Employee Benefits Guide 2018

Transcription

1 Employee Benefits Guide 2018 What s inside: Contact Information How to Enroll Benefits Information Disclosure Let s deal with it together.

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3 Contact Information Table of Contents Enrollment Notice Contact Information 3 Medical Plan Information 5 Health Savings Account Information 7 Flexible Spending Account Information 8 Dental Plan Information 9 Vision Plan Information 10 Life Plan Information 11 STD Plan Information 12 LTD Plan Information (k) 13 I understand that, in order to enroll in benefits, I must login to Ultipro in order to enroll or decline coverage. I understand that if I fail to enroll (within 15 days of hire date), I am waiving coverage and will not have coverage. I understand that my next opportunity to enroll will not be until the next open enrollment in 2019, unless I have a qualified change in status event. First Have an Issue? Call the insurance company or benefit provider using the contact numbers listed below. Second If your issues are still not resolved, please contact Karyne Anderson in Human Resources. Contact Information Benefit Plan Telephone Internet Medical - Group # G SelectHealth selecthealth.org Dental - Group # MetLife Vision - Group # MetLife Life and Disability MetLife Health Savings Account Health Equity Flexible Spending Account NBS metlife.com/mybenefits metlife.com/mybenefits metlife.com/mybenefits healthequity.com nbsbenefits.com Human Resources Karyne Anderson karynea@valleycares.com 3

4 General Information Who is Eligible Fully benefitted employee that works 40+ hours per week. ACA eligible (medical benefits) employee that works hours per week Your legal spouse and/or domestic partners. Your children up to age 26 regardless of marital or student status. Your unmarried children of any age, if they depend on you for support due to a physical or mental disability (documentation required). When does coverage begin for new hires? Coverage begins the first of the month following 30 days of employment. You must be full time and actively at work for your coverage to become effective. Choose Wisely The choices you make will remain in effect during the 2018 plan year unless you have an IRS approved qualifying change of status Financial hardship is not a qualifying event for benefit changes A Qualifying Change of Status Occurs for the Following: You get married, legally separated, or divorced. You add a dependent child through birth, adoption, or change in custody. Your spouse or child dies. Your work schedule changes, i.e. reduction or increase in hours which affects eligibility. Your spouse begins or terminates employment, which affects benefit coverage. You or your spouse loses health coverage through his/her employer. You receive a qualified medical child support order (QMCSO). Your spouse s open enrollment; may be considered a qualifying status change. OR You have a 60 day special election period for the following: You and/or your spouse and dependents gain or lose Medicare or Medicaid coverage. You qualify for a state sponsored premium assistance program. Important Notices The following benefit summaries are for ease of comparison. This brief highlight brochure provides a summary only of benefits available to eligible employees and their eligible dependents. Valley Behavioral Health reserves the right to audit the dependency status of individuals enrolled by an employee. This process may include a complete eligibility verification of all enrolled dependents and/or verifying relationship and status of new dependents registered during open enrollment, by new-hires, and qualifying events. Ensure that you are covering only eligible dependents when you enroll in the plan offerings. The information in this booklet supersedes all prior summaries. However, since this booklet is only a summary, it does not describe every detail of the benefit programs outlined. If there are any inconsistencies or discrepancies between this booklet and the governing plan documents and benefit contracts, the governing plan documents and benefit contracts will prevail. The governing plan documents and benefit contracts are available for your review in your Human Resource Department. Refer to the carrier s literature for specific details. No rights shall accrue to you and/or your dependents because of any statement, error, or omission in this comparison. Reasonable efforts are made to keep employees informed of any changes in benefit plans. Please note that these benefits are subject to change. When Coverage Ends Most coverages terminate on the last day of the month your employment with Valley Behavioral Health ends. Your life and disability coverages will always end on the last day of your employment. Refer to carrier literature, summary plan descriptions, and master plan documents for specific plan provisions, limitations, and exclusions. Whichever is earliest Your employment with Valley Behavioral Health ends The group policy ends You are no longer eligible under the plan Your death You retire You enter the armed forces of any country on a full-time basis Don t forget to add newborn babies to your plan within 30 days of their birth! 4

