2020 BENEFIT GUIDE - AMITA Health
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Covering Dependents Qualifying Life Events.............................................p. 6 Proof of Dependent Relationship.........................p. 7 Accepted Forms for Proof of Dependent Relationship Health Medical Plan..............................................................p. 8 Prescription Drug Plan............................................p. 11 Wellness Program....................................................p. 12 Diabetes Management, Simplified.......................p. 12 Dental Plan.................................................................p. 13 Vision Plan.................................................................p. 15 Premiums for Medical, Dental, Vision.................p. 16 Income Security Basic Life and Supplemental Life/AD&D............p. 17 Spouse/Child Life and AD&D….............................p. 18 Short-Term Disability...............................................p. 19 Long-Term Disability................................................p. 19 Voluntary Whole Life...............................................p. 20 Voluntary Accident...................................................p. 20 Voluntary Critical Illness.........................................p. 20 Ascension Health Retirement Plan......................p. 21 Additional Benefits Legal Plan…................................................................p. 23 Flexible Spending Accounts..................................p. 24 Commuter & Transit Benefits................................p. 26 Employee Assistance Program.............................p. 27 What’s Inside Resources Key Takeaways Mobile Information...................................................p. 28 Benefits at a Glance................................................ p. 4 Benefit Contacts.......................................................p. 29 How to Enroll Important Notifications............................................p. 30 Where to find Benefit Information Frequently Asked Questions (FAQs)...................p. 31 Changes to Benefits Reminders Eligibility and Effective Dates................................ p. 5 Eligible Dependents Available Coverage Levels Paid Time Off Snapshot Coverage Termination This benefits material briefly describes the excellent benefits program that is available as part of employment with AMITA Health. This information is not a contract. Any of the benefits, policies or procedures may be changed as the organization requires, and nothing contained in this material shall be construed as creating an expressed or implied obligation or contract on the part of AMITA Health. Associate is responsible for monitoring work emails, understanding benefit information, how to enroll and premium payroll deductions review.
KEY TAKEAWAYS KEY TAKEAWAYS BENEFITS AT A GLANCE Benefits include - Health, Income Security and additional benefit offerings. Medical (Includes Prescription) This guide provides general information regarding benefit options available to full-time and part-time *To see if your provider(s) are in plan, go to Basic Life/AD&D 1x Salary Long-Term Disability associates including enrollment instructions for your convenience. You will see a few variances between http://www.AMITAhealthprovider.org the ministry benefit offerings. Your enrollment record in Benefit Express will indicate the benefits Dental Voluntary Life/AD&D Hyatt Legal Plan available to you at your work ministry. Vision Spouse Life/AD&D VOYA Critical Illness How to Enroll Where to find Benefit Information Wellness Program / Diabetes Management Child Life/AD&D VOYA Accident Insurance • Log into Benefits Express via a work computer • iAMITA Intranet Site: Health Care Flexible Spending Account Short-Term Disability VOYA Whole Life www.AMITAHealthBenefits.com My Life > Human Resources > Benefits Dependent Care Flexible • After your initial login to a work computer, • Benefit Express under Library: Wellness Program Paid Time Off Spending Account enrollment can be completed from a personal www.AMITAHealthBenefits.com Employee Assistance Program Ascension Health Retirement Plan computer or mobile device. • You MUST enroll within 31 days of start date Changes to Benefits on the Benefits Express website. Eligibility and Effective Dates Available Coverage Levels Outside of New Hire Enrollment or annual Open Enrollment, associates have 31 days from their • Full-Time is 36 – 40 standard hours per week • Employee Only • Employee + Children* Benefit Express qualified life event to make a change in benefit • Part-Time is 20 – 35.99 standard hours per week • Employee + Spouse* • Employee + Family* elections via the Benefit Express website. Medical, dental, vision, flexible spending accounts, *You must click on the check box next to each Examples of Typical Qualified Life Events: life, and legal benefits are effective 1st of the dependent's name, within each benefit page month following 30 days of employment based on to link dependents to each plan that you want • Birth/Adoption of Child them enrolled in. Select WAIVE if you do not benefit eligibility date. Long-Term (LTD) and Short- • Change in Job Status (FT, PT, or PRN) Term Disability (STD) benefit effective dates are want a benefit. • Gain or Loss of other Coverage dependent on the ministry in which you work. • Marriage/Divorce When you access your enrollment record in Paid Time Off (PTO) Snapshot Benefit Express, you will see one of the two Exempt/Salary associates will receive a front- Logging into Benefit Express: effective dates below: loaded PTO bank of 27 days per year, prorated REMINDERS STEP 1: • LTD/STD effective 1st of month following 90 days, based on FTE (Full-Time Equivalent). This PTO bank • YOU MUST ENROLL FOR BENEFITS WITHIN 31 is “use it or lose it” meaning hours remaining in • Your USERNAME and PASSWORD is the same DAYS OF YOUR DATE OF HIRE, FIRST DAY IN A or • LTD/STD effective 1st of month following 30 days bank at end of year will be forfeited. that you chose after logging into your network BENEFIT ELIGIBLE POSITION, OR A QUALIFYING computer for the first time. LIFE EVENT. This includes uploading dependent Non-Exempt/Hourly associates accrue PTO based verification document(s), and/or documentation to Coverage Termination on years of service (prorated based on FTE) and STEP 2: eligible paid hours up to a maximum of 80 paid support your life event. • For dependent child reaching age 26, all • Once you login to Benefits Express, choose hours per pay period. First year associates can • YOU CAN ONLY MAKE CHANGES TO BENEFITS coverage ends 11:59 pm day before 26th birthday accrue up to 16 days. the option to accept the website’s terms DURING NEW HIRE ENROLLMENT, OPEN • Coverage upon termination of employment: and conditions. Medical Residents, Pharmacy Residents, ENROLLMENT, OR WHEN A QUALIFIED LIFE • Click Next to proceed to your personalized EVENT OCCURS. • Medical, dental and vision ends last day of the Physicians, Hospitalists, Hospitals, Mid-Level Benefit