Asante Annual Open Enrollment: Your Guide to 2022 Benefits Nov. 1-15, 2021
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All Asante Health Plan members will
be mailed a new card from Regence
for your 2022 health plan regardless
of whether you participate
in open enrollment.
Asante Annual Open Enrollment:
Your Guide to 2022 Benefits
Nov. 1–15, 2021
What do employees need to do?
During open enrollment, you will have the opportunity to meet virtually with representatives from Regence, MetLife,
HealthEquity, Fidelity, VSP, Guild Mortgage, Mercy Flights, Reliant Behavioral Health, Willamette Dental Group,
The Standard and Asante Healthy Living Incentive Program to discuss your benefits-related questions. Spouses are
welcome to attend all events.
Only employees who want to make changes to their current benefits, are enrolling or re-enrolling in a flexible spending
account (FSA) for 2022 or wish to elect earned time off (ETO) cash-out need to participate in open enrollment this year.
If you do nothing, your current benefits elections and covered dependents will automatically roll over into next year,
except for FSA plan participation and ETO cash-out.
What’s new for 2022 (summary of material modifications) Open enrollment events
HEALTH PLANS Virtual benefits fairs Virtual enrollment assistance
■ Benefits Asante’s new virtual fairs enable you to connect with The Asante Benefits team will be available virtually
All Plans: live representatives from Asante’s benefits vendors via during open enrollment to help you make your
• Acupuncture and chiropractic (spinal manipulation) will have an annual video! Go to myHR during the dates and times listed benefits elections on myHR. The benefits specialists
limit of 12 visits per year, instead of the $2,000 limit. below, select the Open Enrollment widget on the home will be able to remote in to your computer and help
• Added coverage for biofeedback. page, then click the link titled Virtual Benefit Fair. you with your elections only if you are logged into your
• Out-of-network cost shares will be aligned at 50% coinsurance on all No appointment is necessary. Asante computer, not a personal computer.
plans, except for ambulance and emergency room benefit.
Nov. 1 | 7 a.m. to 2 p.m. Need assistance and ready to enroll? Call (541) 789-4551,
• Added coverage for palliative care.
8 a.m. to 5 p.m., Monday through Friday.
• Added cost-share limits for insulin at retail and mail-order. Nov. 4 | 9 a.m. to 4 p.m.
Asante PPO Health Plan: Nov. 9 | 8 a.m. to 3 p.m.
• Added naturopathic services, within the scope of their license.
• Added acupuncture and spinal manipulation (chiropractic) coverage.
• Allergy injection benefit will change to one copay per provider per day.
Health Reimbursement Plan
• Allergy injection benefit will change to one copay per provider per day.
■ Provider networks (applies to all plans)
• Category designation changes due to larger number of providers
within Asante Health Network.
• All PCPs in Jackson and Josephine counties will move to their
appropriately designated category.
■ Rates
• All Asante Health Plans will have a slight increase in premium rates
for 2022 (see rate charts on page 5).
VISION PLANS
■ Benefits
• SunCare benefit name changed to LightCare.
HEALTH SAVINGS ACCOUNT Eligibility rules
Per Internal Revenue Service regulations, the 2022 health savings account (HSA)
contribution limit will increase. Employees up to age 54 may contribute as much as Only those employees and dependents as described Dependents. Your family members (dependents) may
$3,650 annually for employee-only coverage and $7,300 for employees with covered below may be covered under the Asante Health Plans. also be eligible for certain benefits. Eligible dependents
dependents. Employees age 55 and older may contribute an additional $1,000. for health, dental, vision and certain voluntary benefits
All active employees: include your legal spouse and your children who are:
VOLUNTARY BENEFIT PLANS Regular | 0.9–1.0 FTE ■ Under age 26, regardless of their marital and student
■ Hospital Indemnity Plan Scheduled to work at least 72 hours per pay period status and whether they live with you or you provide
Hospital indemnity insurance will be offered to all full-time and part-time any of their support; or
employees for the 2022 plan year. Hospital indemnity insurance covers Regular | 0.7–0.8 FTE
Scheduled to work at least 56 hours per pay period ■ Physically or mentally incapable of self-support due
unexpected out-of-pocket expenses if you end up in the hospital, including
to a physical or mental disability that arose prior to
copays, deductibles and out-of-network charges, as well as everyday living
Regular | 0.5–0.6 FTE attaining the limiting age under the plan and who are
expenses. It pays a benefit directly to you for hospital stays, regardless of
Scheduled to work at least 40 hours per pay period financially dependent on you for more than half of their
your treatment costs or other insurance coverage you might have.