5 Medical Network SelectHealth HDHP High Deductible Health Plan (HSA) In-Network SelectMed Plus Out-of-Network Annual Deductible Out-of-Pocket Max No Lifetime Max $3,000 per Individual $6,000 per Family $5,000 per Individual $10,000 per Family $6,000 per Individual $12,000 per Family $10,000 per Individual $20,000 per Family Preventive Services Covered 100% Not Covered Office Visits Copay Urgent and Emergency Care Mental Health Services Inpatient Outpatient Office Visits Primary Care: $15 AD^ Specialist: $25 AD Urgent Care: $35 AD Emergency Room: $75 AD You Pay: 20% AD You Pay: 20% AD You Pay: $15 AD You Pay: 40% AD Urgent Care: 40% AD Emergency Room: $75 AD You Pay: 40% AD Prescription Drugs 30 Day Supply Prescription Drugs 90 Day Supply Preventive medications available prior to deductible* Tier 1: $7 Copay AD Tier 2: $21 AD Tier 3: $42 AD Tier 4: $100 AD Tier 1 $7 Copay AD Tier 2: $42 AD Tier 3: $126 AD For Inpatient and Outpatient services you pay the full negotiated rate until the annual deductible is met, then you pay coinsurance. Coinsurance AD You Pay: 20% AD You Pay: 40% AD Please refer to the Summary Plan Document for full plan description ^AD = After Deductible *See Carrier Preventive Drug List for specifics Employee Rates per Month With ValleyFit Participation Without ValleyFit Participation Employee $72.04 $93.64 Two-Party $ $ Family $ $

6 Medical Network SelectHealth HDHP High Deductible Health Plan (HSA) In-Network SelectCare Plus Out-of-Network Annual Deductible Out-of-Pocket Max No Lifetime Max $1,750 per Individual $3,500 per Family $5,000 per Individual $10,000 per Family $3,500 per Individual $7,000 per Family $10,000 per Individual $20,000 per Family Preventive Services Covered 100% Not Covered Office Visits Copay Urgent and Emergency Care Mental Health Services Inpatient Outpatient Office Visits Primary Care: $15 AD^ Specialist: $25 AD Urgent Care: $35 AD Emergency Room: $75 AD You Pay: 20% AD You Pay: 20% AD You Pay: $15 AD You Pay: 40% AD Urgent Care: 40% AD Emergency Room: $75 AD You Pay: 40% AD Prescription Drugs 30 Day Supply Prescription Drugs 90 Day Supply Preventive medications available prior to deductible* Tier 1: $7 Copay AD Tier 2: $21 AD Tier 3: $42 AD Tier 4: $100 AD Tier 1 $7 Copay AD Tier 2: $42 AD Tier 3: $126 AD For Inpatient and Outpatient services you pay the full negotiated rate until the annual deductible is met, then you pay coinsurance. Coinsurance AD You Pay: 20% AD You Pay: 40% AD Please refer to the Summary Plan Document for full plan description ^AD = After Deductible *See Carrier Preventive Drug List for specifics Employee Rates per Month With ValleyFit Participation Without ValleyFit Participation Employee $ $ Two-Party $ $ Family $ $

7 Health Savings Account What is an HSA? A tax-advantaged savings account that belongs to you. Works in conjunction with your medical plan to provide a tax free way to pay for medical costs both before and after the deductible. You are only eligible to contribute to an HSA if you are covered by a qualified high-deductible health plan (HDHP). If you have secondary coverage that is not also a HDHP, you are not eligible to contribute to an HSA. This may include coverage with a spouse, Medicare, TriCare, etc. Funds in the HSA can be used for Medical, Dental, or Vision expenses. Funds deposited are not taxed as income and the account can grow income tax free. Can be used for yourself, your spouse, and tax dependent children. How to use an HSA Until you meet your deductible, you are responsible to pay the provider the negotiated rate. This rate is typically lower than any price you could negotiate on your own. Always show your Insurance Card as expenses won t go towards the deductible unless you show your Medical card Some doctors may require that you pay the full amount or a portion of the bill upfront, but most will simply bill your insurance, and then bill you for the balance once the claim has been processed. The insurance plan will apply all discounts that apply and credit your deductible. Once the claim is processed you will receive an explanation of benefits (EOB) showing the amount you are responsible for. When picking up a prescription from the pharmacy, present your insurance card. The pharmacy will apply the carrier discount and then you pay the pharmacy using your HSA debit card. The amount you pay will then be applied to your deductible. Once your single or family deductible has been satisfied, your physician visits, hospital claims, and pharmacy charges will be processed by your health insurance plan and you will pay copays or coinsurance. You can pay these charges using your HSA debit card as long as you have a balance in your HSA. HSA Funding In 2018, the maximum amount the IRS allows you to contribute to your HSA is $3,450 for single and $6,900 for family coverage, but you don t have to contribute it as a lump sum. If you are over age 55, you are eligible to contribute an additional $1,000 per year. You may contribute to your HSA through pre-tax payroll deductions. The more you contribute, the more you have available to pay for medical, dental, and vision expenses on a tax favored basis. Your contribution combined with the contribution from Valley Behavioral Health cannot exceed the IRS maximums without incurring penalties. Please plan your contributions with the maximum limits in mind. Valley Behavioral Health will match your contribution dollar for dollar up to a maximum of $750 for an individual and $1,500 for 2 or more parties enrolled. Why HSAs? Traditional health plans have high premiums. At the end of the year, all of the money that you and your employer have spent on premiums is gone. On the other hand, with a health savings account (HSA)-qualified high-deductible health plan (HDHP), the premium is lower, and some of the money you would have spent on premiums can go into your HSA instead. Additionally, you save money on taxes and are given more flexibility and control over your health care costs You Can Grow Your Account Through Saving or Investing All of the money in the HSA remains yours, even if you leave your job, leave your qualifying health plan, or retire. In other words, an HSA is not a use-it-or-lose-it type of account. You decide how to use the HSA money, including whether to save it or spend it for health care expenses. As your balance rolls over from year to year, it may earn interest. When your balance is large enough, you can invest it tax-free the same way you can invest dollars from other retirement accounts. You Gain Triple-Tax Savings Contributions to the HSA are tax-free for you whether they come from you, your employer, or as gifts from friends or relatives. Your account and investment earnings are tax-free. You can withdraw your money tax-free at any time, as long as you use it for qualified medical expenses. 7

