2015 Employee Benefits Overview

Transcription

1 2015 Employee Benefits Overview

2 This overview is a summary of your benefits as an eligible Kadlec employee. We have worked closely with our benefits consultant, Alliant, to provide you with a comprehensive, cost-effective benefits package. Alliant has created this overview to help you better understand your plans and choices. Each section contains important information, so please read this overview carefully. If you have questions about your benefits or need assistance with claims, please contact a Benefit Advocate at Alliant. Benefit Advocates are professionals who are available to provide confidential assistance for you and your covered family members. Please see the following page of this overview for more information. The benefits in this summary are effective: January 1, 2015 through December 31, 2015 Please note that this guide is a summary of benefits. Refer to your summary plan description (SPD) for a complete description of the benefit provisions. In the event of a discrepancy between this guide and the SPD, the SPD will govern the plan. SPDs are posted at Hard copies are available in Human Resources. TABLE OF CONTENTS Enrollment Information...2 For Assistance...3 Cost of Coverage...4 Medical Plan - Fast Facts...5 Medical Benefits - Basic Plan...6 Medical Benefits - Enhanced Plan...7 Prescription...8 Vision...8 Dental...9 Flexible Spending Account...9 Life/AD&D Disability Income Benefits Annual Notices ENROLLMENT INFORMATION If you are a newly hired employee or a current employee who is newly eligible for benefits, now is the time to elect your Medical, Dental, Flex Spending, Optional Life, and Optional Long Term Disability benefits. The following pages contain summaries of available benefits. To view additional information about our benefits please visit Enroll Online (Medical, Dental, FSA) Detailed web enroll instructions for medical, dental, and flex spending accounts are available at Benefits Attention Newly Eligible Employees Enrollment Instructions. Paper Enrollment Forms Required Basic Life Insurance, Optional Life Insurance, and Optional Long Term Disability require paper enrollment forms to be completed and turned in to Human Resources. For more information, please refer to pages of this booklet. Newly Eligible Employees: Time Limit (30 Days) Benefits must be elected within 30 days of your date of hire or date transferred to a benefits eligible position. IMPORTANT! If you do not elect benefits timely, your next opportunity will be during the next Open Enrollment Period unless you experience a qualifying mid-year event. 2

3 FOR ASSISTANCE Should you have a benefit or claims question, please contact the Benefit Advocate team at Alliant*. Alliant is the benefits consulting firm that assists Kadlec with our benefits program. Alliant Benefit Advocates are available to provide confidential assistance to you and your covered family members. They will: Assist you in understanding your benefits Contact insurance carriers on your behalf to obtain information Assist in resolving claims problems Assist with claims appeals, if necessary Benefit Advocates are available to assist you, Monday through Friday, 8:00AM to 5:00PM, Pacific Time. Please have your insurance identification card available when you call. Kadlec Dedicated Benefit Advocate: Miracle Gladney Telephone: Fax: mgladney@alliant.com Alliant Benefit Advocate Team Telephone: mybenefits@alliant.com *Due to HIPAA Privacy regulations, Alliant may need to obtain your written authorization in order to assist with certain issues. Your Benefit Advocate will provide you with an authorization form, if needed. To contact our vendors directly: Benefit Provider Telephone Website Medical, Prescription & Vision First Choice Dental Delta Dental of Washington Dental Willamette Dental Wellness Viverae Flexible Spending Accounts HealthEquity Retirement Advisors TransAmerica To conduct a provider search: Benefit Medical, Prescription & Vision First Choice Network Dental WDS Premier Network Dental Willamette Dental Clinic Locations How to Find A Provider 1. Go to 2. Click on the green button located on the top left of the screen labeled Click Here to Find a Doctor or Hospital 3. Enter your search parameters 1. Go to 2. Click the link labeled Looking For a Dentist 3. Choose the Delta Dental Premier Plan 4. Enter your search parameters 1. Go to 2. Click the tab labeled Locations 3. Choose the location nearest to you on the map To access Kadlec benefits information online go to: 3