support; or
■ Rates (semimonthly) Flexible | 0.1–0.4 FTE
■ Under age 26 and for whom you are required by a
• Employee Only — $7.19 • Employee + Child(ren) — $13.89 Scheduled to work less than 40 hours per pay period
Qualified Medical Child Support Order, judgment,
• Employee + Spouse — $15.30 • Employee + Family — $23.52 decree or order issued by a court or through an
administrative process established under state law to
WELLNESS PROGRAM provide medical coverage.
Additional opportunities to earn more incentive funds to your HSA or HRA have
been added to Asante’s Healthy Living Incentive Program (see page 10 for details).
2 3
2022 annual open enrollment, Nov. 1–15 | How to enroll Medical/Rx
If you are planning to participate in open enrollment Semimonthly amount (taken from the first two pay periods of each month)
this year, you must do so between Nov. 1 and Asante PPO Health Plan Employee only Employee + spouse Employee + child(ren) Employee + family
Nov. 15, 2021. Funds for 2021 FSAs must be used by
Don’t Dec. 31, 2021, because they do not roll over from
Regular (0.9–1.0 FTE) $39.37 $174.77 $136.41 $225.95
forget year to year. All employees who want an FSA for 2022
Regular (0.7–0.8 FTE) $73.43 $213.60 $166.73 $276.11
Regular (0.5 –0.6 FTE) $104.93 $271.86 $212.18 $351.43
must re-enroll during this open enrollment period.
The deadline to enroll is 1 p.m. on Nov. 15. Asante Savings Health Plan
Regular (0.9–1.0 FTE) $8.01 $74.15 $62.44 $101.46
Regular (0.7–0.8 FTE) $22.32 $105.38 $88.97 $145.18
Employees are required to participate in open enrollment only if:
Regular (0.5–0.6 FTE) $36.45 $145.16 $113.29 $187.64
■ The employee wants to enroll or re-enroll in an FSA for 2022 Asante Reimbursement Health Plan
■ The employee wants to make changes to current benefits Regular (0.9–1.0 FTE) $16.91 $122.58 $95.67 $158.47
■ The employee wants to add or remove dependents from coverage Regular (0.7–0.8 FTE) $43.49 $149.82 $116.94 $193.66
■ The employee wants to elect ETO cash-out Regular (0.5–0.6 FTE) $62.13 $190.68 $148.81 $246.47
Asante Flexible Workforce Health Plan
Flexible (0.1–0.4 FTE) $312.82 N/A $500.53 N/A
How to enroll Refer to the eligibility rules for definitions of regular and flexible employees.
1. Go to myHR: https://hr.asante.org
and click Continue to Sign In
8. Select only the benefits you
plan to change.
Dental
(if you’re automatically signed Semimonthly amount (taken from the first two pay periods of each month)
9. When finished making
in, skip to step 3).
elections, you will land on Regular employees Employee only Employee + spouse Employee + child(ren) Employee + family
2. You will be asked to sign in: the Review and Submit page, MetLife core plan $5.28 $16.20 $15.80 $24.08
• If you are completing this or you can scroll to the bottom MetLife buy-up plan $7.94 $21.93 $21.37 $32.58
from home, use your Asante of the menu and click on
Willamette Dental Group $5.07 $15.59 $15.23 $23.15
email address (e.g., john.doe@ Review and Submit.
asante.org) and Asante 10. All of your elections will display
network password.