Express welcome page. month in which termination falls Providers and contracted associates–refer to • All other coverages end on termination date your agreement. • Choose the Enroll Now option to begin, or select Please note!! In the event you elect benefits in the appropriate life event allowing you to make Benefits Express just to view costs, you MUST • A status change to registry or benefit Holidays during the course of the year consist of benefit changes outside of Open Enrollment. make sure to select WAIVE if you do NOT want ineligible will have coverage to last day eight holiday’s including New Year’s Day, Martin the benefit BEFORE exiting system. of the month Luther King, Jr. Day, Good Friday, Memorial Day, Independence Day, Labor Day, Thanksgiving, Any selections made are finalized during Christmas Day. overnight processing regardless of See respective policies for additional information. completing your enrollment or clicking on the Submit button. Always review and keep a copy of your benefit confirmation statement for your records! QUESTIONS? Call 888.629.6424 4 5
COVERING COVERING DEPENDENTS DEPENDENTS Proof of Dependent Relationship All qualifying events If you are adding a dependent to any of the benefit If your document is not uploaded and approved must be entered into options, you are required to upload dependent within 31 days, you and/or your dependent will be verification documents within 31 days of the removed from coverage. My Benefit Express event date. Documents accepted for verification Dependent verification document approval are listed below. Please note: Provide copies of within 31 days of the the documents – not originals as these will not be generally takes place within 24–72 hours. If you still have not received an email or event date and required returned to you. If you are submitting a copy of your most recent federal tax return, please upload do not see a dependent verified and linked to coverage within 72 hours, contact rHR documentation uploaded the first page only which shows your dependents (blackout income information). immediately at 888.629.6424. Only government issued documents such as If you are having trouble obtaining required marriage certificate, birth certificate, or court documentation for life event or dependent ordered documents are accepted. Please upload verification, you must contact rHR BEFORE documents into My Benefit Express for review the 31 day enrollment window closes. and approval within 31 days of your life event. Qualifying Life Events My Benefit Express no later than March 31st. Verification documents must be uploaded This includes uploading dependent verification If approved, your eligible dependents will A qualifying life event is a change in your situation remain covered. and approved in Benefit Express prior to documents and/or applicable supporting life event the 31 day close of life event window, life – like getting married, having a baby or a gain documentation (i.e. proof of loss or gain of other or dependent verification. or loss of health coverage – that can make you coverage). If you do not, you will not be able to eligible for a special enrollment period, allowing make a coverage change until the next annual you to enroll or cancel some benefit coverages open enrollment period. outside of the annual open enrollment period, Accepted Forms of Dependent Verification (Relationship) Documentation which is generally in November. All qualifying events require proof (e.g., marriage Qualifying events include: DEPENDENT TYPE DOCUMENTATION REQUIREMENTS certificate, etc.) and must be uploaded into My Benefit Express when you enter your life event. Legal Spouse • Government Issued Marriage Certificate and last year filed federal tax return OR • Birth (including adoption)* If the document is NOT approved, you will • Government Issued Marriage Certificate and Proof of Joint Ownership Issued in last 6 months OR • Death of dependent (spouse or child) • Government Issued Marriage Certificate ONLY (if married in current calendar year). receive a work email letting you know what • Entitlement to or loss of Medicare or Medicaid else is needed, or if there is a problem with Biological Child • Government Issued Birth Certificate ONLY. (60 day enrollment window) (Age 0 up to 26) your enrollment. Disabled • Government Issued Birth Certificate AND completed disabled child certification form (must be • Gain of other coverage Adding a dependent will require a dependent Biological Child medically certified by a physician as disabled or by Social Security Disability (SSDI). • Legal Separation verification supporting document to be uploaded Step-Child • Government issued Birth Certificate AND Associate’s Government issued Marriage Certificate. and approved before your dependent information • Loss of eligibility for participation in Dependent (Age 0 up to 26) will be sent to the carrier(s). Link dependents to Care Flexible Spending Account (DFSA) Disabled Step-Child • Government issued Birth Certificate AND Associate’s Government issued Marriage Certificate AND applicable cover as you are completing your completed disabled child certification form (must be medically certified by a physician as disabled or • Loss of other coverage life event. by Social Security Disability (SSDI). • Marriage/Divorce *F or a birth or adoption event, you will be Adopted Child • Adoption Placement Agreement and Petition for Adoption OR A status change from full-time to part-time or able to add the dependent without the social (Age 0 up to 26) • Adoption Certificate ONLY. a benefit ineligible to an eligible position will security number. Once you receive his/her Disabled • Adoption Certificate AND completed disabled child certification form (must be medically certified by a automatically trigger an enrollment event. You will social security number, you must enter it into My Adopted Child physician as disabled or by Social Security Disability (SSDI). need to access My Benefit Express to enroll in Benefit Express as soon as possible. However, Legal Ward • Government Issued Birth Certificate AND Court Ordered Document of Legal Custody. coverage(s) within 31 days of the change date. the newborn will not be marked as verified until you have provided a government issued Disabled Legal Ward • Government Issued Birth Certificate AND birth certificate. The birth certificate MUST be • Court Ordered Document of Legal Custody AND All qualifying events must be entered into My provided within 31 days of the date of birth. If • Completed disabled child certification form (must be medically certified by a physician as disabled or Benefit Express within 31 days of the event date by SSDI. and required documentation uploaded. you do not provide the birth certificate within 31 days, your newborn will be removed from Qualified Medical • Qualified Medical Child Support Order ONLY. Must be ordered for the associate or spouse. coverage. If there is a problem with your life Support Order For example, if your child is born on March 1st, event or supporting dependent verification, an PLEASE NOTE: Verified dependent's are covered ONLY, if you have clicked the check box in each plan next to their name. you must enter the date of birth as the event date AND link the child to coverage(s) in email will be sent from Benefit Express to your work email. It is your responsibility to monitor 6 work emails! 7