4 COST OF COVERAGE HRA Basic Plan: 2015 Employee Cost 2015 Employer Cost Full Time Employee Per Pay Period Costs Per Month Per Pay Period Costs Per Month Full Premium Employee Only $22.66 $45.32 $ $ $ Employee + Spouse * $ $ $ $1, $1, Employee + Child(ren) ** $30.00 $60.00 $ $1, $1, Employee + Family $ $ $ $1,489.7 $1, HRA Enhanced Plan: Full Time Employee 2015 Employee Cost 2015 Employer Cost Per Pay Period Costs Per Month Per Pay Period Costs Per Month Full Premium Employee Only $48.59 $97.19 $ $ $ Employee + Spouse * $ $ $ $1, $1, Employee + Child(ren) ** $68.91 $ $ $1, $1, Employee + Family $ $ $ $1, $1, HRA Basic Plan: Part Time Employee 2015 Employee Cost 2015 Employer Cost Per Pay Period Costs Per Month Per Pay Period Costs Per Month Full Premium Employee Only $ $ $ $ $ Employee + Spouse * $ $ $ $ $1, Employee + Child(ren) ** $ $ $ $ $1, Employee + Family $ $1, $ $ $1, HRA Enhanced Plan: Part Time Employee 2015 Employee Cost 2015 Employer Cost Per Pay Period Costs Per Month Per Pay Period Costs Per Month Full Premium Employee Only $ $ $ $ $ Employee + Spouse * $ $ $ $ $1, Employee + Child(ren) ** $ $ $ $ $1, Employee + Family $ $1, $ $ $1, Dental Plans Bi-Weekly Cost Bi-Weekly Cost Bi-Weekly Cost Plan Name WDS Basic Option WDS High Option Willamette Dental Employee Only $5.98 $9.49 $5.31 Employee + Spouse * $29.47 $36.46 $29.86 Employee + Child(ren) ** $30.61 $45.53 $29.86 Employee + Family $54.03 $73.94 $49.73 * Registered same sex or opposite sex Domestic Partners, with one partner at least 62 years old. Domestic Partner contributions can t be deducted on a pre-tax basis, and Kadlec contributions to Domestic Partner premiums are considered taxable income to the employee. ** Coverage of enrolled children will cease at age 26 (unless applicable law requires us to offer coverage for a longer period of time). Contact us at Human Resources at or hr@kadlec.org. 4

5 MEDICAL PLAN FAST FACTS How Your HRA Works: Your HRA gives you a first dollar benefit. If you have money in your HRA account, any non-preventive medical expense will be paid up to your HRA balance. HRA funds cannot be used for vision costs, as reimbursement for these benefits are not subject to the deductible. * Once you exhaust the funds in your HRA, you will be responsible for a bridge. The bridge is your annual deductible, offset by the HRA. After you ve met your bridge, medical expenses are covered at the appropriate coinsurance level up to the out-ofpocket maximum. Preventive care is covered at 100%, the deductible is waived, and seeking preventive care does NOT deplete your HRA. With Completing Wellness Requirements Network Preventive Care Prescription Drugs Vision Exam & Hardware HRA (Paid by Kadlec) Pays First Bridge** You Pay Medical Plan Coverage Plan pays: KRMC*** 80% In-Network*** 60% Non-Network*** Total Annual Deductible Once the total annual deductible is met for the year, the plan pays coinsurance amounts The amount you pay can be reduced by wellness dollars earned, and by HRA dollars unused and carried over from prior years on Kadlec's HRA Plan. **Your share of the Total Annual Deductible, is the called the Bridge. The Bridge is reduced by earned wellness HRA dollars and/ or unused HRA dollars from the previous year. Unused HRA dollars roll over from year-to-year to a maximum of $4,500. Earn more HRA dollars by participating in the wellness program. Refer to the Wellness Program Overview (insert) for detailed information. ***Emergency Room claims paid at 80%. 5

