BENEFITS GUIDE 2019 - Sheridan Memorial Hospital
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2019 BENEFITS GUIDE Enrollment Guidelines…2 Enrollment Instructions…3-4 Medical Plan Options Traditional PPO Plan…5 HDHP Plan & HSA….6 Dental Summary ….7 Working on Wellness…7 Vision Summary….8 Discounts, Eye Care & Hearing Aids…9 Life Insurance & Voluntary Supplemental Term Life…10 Dependent Care Flex Account …11 Retirement Plans - 457(b) & 401(a)… 11 Employee Assistance Program & Other Benefits…12 & 13 Employee Premium Rates…14 Important Contacts…15 This Benefits Guide is an overview of the benefits provided by Sheridan Memorial Hospital. It is not a Summary Plan Description or Certificate of Insurance. If a question arises about the nature and extent of your benefits under the plans and policies, or if there is a conflict between the informal language of this Benefits Guide and the contracts, the Summary Plan Description or Certificate of Insurance will govern. Please note that the benefits in your Benefits Guide are subject to change at any time. The Benefits Guide does not represent a contractual obligation on the part of Sheridan Memorial Hospital.
ENROLLMENT GUIDELINES Welcome to the 2019 Benefits Guide for Sheridan Memorial Hospital. This Guide provides a quick overview of the benefits program and helps to remove confusion that sometimes surrounds employee benefits. The SMH benefits program is structured to provide comprehensive coverage for you and your family. Benefit programs provide a financial safety net in the event of unexpected and potentially catastrophic events. Eligibility You are eligible to enroll in the benefits program if you are in a benefits eligible status working at least 32 hours per pay period. Benefits for newly hired eligible employees will take effect the first of the month following your date of hire. Your legal spouse and your dependent children (less than 26 years of age) are eligible for medical coverage. Disabled children over age 26 may be eligible to continue benefits after approval of necessary applications. Open Enrollment Open enrollment is once a year and benefit elections will take effect January 1st. Participants may switch between the medical plan options at this time. Late entrants (employees or dependents who apply for coverage more than 31 days after the date of individual eligibility) are also provided an opportunity to enroll for coverage during the plan’s open enrollment. The elections you make stay in effect the entire plan year, unless a qualifying life event occurs. Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself or your dependents in this plan if you or your dependents lose eligibility for that other coverage, or if the employer stops contributing towards your or your dependents’ other coverage. Under the medical plan, Open Enrollment under your spouse’s group plan will also be considered a qualifying event. However, you must request enrollment within 31 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. (You have 60 days to complete and enter a new enrollment in PlanSource after coverage under Medicaid or CHIP terminates.) Employee Benefits Portal PlanSource - All benefit elections, changes, and waivers must be made by using the PlanSource Enrollment Portal. Instructions are found on the following page. Copyright (c) 2017 (Novo Benefits) - All Rights Reserved. This employee guide is intended solely for the use of participants of the employee benefit plan specified herein. It may contain confidential or privileged information. If you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited without the written consent of Novo Benefits. 2
ONLINE ENROLLMENT INSTRUCTIONS 1. Login ENROLLMENT URL: https://benefits.plansource.com • USERNAME: Your user name is the following: the first initial of your first name, up to the first six characters of your last name, and the last four of your SSN. For example: If your name is Jane Anderson and the last four of your SSN is 1234, your user name would be janders1234 • PASSWORD: Passwords will be reset for Open Enrollment to Employee’s Birth Date formatted as YYYY/MM/DD At initial login, you will be prompted to change your password. 2. Launch Enrollment • Click on “Make a Change to My Benefits” to begin. If you are a new hire – this link will say “New Hire - Enroll” and during annual enrollment “Enroll – Annual”. 3
3. Enroll • Follow the enrollment through each step of the enrollment process from top to bottom • In making your elections, choose the plan option of $2250/$4500 choice or select the “Decline” option and then select “Continue” after each election has been made until you reach the confirm page. 4. Confirm Enrollment Selections • Once you complete all coverage elections, you will land on the Confirmation Statement. Click the “Confirm Enrollment” button at the bottom of the page to complete your enrollment process. 4