HEALTH HEALTH AMITA Health Medical Plan 2020 Schedule of Benefits: PPO 500 90/10 Plan AMITA Health offers associates a Preferred • Claims questions, benefit questions, eligibility: Contact ABS Customer Service at 844.659.2519 • To view claims or order an ID card visit: www.abs-tpa.com Provider Organization (PPO) plan administered by • To find a doctor or view the provider directory at www.mysmarthealth.org Automated Benefit Services (ABS) and consists All eligible medical expenses apply towards all deductibles and out-of-pocket maximums. of the BlueCross BlueShield’s National Provider Benefits Tier 1 AMITA Network Tier 2 National Network (BCBS) Tier 3 Out-of-Network* Network (BCBS of Michigan, aka BCBSM). PPO plans allow associates to seek services from the Deductible • Individual • Family $500 / $1000 $1,500 / $3,000 $4,000 / $8,000 provider of their choice. The AMITA Health Medical Coinsurance Plan is a ‘tiered’ network with three tiers: • Plan Pays 90% after AMITA 70% after National 50% after Network Deductible Network Deductible OON Deductible 1. SmartHealth Network (Tier 1) consisting of • You Pay 10% after AMITA 30% after National 50% after Network Deductible Network Deductible OON Deductible AMITA Health, Adventist Midwest Health, You and your family members will experience • Total out-of-pocket Maximum (Deductible plus coinsurance and copays) Alexian Brothers Health System and a significantly higher level of benefits when • All eligible medical / Rx expenses apply toward all out-of-pocket maximums Presence Health System facilities and receiving your care from a SmartHealth • Individual • Family $4,000 / $8,000 $6,000 / $12,000 $10,000 / $20,000 contracted providers; Providers can be Network provider. Lifetime Maximum Unlimited found by going to the AMITA Health Services AMITA Network National Network Out-of-Network* (OON) provider website at www.mysmarthealth.org. Certain services may require satisfying a Preventive Service $0 $0 50% coinsurance after OON deductible. Once the deductible is satisfied by the Annual Routine Physical, Annual Sports Deductible 2. BlueCross BlueShield National Provider member, the plan will begin paying a portion of Physical, Well Baby/Child Care, Routine Network (Tier 2); and your remaining charges known as co-insurance. Immunizations, Annual Gynecological Exam/Annual Mammogram, AMITA Health PPO plan provides associates Screening Colonoscopy 3. Out of Network (Tier 3) – facilities/providers not financial security by placing an out-of-pocket limit Outpatient/Diagnostic Services 10% after AMITA 30% after National 50% after contracted with BlueCross BlueShield National on health care expenses. Physical/Occupational/Speech Therapy Network Deductible Network Deductible OON Deductible Provider Network. (Annual Maximum – 60 Visits), Lab, Associates are free to seek services from the Pathology, Radiation and Chemotherapy, provider of their choice, however, associates’ Radiology, Outpatient Surgery You and your family members will experience a out-of-pocket expenses will be significantly High Tech Radiology Pre-Certification Required Pre-Certification Required Pre-Certification Required significantly higher level of benefit coverage when • MRI, PET Scan, MRA 10% after AMITA 30% after National 50% after OON Deductible lower if services are received from a receiving your care from a SmartHealth Network Network Deductible Network Deductible SmartHealth Network Provider. provider. If you choose to seek care outside of • Dialysis 10% after AMITA 30% after National 50% after AMITA Health, you will have access to BlueCross Detailed Plan documents are available in Network Deductible Network Deductible OON Deductible BlueShield’s National Provider Network. Benefit Express > Library. Office Visits Primary Care $20 Copay $40 Copay 50% after (Family Practice/General Internal OON Deductible Medicine/Pediatrics) • Specialist (Including OB/GYN) $40 Copay $60 Copay 50% after OON Deductible SmartHealth BlueCross BlueShield • Pre/Postnatal Care $20 Copay $40 Copay 50% after Out-of-Network OON Deductible Network National Network • Chiropractic Office Visit (Annual $20 Copay $40 Copay 50% after maximum – 60 visits) Ancillary services OON Deductible are subject to deductible/coinsurance Tier 1 Tier 2 Tier 3 Mental Health $20 Copay $40 Copay 50% after • Individual Therapy/Group Therapy OON Deductible AMITA, Ascension, Providers in the BCBS Providers not in the • Inpatient Admission/Partial Day 10% after AMITA 30% after National 50% after and Adventist National Network BCBS Network Treatment, Intensive Outpatient Therapy Network Deductible Network Deductible OON Deductible Health System Substance Abuse $20 Copay $40 Copay 50% after • Individual Therapy/Group Therapy OON Deductible • Intensive Outpatient Therapy, Acute 10% after AMITA 30% after AMITA 50% after Least Expensive Most Expensive Inpatient Care Network Deductible Network Deductible OON Deductible • Residential Treatment Center Pre-Certification Required Pre-Certification Required Pre-Certification Required 10% after AMITA 30% after National 50% after Network Deductible Network Deductible OON Deductible Note: If you or your spouse are Medicare-eligible and continuing medical coverage through COBRA, your medical coverage through AMITA Health becomes secondary and Medicare is primary even if you are not enrolled in Medicare Part B. If you leave employment or lose benefit eligibility, contact • Partial Hospital Program 10% after AMITA 30% after National 50% after your local Social Security office to enroll in Medicare Part B as soon as possible Network Deductible Network Deductible OON Deductible Emergency Care • ER Visit – Copay $200 Copay $200 Copay $200 Copay waived if admitted 8 9