8 Flexible Spending Account What is a Flexible Spending Account? A tax-advantaged plan that allows you to put money aside for your plan year. Monies elected are not taxed, saving you from 10%-30% or more on the money deposited, depending on your tax rate. All money elected is available from the 1st day of the plan year. PICK APPROPRIATE {Full} You can elect up to the IRS allowed amount annually, deducted on a per paycheck basis. Amounts can be used for Medical, Dental, and Vision expenses. Generally, over the counter items are not eligible. Receipts may be required for reimbursement. {Limited Purpose} You can elect up to the IRS allowed amount annually, deducted on a per paycheck basis. If you have a Qualified High Deductible Medical Plan coupled with an HSA, mounts can be used for Dental or Vision expenses. You cannot use the FSA for medical expenses until you have met your plan deductible. Generally, over the counter items are not eligible. Receipts may be required for reimbursement. Applies to both Full & Limited Purpose Eligible expenses need to have been incurred during the plan year. {Rollover} The plan will roll over up to $500 a year. You have until March 1st to submit for reimbursement from the prior plan year. Any amount over $500 is forfeited. {Grace} You have until March 15th to incur eligible services from the prior plan year. Requests for reimbursement must be submitted by March 30th. Any funds left in the account is forfeited. How it Works During annual enrollment or your initial enrollment, you decide how much you want to deposit into your reimbursement account(s). That amount is deducted evenly during the year from your paycheck before taxes are taken out. When you have an expense that qualifies, you may use your FSA Card or you may pay the bill, submit a claim, and receive a reimbursement with tax-free dollars from your account. It is important to retain receipts whether you re using your debit card or submitting claims for reimbursement in case of IRS audit or in case substantiation is requested by National Benefit Services, LLC (NBS). You can check your balance and view detailed claims history by logging into your account at What is a Dependent Care Reimbursement Account? The Dependent Care Reimbursement Account lets you set aside up to $5,000 in pre-tax dollars to pay for eligible dependent care expenses so you and your spouse, if married, can work. With the Dependent Care Account, you can set aside taxfree income to pay for qualified dependent care expenses, such as day care, that you normally pay with after-tax dollars. Qualified dependents include children under 13 and/ or dependents who are physically or mentally handicapped. If your spouse is unemployed or doing volunteer work, you cannot set up a reimbursement account. You must meet the following criteria in order to set up this account: Your child is under the age of 13 or is mentally/ physically handicapped; You and your spouse both work; You are a single head of household; or Your spouse is disabled or a full-time student. Each calendar year the IRS allows you to contribute the following amounts, depending on your family status: If you are single, the lesser of your earned income or $5,000. If you are married, you can contribute the lowest of: Your (or your spouse s) earned income. $5,000 if filing jointly, or $2,550 if filing separately. 8

