Health Benefits Effective January 1, Subject to change.

Transcription

1 Health Benefits Effective January 1, Subject t change. Purpse: T utline the guidelines related t medical, prescriptin, dental and visin benefits. Scpe: All team members f Hackensack Meridian Health. Plicy: Hackensack Meridian Health, HMH, prvides a grup Health Benefits Prgram t eligible team members. Eligibility Team members are eligible fr the Health Benefits Prgram if they are in a regular full-time r regular part-time benefit-eligible psitin, (wrking hurs per week) with standard hurs f 20 hurs r mre per week. Team members whse standard hurs are less than 20 hurs per week, have a status f Per Diem r Temprary are nt eligible fr the prgram. Cverage becmes available effective the first day f the mnth fllwing date f emplyment. Benefit-eligible team members and their cvered dependents may participate in single, emplyee/spuse, emplyee/child(ren), r family medical, prescriptin, dental, r visin cverage. It is the team member's respnsibility t ntify HMH in the event f a change in enrllment status within 31 days f a qualifying life r enrllment event. Failure t d s will result in disciplinary actin, up t and including terminatin f emplyment. (See Qualifying Life Events sectin belw fr mre details) HMH shares a prtin f the cst f cverage fr team members and their cvered dependents fr the medical/rx and dental plans. Team members pay the full cst f any visin electin. Definitin f Eligible Dependents Legal Spuse shall mean the persn recgnized as the cvered team member's husband r wife under the laws f the state where the cvered emplyee lives. Civil Unin is a legally recgnized unin f a same-sex cuple, with rights similar t thse f marriage. Imputed incme applies fr civil unin partners unless he/she meets definitin f dependent as defined under Sectin 152 f the Internal Revenue Cde ( IRC ) Defense f Marriage Act (DOMA) - The IRS ruled that the same-sex cuples, legally married in jurisdictins that recgnize same-sex marriage, will be treated as married fr Federal tax purpses. The ruling's brad impact extends t matters such as: Spusal prtectins and rllver rights in retirement plans Taxatin f grup health benefits COBRA health cverage electins Special enrllment rights under the Health Insurance Prtability and Accuntability Act Leave rights under the Family and Medical Leave Act Grandfathered Dmestic Partners, f the same r ppsite sex, bth f whm are at least 18 years f age, must share a clse persnal relatinship, and have shared the same residence fr n less than six (6) mnths. This is a clsed grup wh must still meet certain eligibility criteria in rder t maintain eligibility. The cst f the benefit is subject t imputed incme unless DP is cnsidered a dependent under IRC Sectin 152. Children wh have nt attained age 26 will be eligible fr cverage under the medical plan regardless f their eligibility fr ther insurance cverage, student status, tax dependency r marital status.

2 Children wh have nt attained age 19, r are full-time cllege students (12 credits fr undergrad, 9 credits fr graduate) age 19-23, will be eligible fr cverage under the dental and visin plans. In rder t maintain eligibility as dependents under the dental r visin plans, student dcumentatin shwing eligibility must be submitted in the Spring and Fall upn request. Dcumentatin must include a bursar's receipt r transcript fr the semester in questin. The term "child" r "children" shall include: natural children adpted children Children placed with a cvered emplyee in anticipatin f adptin. The term "placed" means the assumptin and retentin by such team member f a legal bligatin fr ttal r partial supprt f the child in anticipatin f adptin f the child. Cverage f these pre-adptive children is in accrdance with the requirements f the federal Omnibus Budget Recnciliatin Act f The child must therwise be available fr adptin and the legal prcess must have cmmenced. Step-children If a cvered team member is the legal guardian f an unmarried child r children, these children may be enrlled in the health plan as cvered dependents. Any child wh is an alternate recipient under a qualified medical child supprt rder shall be cnsidered as having a right t dependent cverage under the health plan. Cverage f these children is in accrdance with the requirements f the federal Omnibus Budget Recnciliatin Act f Unmarried dependent children age 19 r ver, unable t earn a living due t mental r physical disability and wh depend n the cvered emplyee fr supprt. Fster children are ineligible t participate. Enrllment Dcumentatin If yu enrll r make changes in ur health benefits plans, Human Resurces may require prf f eligibility upn request thrugh an independent auditing firm, t supprt prf f eligibility. The fllwing dcuments may be requested by the auditing firm t enrll r maintain cverage fr eligible dependents as defined abve: 1. Legal Spuse - certified marriage certificate frm the municipality in which yu were married 2. Dependent Children - certified birth certificate, adptin papers and/r legal dcumentatin frm the curt 3. Scial Security Numbers f all dependents. 4. Prf f ttal disability fr cvered dependent wh is disabled 5. Prf f student status - 12 credits fr undergrad, 9 credits fr graduate fr dependents age 19 and ver fr dental and visin plans 6. Tax Recrds 7. Civil Unin Certificate f Civil Unin, r certified Marriage Certificate T maintain eligibility fr a grandfathered dmestic partner status, all dcumentatin must prve t have been in effect fr a minimum f six (6) mnths prir t the health insurance cverage effective date. All three (3) dcuments prvided as prf must be selected frm the separate grupings belw - (ne selectin per grup). Three f the fllwing dcuments evidencing the cmmitment f the relatinship are required. Jint mrtgage r lease Designatin f the dmestic partner as primary beneficiary in the team member's will, life insurance, r retirement cntract. Durable pwer f attrney fr health care r financial management. Jint wnership f a mtr vehicle, a jint checking accunt r a jint credit card