• If you are completing this
at the bottom of the Review
and Submit page. To submit
Vision
from any Asante network your elections, click the blue Semimonthly amount (taken from the first two pay periods of each month)
workstation, use your Asante Submit button at the top of Regular employees Employee only Employee + spouse Employee + child(ren) Employee + family
network username and the page.
password. Core vision $0.93 $2.77 $2.89 $6.76
11. Confirm your submission. Buy-up vision $4.49 $8.23 $8.46 $15.75
3. On the myHR home page,
locate the widget titled Once you’ve submitted your
elections, a confirmation
Open Enrollment.
statement will be sent to your
Asante Health Plan medical premium assistance
4. Click on My Open Enrollment. Asante email address. 2022 hourly wage
This program is intended to help offset a portion of the
5. If you plan to add new 12. To make changes to elections cost of health plan coverage for lower-wage employees. Health plan category
Health plan comparison chart
Asante PPO Health Plan Asante Savings Health Plan Asante Reimbursement Health Plan
Asante Regence Asante Regence Asante Regence
Medical Preferred Regence Limited Out-of- Preferred Regence Limited Out-of- Preferred Regence Limited Out-of-
Network Network Network network Network Network Network network Network Network Network network
(Category 1) (Category 2) (Category 3) (Category 4) (Category 1) (Category 2) (Category 3) (Category 4) (Category 1) (Category 2) (Category 3) (Category 4)
Deductible — individual $500 $1,500 $2,500 $1,400 $3,000 $4,500 $1,000 $1,500 $2,500 $4,000
Deductible — family $1,000 $3,000 $4,000 $2,800 $6,000 $9,000 $2,000 $3,000 $5,000 $7,000
Out-of-pocket maximum — individual $2,500 $3,500 $6,000 $8,250 $2,000 $3,000 $5,000 $8,000 $2,000 $3,500 $5,500 $8,000
Out-of-pocket maximum — family $5,000 $7,000 $12,000 $16,500 $3,000 $6,000 $10,000 $14,000 $4,000 $7,000 $11,000 $16,000
Office visit — primary care provider $10* $25* $75* 50% 10% 15% 40% 50% $10* $25* $75* 50%
Office visit — specialist $10* $25* $75* 50% 10% 15% 40% 50% $10* $25* $75* 50%
Inpatient/outpatient professional 15% 15% 40% 50% 10% 15% 40% 50% 10% 15% 40% 50%
Inpatient/outpatient facility 15% 30% 40% 50% 10% 30% 40% 50% 10% 30% 40% 50%
Lab/X-ray 15% 30% 40% 50% 10% 30% 40% 50% 10% 30% 40% 50%
Urgent care $10* $25* $75* 50% 10% 15% 40% 50% $10* $25* $75* 50%
Emergency Department $150* (waived if admitted) 15% 15% 15% 15% $150* (waived if admitted)
Acupuncture (12 visit limit) $10* $25* $75* 50% 10% 15% 40% 50% $10* $25* $75* 50%
Chiropractic (12 visit limit) $10* $25* $75* 50% 10% 15% 40% 50% $10* $25* $75* 50%
Healthy Living Incentives (see page 10 for details)
Asante Health Fund Contributions to HealthEquity HRA Contributions to HealthEquity HSA Contributions to HealthEquity HRA
Annual basic contributions
Only full-time employees enrolled as of $300 — Employee-only coverage category $300 — Employee-only coverage category
Jan. 1, 2022, are eligible. Contributions $0
$600 — All other coverage categories $600 — All other coverage categories
will be made in January 2022.