9 Dental Network In-Network MetLife - PDP Plus MetLife Out-of-Network Annual Deductible Calendar Year Maximum Preventive services Exams, Cleanings $50 per Individual, $150 per Family The deductible is waived for preventive/diagnostic care and applies to basic and major expenses. Plan pays 100% of covered services $2,000 per Individual Covers up to 80% of MAC Limited to one routine visits per six months Intra-oral complete series of x-rays or panoramic film x rays: once every 60 months Topical fluoride treatment: once every 12 months to age 14 Sealants: application provided to dependents to age 14 no more than once per tooth every 60 months Basic Services You pay 20% Covers up to 60% of MAC Major Services You pay 50% Covers up to 40% of MAC Orthodontic Care Orthodontic Lifetime Max Not covered N/A Please refer to the Summary Plan Document for full plan description The Maximum Allowed Charge (MAC) means the lesser of the amount charged by the dentist or the maximum amount which the In-Network dentist has agreed to accept as payment in full for the dental service. Employee Rates per Month Employee $7.70 Two-Party $15.40 Family $

10 Vision MetLife In-Network Out-of-Network Network Vision PPO Exams - Every Plan Year You pay $10 $45 Allowance Lenses - Every Plan Year Single Vision Lined Bifocal Lined Trifocals Lenticular You pay $10 $30 Allowance $50 Allowance $65 Allowance $100 Allowance Frames - Every Plan Year $150 Retail Allowance $70 Allowance Contacts - Every Plan Year Elective (Instead of Glasses) Contact Lense Fitting Standard $150 Retail Allowance Covered in full with maximum copay of $60 $150 Allowance Applied to the contact lens allowance Please refer to the Summary Plan Document for full plan description. Employee Rates per Month Employee $10.28 Two-Party $19.32 Family $

11 Life Insurance Being a responsible adult means making sure loved ones who depend on you are financially safeguarded if you unexpectedly leave them behind. The way you provide that protection is with life insurance. Basic Life and Accidental Death and Dismemberment Valley Behavioral Health is pleased to provide each full time active benefits eligible employee with basic life insurance and accidental death and dismemberment (AD&D) through MetLife. This coverage is completely free to you as the employee Basic Employee Life 1x salary up to $300,000 Basic AD&D 1x salary up to $300,000 Basic Spouse Life $10,000 Basic Child Life Voluntary Life $5,000 (Benefit for children age 15 days to less than 6 months is $100) Voluntary Life is additional protection you can purchase to provide more coverage for you and your family. This policy gives you the advantage of purchasing life insurance at group rates with the convenience of being payroll deducted. This benefit is not a pre-tax benefit option. Enrollment When you first become eligible for our benefit program(s), you must either enroll or waive coverage for Voluntary Life Insurance. If you do not enroll yourself and your dependents for coverage the first time you are eligible and you wish to enroll during a subsequent enrollment period, you will have to provide proof of good health by filling out a MetLife Evidence of Insurability (EOI) form, which may include taking a physical examination, and you may be declined coverage. Future exams will be at your cost. Employee You may purchase coverage in $25,000 increments up to $500,000, not to exceed 5 times your basic annual earnings. There is a Life Coverage Amount of $100,000 without providing proof of good health during the initial enrollment period only. Spouse You may purchase Voluntary Life Insurance for your spouse. Coverage is in increments of $5,000, up to $150,000, not to exceed 50% of the employee s supplemental life insurance amount. Anything up to $25,000 is available to your spouse without proof of good health during the initial enrollment period. Children Children s insurance coverage is for unmarried dependent children from 15 days of age to age 26, subject to eligibility requirements. Coverage for children age 15 days to less than 6 months is $100. From age 6 months to age 26, coverage can be elected for $1,000, $2,000, $4,000, $5000, or $10,000 and is inclusive for all children. This means that if you have one child or many, you pay one flat amount; however, each child is covered individually for the selected coverage amount. Age Reductions The coverage you have or select as additional coverage will reduce by 35% beginning at age 65, an additional 15% at age 70, and another 15% at age 75. Benefits will terminate at retirement. Voluntary AD&D Life Coverage Amount 11 Increments Maximum Amount Voluntary Employee Life $100,000 $25,000 $500,000 Voluntary Spouse Life $25,000 $5,000 $150,000 Voluntary Child Life $10,000 $1,000 $10,000 Voluntary AD&D maximum amounts are equal to your supplemental life insurance. No Evidence of Insurability is required to elect Voluntary AD&D. AD&D is a policy that pays benefits to your beneficiary if the cause of your death is due to an accident. Fractional amounts of the policy will be paid out if you lose a bodily appendage or sight because of an accident. Additionally, AD&D generally pays benefits for the loss of limbs, fingers, toes, sight, and permanent paralysis. In the event of an accidental death, this insurance will pay benefits in addition to any life insurance. Benefits resulting from the accidental death are paid to the named beneficiary. Benefits resulting from a dismembering injury are paid to the insured. The loss must occur 365 days of the accident. Maximum Amount Rate per $1,000 Employee $500,000 Included Spouse $150,000 with Life rate Child(ren) $10,000