3 A relatin r chabitatin cntract which bligates each f the parties t prvide supprt fr the ther party State f New Jersey Certificate f Dmestic Partnership T maintain eligibility in the medical plan fr a grandfathered Civil Unin partner status, a Certificate f Civil Unin r marriage license must be submitted as prf evidencing the cmmitment f the relatinship. Please nte: Child(ren) f grandfathered dmestic partners r grandfathered Civil Unin, are eligible dependents cvered under the plans discussed in this plicy. Tax treatment f the team member s cntributin will be dependent upn whether the dependent is cnsidered yur qualified tax dependent under IRC Sectin 152. Yu may be asked t prduce prf f tax dependency at least annually at the end f the plan year. If yur dependent is nt a qualified tax dependent, the value f the HMH prvided medical cverage fr the dependent will be treated as taxable incme t yu, a cncept knwn as imputed incme. Medicare Eligibility Team members wh are eligible fr Medicare, actively wrking with HMH and age 65 r ver, and/r their spuse is eligible fr Medicare and age 65 r ver, bth the team member and the spuse must be aware that their benefits thrugh HMH are their primary health benefits. If team members are eligible fr Medicare, and are nt actively emplyed at age 65 r ver, the benefits will be reduced t the extent that benefits fr the services received are available under Medicare. If team members are under 65 and disabled, the HMH benefits will be primary. Medicare will supplement these benefits. Enrllment/Changes At the time f hire/eligibility, the qualifying team member must access the Team Member Benefits Prtal thrugh MyWay - PepleSft. If the team member enrlls dependents, their cverage will becme effective n the first day f the mnth fllwing date f emplyment. All team members are still required t prvide prf f eligibility upn request. Team members ging frm benefit-ineligible t benefit-eligible will immediately be able t enrll in the apprpriate benefits n the date f the jb change if they have already satisfied the initial waiting perid. Qualifying Life Events Team members wh d nt enrll themselves and/r their eligible dependents at the time f eligibility will nt be eligible fr cverage until a subsequent pen enrllment perid r a qualifying life status event as determined by the IRS ccurs. Qualifying life status events include the fllwing: Changes in the team member's legal marital status (marriage, death f spuse, divrce, legal separatin (under state law), and annulment). Change in the number f team member's dependents (birth, death, adptin, placement fr adptin). Change in the emplyment status f the team member, spuse, r dependent (terminatin/ cmmencement f emplyment, beginning r end f an unpaid leave f absence, change in wrk site. Als included is change in emplyment status that affects plan eligibility, such as changing frm hurly t salaried status). Change in dependent status (dependent reaching cntract terminatin age, marriage f the child). Change in residence f the team member, spuse r dependent. (When team member/dependent mves ut f a plan's service area, i.e. an HMO.) The annual Cafeteria Plan pen enrllment fr a spuse's plan.