HEALTH HEALTH 2020 Schedule of Benefits: PPO 500 90/10 Plan (continued) Prescription Drug Coverage • Urgent Care $40 Copay $60 Copay 50% after Associates enrolled in the Medical Plan OON Deductible automatically receive the Prescription Drug • Ambulance 10% after AMITA 10% after AMITA 10% after AMITA Coverage benefit which is managed through Cigna. Network Deductible Network Deductible Network Deductible Members (including dependents) will receive • Medical Transfer/Transport Pre-Certification Required Pre-Certification Required Pre-Certification Required (non-emergent) their own Pharmacy ID card. For a complete listing of medications covered, go to www.myCigna.com. Inpatient Services • Per Admission Pre-Certification Required Pre-Certification Required Pre-Certification Required • Room and Board • Ancillary Services 10% after AMITA 30% after National 50% after OON Deductible • Surgery • Anesthesia Network Deductible Network Deductible Use of AMITA Health In-House pharmacies, may • Physician Charges reduce your medication expense. • Emergency Room Admission 10% after AMITA 30% after National 50% after Network Deductible Network Deductible OON Deductible Certain medications require Prior Authorization • Extended Care Facility 10% after AMITA 30% after National 50% after (Annual maximum – 120 days) Network Deductible Network Deductible OON Deductible from Cigna before they are covered by the plan. If you are not sure a medication requires approval, Other Services Pre-Certification Required Pre-Certification Required Pre-Certification Required • Durable Medical Equipment (DME) 10% after AMITA 30% after National 50% after OON Deductible please check on-line or call the toll-free number Network Deductible Network Deductible on the back of your Cigna ID card. In these cases, • Prosthetics & Orthotics (P&O) 10% after AMITA 30% after National 50% after if your doctor feels that an alternative medication Network Deductible Network Deductible OON Deductible isn’t right for you, he or she can ask Cigna to • Foot Orthotics – 2 pairs every 3 years 50% after AMITA 50% after National 50% after consider approving coverage of your medication. Network Deductible Network Deductible OON Deductible In addition, certain high-cost medications are • Hearing Aid ($2,000 max, every 3 years) 10% after AMITA 30% after National 50% after part of the Step Therapy program. Step Therapy Network Deductible Network Deductible OON Deductible encourages the use of lower-cost medications •Home Health Care (Annual max – 10% after AMITA 30% after National 50% after 100 visits) Network Deductible Network Deductible OON Deductible (typically generics and preferred brands) that can • Hospice 10% after AMITA 30% after National 50% after be used to treat the same condition as the higher- Network Deductible Network Deductible OON Deductible cost medication. • Allergy Testing & Treatment 10% after AMITA 30% after National 50% after Network Deductible Network Deductible OON Deductible Please note: 90-day supplies must be filled by • Bariatric Surgery Pre-Certification Required Pre-Certification Required Pre-Certification Required the AMITA Health pharmacies. Prescription drugs 10% after AMITA 30% after National 50% after OON Deductible classified as specialty medications may only be Network Deductible Network Deductible filled through an AMITA Health pharmacy. • Organ/Bone Marrow/Other Transplants Pre-Certification Required Pre-Certification Required Pre-Certification Required 10% after AMITA 30% after National 50% after OON Deductible Network Deductible Network Deductible • Wellness/Disease Management $0 $0 50% after • Diabetic Education OON Deductible • Smoking Cessation Counseling Intervention This is a brief summary of benefits, which are subject to change. In the case of a conflict between this summary and the official Summary Plan Description, the language in the Summary Plan Description will prevail. For further details about plan benefits, please contact ABS Customer Service at the number shown on the back of your ID card. Network Description: Tier 1 rep- resents the AMITA network, which is comprised of participating AMITA providers and facilities, as well as the broader Ascension AMITA network. Tier 2 represents BCBS participating providers. Members should make every effort to utilize a BCBS provider whenever an AMITA provider is not available in their area. Tier 3 represents Out-of-Network (OON) and any claim incurred could result in balance billing and/or additional charges to the member. Pre-certification Required - Failure to secure “Pre-certification” for services noted in the Summary Plan Description will result in no coverage/benefit paid under the Plan. For inpatient admissions, failure to obtain a pre-cert within (2) business days of admission will result in a $500 reduction in the facility pay- In-House Pharmacies Retail Pharmacies Out-of-Network* ment. Contraceptive Coverage: The U.S. Department of Health and Human Services, the Department of Labor and the Internal Revenue Service have jointly released final regulations regarding women’s preventive services under the Affordable Care Act (“ACA”). The ACA requires group health plans to provide coverage for “contraceptive services” as part of an array of women’s pre- Generic • 30 day $5 $10 No Coverage ventive services that must be included in health plans without cost sharing to covered participants (for AMITA and Alexian Brothers ministries). Exclusions - See the Summary Plan Description • 90 day supply $10 No coverage for complete information regarding exclusions. Preferred Brand • 30 day 15% ($25 Min / $50 Max) 25% ($40 Min / $80 Max) No Coverage • 90 day supply 15% ($50 Min / $100 Max) No coverage) Benefit Elevation Non-Preferred Brand AMITA's Benefit Elevation Program expands our • 30 day 20% ($50 Min / $100 Max) 25% ($80 Min / $160 Max) No Coverage **Please note that it takes a minimum of • 90 day supply 20% ($100 Min / $200 Max) No coverage network for needed specialties by allowing you 10 business days to process all benefit Specialty Rx – 30 Day Supply to use a National Network (Tier 2) provider and elevation requests.** • Available at AMITA 15% ($50 Min / $100 Max) No Coverage No Coverage receive the Tier 1 benefit coverage when a Tier 1 In-House Pharmacy provider is not available within 20 miles radius of For more information, go to Specialty medication administered by a healthcare provider or via infusion will be billed through medical and medical deductible/coinsurance participant’s zip code on record. http://www.amitahealthproviders.org/provider/ will apply. Self-administered specialty medications will be billed through Cigna. infocenter/member In-House pharmacy list is available at www.AMITAHealthproviders.org under Member Info Center/Pharmacy Self Service/AMITA In-House Pharmacy Directory. 10 11
HEALTH HEALTH Wellness Program What do I need to do in order to be eligible for AMITA Health Dental Plan incentives? AMITA Health provides you with a choice of Healthy Journey To be eligible for the grand prize drawing and 2021 medical insurance incentive, you must complete two dental PPO plans through Delta Dental—a “High” and “Low” Plan. Both are Delta Dental Together with CREATION Health the following steps by September 30, 2020: Preferred Provider Organization (PPO) plans, giving you the freedom to visit any licensed network or Our goal at AMITA Health is to improve the quality 1. Complete the on-site biometric screening non-network dentist for covered services. You do of life of the patients and communities we serve, (see schedule in Wellness portal), not have to designate a primary care dentist. Plus, but too often we are so focused on taking care of 2. Complete the online Health Risk Assessment, you can visit any dental specialist for covered others that we forget about our own health and and benefits up to an annual limit without waiting for wellness. That’s why the Wellness department is prior approval from the plan. 3. Earn a minimum of 100 points on the dedicated to inspiring, motivating