Annual Healthy Living Incentive $525 (EE only) $675 (EE only) $750 (EE only)
$900 (EE + SP) $1,225 (EE + SP) $1,350 (EE + SP)
Prescription drug (Rx)
Regence Regence Regence
Asante Participating Asante Participating Asante Participating
Pharmacies Regence Pharmacies Pharmacies Regence Pharmacies Pharmacies Regence Pharmacies
Asante Retail Participating Mail Order Out-of- Asante Retail Participating Mail Order Out-of- Asante Retail Participating Mail Order Out-of-
Pharmacies 31-90 days Pharmacies (90 days) network Pharmacies 31-90 days Pharmacies (90 days) network Pharmacies 31-90 days Pharmacies (90 days) network
Rx out-of-pocket maximum Shared with Regence Network OOPM Not Shared with Regence Network OOPM Not Shared with Regence Network OOPM Not
($3,500 Ind./$7,000 Family) covered ($3,000 Ind./$6,000 Family) covered ($3,500 Ind. / $7,000 Family) covered
$5* $10* $15* $20* Not $5* $10* $15* $20* Not $5* $10* $15* $20* Not
Generic Rx covered covered covered
25% up to 25% up to 35% up to 35% up to Not 25% up to 25% up to 35% up to 35% up to Not 25% up to 25% up to 35% up to 35% up to Not
Brand formulary Rx $30 max $60 max $60 max $120 max covered $30 max $60 max $60 max $120 max covered $30 max $60 max $60 max $120 max covered
30% up to 30% up to 40% up to 40% up to Not 30% up to 30% up to 40% up to 40% up to Not 30% up to 30% up to 40% up to 40% up to Not
Non-brand formulary Rx $100 max $300 max $200 max $600 max covered $100 max $300 max $200 max $600 max covered $100 max $300 max $200 max $600 max covered
* = Deductible waived % = Coinsurance (amount you pay)
6 7
Asante Health Plans 2020
Provider networks explained Basic and supplemental life insurance
You have the freedom to choose your providers on all Asante Health Plans; however, depending on which network your Asante pays for a basic life insurance policy for all regular employees, and you are automatically enrolled on your
provider has chosen to participate in, it will affect your out-of-pocket costs differently. date of hire (or benefits eligibility date). For details about this plan, please refer to myHR. Employees may elect
to purchase additional life insurance for themselves, their spouse or their child(ren). Refer to myHR for rates and
biweekly premium amounts. Coverage limitations are as follows.
Four categories in each plan
Each plan offers four categories of network coverage.
Supplemental life insurance coverage limitations
Asante Preferred Network (Category 1) Guarantee issue at initial eligibility: up to $150,000
Employee coverage ■
■ (1) Asante providers, services and facilities and (2) independent providers, services ■ Guarantee issue increases at open enrollment: $20,000*
and facilities aligned with Asante through the Asante Health Network* ■ Maximum coverage with evidence of insurability: $450,000
Best value Guarantee issue at initial eligibility: up to $25,000
Spouse coverage ■
■ Guarantee issue increases at open enrollment: $10,000*
Regence Network (Category 2) ■ Maximum coverage with evidence of insurability: up to $250,000 (but not more than
■ Providers, services and facilities not in the Asante Preferred Network but part of employee coverage**)
the Regence-contracted network
More options Child(ren) coverage ■ Guarantee issue at any time: up to $10,000
■ All OB/GYNs in Jackson and Josephine counties who see adult patients, regardless
■ Coverage options: $2,500, $5,000, $7,500, $10,000
of network status
■ Independent specialty services not offered in the Asante Preferred Network
*Increases above the guarantee issue amount are approved following medical underwriting approval. If you or your covered spouse
reaches an age shown below, the amount of life insurance will be the amount you have, reduced to the following percentage of your
benefit: age 70–74: 67%; age 75 and older: 50%. Limitations apply to coverage increases when the covered member is not actively at
Regence Limited Network (Category 3) work on the coverage effective date.
■ Providers and facilities that are contracted in the Regence BlueCross BlueShield **Employee coverage includes the employee’s supplemental life insurance policy in addition to the basic life insurance policy that
of Oregon PPO Network that provide services already offered in the Asante pays for.
Costlier Asante Preferred Network
Out-of-network (Category 4)
Additional benefits options†
■ Providers or facilities that are not contracted with the Regence Blue Cross Blue Shield
of Oregon PPO Network or providers that are not contracted with the national ◼ Accident insurance
Rare BlueCard network are considered non-participating (out of network)
◼ Auto and home insurance
*To check providers in the Asante Health Network go to asantehealthnetwork.org. ◼ Critical illness insurance
You can also visit Regence.com to check provider categories. ◼ Dependent care FSA, health FSA,
limited-purpose FSA
◼
Frequently asked questions ◼
MetLife Legal Services
Mercy Flights
What if my provider is in the My doctor is not in the Asante What if I want to continue seeing ◼ Short-term disability insurance
Asante Preferred Network Preferred Network. Will an my specialist who is not part of ◼ Hospital indemnity insurance
(Category 1) but refers me Asante provider be available the Asante Preferred Network?
outside that network for for me? If that provider offers the same clinical †Please refer to myHR or
services such as an imaging Asante employees who services as an Asante Preferred asante.org/employee-benefits for
scan or laboratory test? choose to establish care with Network specialist, your out-of-pocket detailed benefits information.