6 MEDICAL BENEFITS Kadlec is pleased to provide you with the option of two major medical plans (Basic and Enhanced Plans) administered by First Choice Health. With the choice of two plans, you are able to select the plan that best fits you and your family s healthcare needs. Medical Benefits - Kadlec Basic Plan Health Reimbursement Account (HRA) is entirely funded by Kadlec and can only be used for medical expenses. HRA funds cannot be allocated to vision costs. Kadlec Basic Plan Bridge = Deductible HRA Balance Annual HRA (offsets total deductible) Wellness Participation Dollars Combined for In and Out-of-Network Annual Bridge (your share of total deductible) Wellness: Participating Wellness: Non-Participating Total Annual Deductible Employee Only $500 $250 $1,250 $1,500 $2,000 Employee + Spouse $625 $500 $1,875 $2,375 $3,000 Employee + Child(ren) $875 $250 $1,875 $2,125 $3,000 Employee + Family $1,000 $500 $2,500 $3,000 $4,000 Annual Coinsurance Maximum Employee Only Employee + Spouse Employee + Child(ren) Employee + Family If you cover a dependent, you must meet the total bridge amount before benefits begin. Earn extra HRA dollars by completing the wellness program requirements (see insert). Unused HRA funds roll over from year-to-year to a maximum of $4,500. Combined for In and Out-of-Network $2,000 $3,000 $3,000 $4,000 Out-of-Pocket Medical Maximum = Coinsurance Maximum + Bridge If you cover a dependent, you must meet the total coinsurance maximum tier amount in order for 100% coinsurance coverage for subsequent covered benefits. Medical Benefits - Kadlec Enhanced Plan Health Reimbursement Account (HRA) is entirely funded by Kadlec and can only be used for medical expenses. HRA funds cannot be allocated to vision costs. Kadlec Enhanced Plan Bridge = Deductible HRA Balance Annual HRA (offsets total deductible) Wellness Participation Dollars Combined for In and Out-of-Network Annual Bridge (your share of total deductible) Wellness: Participating Wellness: Non-Participating Total Annual Deductible Employee Only $500 $250 $750 $1,000 $1,500 Employee + Spouse $625 $500 $1,125 $1,625 $2,250 Employee + Child(ren) $875 $250 $1,125 $1,375 $2,250 Employee + Family $1,000 $500 $1,500 $2,000 $3,000 Annual Coinsurance Maximum Employee Only Employee + Spouse Employee + Child(ren) Employee + Family If you cover a dependent, you must meet the total bridge amount before benefits begin. Earn extra HRA dollars by completing the wellness program requirements (see insert). Unused HRA funds roll over from year-to-year to a maximum of $4,500. Combined for In and Out-of-Network $2,000 $3,000 $3,000 $4,000 Out-of-Pocket Medical Maximum = Coinsurance Maximum + Bridge If you cover a dependent, you must meet the total coinsurance maximum tier amount in order for 100% coinsurance coverage for subsequent covered benefits. 6

7 MEDICAL BENEFITS Medical Benefits - Kadlec Basic and Enhanced Plan Kadlec Regional Medical Center* First Choice (In-Network) Out-of-Network Lifetime Plan Maximum Unlimited Office Visit/Exam Primary Provider Specialist N/A Plan pays 80% after deductible Plan pays 60% after deductible Preventive Services Well-Child Care Well Woman Exams Routine Adult Physicals Plan pays 100% (see contract for scheduled covered visits/screenings) Chiropractic Services (12 visits per calendar year) N/A Plan pays 80% after deductible Plan pays 60% after deductible Diagnostic X-Ray N/A Plan pays 80% after deductible Plan pays 60% after deductible Inpatient Hospital Services Plan pays 90% after deductible Plan pays 80% after deductible Plan pays 60% after deductible Outpatient Surgery Plan pays 90% after deductible Plan pays 80% after deductible Plan pays 60% after deductible Emergency Room Facility Services Professional Services Plan pays 90% after deductible Plan pays 80% after deductible Plan pays 80% after deductible Plan pays 80% after deductible Mental Health Benefits Inpatient Care Outpatient Care N/A Plan pays 80% after deductible Plan pays 60% after deductible *Please note: For benefits to be paid at the 90% coinsurance level, services must be rendered and billed by Kadlec Regional Medical Center unless specifically stated otherwise. Out-of-Pocket Medical Maximum: Once you reach the Annual Out-of-Pocket Medical Maximum in qualified out-of-pocket expenses, the plan will pay 100% of those expenses for the remainder of the year. This limit DOES NOT include ALL out-of-pocket expenses such as charges that exceed the plan s usual & customary limits, services that exceed plan limitations, or vision costs. HRA Wellness Incentive: Earn extra HRA dollars by completing the wellness program requirements (see insert). 7