TRADITIONAL PPO MEDICAL PLAN What you pay and what the plan pays The below Summary of Benefits shows how much you pay for care, and how much the plan pays. It’s a brief listing of what is included in your benefits plan. For more detailed information, see your summary plan description. After you pay your annual deductible and/or any up-front copays, the plan begins to pay a percentage of your provider’s charges, for example 80%. The remaining percentage, for example 20%, is your responsibility – your “out-of-pocket” costs. You’re protected from financial hardship by a maximum out-of-pocket amount each year – the most you’ll have to pay before the plan covers costs at 100% (excluding non-covered expenses and expenses above reasonable and customary charges). (Copays do not apply to the out-of-pocket maximum.) Save when you see network providers This plan offers a Preferred Provider Organization (PPO), a network of doctors and other healthcare professionals who have agreed to accept lower amounts than their standard charges. These lower amounts are negotiated and predetermined. That means when you see a PPO provider, your share of costs is based on a lower charge – so your costs are lower, too. PPO providers are conveniently located in both urban and rural areas. Remember: If you go outside the PPO network, you may still have benefits, but your share of costs will be higher, and the amount you pay will not be based on a lower rate. Traditional PPO Plan Benefit Sheridan Memorial Hospital Network Providers Non-Network Providers Providers Deductible $1,250/single $1,250/single $1,250/single $2,500/family $2,500/family $2,500/family Out-of-Pocket Max* $1,750/single $2,250/single $2,750/single $3,500/family $4,500/family $5,500/family Preventive Care 100%, DW 100%, DW 60%, AD Office Visit $20 Copay $20 copay 60%, AD Specialist Office visit $20 Copay $20 copay 60%, AD Outpatient Hospital 90%, AD 80%, AD 60%, AD Inpatient Hospital 90%, AD 80%, AD 60%, AD Emergency Room 90%, AD 80%, AD 80%, AD Prescriptions Retail – 30 day supply Generic $5 copay, plus 20% DW $5 copay, plus 20% DW $5 copay, plus 20% DW Preferred $10 copay, plus 20% DW $10 copay, plus 20% DW $10 copay, plus 20% DW Non-Preferred $20 copay, plus 50% DW $20 copay, plus 50% DW $20 copay, plus 50% DW Maximum Out of Pocket Rx $2,500 $2,500 $2,500 Mail Order – 90 day supply $10 copay, plus 20% DW $10 copay, plus 20% DW $10 copay, plus 20% DW Generic $20 copay, plus 20% DW $20 copay, plus 20% DW $20 copay, plus 20% DW Preferred $40 copay, plus 50% DW $40 copay, plus 50% DW $40 copay, plus 50% DW Non-Preferred *Includes Deductible AD – After Deductible DW – Deductible Waived 5
HDHP PLAN WITH HSA OPTION High Deductible Health Plan (HDHP) Benefit Sheridan Memorial Hospital Network Providers Non-Network Providers Providers Deductible $2,250/single $2,250/single $2,250/single $4,500/family $4,500/family $4,500/family Out-of-Pocket Max* $2,750/single $3,250/single $4,250/single $5,500/family $6,500/family $8,500/family Preventive Care 100%, DW 100%, DW 60%, AD Office Visit 90%, AD 80%, AD 60%, AD Specialist Office visit 90%, AD 80%, AD 60%, AD Outpatient Hospital 90%, AD 80%, AD 60%, AD Inpatient Hospital 90%, AD 80%, AD 60%, AD Emergency Room 90%, AD 80%, AD 80%, AD Prescriptions 80%, AD 80%, AD 80%, AD *Includes Deductible AD – After Deductible DW – Deductible Waived Health Savings Accounts (HSA) 2019 IRS Contribution Limits for HSAs (Including Employer Contributions) What is an HSA? An HSA is an account that can be funded by you with pre-tax Individual $3,500 dollars. The HSA helps pay for eligible medical expenses not covered by an insurance plan, including the deductible, Family $7,000 coinsurance, and prescriptions. How HSAs Work Catch-Up Contribution (Age 55+ ) $1,000 Participants make contributions to HSAs up to the allowable IRS limits. The funds can earn interest and be withdrawn at any time to cover qualified medical expenses. Unlike a flexible spending account, there is not a “use-it-or-lose-it” rule. The account will automatically roll over year-after-year. It is an individual account; if you change health plans or jobs, the balance is yours to keep. When do I use my HSA? After visiting a physician, facility, or pharmacy, 2019 Annual Employer HSA Contributions request they submit your claim to your Health Plan for payment. You should make sure your provider has your most up-to-date insurance information. Full-Time Part-Time Once the claim has been processed, any out-of- pocket expenses will be billed. Always ask that your claim be submitted to the health plan before you Individual $ 500 Individual $ 375 seek HSA reimbursement. This will ensure provider discounts are applied. Also, remember to keep all Family $1,000 Family $ 750 medical receipts and Explanation of Benefits (EOBs) to support your personal tax record. You can choose to save your HSA dollars for future medical expenses. 6