12 Short & Long Term Disability Short & Long Term Disability How long would your savings last if you could not work for several weeks or even months? After a benefit waiting period, Short Term Disability replaces a portion of your income by paying monthly benefits if you experience a covered Shortterm illness or accident. Short Term Disability insurance is designed to pay a monthly benefits to you in the event you cannot work because of a covered illness or injury. This benefit replaces a portion of your income, thus helping you to meet your commitments in a time of need. Chances are you already purchase home, auto and life insurance to protect yourself against the threat of loss. And you probably have health insurance to guard against costly medical bills. So, what steps have you taken to help shield yourself, your lifestyle and those who count on you from an unexpected loss of income? Would you be able to meet your financial obligations if you became disabled and unable to work? Group Short Term Disability insurance is designed to pay a monthly benefit to you in the event you cannot work because of a covered illness or injury. This benefit replaces a portion of your income, thus helping you to meet your financial commitments in a time of need. By sponsoring group Short- Term disability insurance through MetLife, your employer offers you an excellent opportunity to help protect yourself and your lifestyle. The advantages to you include: Convenience with premiums deducted directly from your paycheck, you do not have to worry about mailing monthly payments; and Peace of Mind you can take comfort and satisfaction in knowing that you have taken a step toward securing your income during a period of a covered disability. Short Term Disability Benefits Weekly Benefit 60% of your weekly salary Maximum Weekly Benefit $1,000 Elimination Period - Injury Maximum Benefit Period - Injury Elimination Period - Sickness Maximum Benefit Period - Sickness Long Term Disability Benefits Weekly Benefit 14 days 11 weeks 14 days 11 weeks 50% of the first $20,000 of predisability earnings Maximum Monthly Benefit $10,000 Elimination Period - Injury Maximum Benefit Period - Injury Elimination Period - Sickness Maximum Benefit Period - Sickness 90 days SSNRA 90 days SSNRA 12

13 401(k) 401(k) Retirement Savings Plan Eligibility There is no age requirement to participate in the 401(k). Employees are eligible to participate following one year of employment, and must have completed 1000 hours of service. Employer Match Valley Behavioral Health will make a safe harbor matching contribution equal to 100% of your elective deferrals that do not exceed 5% of your compensation. Vesting Your vested percentage in your account attributable to qualified safe harbor contributions is determined under the following schedule. You will always, however, be 100% vested in your qualified safe harbor contributions if you are employed on or after your normal retirement age or if you terminate employment on account of your death, or if you terminate employment as a result of becoming disabled. Vesting Schedule Qualified Safe Harbor Contributions Years of Service Percentage Less than 2 0% 2 years 100% Automatic Enrollment If you do not take action to enroll or opt out of participation then you will be auto-enrolled for a 3% pre-tax contribution. Your contribution rate will increase 1% annually until you reach 6%. Get More Information Visit the web site at or call the Voice Response System, toll free, at for more information. The web site provides information regarding your plan, as well as financial education information, financial calculators, and other tools to help you manage your account. Investment Options and Allocation Changes A wide array of core investment options are available through your plan. Once you have enrolled, investment option information is available through the web site or Voice Response System. Use your Personal Identification Number (PIN) and username to access the web site, or you can use your Social Security Number and PIN to access the Voice Response System. You can move all or a portion of your existing balances between investment options (subject to plan rules) and change how your payroll contributions are invested. Withdrawals Qualifying distribution events are as follows: Retirement Permanent disability Financial hardship (as defined by the Internal Revenue Code and your Plan s provisions) Severance of employment (as defined by the Internal Revenue Code provisions) Attainment of age 59 1/2 Death (your beneficiary receives your benefits) 13