Imaging, lab services and procedures an Asante Physician Partners costs will fall under the Regence
performed outside an Asante primary care provider are given Limited Network (Category 3). If the
Preferred Network facility fall under preferential access. The Asante Preferred Network does not
the Regence Limited Network new-patient access team can offer that specialty service, however,
(Category 3). be reached at (541) 789-1234. that provider would be under the
Regence Network (Category 2).
8 9
Asante Health Plan
2022 Healthy Living Incentive Program Annual required notices
Healthy Living Activities 2. Complete an Interactive Program on Regence This document provides you with important notices and information Website: oregon.gov/OHA/healthplan/Pages/index.aspx
Engage in these activities and maximize your HSA empower (12 options to choose from to support about the Asante Health Plan. Address: 500 Summer St. NE E37, Salem, OR 97301-1079
To request special enrollment or obtain more information, contact the
or HRA contribution for 2022! Incentives apply to you where you are). ■ Women’s health and cancer rights
Asante Human Resources Department at (541) 789-4551.
■ Special enrollment rights
enrolled employees and their enrolled spouses; some Interactive programs include: Improving Your Blood ■ Newborns’ and mothers’ health protection
restrictions apply. Pressure, Managing Your Stress, Improving Your ■ Premium assistance under Medicaid and the Children’s Health
Notice about newborns’ and mothers’ health protection
Group health plans and health insurance issuers generally may not,
Sleep, Achieving Your Healthy Weight, Building Insurance Program (CHIP)
1. Annual preventive exam that is age-appropriate under federal law, restrict benefits for any hospital length of stay in
Resilience, Enhancing Your Physical Activity, Nutrition Notice about women’s health and cancer rights in the connection with childbirth for the mother or newborn to less than
(complete one):
for Better Health, Quitting Tobacco, Staying Tobacco- Asante Health Plan 48 hours following a vaginal delivery or less than 96 hours following
Age-appropriate preventive exams include: adult Free, Improving Your Oral Health and Financially Fit. a cesarean section. However, federal law generally does not prohibit
The Women’s Health and Cancer Rights Act of 1998 requires group the mother’s or newborn’s attending provider, after consulting with the
physical, routine OB/GYN exam, colorectal cancer health plans to cover certain expenses relating to a mastectomy. The mother, from discharging the mother or her newborn earlier than
screening, cervical cancer screening and routine 3. Complete a Personalized Wellness Plan with an Asante Health Plan complies with this law and covers the following: 48 hours (or 96 hours as applicable). In any case, plans and issuers may
mammogram. Also included are establish-care visits Asante health coach. ■ Medical and surgical charges directly related to a mastectomy not, under federal law, require that a provider obtain authorization from
as well as preventive dental and vision exams. ■ Reconstruction of the breast on which the mastectomy has been the plan or the insurance issuer for prescribing a length of stay not in
performed excess of 48 hours (or 96 hours).
■ Surgery and reconstruction of the other breast as necessary to provide
a symmetrical appearance Notice about premium assistance under Medicaid
and the Children’s Health Insurance Program
Annual Healthy Living Incentive amounts
■ Prosthetic devices relating to such breast reconstruction
■ Treatment of physical complications arising from a mastectomy If you or your child(ren) are eligible for Medicaid or CHIP and you are
These benefits will be provided subject to the same deductibles, co-pays eligible for health coverage from your employer, your state may have
and co-insurance provisions applicable to other medical and surgical a premium assistance program that can help pay for coverage, using
Asante Asante Savings Asante funds from its Medicaid or CHIP program. If you or your child(ren)
PPO Health Plan Reimbursement benefits provided under the plan.
are not eligible for Medicaid or CHIP, you will not be eligible for these
Health Plan (HSA) Health Plan If you have any questions regarding this law, please contact the Asante premium assistance programs but you may be able to buy individual
Human Resources Department at (541) 789-4551 or Regence at insurance coverage through the health insurance marketplace. For more
Healthy Living Activities Who is eligible? Award amount Award amount Award amount (888) 344-8235. information, visit healthcare.gov.