8 PRESCRIPTION BENEFITS For your convenience, you can choose to obtain a 90-day supply of your maintenance prescriptions either through the Mail Order Program or at Participating Choice 90MAC Pharmacies (excludes Walgreens and CVS pharmacies). Please note: Certain drugs may require preauthorization, step therapy, or have dispensing limitations. Specialty injectible prescriptions may need to be purchased from a specific provider. This plan encourages the use of generic drugs whenever available. If you choose a brand-name drug instead of a generic equivalent, you will be required to pay the cost difference between the generic and the brandname drug. For more information, please consult First Choice Health at Kadlec Basic & Enhanced Plans First Choice Network Out-of-Network Pharmacy Supply Limit Generic Brand Mail Order or Choice 90 Supply Limit Generic Brand Annual Out-of-Pocket Prescription Maximum 30 days Plan pays 90% Plan pays 70% 90 days Plan pays 90% Plan pays 70% $2,500 per person HRA funds may not be used for pharmacy costs. Dispensing of generic drugs is mandatory. See contract for limitations on non-discounted pharmacy. 30 days Plan pays 90% Plan pays 70% 90 days Plan pays 90% Plan pays 70% VISION BENEFITS Kadlec offers you a vision benefit through First Choice. A routine eye exam is important, not only for correcting vision, but because it can lead to detecting other serious health conditions. The plan also includes coverage for vision hardware, either eyeglasses or contact lenses. Please note that the vision hardware plan may not cover all costs including lens coatings, contact lens fitting and taxes. If you choose to use an out-of-network provider, you will have to pay your provider at the time of service and you may be required to submit your own claim to the insurance company. Kadlec Basic & Enhanced Plans In-Network Out-of-Network Examination Plan pays 100% Plan pays 100% (once per calendar year, up to allowed amount) Lenses, Frames or Contacts Plan pays 100% Plan pays 100% Adults Plan pays 100% up to $150 per calendar year Children (up to age 19) Plan pays 100% up to $150 then plan pays 80% Plan pays 100% up to $150 then plan pays 60% 8