and encouraging Wellness portal. healthy behaviors in you! You will generally save on the cost of covered Additional information on Wellness dental care when you use a dentist who The Wellness team invites you to join Healthy Program is available on iAmita under participates in the Delta Dental PPO network. Journey in 2020. This exciting, innovative program is designed to engage you all year long. Focused Departments>Wellness. on choice and convenience, Healthy Journey offers a variety of programs with the chance to win prizes! For More Information: • Search Delta Dental’s online dentist directory at Who can participate in the Healthy http://www.deltadentalil.com Preventative Dental Care Is Important! Journey program? Diabetes Management, Simplified You may receive two in-network cleanings • AMITA Health is part of the Delta Dental PPO free-of-charge each plan year. You are eligible to participate in Healthy Journey AMITA Health now offers Livongo® for Diabetes Plus Premier Network – meaning you can go to if you are eighteen (18) years of age and an AMITA to you. It’s covered 100% by your health plan. This any dentist in the PPO or Premier Network Seeing a dentist regularly helps to keep your Health associate or an Independent Contractor, open enrollment period, register for Livongo® teeth healthy and allows your dentist to watch for Student, Intern, Volunteer, or otherwise employed and receive a welcome kit in only 3-5 days. The • The Delta Dental PPO toll free number developments that may point to health issues. at an AMITA Health facility. You do not have to program is available at no cost to you and your is 800.323.1743 Remember to visit your dentist for your exam and be benefit eligible to participate! However, if you dependents who have diabetes and are covered teeth cleaning. are not paying for your own medical coverage, through the AMITA Health medical plan. you will not be eligible for the premium reduction. Coverage for spouse and children is not eligible for Eligible Members: The program is available premium reduction. at no cost to you and your dependents who have High Plan Dental Highlights diabetes and are covered through the AMITA Annual Deductible (applies to Basic and Major Services Only) $50/person; $150/family What is the 2021 incentive? Health medical plan. Annual Maximum $1,500/person All participants can earn an entry into the Here are some of the benefits of this program: Enhanced Benefits Program – Your plan provides additional cleanings and/or applications of topical fluoride to people with specific health conditions that put them at risk for oral health disease. Grand Prize Drawing for a chance to win one of ten $1,000 prizes. • More Than a Standard Meter: The Livongo® Lifetime Orthodontic Maximum $1,500/person meter is connected and provides real-time tips Delta Dental PPO Delta Dental Premier® Non- Network Network Dentist Network Dentist Dentist Associates who pay for medical coverage can and automatically uploads your blood glucose potentially earn a premium discount for plan readings, making log books a thing of the past. PREVENTIVE/DIAGNOSTIC SERVICES Not subject to annual maximum • Routine exams (twice per benefit year) • Dental prophylaxis (twice per benefit year) • X-rays (bitewings-twice per benefit 100%* 100%** 100%*** year 2021. year; full mouth-every three years) • Fluoride treatments (once per benefit year to age 19) • • Unlimited Strips at No Cost to You: Get as many Space maintainers (once per lifetime to age 14) • Sealants (to age 16) • Periodontal maintenance • Emergency exams and palliative treatment The premium reduction applies to medical strips and lancets as you need with no hidden BASIC SERVICES • Amalgam and composite resin (anterior) fillings • Posterior composites (tooth 80%* 80%** 80%*** coverage only and cannot be applied to dental or costs. When you are about to run out, Livongo colored fillings on back teeth) • Non-surgical Periodontics • Surgical Periodontics • Endodontics • vision premiums or combined with the Social ships more supplies, right to your door. Oral surgery – simple extractions • Oral surgery – surgical extractions including general anesthesia • IV sedation • Denture repairs Just Subsidy. • Coaching Anytime and Anywhere: The Livongo® MAJOR RESTORATIVE SERVICES • Implants • Cast restorations – crowns, onlays, post and core • 50%* 50%** 50%*** Prosthodontics – bridges, partial dentures/complete Each period, participants also have a chance to coaches are Certified Diabetes Educators who ORTHODONTICS – dependents to age 26 and Adults Treatment necessary for proper alignment 50%* 50%** 50%*** earn wellness merchandise items or enter the are available anytime via phone, text, and our of teeth drawing for a chance to win one of the fifteen mobile app to give you guidance on your nutrition No TMJ Coverage 0% 0% 0% $300 prizes. and lifestyle questions. *Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network dentists cannot charge you for costs exceeding the PPO fee. **Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. Premier den- To Learn More or Join: join.livongo.com/AMITA/hi tists may not charge you for costs exceeding the maximum plan allowance. ***Non-network dentists (non-Delta Dental PPO/non-Delta Dental Premier) do not agree to accept Delta Dental’s allowed fees as payment in full; payment is based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. These dentists can charge you for costs exceeding the maximum plan allowance. 12 13
HEALTH HEALTH Vision Care through Vision Service Plan (VSP) AMITA Health vision benefits are administered by Vision Service Plan (VSP). You can go to any eye care professional you choose but if you use a VSP network provider you’ll pay less. To use your VSP benefit: • Create an account at www.vsp.com to review your benefits. • To find a doctor who is right for you, visit www.vsp.com or call 800.877.7195. • At your appointment, tell your provider you have VSP. There is no ID card necessary. If you’d like a card as a reference, you can print one from www.vsp.com. •T hat is it! There are no claim forms to complete when you see a VSP provider. Eyeconic Eyewear Store Convenient online shopping! Eyeconic is an online eyewear store for VSP members. You can visit Eyeconic to purchase eyewear or contact lenses with your VSP insurance – in network. Visit www.eyeconic.com and connect your VSP account to the Eyeconic store. Benefit Description Copay Frequency Your Coverage with a VSP Provider WellVision Exam • Focuses on your eyes and overall wellness $10 Every 12 months Prescription Glasses $15 See frame and lenses Frame • $160 allowance for a wide selection of frames Included in Every 12 months • $180 allowance for featured frame brands Prescription Glasses • 20% savings on the amount over your allowance Dental Plan Highlights - Low Plan • $90 Costco® frame allowance Lenses • Single vision, lined bifocal, and lined trifocal lenses Included in Every 12 months Annual Deductible (applies to Basic and Major Services Only) $75/person; $225/family • Polycarbonate lenses for dependent children Prescription Glasses Annual Maximum $1,000/person Lens Enhancements • Scratch Resistant Coating $0 Every 12 months • Standard progressive lenses $55 Enhanced Benefits Program – Your plan provides additional cleanings and/or applications of topical fluoride to people with specific health conditions that put • Premium progressive lenses • Custom progressive lenses $95-105 them at risk for oral health disease. • Average savings of 20-25% on other lens enhancements $150-$175 Lifetime Orthodontic Maximum $1,000/person Contacts • $160 allowance for contacts; copay does not apply Up to $50 Every 12 months Delta Dental PPO Delta Dental Premier® Non- Network (instead of glasses) • Contact lens exam (fitting and evaluation) Network Dentist Network Dentist Dentist Diabetic Eyecare Plus • Services related to diabetic eye disease, glaucoma and age-related macular $20 As needed PREVENTIVE/DIAGNOSTIC SERVICES Not subject to annual maximum • Routine exams (twice 100%* 100%** 100%*** Program degeneration (AMD). Retinal screening for eligible members with diabetes. per benefit year) • Dental prophylaxis (twice per benefit year) • X-rays (bitewings-twice per benefit Limitations and coordination with medical coverage may apply. Ask your VSP year; full mouth-every three years) • Fluoride treatments (once per benefit year to age 19) • doctor for details. Space maintainers (once per lifetime to age 14) • Sealants (to age 16) • Periodontal maintenance • Extra Savings Emergency exams and palliative treatment Glasses and Sunglasses BASIC SERVICES • Amalgam and composite resin (anterior) fillings • Posterior composites (tooth 60%* 60%** 60%*** • Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details. colored fillings on back teeth) • Non-surgical Periodontics • Surgical Periodontics • Endodontics • • 20% savings on additional glasses/sunglasses, including lens enhancements, from VSP provider within 12 months of WellVision Exam. Oral surgery – simple extractions • Oral surgery – surgical extractions including general anesthesia • IV sedation • Denture repairs Retinal Screening MAJOR RESTORATIVE SERVICES •Implants • Cast restorations – crowns, onlays, post and core • 50%* 50%** 50%*** • No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam • Laser Vision Correction Prosthodontics – bridges, partial dentures and complete • Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities ORTHODONTICS – dependents to age 26 and Adults Treatment necessary for proper alignment 50%* 50%** 50%*** Your Coverage with Out-of-Network Providers of teeth Get the most out of your benefits and greater savings with a VSP network doctor. Your coverage with out-of-network providers will be less or you’ll receive a lower No TMJ Coverage 0% 0% 0% level of benefits. Visit vsp.com for plan details. Exam…up to $45 • Lined Bifocal Lenses...up to $50 • Progressive Lenses...up to $50 • Frame...up to $70 • Contacts…up to $105 *Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network dentists cannot charge you for costs Lined Trifocal Lenses…up to $65 • Single Vision Lenses…up to $30 exceeding the PPO fee. **Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. Premier den- tists may not charge you for costs exceeding the maximum plan allowance. ***Non-network dentists (non-Delta Dental PPO/non-Delta Dental Premier) do not agree to accept Delta Dental’s Coverage with participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information subject to change. In the event of conflict between allowed fees as payment in full; payment is based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. These dentists can charge you for costs this information and your organization’s contract with VSP, the terms of contract prevails. Based on applicable laws, benefits may vary by location. In state of Washington, VSP Vision Care, exceeding the maximum plan allowance. Inc., is the legal name of the corporation through which VSP does business. 14 15
INCOME HEALTH SECURITY 2020 Medical, Dental and Vision Premiums Life and Disability Benefits Per Pay Period (Bi-Weekly) Basic Life Supplemental AD&D* 100% Associate Paid Full-Time Salary Banding Associate Associate + Associate + Family Associates are automatically enrolled in Basic Life All benefit eligible associates can purchase Standard Premium Spouse Children and AD&D. AMITA Health provides this benefit supplemental life coverage for one to ten times $0 – $14.42 $62.66 $125.99 $118.07 $181.40 at no cost to benefit eligible associates. All full- your covered base annual earnings up to a $14.43 – $28.85 $69.64 $144.15 $134.84 $209.34 time and part-time benefit eligible associates are maximum of $2,500,000. Premiums are deducted provided employer paid Basic Life/AD&D coverage on an after tax basis from your paycheck. Coverage $28.86 – $48.08 $74.30 $156.26 $146.01 $227.97 at 1x annual earnings to a maximum of $1,000,000. will be reduced as you age – 50% at age 70. $48.09+ $78.96 $168.36 $157.19 $246.60 The Prudential Insurance Company of America Full-Time $0 – $14.42 $39.58 $102.91 $94.99 $158.32 provides this insurance. When Coverage Ends Wellness Premium $14.43 – $28.85 $46.57 $121.07 $111.76 $186.26 Life and disability coverages end date of Basic Life – Key Provisions termination of your employment, or if you transfer $28.86 – $48.08 $51.22 $133.18 $122.93 $204.89 • If you are terminally ill, you can get a partial to a benefit ineligible position. You may port $48.09+ $55.88 $145.29 $134.11 $223.52 payment of your group life insurance benefit. You (continue) your group coverage in an amount Part-Time $119.73 $220.23 $198.97 $323.65 can use this payment as you see fit. The payment equal to or lower than your current benefit amount Standard Premium to your beneficiary will be reduced by the amount (exclusions and limits apply, see SPD for details). you receive with the Accelerated Benefit Option. Part-Time $96.65 $197.16 $175.90 $300.57 Wellness Premium • Payment of premium can be waived if you are totally disabled for 6 months, you are less than PLEASE NOTE! Dental HIGH $5.47 $10.95 $13.29 $20.61 60 years old when disability begins, and you Changes to salary will impact Life, AD&D, Full-Time Premium continue to be totally disabled. The waiver and disability elected levels of coverage. terminates at normal social security retirement Dental HIGH $15.66 $31.32 $38.02 $58.98 age. This provision may vary by state. Part-Time Premium • Coverage will be reduced as you age – Dental LOW $4.46 $8.92 $10.85 $16.83 50% at age 70. Full-Time Premium Supplemental Life* 100% Associate Paid Dental LOW $12.76 $25.52 $31.06 $48.17 Part-Time Premium • You can elect a coverage from one to seven times your covered base annual earnings, not Refer to any benefit Vision $4.21 $6.73 $6.88 $11.10 to exceed $2,500,000. Rates for this insurance Summary Plan are determined by your use of tobacco and age. Document (SPD) Legal Plan $3.81 NA NA $5.54 Premiums are deducted on an after tax basis from located on the your paycheck. intranet, or in the • Coverage will be reduced as you age – Benefit Express There are 26 pay periods in the 50% at age 70. Library for detailed calendar year. It is an associate’s Plan information. responsibility to confirm payroll Basic Accidental Death & Dismemberment accuracy, including benefit (AD&D)* – Key Provisions deductions. Any missed deductions • Basic AD&D pays you and your beneficiary a will automatically be collected. benefit for loss of life or other injuries resulting from a covered accident. 