Notice about special enrollment rights in the Asante Health Plan If you or your dependents are already enrolled in Medicaid or CHIP
Complete an age-appropriate Employee and $50 (EE) $125 (EE) $125 (EE) Loss of other coverage. If you declined enrollment for yourself or your and you live in a state listed below, contact your state Medicaid or CHIP
preventive exam. spouse $50 (SP) $125 (SP) $125 (SP) dependents (including your spouse) because of other health insurance office to find out if premium assistance is available.
or group health plan coverage, you may be able to enroll yourself and
If you or your dependents are not currently enrolled in Medicaid or
Complete any interactive your dependents in this plan if you or your dependents lose eligibility
CHIP and you think you or any of your dependents might be eligible
for that other coverage (or if the employer stops contributing toward
program on Regence Empower Employee and $75 (EE) $225 (EE) $225 (EE) your or your dependents’ other coverage). You do not need to wait for
for either of these programs, contact your state Medicaid or CHIP
12 options to choose from spouse $75 (SP) $225 (SP) $225 (SP) the next open enrollment period. You must request enrollment within
office, call (877) KIDS NOW or visit insurekidsnow.gov to find out
how to apply. If you qualify, ask your state if it has a program that
to support you where you are. 30 days after your or your dependents’ other coverage ends (or after the
might help you pay the premiums for an employer-sponsored plan.
employer stops contributing toward the other coverage).
If you or your dependents are eligible for premium assistance under
Complete a Personalized New dependent by marriage, birth, adoption or placement for adoption.
Employee and $400 (EE) $325 (EE) $400 (EE) If you have a new dependent as a result of marriage, birth, adoption Medicaid or CHIP and are eligible under your employer plan, your
Wellness Plan with an Asante employer must allow you to enroll in your employer plan if you aren’t
spouse $250 (SP) $200 (SP) $250 (SP) or placement for adoption, you may be able to enroll yourself and
health coach.* your dependents without waiting for the next open enrollment period. already enrolled. This is called a “special enrollment” opportunity, and
You must request enrollment within 30 days after the marriage, birth, you must request coverage within 60 days of being determined eligible
$525 (EE only) $675 (EE only) $750 (EE only) adoption or placement for adoption. for premium assistance. If you have questions about enrolling in your
Total Potential Incentive Funds employer plan, contact the Department of Labor at askebsa.dol.gov or
$900 (EE + SP) $1,225 (EE + SP) $1,350 (EE + SP) Individuals who become eligible for state premium assistance subsidy. call (866) 444-EBSA (3272).
If you declined enrollment for yourself or your dependents (including
* Previously earned through Know Your Numbers premium credit. your spouse), you may enroll yourself or your dependent(s) in this plan if: If you live in Oregon, you may be eligible for assistance paying your
employer health plan premiums. If you reside in another state, please
• The family loses its Medicaid or CHIP coverage because its contact Asante Human Resources at (541) 789-4551.
employment situation improves; the family can then sign up for
employer-sponsored coverage without having to wait for the open The following is current as of July 31, 2021. Contact your state for more
enrollment period and experiencing a gap in coverage. information about eligibility.
Annual basic contribution • A child becomes eligible for Medicaid or CHIP and has access to OREGON — Medicaid
employer-sponsored coverage that the state wishes to subsidize healthcare.oregon.gov • Phone: (800) 699-9075
through a premium assistance option; the family may then sign up
In addition to the above incentives, every January all full-time employees enrolled in the Asante Saving Health Plan immediately and does not have to wait for the open enrollment To see if any other states have added a premium assistance program since
or the Reimbursement Health Plan will receive a contribution to their HSA or HRA: period. Enrollment must be requested within 60 days following the July 31, 2021, or for more information about special enrollment rights,
date of the eligibility event. contact either of the following:
• $300 – Employee only coverage • $600 – All other coverage For information about eligibility for coverage either through Medicaid U.S. Department of Labor
or Oregon’s CHIP program (typically administered through the Oregon
Employee Benefits Security Administration
Health Plan), please contact the Department of Human Services:
dol.gov/ebsa • (866) 444-EBSA (3272)
Oregon Department of Human Services,
Office of Medical Assistance Programs U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
Phone: (503) 945-5772 • Toll-free: (800) 527-5772
cms.hhs.gov • (877) 267-2323, menu option 4, ext. 61565
TTY: (800) 375-2863 • Email: dhs.info@state.or.us
10 11
Notice regarding Asante Wellness Programs your doctor) to find an alternative task with the same incentive that is right for
The Asante Wellness Program (“Program”) is a voluntary wellness program you in light of your health status.