9 DENTAL BENEFITS Kadlec offers three dental plans choices: two through Washington Dental Service (WDS) and one through Willamette Dental. Both WDS plans allow you to seek care from any licensed dental provider. However, both plans are contracted with a network of participating dentists. When you visit a participating dentist you can maximize your benefit plan with access to lower out-of- pocket expenses. If you visit an outof-network dentist you may be responsible for additional costs if the provider s charges exceed the plan s usual & customary levels. The Willamette Dental option is a Dental Maintenance Organization (DMO), you can only see a dentist in the Willamette Dental Network, and each covered service has a defined co-pay. Annual Deductible WDS Dental: High Option WDS Dental: Basic Option Willamette Dental: DMO In-Network Out-of-Network In-Network Out-of-Network Out-of-Network $25/Individual $75/Family $25/Individual $75/Family $10 copay per office visit Annual Dental Benefits Maximum $2,000 per person $1,000 per person Unlimited Diagnostic & Preventive Services Plan pays 100% Plan pays 100% $10 copay then plan pays 100% Basic Services Fillings Endodontic Treatment Periodontic Treatment Plan pays 90% after deductible Plan pays 80% after deductible Plan pays 90% after deductible Plan pays 80% after deductible $10 copay then 100% $ copay then 100% $ copay then 100% Major Services Plan pays 50% after deductible Plan pays 50% after deductible $ copay then 100% Orthodontia Dependent Children Adults Lifetime Orthodontia Plan Maximum Covered Covered Plan pays 50% up to $2,000 Not covered Not covered N/A Dependent Children and Adults: $150 copay Pre-Orthodontic Service then$1,000 copay Comprehensive Orthodontia N/A FLEXIBLE SPENDING ACCOUNT The Flexible Spending Account (FSA) through HealthEquity enables employees to set aside pre-tax dollars out of their paycheck to pay for eligible health care and/or child care expenses. Common health care eligible expenses are office visit co-pays, vision expenses, dental work, orthodontia, prescription co-insurance, and expenses that are applied to medical plan deductibles. Expenses that are for one s general well-being, cosmetic in nature or not medically necessary are not eligible. The maximum annual contribution to your Healthcare Flexible Spending Account is $2,550 for the 2015 Plan Year. USE IT OR LOSE IT RULE Flexible Spending Accounts are governed by the use-it-or-lose-it rule. IRS regulations state that you must forfeit any contributions you do not use for eligible expenses incurred within the plan year. Because of this rule, please estimate your expenses conservatively. The Dependent Care Flexible Spending Account enables employees to set aside pre-tax dollars out of their paycheck to pay for eligible child care expenses. The annual Dependent Care Flexible Spending Account maximum for each Plan Year is $5,000. Separate Accounts Your Healthcare and Dependent Care Accounts are separate. You cannot receive reimbursement from your Dependent Care Account for Healthcare expenses, or vice versa. Funds put aside in either account may only be used for qualifying expenses under that account. Changes to Election Amounts You may only make changes to your elections if a specific change in status occurs. Examples of a change in status are: change in marital status; change in number of tax dependents; termination or commencement of employment by the employee, spouse or dependent; change in employment status resulting in gain or loss of eligibility for health coverage; Medicare or Medicaid entitlement for the employee, spouse or dependent; change in cost of coverage (for Dependent Care Accounts only). If you have experienced a change in status and would like to make changes to your elections, please contact HR. Increase Your Spendable Income Wouldn t you love to pay less tax? By enrolling in a FSA, you can withhold money from your paycheck on a pretax basis to pay for preplanned health and dependent care expenses. The FSA allows you to pay these expenses with untaxed dollars saving you 10-35%! 9

10 LIFE/AD&D BENEFITS If you have loved ones who depend on your income for financial support, you are probably aware of the importance of Life and AD&D (Accidental Death & Dismemberment) protection. Life insurance pays your beneficiary a benefit, should you die and AD&D insurance pays a benefit, should your death result from an accident OR if you are severely injured in an accident. Age may affect coverage levels. Basic Life/AD&D Insurance Enrollment is automatic and your employer pays the full cost for all basic coverage. You do need to designate a beneficiary. Beneficiary forms are available online at Benefits Life. Benefit Amount 1 times your annual salary to a maximum of $250,000 Benefits reduce at age 75 and terminate upon retirement. Optional Life Insurance If you need additional Life coverage to meet your financial needs, you can purchase supplemental Life insurance through Met Life for you and your dependents. You must elect Voluntary Life coverage for yourself in order to cover your spouse or children. Basic Annual earnings consists of your current salary or wage. This does not include commissions, bonuses, overtime pay, or any other extra compensation. You or your dependents must apply within 31 days of your initial eligibility date in order to be eligible for Guarantee Issue coverage. Late applicants must complete Health Underwriting (Evidence of Insurability). Domestic Partnership coverage is not available on Voluntary Life. Benefits will reduce as you age, please consult the summary plan description for details. Continuation of coverage may be available if your group coverage ends, please consult summary plan description. Guarantee Issue Employee The lesser of: 3 times Basic Annual Earnings OR $100,000 Spouse $50,000 Child(ren) $10,000 (Coverage ends at 19, or 25 if a full time student) Benefit Amount Employee Increments of $10,000 to lesser of: 5 times earnings or $300,000 Spouse Child(ren) Optional Life Rates (Monthly) Increments of $5,000 to lesser of: $100,000 or 50% of employee s coverage Spouse premium is based on spouse s age Increments of $2,500 for each child to lesser of: $10,000 or 50% of employee s coverage Coverage ends at 19, or 25 if a full time student; Children from 14 days to 6 months have a benefit maximum of the greater of 10% of the employee amount or $500 Employee or Spouse Age Voluntary Life Rate per $1,000 Employee or Spouse Age Voluntary Life Rate per $1, $ $ $ $ $ $ $ $ $ Child(ren) $ $ How to Enroll During the Initial Eligibility Period If Optional Life is elected timely within the eligibilty period (31 days from date of eligibility) then Evidence of Insurability is not required. Complete, sign and return the Met Life Optional Life Enrollment Form. Form is available at Benefits Life. Hard copies are available in HR. 10