100% is paid for loss of Premiums for Life, Supplemental Life, life. A lesser percentage is paid for other injuries Supplemental Accidental Death & such as loss of sight or speech, paralysis, and Disability (AD&D), disability benefits, dismemberment of hands or feet. and voluntary benefits will be • Basic AD&D benefits are paid regardless of other available during the enrollment coverages in place. process in Benefit Express website. • You are automatically enrolled for an amount equal to your Basic Life coverage amount. • Coverage will be reduced as you age – 50% at age 70. *SEE NEXT PAGE 16 17
INCOME INCOME SECURITY SECURITY *Evidence of Insurability (EOI) is a questionnaire Insurance companies will request EOI to approve Short-Term Disability* (STD) Benefit that insurance companies use to ask about the limits of insurance beyond the Guaranteed Issue Remember to review Plan information health of an associate and/or dependent spouse. amount and, if you waived coverage upon initial STD is a benefit with coverage amounts and and coverage options in Benefit Express. Depending on responses, this may lead into further offer. If coverage is approved, the effective date eligibility varying depending on the Ministry where questions about your/your dependent’s health. will be the date the carrier approves coverage. you work. When you access Benefit Express, you will be able to see Plan details, eligibility, coverage Benefit Express uses the same network user ID effective date, costs and coverage amounts and password that you use to access a computer Dependent Life* specific to your Ministry. at work. The enrollment site is available for Plan Spouse - Dependent Life* (100% associate paid) information review from any location with internet • This plan provides a benefit for disability, access 24 hours / 7 days a week. You can also Spouse* Term Life AD&D illness or injury that is not work-related, access Benefit Express through rAMITA. Eligibility May purchase only if associate elects Supplemental Life. May purchase only if associate elects Supplemental AD&D. including pregnancy. • Your plan also includes Rehabilitation benefits *Evidence of Insurability (EOI) is a questionnaire Coverage and Limits • Coverage amount cannot be greater than 50% of the Spouse AD&D must not exceed 65% of the associate’s associate Supplemental Life coverage amount. Supplemental AD&D. that provide services and support targeted at that insurance companies use to ask about the • May elect in increments up to $250K. helping you return to active work. health of an associate. Depending on response, this may lead into further questions about your Evidence of Insurability (EOI) At time of hire may elect up to 25K without EOI. If increased or elected any other time, EOI will be required. There are no health requirements. • Pre-existing Condition clause: STD and LTD health. benefits will not be paid for a disability that Age Reduction 50% at age 70 50% at age 70 Insurance companies will request EOI to approve begins within 3 months of your coverage limits of insurance beyond the Guaranteed Issue Portability Coverage will end at the termination of your employment or Coverage will end at the termination of your employment or if effective date and due to a pre-existing condition. amount and, if you waived coverage upon initial if an associate transfers to a benefit ineligible position. You an associate transfers to a benefit ineligible position. May be may port (continue) your group coverage in an amount equal ported only if associate coverage is ported. A pre-existing condition is an injury or sickness offer. If coverage is approved, the effective date to or lower than your current coverage level only if associate (including pregnancy) for which you received will be the date the carrier approves coverage. coverage is ported (exclusions and limits apply, see SPD for details). medical treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for Child Dependent Life (100% associate paid) which you followed treatment recommendations during the 12 months prior to your effective date Child Term Life AD&D of coverage. Eligibility May purchase only if associate elects Supplemental Life. May purchase only if associate elects Supplemental AD&D. Coverage may begin from live birth up to age 26. Coverage may begin from live birth up to age 26. Coverage and Limits •Coverage amount elected cannot be greater than 50% of the Child AD&D must not exceed 25% of the associate’s Long-Term Disability* (LTD) Benefit associate Supplemental Life coverage amount. Supplemental AD&D. LTD is a benefit with coverage amounts and • May elect either $5,000 per $10,000 per child. eligibility varying depending on the Ministry where Evidence of Insurability (EOI) There are no health requirements. There are no health requirements. you work. When you access Benefit Express, you will be able to see Plan details, eligibility, coverage Portability Coverage will end at the termination of your employment or Coverage will end at the termination of your employment or if if an associate transfers to a benefit ineligible position. You an associate transfers to a benefit ineligible position. May be effective dates, costs and coverage amounts may port (continue) your group coverage in an amount equal ported only if associate coverage is ported. specific to your Ministry. to or lower than your current coverage level only if associate coverage is ported (exclusions and limits apply, see SPD for • Provides coverage for on–and-off-the-job details). accidents, and benefits may be reduced if receiving other income. • Pre-existing Condition clause: STD and LTD benefits will not be paid for a disability that begins within 3 months of your coverage effective date and due to a pre-existing condition. A pre-existing condition is an injury or sickness (including pregnancy) for which you received medical treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for which you followed treatment recommendations during the 12 months prior to your effective date of coverage 18 D 19
