For Your Benefit. Annual Benefits Election Period November 8 November 30, 2010 What s New in Brief! Human Resources Benefits Office

Transcription

1 Human Resources Benefits Office For Your Benefit 2011 Associates Program Annual Benefits Election Period November 8 November 30, 2010 What s New in Brief! Medical Benefits Health Net HMO participants must make a new medical election for 2011 Expanded Dependent Coverage New Nutritional Counseling Benefit MonteCare PPO In-network Copay Changes: oroutine o Physical Exams 100% ooutpatient o Surgery: 100% at Montefiore 100% after $250 copay at an Empire BlueCard PPO facility omental o Heath/Substance Abuse Care: 100% after $15 copay/visit with an MIPA physician 100% after $25 copay/visit with an Empire BlueCard PPO Physician oout-of-network o Benefits Lifetime Limit Eliminated Health Care FSA OTC medications require a prescription Life & Accident Insurance Principal/OneBeacon New Insurance Carrier Increased Accelerated Death Benefit NEW Wellness Program To Your Health! Voluntary Tax Deferred Annuity 403(b) Plan To All Associates The 2011 Associate Benefits Program changes primarily reflect the requirements of recently enacted federal health care reform legislation as well as improvements and modifications that support Montefiore s wellness initiative. The wellness initiative was introduced in October with the launch of the To Your Health! website, powered by WebMD. This year s changes also include a new MonteCare PPO nutritional counseling benefit, eliminating one of our HMOs and adding a facility copayment for in-network outpatient surgery performed outside of Montefiore. In addition, 2011 health insurance premiums will increase. These higher premiums reflect increased utilization and the overall increase in the cost of medical services. To help moderate future cost increases, in the spring of 2011, the MonteCare PPO will include a new voluntary medical management program. This program will assist individuals with chronic health conditions. Additional details will be announced early next year. It is important that you take the time to review the 2011 Benefits Program changes and take an active role in selecting the options that will work best for you. Don t miss this opportunity during the Annual Benefits Election Period November 8 th through November 30 th to change your benefits. If you need assistance, contact the HR-Benefits Office by at montebenefits@montefiore.org or call Sincerely, William Shanahan Vice President, Human Resources Total Compensation

2 2011 Health Care Premiums Rising healthcare costs continue to be a significant concern. The cost of providing healthcare benefits consumes a greater share of our benefits budget each year. For 2011, your payroll deductions for Medical coverage will increase. Keep in mind that Montefiore continues to pay the major percentage of the overall cost. Increase in MonteCare PPO Premiums As the cost of medical coverage increases, our salary-based premium contribution structure assures that MonteCare PPO coverage remains relatively affordable for Associates at all income levels. The bi-weekly premium contributions for full-time and part-time Associates will increase for 2011 to the levels shown below. Stipend Band 2011 MonteCare PPO Bi-weekly Premium Contributions Full-time Associates You Only You and Your Family Part-time Associates You Only You and Your Family Under $60,000 $53.00 $ $ $ $60,000 $99,999 $63.75 $ $ $ $100,000 $149,999 $69.00 $ $ $ $150,000 and over $74.50 $ $ $ Increase HMO Premiums Bi-weekly HMO premium contributions will also increase for 2011 as shown below. Contributions are the same for either of the available HMOs based on whether you elect single or family coverage. Health Maintenance 2011 Bi-weekly Premiums Full-time Associates Organizations You Only You and Your Family Aetna HMO Patriot 15 $ $ Empire BlueCross BlueShield HMO Direct $ $ Dental Premiums Your cost for dental coverage is based on the option and coverage level you elect. You pay the full cost of dental coverage during your first year at Montefiore. After one year, Montefiore s premium subsidy for Preventive and Diagnostic Care and the Indemnity/PPO Dental Plan begins. The bi-weekly premium contributions for full-time Associates are shown below Bi-weekly Premiums Full-time Associates Dental You Only You and Your Family Preventive & Diagnostic Dental Care Only oyour o first year at Montefiore $4.45 $12.47 oafter o your first year at Montefiore $0.00 $0.00 Indemnity/PPO Dental Plan oyour o first year at Montefiore $15.54 $43.51 oafter o your first year at Montefiore $7.50 $24.25 Aetna Dental Maintenance Organization $10.40 $ Buy-up Long Term Disability (LTD) Insurance Increased Premiums Due to higher than expected claims experience, effective January 1, 2011 the cost of Buy-up LTD insurance for the Executive and Physician group (LTD Class 1) will increase by 15% to $1.219/$100 of monthly benefit. There will be no increase in cost for all other LTD classes covered under the Group LTD plan.