11 DISABILITY INCOME BENEFITS If you become disabled and cannot work, no benefit becomes more important to your financial security than Disability Income protection. SunLife is the carrier for this coverage. Voluntary Long Term Disability Insurance The Long Term Disability plan pays you a benefit for each month you are unable to work due to a disabling condition. Enrollment is voluntary, and you pay the entire cost of the coverage. Please note that you are able to apply for this coverage on a Guarantee Issue basis during your initial eligbility period only. If you apply for coverage later than 31 days after your eligiblity date you ll be required to complete Evidence of Insurability and coverage is not guaranteed. Benefits begin after satisfying a 90-day elimination period and continue until Social Security Normal Retirement Age (SSNRA) if you are unable to return to work. Pre-existing conditions may be subject to a waiting period, please review the summary plan description. Important contract limitations apply. Note: The age at which you become disabled may affect the duration of your benefits. Refer to Met Life Plan document for additional information and guidelines. Benefit Amount Plan pays 60% of covered monthly earnings up to $3,000 Voluntary Long Term Disability Rates (Monthly) Age Band Rate per $100 of Payroll $0.14 $0.33 $0.53 $0.76 $1.02 $1.24 $1.54 $1.30 $1.14 $0.96 EMPLOYEE ASSISTANCE PROGRAM Life is unpredictable. To help you and your household members cope with everyday life, work challenges, stress, family problems, and other personal issues, an Employee Assistance Program (EAP) is available 24 hours a day, seven days a week through ValueOptions. The Caregiver Assistance Program is completely confidential and is available to all employees and their household members. Enrollment is automatic, and Kadlec pays the full cost for this service. Benefits include confidential access to the following: Free telephonic visits with trained counselors per issue, per year for assistance with issues including the following: depression, stress, or grief marital and parenting problems alcohol and substance abuse conflicts Referrals for sessions with a nearby counselor Child and elder care referral service Family resources (finding pet care, planning for college, relocating to a new city) Legal resources and referral service (divorce, bankruptcy, wills, real estate transactions) Financial counseling resource (getting out of debt, tax questions, retirement planning) Telephone: CONTACT INFORMATION Online: 11

12 ANNUAL NOTICES The Women s Health and Cancer Rights Act of 1998 The Women s Health and Cancer Rights Act of 1998 provides benefits for mastectomy-related services. These services include: Reconstructive surgery Surgery to achieve symmetry between the breasts Prostheses Physical complications resulting from a mastectomy (including lymphedema) Please refer to your medical plan summary plan description for details, or contact your plan administrator for more information. The Newborns and Mothers Health Protection Act The Newborns and Mothers Health Protection Act requires that your plan generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child. Length of stay in connection with childbirth may not be less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section unless an attending provider, in consultation with the mother, provides an exception to discharge the mother and newborn earlier. An attending provider is restricted to an individual who is licensed under applicable state law to provide maternal or pediatric care and who is directly responsible for providing such care to a mother or newborn child. The definition of an attending provider does not include a plan, hospital, or managed care organization. Please refer to your medical plan summary plan description for details, or contact your plan administrator for more information. Please be aware that in order to add a newborn dependent to the plan, you need to submit your enrollment change application to Human Resources in a timely manner (usually within 30 days of birth). Special Enrollment Rights Loss of Coverage If you decline enrollment for yourself or for an eligible dependent (including your spouse) because you or your dependents have other health insurance or a different group health plan in effect, you may be able to enroll yourself and your dependents in these plans if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 30 days after your or your dependents other coverage ceases. New Dependent by Marriage, Birth, Adoption, or Placement for Adoption In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption. Please refer to your medical summary plan document (SPD) for details, or contact your plan administrator for more information. Please be aware that in the event of a qualified change in family status, you need to submit your enrollment change application to Human Resources in a timely manner (usually within 30 days of the event). 12