INCOME INCOME SECURITY SECURITY Voluntary Permanent Whole Life – Accident Insurance pays you benefits for specific Ascension Healthcare Retirement Savings Program— injuries and events resulting from a covered Voya Voluntary Benefit accident that occurs while you are not at work, on Alexian Brothers/Presence Health Voluntary Permanent Whole Life Insurance through or after your coverage effective date. Features How It Works VOYA Financial is an associate paid benefit available to benefit eligible full-time and part-time The benefit amount depends on the type of injury 2020 retirement plan components associates. To supplement your Basic Life AD&D and care received. You have the option to elect • Your pretax contribution This is the amount you elect to contribute to the plan. insurance provided by AMITA, you may purchase Accident Insurance to meet your needs. Accident • Employer Matching Contribution See Employer Matching Contribution below. • Employer Automatic Contribution (EAC) See EAC information on page 2. additional life insurance coverage for yourself, your Insurance is a limited benefit policy. It is not health Your pretax contribution • You can make pretax salary deferrals (a percentage of pay or a flat spouse and dependent children through Voya. insurance and does not satisfy the requirement of •A scension Healthcare 403(b) Retirement Savings Plan dollar amount) up to 80% of salary or IRS dollar limit ($19,500 in 2020). A minimum essential coverage under the Affordable (not-for-profit ministries) catch-up provision allows associates age 50 and older to contribute an additional $6,500. Voluntary Permanent Life insurance provides a Care Act. • Standard investment lineup for all plans financial benefit that your family can depend on • Loans – 403(b). No more than two loans per plan. and getting it at work is easier, more convenient and more affordable than doing it on your own. Critical Illness Insurance – • Hardship withdrawals – 403(b) only • In-service withdrawal at age 59½ Voya Voluntary Benefit • Variety of distribution options at termination or retirement If you have financial dependents - a spouse, Do you know someone who has had a serious Employer Matching Contribution • Eligibility: 40 standard scheduled hours per pay period children or aging parents, having life insurance illness like a heart attack or stroke? You probably • 50% of the first 6% of earnings you contribute each pay period to the is a responsible and smart decision. Premiums do but don’t expect to ever experience one Ascension Healthcare 403(b) Retirement Savings Plan • If you are an eligible associate with at least one paid hour of service prior never increase due to an increase in age and the yourself. The problem is, no one thinks it could to January 1, 2020, you are 100% vested. coverage is fully portable. Accelerated Life Benefit happen to them and when it does, they may not be • If you were hired on January 1, 2020 or later, you are vested after three Included: A lump sum benefit is paid to you if you prepared for the financial ramifications. years of service. A year of vesting service is granted for each calendar year in which you have at least 1,000 hours of service. are diagnosed with a terminal condition, as defined • You can take full advantage of the match by saving at least 6% of your by the plan. On top of the medical bills, there are still everyday earnings per pay period. expenses to pay for, which can be challenging Employer Automatic Contribution and the Matching Contribution are subject to plan vesting requirements. Descriptions of plan features and benefits are subject to the plan document, which will govern in the event of any inconsistencies between this newsletter and the formal plan documents. during recuperation. Plus, you may need help with For more information, call Voya at day-to-day tasks like house maintenance, child care 800.537.5024 or visit www.voya.com. and transportation. That’s where Critical Illness Plan Features How It Works You can view plan information Insurance can help. Employer Automatic Contribution (EAC) Eligibility in Benefit Express under the • For those eligible, your employer will put an annual contribution into your retirement account. • You are initially eligible to receive an EAC the first calendar year in which you have at least 1,000 hours of service. Library category. For more information, call Voya at 800.537.5024 • How much you receive is based on years of benefit service or $600 • Thereafter, the EAC is earned in any calendar year in which you are a or visit www.voya.com. (for full time 2,080 hours) — whichever is greater. participant and have at least 500 hours of service. Years of Contribution Benefit Service Percentage • You must be employed on December 31 to receive an EAC for the year, unless you leave employment after age 55 and are vested. No medical questions asked, if you enroll when Less than 5 years...........................................................2.0% of earnings 5–9 years..........................................................................2.5% of earnings Vesting initially offered the coverage unless you elect over • A year of vesting service is granted for each calendar year in which you 10–14 years.......................................................................3.0% of earnings the guarantee issue amount. have at least 1,000 hours of service. 15 years or more..............................................................3.5% of earnings • Vesting in your account requires at least five years of vesting service. • Spouses and Children are limited to 50% of the OR if greater, $600 (prorated for less than 2,080 hours) • Active participants who reach age 65 are vested with one year of associate face amount for amounts in excess vesting service. of $5,000 Timing of Contribution • Generally, the EAC is deposited in the spring after the end of each • Age reduction rules apply. Contact Voya calendar year. for details. • For example, the 2020 EAC will be deposited in late March/early April 2021. Fees Accident Insurance – The following fees are charged in the Retirement Program: Voya Voluntary Benefit • Investment management fees — Pay for fund management, investment research, and other investment-related expenses. Fees differ by investment option. • Administrative fees — P ay for core services provided to all participants. The annual administrative fee is $36 per account, charged monthly at $3 per account. Have you ever dislocated a joint or gotten a deep More information on investments and fees can be found at transamerica.com/portal/ascension. cut? How about something more severe, like a Need help? Contact Transamerica. • Meet with your onsite Retirement Planning Consultant. concussion or broken bone? Most of us have •C all Transamerica at 877.346.7284, and say “Yes” when prompted to experienced an accident that needed medical access your Retirement Savings Program account. attention as least once in our lives. Accident • Visit transamerica.com/portal/ascension. Insurance can help relieve some of the financial Retirement Planning Consultants are registered representatives of Transamerica Investors Securities Corporation (TISC), member FINRA, 440 Mamaroneck Avenue, stress that goes along with an accidental injury. Harrison, NY 10528. Investment advisory services are offered through Transamerica Retirement Advisors, LLC (TRA), registered investment advisor. All Transamerica companies identified are affiliated, but are not affiliated with your employer. 20 21
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