursday, Oct. 27, 7 11 a.m. At LVHN Mack Boulevard, Department of Education Learning Center, Computer Lab 9 (sixth floor) Monday, Oct. 24, 7 11 a.m. At Health Network Laboratories, 794 Roble Road, Main Computer Training Room Thursday, Oct. 13, 2 5 p.m. Tuesday, Oct. 18, 7 11 a.m. Thursday, Oct. 20, 6 9 p.m. Thursday, Oct. 27, 10 a.m. 1 p.m Open Enrollment Benefit Highlights 7

8 How to Enroll for 2017 Benefits You will make your benefit selections through Lawson employee self-service from your computer at work or home by following these two easy steps. Open Enrollment takes place Oct. 7 Oct. 28, You must take action during Open Enrollment to have LVHN benefits in Changes will not be accepted after Oct. 28, STEP 1 STEP 2 Log on to Lawson with your user name and password. Employee Self-Service dashboard, under Benefits, click on Open Enrollment. As part of the enrollment process, you will be asked to certify whether or not you use tobacco. If you cover your spouse for medical coverage, you also will be asked to certify whether he or she has coverage available through his or her employer other than LVHN or HNL, and if so, the name of the employer. If you enroll any dependents, you will be required to verify that your covered dependents are listed with their correct information (i.e., Social Security number, date of birth, relationship, address, etc.) and add any new dependents you wish to enroll in 2017 who are not listed. Please be sure to update the address(es) of your dependent(s), including if your dependent(s) resides outside of the in-area zip codes. Refer to the dependent eligibility guidelines on the HR intranet (hr.content.lvh.com). If you add dependent(s) to your medical, dental and/or vision plan(s) who were not on your insurance prior to Jan. 1, 2017, you can send the necessary documentation to human resources by Dec. 15, 2016, in order for coverage to be effective for Jan. 1, Note: The LVHN medical plan complies with all Health Care Reform coverage requirements. If you enroll for LVHN medical coverage for 2017, you will have met the individual mandate for health care coverage in You also will be required to provide information related to Coordination of Benefits during the benefit enrollment process. You will need to provide details (cardholder name, insurance company name, group/employer name, group number and effective date) related to any other medical or dental insurance coverage for yourself and any enrolled dependents. If additional information is required, you will receive a request from Populytics. If the information is not received within 30 days of the request, all claims will be denied. After you have completed your benefits enrollment, click Save Your Enrollment on the last screen to complete your enrollment process and to print your confirmation statement. You automatically will be sent an confirmation statement to your work address. Keep a copy for your records. Throughout the Open Enrollment period, you will be able to access the system and make additions or changes until Oct. 28. However, once the Open Enrollment period is over, changes will not be accepted. Get Help Get step-by-step Open Enrollment instructions on the HR intranet (hr.content.lvh.com). For HNL employees, please access the HNL HR page at myhnl2.healthnetworklabs.com. If you need assistance accessing Lawson, please contact I/S customer service at If you have questions regarding Open Enrollment, please contact HR benefits at or HNL HR at Additional benefit information is available in the Benefit Information Guide on the HR intranet at hr.content.lvh.com (available in early October) / CARE LVHN.org