13 ANNUAL NOTICES 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. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial KIDS NOW or www. insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at or by calling toll-free EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, You should contact your state for further information on eligibility: ALABAMA Medicaid Website: Phone: ALASKA Medicaid Website: health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): Phone (Anchorage): ARIZONA CHIP Website: Phone (Outside of Maricopa County): Phone (Maricopa County): COLORADO Medicaid Website: Phone (In state): Phone (Out of state): FLORIDA Medicaid Website: Phone: GEORGIA Medicaid Website: dch.georgia.gov Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: IDAHO Medicaid and CHIP Medicaid Website: PremiumAssistance/tabid/1510/Default.aspx Phone: INDIANA Medicaid Website: Phone: IOWA Medicaid Website: Phone: KANSAS Medicaid Website: Phone: KENTUCKY Medicaid Website: chfs.ky.gov/dms/default.htm Phone: LOUISIANA Medicaid Website: Phone: MAINE Medicaid Website: Phone: TTY MASSACHUSETTS Medicaid and CHIP Website: Phone: MINNESOTA Medicaid Website: Click on Health Care, then Medical Assistance Phone: MISSOURI Medicaid Website: Phone: MONTANA Medicaid Website: medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml Phone: NEBRASKA Medicaid Website: Phone: NEVADA Medicaid Website: dwss.nv.gov Phone: NEW HAMPSHIRE Medicaid Website: Phone: NEW JERSEY Medicaid and CHIP Medicaid Website: Medicaid Phone: CHIP Website: CHIP Phone: NEW YORK Medicaid Website: Phone:

14 ANNUAL NOTICES NORTH CAROLINA Medicaid Website: Phone: NORTH DAKOTA Medicaid Website: Phone: OKLAHOMA Medicaid and CHIP Website: Phone: OREGON Medicaid and CHIP Website: OR Phone: PENNSYLVANIA Medicaid Website: Phone: RHODE ISLAND Medicaid Website: Phone: SOUTH CAROLINA Medicaid Website: Phone: SOUTH DAKOTA - Medicaid Website: dss.sd.gov Phone: TEXAS Medicaid Website: Phone: UTAH Medicaid and CHIP Website: health.utah.gov/upp Phone: VERMONT Medicaid Website: Phone: VIRGINIA Medicaid and CHIP Medicaid Website: Medicaid Phone: CHIP Website: CHIP Phone: WASHINGTON Medicaid Website: Phone: ext WEST VIRGINIA Medicaid Website: Phone: , HMS Third Party Liability WISCONSIN Medicaid Website: Phone: WYOMING Medicaid Website: health.wyo.gov/healthcarefin/equalitycare Phone: To see if any more States have added a premium assistance program since July 31, 2014, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services EBSA (3272) , Menu Option 4, Ext Important Notice from Kadlec Regional Medical Center About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Kadlec Regional Medical Center and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Kadlec Regional Medical Center has determined that the prescription drug coverage offered by the Kadlec Regional Medical Center Group Health Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. 14

15 ANNUAL NOTICES When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your Kadlec Regional Medical Center coverage will not be affected. See below for more information about what happens to your current coverage if you join a Medicare drug plan. Since the existing prescription drug coverage under the Kadlec Regional Medical Center Group Health Plan is creditable (e.g. as good as Medicare coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan; or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug coverage. If you do decide to join a Medicare drug plan and drop your Kadlec Regional Medical Center prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Kadlec Regional Medical Center and don t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage Contact the person listed below for further information. NOTE: You ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Kadlec Regional Medical Center changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: October 2014 Name of Entity/Sender: Kadlec Health System Contact--Position/Office: HR Benefit Team Address: 888 Swift Blvd., Richland, WA Phone Number: (509)

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