available to employees and their spouses participating in one of the Asante medical The information from any of the tasks listed above will be used to provide you
plan options. The Program is administered according to federal rules permitting with follow-up information to help you understand your current health and
employer-sponsored wellness programs that seek to improve employee health potential health risks, and in some cases may also be used to offer you additional
or prevent disease, including the Americans with Disabilities Act of 1990, the services through the Program. You also are encouraged to share your results or
Genetic Information Nondiscrimination Act of 2008 and the Health Insurance concerns with your own doctor.
Portability and Accountability Act (HIPAA), as applicable, among others.
Protections from disclosure of medical information
Asante Wellness Programs The medical information received as part of the Program is subject to the privacy
The Program provides incentives of up to $1,350 in annual contributions to the and security rules of a federal law called HIPAA. The Program is required by
employee’s health reimbursement account (HRA) or health savings account HIPAA and other applicable law to maintain the privacy and security of your
(HSA) based on the plan enrollment. These incentives are available if the personally identifiable health information. Although the Program and Asante
employee and/or spouse completes one of the following three tasks: may use aggregate information Asante receives from the Program to improve
1. Task 1: Have one of the following preventive exams that is age-appropriate: program design based on identified health risks in the workplace, the Program
adult physical, routine OB-GYN exam, colorectal cancer screening, cervical will never disclose any of your personal information either publicly or to your
cancer screening and routine mammogram. Also included are establish-care employer, except as necessary to respond to a request from you for a reasonable
visits as well as preventive dental and vision exams. accommodation needed to participate in the Program, or as otherwise expressly
permitted by law. Medical information that personally identifies you that is
2. Task 2: Complete any interactive program on Regence Empower. These provided in connection with the Program will not be provided to your supervisors
include: Improving Your Blood Pressure, Managing Your Stress, Improving or managers and may never be used to make decisions regarding your employment.
Your Sleep, Achieving Your Healthy Weight, Maintaining Your Healthy
Weight, Building Resilience, Enhancing Your Physical Activity, Nutrition Your health information will not be sold, exchanged, transferred or otherwise
for Better Health, Quitting Tobacco, Staying Tobacco Free, Improving Your disclosed except to the extent permitted by law to carry out specific activities related
Oral Health and Financially Fit. to the Program, and you will not be asked or required to waive the confidentiality
of your health information as a condition of participating in the Program or
3. Task 3: Complete a Personalized Wellness Plan with an Asante receiving an incentive. Anyone who receives your information for purposes of
health coach. providing you services as part of the Program will abide by the same confidentiality
For an employee or spouse participating in the Asante PPO Health Plan: requirements. The only individuals who will receive your personally identifiable
1. If the employee or spouse completes Task 1, the employee will receive a $50 health information are those who will provide you with services under the Program.
contribution into the employee's HRA. If both the employee and spouse Task 3, completion of a Personalized Wellness Plan with an Asante health coach,
complete Task 1, the employee will receive a $100 contribution into the may include coordinating with your other Asante providers under the Program to
employee's HRA. provide follow-up information to help you understand your current health and
2. If the employee or spouse completes Task 2, the employee will receive a $75 potential health risks, and in some cases may also be used to offer you additional
contribution into the employee's HRA. If both the employee and spouse services through the Program. You may choose to opt-out of having your Asante
complete Task 2, the employee will receive a $150 contribution into the health coach share information for this purpose.
employee's HRA. In addition, all medical information obtained through the Program will be
3. If the employee or spouse completes Task 3, the employee will receive a maintained separate from your personnel records, information stored electronically
$400 contribution into the employee's HRA. If both the employee and will be encrypted, and no information you provide as part of the Program will be
spouse complete Task 3, the employee will receive a $650 contribution into used in making any employment decision. Appropriate precautions will be taken to
the employee's HRA. avoid any data breach, and in the event a data breach occurs involving information
For an employee or spouse participating in the Asante Savings Health Plan: you provide in connection with the Program, we will notify you immediately.