3 The following changes are being made to meet the requirements of the Patient Protection and Affordable Care Act (PPACA), amended by the Health Care and Education Reconciliation Act of Medical Benefits Expanded Dependent Coverage The PPACA extends the opportunity for all children to be covered under a parent s plan up to age 26. Children are no longer required to be unmarried, full-time students or dependent on financial support to be eligible for coverage. As previously announced, Montefiore elected to make this change effective September 1, 2010 earlier than the January 1, 2011 date the law requires. In addition, Montefiore decided to cover children to the end of the year they turn age 26 (the law only requires coverage up to the child s 26 th birthday) and to broaden the coverage opportunity to its self-insured dental plans. Montefiore is also extending coverage to children whether or not they are eligible for their own employer-sponsored health coverage. If you have not already done so, you may enroll any eligible children (along with proof of his or her family status a birth certificate, adoption papers, etc.) during this annual election period. If you previously enrolled a child effective September 1 st, your child will be listed under your family coverage online at MonteCare PPO In-network Copayments for Preventive Care In-network copayments for preventive services have been eliminated, regardless of whether you use Montefiore facilities and physicians in the Montefiore Integrated Provider Association (MIPA) or the Empire BlueCard PPO Network. The following changes are being made to MonteCare PPO in-network copayments. In addition, in network copayments for mental health and substance abuse services are now set at the same level as primary care physicians, as opposed to specialists. Professional Services Preventive Care including: oannual o Physical Exam oroutine o OB/GYN Exams owell o Child Exams/ Immunizations Office Visits including Mental Health/Substance Abuse Care oprimary o Care Physician omental o Health Providers ospecialist o MonteCare PPO Pays MIPA/MBCIPA Empire BlueCard PPO Network 100% 100% 100% after $15 copay 100% after $25 copay 100% after $15 copay 100% after $25 copay 100% after $25 copay 100% after $35 copay 3

4 Out-of-network Benefits Lifetime Limit Eliminated The lifetime limit on the dollar value of outof-network benefits under the MonteCare PPO no longer applies. Individuals whose coverage ended due to reaching the lifetime limit under the plan are eligible to enroll during this Annual Benefits Election Period. Changes to Eligible Expenses for Health Care FSA Reimbursement Effective January 1, 2011, you will need a doctor s prescription for over-the-counter (OTC) medications (such as cough medicines, pain relievers, acid controllers, asthma and allergy medications) to be eligible for reimbursement from your Health Care Flexible Spending Account (FSA). Insulin will remain eligible without a prescription. In addition, you will no longer be able to pay for prescribed OTC medications using the WageWorks Health Care Card. You will need to use another form of payment and then submit a reimbursement request along with the doctor s prescription. During the FSA grace period, when you can apply eligible health care expenses incurred from January 1, 2011 through March 15, 2011 against your 2010 Health Care FSA, over-the-counter medications will not be eligible for reimbursement unless you have a doctor s prescription. Certain health care expenses may require a Letter of Medical Necessity from your provider when you submit claims to determine if your expenses qualify for reimbursement (e.g., alternative healers, dietary supplements and humidifiers). A complete list of these expenses can be found on the Benefits CD and at Claim Denials and Appeals Process The PPACA also requires the following changes to the Claim Denials and Appeals process. Rescission of coverage (i.e., if coverage is terminated retroactively) will be treated as a claim denial for purposes of applying the internal appeals requirements. Urgent care claims must be decided and you must be notified within 24 hours after the claim is received, unless your claim is incomplete. The plan must provide you with detailed information about the grounds for the denial of claims or coverage. If a claim is denied, you have the right to appeal the plan s decisions: othrough o the plan s internal claim appeal and review process, and oto o an outside, independent decision-maker, regardless of your state of residence or type of health coverage. The plan must notify you about your right to appeal and instruct you on how to begin the appeals process. The plan must ensure a full and fair review of the denial by taking steps to avoid conflicts of interest in the appeals process and ensure that individuals who make benefit determinations are independent and impartial. If the plan or the claims administrator fails to comply with any aspect of the appeals requirements, you have the right to bring a civil action under Section 502(a) of ERISA. The plan must also comply with the consumer protections provided in the Uniform Health Carrier External Review Model Act. Additional information about Claim Denials and Appeals can be found on the Benefits CD. 4