14 Disclosure Notices Privacy Policy Summary of Privacy Practices This Summary of Privacy Practices summarizes how medical information about you may be used and disclosed in the administration of your claims, and of certain rights you have. Our Pledge Regarding Medical Information We are committed to protecting your personal health information. We are required by law to (1) make sure that any medical information that identifies you is kept private; (2) provide you rights with respect to your medical information; (3) give you a notice of our legal duties and privacy practices; and (4) follow all privacy practices and procedures currently in effect. How We May Use and Disclose Medical Information About You We must obtain your written authorization for any use and disclosure of your medical information. We may use and disclose your personal health information without your permission to facilitate your medical treatment, of payment for any medical treatments, and for any other health care operation. We may also use and disclose your personal health information without your permission as allowed or required by law. We cannot retaliate against you if you refuse to sign an authorization or revoke an authorization you had previously given. Your Rights Regarding Your Medical Information You have the right to inspect and copy your medical information, request corrections of your medical information and to obtain an accounting of your medical information. You also have the right to request that additional restrictions or limitations be placed on the use or disclosure of your medical information, or that communication about your medical information be made in different ways or at different locations. Women s Health and Cancer Rights Act In accordance with the Women s Health and Cancer Rights Act (WHCRA), we will cover the following for the treatment of breast cancer: Mastectomies Reconstructive Surgery If you are receiving benefits in connection with a mastectomy, coverage will be provided according to the carrier Utilization Management criteria and in a manner determined in consultation with the attending physician and the patient for the following: All stages of reconstruction on the breast on which the mastectomy was performed Surgery and reconstruction of the other breast to produce a symmetrical appearance Prostheses and treatment of physical complications of the mastectomy including lymphedema Under WHCRA, coverage of mastectomies and breast reconstruction benefits are subject to deductibles, copayments, and coinsurance limitations consistent with those established for other benefits under your plan. Following the initial reconstruction, any additional modification or revision is covered only to the extent that it is not otherwise limited or excluded from coverage by your plan. Revisions requested as the result of the normal aging process will not be covered. Michelle s Law A new federal law allows continued coverage for seriously ill college students. A college student will be able to maintain health care eligibility for up to one year after full-time student status is lost due to a medically necessary leave of absence from school. Genetic Information Nondiscrimination Act (GINA) Under this Federal law, group health plans are prohibited from adjusting premiums or contribution amounts for a group based on genetic information. A health plan is also prohibited from requiring an individual or his/her family member to undergo a genetic test, although the plan may require that a voluntary test be taken for research purposes. Mandatory Insurer Reporting Law This law took effect 01/01/2009 and is part of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). Under this Federal law, providers of group health plans are required to report certain information to the Secretary of Health and Human Services to determine Medicare entitlement. As such, employees are required to provide social security numbers for all dependents enrolled in the medical plan. You will be asked to enter social security numbers for all dependents you cover on your medical plan. Waiving Coverage If you decide that you and/or your dependents have appropriate benefits from an alternate source, you may choose to waive your existing coverage. If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself and/or your dependents in this plan, providing that you request enrollment within 30 days after your other coverage ends. If you have a new dependent as a result of your marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents provided that you request enrollment within 30 days after the event. 14

15 Disclosure Notices Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren t eligible for Medicaid or CHIP, you won t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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, contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren t 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, contact the Department of Labor Utah Medicaid and Chip information: Website: Phone: Newborns and Mothers Health Protection Act The Newborns and Mothers Health Protection Act of 1996 (NMHPA) affects the amount of time you and your newborn child are covered for a hospital stay following childbirth. In general, health insurers and Health Maintenance Organizations (HMOs) may not restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. If you deliver in the hospital, the 48-hour (or 96-hour) period starts at the time of delivery. If you deliver somewhere other than the hospital and you are later admitted to the hospital in connection with the childbirth, the period begins at the time of admission. Also, a health insurer or HMO cannot require you or your attending provider to obtain prior authorization for your delivery or show that the 48-hour (or 96-hour) stay is medically necessary. However, a health insurer or HMO may require you to get prior authorization for any portion of stay after the 48 hours (or 96 hours) 15 Medicare Part D Creditable Coverage Notice Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Valley Behavioral Health 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. Valley Behavioral Health has determined that the prescription drug coverage offered by the Benefit 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. 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 15 th to December 7 th. 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. These are only summaries. Full statements are available from Human Resources. ACA Pursuant to the Affordable Care Act, Valley Behavioral Health has adopted a 12-month lookback measurement period in order to determine the full-time status of new and ongoing part-time, variable hour, or seasonal employees. According to the ACA, any employee who is employed for, on average, at least 130 hours of service a month during that lookback period must be considered full time and offered health insurance benefits during a subsequent stability period. The applicable stability period for Valley Behavioral Health is 12 months. This offer of coverage is being made because you met this definition of a full-time employee during your applicable lookback period.

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