4 Human Resurces must be ntified within 31 days f a qualifying event. If yu d nt ntify the Plan within 31 days f the event and yur ineligible dependents cntinue t utilize services under the Plan, this will be cnsidered fraud and will result in the terminatin f the team member's and the dependents' cverage. Enrllment int the benefits plan is nt autmatic; the team member must access the Team Member Benefits Prtal thrugh MyWay - Peplesft. Team members have 31 days t make a change after a qualifying life event. Team members will be mailed identificatin cards fr their medical, dental, visin and prescriptin cverage. These cards shuld be carried at all times and presented t the hspital r physician whenever emplyees r eligible dependent(s) receive medical/prescriptin r dental services. Online Resurces The benefit plan carriers ffer 24/7 nline access t claims statements, Explanatin f Benefits (EOB), prvider selectin infrmatin, and ther member tls. Yu can visit fr mre infrmatin. COVERAGE The health plans ffered are described in detail in the varius Summary Plan Descriptins (SPDs) available n the Team Member Benefits Prtal. Team members are encuraged t review the SPDs t becme familiar with their cverage tiers, deductibles, and c-insurance charges. After reviewing the SPDs, if emplyees still have questins regarding their cverage, they may cntact the plan carriers thrugh the member services cntacts fund n The team member s prtin f the health, dental and visin premiums are deducted bi-weekly, frm their paychecks. Prescriptin Plan HMH ffers nsite pharmacies created s team members can cnveniently fill prescriptins fr themselves and their families. In Huse pharmacies accept OptumRX cards and ther third-party insurance plans. In-huse pharmacies als prvide team members with the pprtunity t btain 90-day supplies f maintenance medicatins. The percentages f csts and maximums fr the 90-day supply f maintenance medicatins are mre favrable ut-f-pcket thrugh In-Huse Pharmacy vs Mail-rder fr 90-day supply. Specifics regarding cverage tiers, deductibles, and c-insurance charges under the prescriptin plan are available at the Team Member Benefits Prtal. Team members must fill their maintenance medicatins thrugh any in-huse pharmacies r thrugh mail rder with OptumRx. If a generic is available and the pharmacy fills it with the brand name drug fr any reasn, the team member will pay the difference between the generic and the brand, as well as the generic c-pay. Dental Plan HMH ffers a cmprehensive dental plan administered by Hrizn Blue Crss Blue Shield f NJ. Eligibility fr the dental plan is n the 1st day f the mnth fllwing date f emplyment. Dependent children are cvered t age 19, 23 if full-time cllege students. Mre specifics regarding dental cverage are available at the Team Member Benefits Prtal.

5 Visin Plan A visin plan thrugh Hrizn Blue Crss Blue Shield f NJ is ffered t benefit eligible team members. NOTE: Prf f full-time student status fr the fall and spring semesters are required t btain r maintain cverage. Failure t submit prf f student status will result in dis-enrllment f the dependent child(ren) frm the dental and visin plans. TERMINATION OF HEALTH COVERAGE When a team member terminates r becmes ineligible due t a reductin f hurs, cverage ceases n the day in which the change ccurs. Cverage ceases fr dependent children the end f the mnth in which they reach the limiting age f 26 fr medical, the actual day yur dependent reach age 19, r 23 if full-time cllege student, fr dental r visin cverage. Excluded frm age limits are children physically r mentally disabled and incapable f earning their wn living. Shuld HMH terminate the benefits plan, cverage fr all team members will end n that date. COBRA With the passage f the Cnslidated Omnibus Recnciliatin Act f 1985, team members are required t ffer frmer team members, retirees, spuses and dependent children the right t cntinue health cverage. HMH is mandated by law t ntify the Plan Administratr (Hrizn BCBS f NJ) f a qualifying event within 30 days f a team member's terminatin, reductin in hurs, death r entitlement t Medicare. Qualified beneficiary must ntify HMH within 60 days f divrce, legal separatin r child ceasing cverage. Under COBRA, team members and their eligible dependents may elect t cntinue grup health cverage if their cverage wuld have therwise ended as a result f the fllwing events: Vluntary r invluntary terminatin Reductin in the number f hurs Medicare entitlement Divrce r legal separatin Death f cverage emplyee Lss f dependent child status Scial Security disability If cverage is t cntinue, the team member and/r eligible dependents will be respnsible fr paying 102% f the premium fr that cverage. Cverage will be identical t the health care cverage fr the grup and wuld be extended as fllws: Qualifying Events Beneficiary Cverage Terminatin Team Member 18 Mnths Reduced hurs Spuse/Dependent Child 18 Mnths Team Member entitled t Medicare, Divrce/Legal Separatin r death f Team Member Spuse/Dependent Child 36 Mnths

6 Lss f Dependent Child Status Dependent Child 36 Mnths Scial Security Disability Team Member/Spuse 29 Mnths HMH expressly reserves the right, in its sle and abslute discretin, t change, mdify r delete the prvisins f this plicy in whle r in part, at any time r fr any reasn withut ntice. The emplyment terms set ut in this plicy wrk in cnjunctin with, and d nt replace, amend, r supplement any terms r cnditins f emplyment stated in any applicable cllective bargaining agreement. Wherever emplyment terms in this plicy differ frm the terms expressed in the applicable cllective bargaining agreement, team members shuld refer t the specific terms f the cllective bargaining agreement, which will cntrl. Any questins regarding this plicy and prcedure may be referred t Human Resurces.