5 Non-PPACA Changes New Nutritional Counseling Benefit! Effective January 1, 2011, as part of Montefiore s focus on wellness, if you are referred by a physician, the MonteCare PPO will provide in-network coverage for up to six nutrition counseling sessions each calendar year at no cost to you. Services must be provided by a Registered Dietician in the Empire BlueCard PPO Network. Conditions that will allow an individual to take advantage of this benefit include, but are not limited to: Anorexia nervosa/bulimia Celiac disease Cardiovascular disease Crohn's disease Diabetes Disorders of metabolism Hyperlipidemia Hypertension Liver disease Metabolic syndrome x Malabsorption syndrome Metabolic syndrome x Multiple or severe food allergies Nutritional deficiencies, Obesity (bmi 27 or 95th percentile) Post- bariatric surgery Pre-diabetes Renal failure Ulcerative colitis. MonteCare Outpatient Surgery In-network Copayment Beginning January 1, 2011, individuals who undergo outpatient surgery at a non-montefiore facility will be subject to an in-network facility copayment of $250. This new copayment does not apply to colonoscopies, which are considered a preventative procedure, regardless of where the procedure is performed. MonteCare PPO Facilities Montefiore Empire BlueCard PPO Network Outpatient Surgery 100% 100% after $250 copay Health Net EPO Charter Plan II HMO will not be offered in 2011 Earlier this year, Health Net s northeast subsidiaries were acquired by United Healthcare. For this reason and due to extremely low participation in Health Net, the Health Net EPO Charter Plan II HMO will no longer be offered as an option for If you are currently a Health Net member, you must make a new medical election during the Annual Benefits Election Period. If you do not make a new election, you will be automatically enrolled in the MonteCare PPO in the same coverage category i.e., you alone or you and your family. 5

6 Group Life and Accident Insurance Plan Improvements 6 Important The number of options, maximum limits and cost for every $1,000 of Life and Accident Insurance has not changed. There is no need to re-enroll unless you wish to increase your coverage. Effective January 1, 2011, the Group Life Insurance Plan will be underwritten by Principal Life Insurance Company and Group Accidental Death & Dismemberment (AD&D) coverage will be underwritten by OneBeacon, a Principal Life Insurance Company business partner. As a result of the change in insurance carriers, important improvements have been made to the plans. Increased Accelerated Death Benefit Under the Group Life Insurance Plan, the Accelerated Death Benefit provision allows you to request payment of up to 75% of your Basic and/or Supplemental Life Insurance ($187,500 maximum payment for each line of coverage; $375,000 combined), if you have a terminal illness with a life expectancy of 12 months or less. Under the current plan you may only request up to 50% of your Basic Life Insurance up to a maximum benefit of $125,000. Additional AD&D Benefits: ohome o Alteration and Vehicle Modification Benefit If you require a wheelchair on a permanent basis, you may be eligible for a benefit equal to the lesser of the actual onetime cost, 10% of the Principal Sum or $10,000. orehabilitation o Benefit If you require occupational training, you may be eligible for a benefit equal to the lesser of the actual cost of training, 10% of the Principal Sum or $10,000. oseat o Belt and Air Bag Benefit if you were wearing a seat belt and protected by an airbag during a fatal car accident, your beneficiary may be entitled to a benefit equal to the lesser of 10% of your Basic AD&D Insurance or $10,000. otravel o Assistance Services If you travel 100 or more miles away from your home, Travel Assistance Services include pre-trip information, emergency medical evacuation and repatriation. Continuation of Coverage Additional opportunities are available after you leave Montefiore to continue: obasic o and Supplemental Life Insurance coverage as a group term life insurance policy and ooptional o AD&D coverage. Currently, after you leave Montefiore, if you wish to continue life insurance coverage, you can only convert to a more expensive whole life insurance policy and there is no opportunity to continue your AD&D coverage. Evidence of Insurability (EOI) If you want to increase your Supplemental Life Insurance, you may need to provide Evidence of Insurability (EOI) to the insurance company before changes to your coverage can take effect. Evidence of Insurability will be required if you make make any of the following changes: oyou o previously waived coverage and wish to elect Supplemental Life Insurance during this Annual Benefits Election Period. oyour o current Supplemental Life Insurance is equal to or greater than three times your annual base salary and you wish to increase your coverage. oyou o wish to increase your Supplemental Life Insurance by more than one times your annual base salary (even if your coverage is less than three times your salary for example, if you currently have coverage of one times your salary and you want to increase it to three times your salary). Evidence of Insurability is not required in the following situations: oyour o current Supplemental Life Insurance is less than three times your annual base salary, and you wish to increase your coverage by one times your annual base salary (up to the three times maximum). oyour o coverage increases because your salary or the maximum increases. If your election requires EOI, coverage and contributions won t begin until you receive written approval from the insurance company.