1. If the employee or spouse completes Task 1, the employee will receive a You may not be discriminated against in employment if you decide not to
$125 contribution into the employee’s HSA. If both the employee and participate in the Program or because of the medical information you provide as
spouse complete Task 1, the employee will receive a $250 contribution into part of participating in the Program. You will not be subjected to retaliation if you
the employee’s HSA. choose not to participate.
2. If the employee or spouse completes Task 2, the employee will receive a If you have questions or concerns regarding this notice, or about protections
$225 contribution into the employee’s HSA. If both the employee and against discrimination and retaliation, please contact Asante Human Resources
spouse complete Task 2, the employee will receive a $450 contribution into at (541) 788-4551.
the employee’s HSA. Notice of nondiscrimination
3. If the employee or spouse completes Task 3, the employee will receive a
$325 contribution into the employee’s HSA. If both the employee and
■ Asante complies with applicable federal civil rights laws and does not
spouse complete Task 3, the employee will receive a $525 contribution into discriminate on the basis of race, color, national origin, age, disability or
the employee’s HSA. gender. Asante does not exclude people or treat them differently because of
race, color, national origin, age, disability or gender.
For an employee or spouse participating in the Asante Reimbursement Health Plan: ■ Asante provides free aids and services that allow people with disabilities to
1. If the employee or spouse completes Task 1, the employee will receive a communicate effectively with caregivers and others in the organization, including:
$125 contribution into the employee’s HRA. If both the employee and • Qualified sign language interpreters
spouse complete Task 1, the employee will receive a $250 contribution into • Written information in other formats (large print, audio,
the employee’s HRA. accessible electronic formats and other formats)
2. If the employee or spouse completes Task 2, the employee will receive a ■ Asante provides free language services to people whose primary language is
$225 contribution into the employee’s HRA. If both the employee and not English, including:
spouse complete Task 2, the employee will receive a $450 contribution into • Qualified interpreters
the employee’s HRA. • Information written in other languages
3. If the employee or spouse completes Task 3, the employee will receive a If you need these services, contact Alicia Lorenz at the phone number or email
$400 contribution into the employee’s HRA. If both the employee and address listed below.
spouse complete Task 3, the employee will receive a $650 contribution into
the employee’s HRA. If you believe that Asante has failed to provide these services or discriminated
in another way on the basis of race, color, national origin, age, disability or
Rules applicable to the Program and Annual Incentive gender, you can file a grievance with:
Award Contributions Alicia Lorenz, director of employee and labor relations
You are not required to complete any of the three tasks listed above. However, 2635 Siskiyou Blvd., Medford, OR 97504
only employees and spouses who choose to complete the tasks will receive Phone: (541) 789-4227 • Fax: (541) 789-4509
incentives under the Program. Email: alicia.lorenz@asante.org
Spouses who participate in the Program must complete an authorization form You can file a grievance in person or by mail, fax or email. If you need help
prior to receiving incentives for completing Task 1 or participating in Task 2 and filing a grievance, Alicia Lorenz is available to help. You can also file a civil
Task 3 of the Program. This form is available from Asante Human Resources; to rights complaint electronically through the Office for Civil Rights Complaint
obtain a copy, please call (541) 789-4551. Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
or by mail or phone at:
If you are unable to participate in any of the tasks required to earn an incentive
under the Program, you may be entitled to a reasonable accommodation or an U.S. Department of Health and Human Services
alternative standard. If you think you might be unable to meet a standard for 200 Independence Ave., SW, Room 509F, HHH Building
an incentive, you can earn the incentive by different means. You may request Washington, DC 20201
a reasonable accommodation or an alternative standard by contacting Asante Phone: (800) 368-1019 • TDD: (800) 537-7697
Human Resources at (541) 789-4551. We will work with you (and, if you wish, Complaint forms are available at hhs.gov/ocr/office/file/index.html.
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