7 To Your Health! New Wellness Program Montefiore s new To Your Health! website provides a variety of resources and tools that can help you become active, stay healthy and enable you to realize your health potential. Register on the To Your Health! website and take the first step toward control of your health and well-being. Next, complete the To Your Health! Assessment. Just answer a few questions about your current health status and lifestyle. The assessment will only take about 15 minutes and within moments you ll receive a detailed, easy-to-understand report that identifies your personal health risks along with a customized plan to help reduce or eliminate them. Your answers are completely confidential. No one at Montefiore will see your personal information. Federal law (HIPAA) prohibits any health care organization from sharing your personal health information without your prior consent. To get the most out of the To Your Health! Assessment, you should have the following information in front of you before you begin to answer the questionnaire: Your height Your weight Your blood pressure Your total cholesterol, LDL, HDL and triglycerides. You can take the Health Assessment without this information, but you will get a more accurate picture of your health if you can provide some or all of it. Remember, take the To Your Health! Assessment by December 31, 2010, to be eligible (full-time and part- time associates only) for a pedometer, t-shirt, and voucher for a healthy meal at the cafeteria. Save and print out the Congratulations you receive after you complete the assessment. You will need it to claim your reward at one of the distribution locations listed on the Montefiore Intranet and in Montefiore Update. Associate Registration Spouse/Domestic Partner Registration toyourhealth@montefiore.org to receive an access code for your spouse or domestic partner. The should include your name, your spouse s or domestic partner s name, his or her date of birth, and address. 7

8 SOME IMPORTANT REMINDERS! Save Money through Flexible Spending Accounts (FSAs)! You must make a new Health Care and/or Dependent Care FSA election if you want either or both of these accounts in Your current FSA elections will not roll over into next year. Health Care FSA This account pays your out-of-pocket health care expenses including: deductibles, coinsurance, copayments, amounts above reasonable and customary limits, and other unreimbursed medical, dental, prescription drug, vision and hearing expenses. Use this account to pay expenses for anyone you claim as a dependent on your federal income tax return as well as children to age 26, regardless of whether they are dependent upon you and whether or not they are enrolled in Montefiore s medical or dental plans. Estimate your out-of-pocket health care expenses and FSA election conservatively to avoid forfeitures. You can always increase your contributions next year. To see how a Health Care FSA can save you money, try the WageWorks Health Care FSA Calculator ( employee/health-care/calculators/fsa.aspx). Dependent Care FSA Use this account to pay an individual or facility to provide day care for your eligible family members children under age 13 or incapacitated adults you claim as dependents on your federal income tax return. The Dependent Care FSA is strictly for day-care-related expenses you incur because you (and your spouse, if you are married) work or are looking for work not for dependent health care expenses. Estimate your out-of-pocket dependent care expenses and FSA election conservatively to avoid forfeitures. You can always increase your contributions next year. To see how a Dependent Care FSA can save you money, try the WageWorks Dependent Care FSA Calculator ( 8

9 Non-tobacco User Savings for Supplemental Life Insurance Continue Tobacco use translates into additional health risks and increased dollars being spent on health care and has an adverse effect on overall life expectancy. If you are a non-tobacco user and answer No to the tobacco use question when you elect Supplemental Life Insurance, you will receive a 10% discount on your insurance premiums. This benefit continues from last year, when the discount was first introduced. You are considered a non-tobacco user if you have not smoked cigarettes or cigars, used pipe tobacco or chewing tobacco during the 12 months immediately before October 1, Rate per $1,000 Rate per $1,000 Rate per $1,000 Age Nonsmoker Age Non- Age Non- Group Smoker Group smoker Smoker Group smoker Smoker Under Be sure to answer honestly. Failure to accurately respond to the tobacco use question is a policy violation that may result in loss of benefits and future forfeiture of Supplemental Life proceeds. Montefiore Medical Center Voluntary Tax Deferred Annuity 403(b) Plan The Montefiore Medical Center Voluntary Tax Deferred Annuity 403(b) Plan provides an excellent tool to help you save for your future financial security. Your before-tax contributions are automatically deducted from your paycheck and accumulate earnings on a tax-deferred basis. You make your own investment decisions based on your investment strategy and the level of risk you are willing to accept. You can change your allocations and transfer amounts among investment options. Maximum contributions are determined by the IRS and are adjusted annually. Plus, there are two catch-up opportunities. The maximum you can If you: contribute for 2011 is: Are under age 50 $16,500 Qualify for the full annual 15+ Years of Service Catch-up Contribution $19,500 (16,500 + $3,000) Qualify for the Age 50+ but not the 15+ Years of Service Catch-up $22,000 ($16,500 + $5,500) Contribution Qualify for the Age 50+ and the 15+ Years of Service Catch-up Contributions $25,000 ($16,500 + $3,000 + $5,500) At any time during the year, to elect the Voluntary Tax Deferred Annuity 403(b) Plan, change your election and/or if you are eligible for and want to make a catch-up contribution, contact Principal at or go online to 9

10 During Enrollment, Don t Forget Log on to Montefiore s Benefits Website or call the Benefits Enrollment Call Center at , Monday through Friday, between 8am and 8pm EST. You ll speak to an enrollment specialist who will help you enroll. Review your current information (address, phone number, etc.) and notify HR of any corrections on a Change of Information Form (a copy is on the Benefits CD under the Resource section or on the HR site of the Corporate Intranet). Life Insurance oanswer o the tobacco use question for Supplemental Life Insurance. Answer Yes if you have smoked cigarettes or cigars, used pipe tobacco or chewing tobacco at any time during the 12 months prior to October 1, Answer No if you are a non-tobacco user. You will receive a 10% discount on your Supplemental Life Insurance premiums. omake o sure your beneficiary designations are up-to-date for Life and AD&D Insurance. Health Care Make sure you record each family member you wish to enroll in health care coverage! All enrolled family members must have their Social Security Numbers on file to be eligible for coverage. Flexible Spending Accounts You must make a new Health Care and/or Dependent Care FSA election if you want either or both of these accounts in Your current elections will not roll over into next year. 10

11 We Want To Hear From You! Last year during the annual election period, we conducted a survey about our Benefits Communication. Thanks to the feedback we received, we have a better understanding of your communication needs and can respond accordingly. For example, we heard from a number of respondents that the enrollment period was too short; this year we have extended it to three weeks. We are conducting another survey this year, focusing on different areas. We encourage you to complete the online survey it will only take a few minutes. Your feedback will help us improve our future benefits communication. You can find a link to the survey on the Benefits CD, after you enroll on or you can go directly to 11

12 This Newsletter provides only highlights of the Associate Benefits Program in effect on January 1, 2011 and serves as a Summary of Material Modifications to the Summary Plan Description dated January 2010 describing the Montefiore Medical Center Associate Benefits Program, Montefiore Medical Center Multi-Benefit Cafeteria Plan and the Montefiore Medical Center Insured Benefit Plan with respect to Associate benefits. It describes benefit changes as well as additional Plan administrative information required by the Employee Retirement Income Security Act of 1974 (ERISA) and the Health Insurance Portability and Protection Act (HIPAA). You can find additional information about the Associate Benefits Program on the Benefits CD and on Montefiore s Benefits Website at The actual provisions of the plans that make up the Associate Benefits Program are governed by the legal documents for each. If there is a discrepancy between the information presented here, in the Summary Plan Description and the legal documents, the legal documents will govern. Montefiore Medical Center expects to continue these plans indefinitely, but reserves the right to change, modify or terminate the Plans, in whole or in part, at any time and for any reason. In addition, the tax treatment of these benefits is subject to change without notice, as determined by federal, state or local tax authorities. Corporate Human Resources Division HR-Benefits Office 111 East 210th Street, Bronx, NY montebenefits@montefiore.org