Dental Benefits DENTAL AND WELLNESS BENEFITS Sheridan Memorial Hospital offers dental benefits through UMR. If you opt out of the medical plan you may elect dental only. Dental Plan Benefits Deductible $50/single $100/two-Party $150/family Calendar Year Maximum $1,000/person, does not apply to dependent children under age 19 Preventive Services • Oral Exams 100%, deductible waived • X-rays • Cleanings Basic Services • Fillings • General Anesthesia 50%, after deductible • Space • Palliative Treatment Maintainers Major Services • Crowns • Dentures 50%, after deductible • Inlays & Onlays • Complex Surgical Extractions • Bridgework At Sheridan Memorial Hospital, we strive to build a “Culture of Health” within our organization and to be a wellness role model for our community. The Working On Wellness (W.O.W.) program focuses on supporting the overall health and wellbeing of our employees knowing that being our individual best contributes to excellent care for our patients and their families. Throughout the year, the W.O.W. team provides a variety of opportunities for our employees to participate in wellness activities supporting healthy habits and attitudes to live healthier, happier, and more fulfilling lives both at work and at home. For 2019, we are offering wellness incentives to encourage employee participation in the W.O.W. program. This year the incentives are in the form of a cash benefit, to be paid out each quarter (the amount is based on your medical plan election). The program is completely voluntary, but we hope the incentives inspire you to participate. To take advantage of the incentives, you are required to participate in a Wellness Blood Draw, Online Health Risk Assessment, and Biometrics. You may also participate in an optional Physical Assessment. To join the program, simply select the WELLNESS option in the online employee benefits portal during annual open enrollment or when you become a new employee. You can always participate in our wellness activities without joining the 2019 Wellness Program, but we hope you decide to join us in building a culture of health at Sheridan Memorial Hospital. We are excited to focus on our hospital’s most valuable strength – YOU! 7
VISION BENEFITS Sheridan Memorial Hospital offers voluntary vision benefits through VSP. The vision plans through VSP provide access to a national network including both private practice and retail chain providers. To find a participating provider, visit www.vsp.com. VISION PLAN In-Network Basic Plan In-Network Premium Plan Vision Exam $10 copay Frequency Once every 12 months Routine Retinal Screening covered after $39 maximum copay Frames *Wide Selection $130 allowance $150 allowance *Featured Brands $150 allowance $170 allowance Additional Savings: 20% 20% Frequency: Every 24 months Every 24 months Lenses (in lieu of contacts) *Single Vision $25 materials copay *Lined Bifocal $25 materials copay *Lined Trifocal $25 materials copay *Lenticular $25 materials copay Frequency: Every 12 months Lens Enhancements: *Standard Progressive No additional copay No additional cost *Premium Progressive Additional $95-$105 copay No additional cost *Custom Progressive Additional $150-$175 copay No additional cost *Anti-Reflective Coating Additional $41 copay No additional cost *Scratch Resistant Coating Additional $17 copay No additional cost *Tints/Photochromic Lenses Additional $70-$82 copay No additional cost Contacts (in lieu of lenses) $130 allowance, no copay $150 allowance, no copay Lens exam (fitting/evaluation) 15% discount to a maximum copay 15% discount to a maximum copay of $60 of $60 Frequency: Every 12 months Every 12 months Network Providers VSP Physicians; plus, Eye Masters, Costco, Vision Works, Pearle Vision, Eye Care Centers of America, etc. Out-of-Network Benefits $45 Exam Allowance $30 Single Vision Lenses/$50 Bifocal Lenses/$65 Trifocal Lenses $100 Lenticular Lenses/$50 Progressive Lenses $70 Frame Allowance/$105 Elective Contact Lenses $210 Medically Necessary Contact Lenses Note: When using a non-network provider, the participant pays the full fee to the provider, and VSP reimburses the customer for services rendered up to the maximum allowance. All receipts must be submitted at the same time. While out-of-network, Sam’s Club and Walmart will file claims to VSP for you. 8
VSP DISCOUNTS: EYE CARE & HEARING AIDS VSP Primary EyeCare You can visit your VSP Doctor as often as needed, paying only a $20 copay for services, which allows for greater savings compared to the specialist copay under your medical plan. To Find a VSP Doctor, visit vsp.com or call 800-877-7195. At your appointment, tell them you have VSP . There’s no ID card necessary. Office visit copay includes treatment for: • Eye Pain • Exams to monitor cataracts • Conditions like Pink Eye • Retinal screenings • Tests to diagnose sudden vison changes • Pictures of your eyes to detect and track conditions for glaucoma and diabetic eye disease TruHearing® is making hearing aids affordable by providing exclusive savings to all VSP® Vision Care members. You can save up to $2,400 on a pair of hearing aids with TruHearing pricing. What’s more, your dependents and even extended family members are eligible, too. In addition to great pricing, TruHearing provides : Plus, with TruHearing you’ll get: • Three provider visits for fitting, adjustments, and • Access to a national network of more than 4,500 cleanings licensed hearing aid professionals • 45-day money back guarantee • Straightforward, nationally fixed pricing on a • Three-year manufacturer’s warranty for repairs and selection of more than 90 digital hearing aids in one-time loss and damage 400 styles • 48 free batteries per hearing aid • Deep discounts on replacement batteries shipped directly to your door Best of all, if you already have a hearing aid benefit from your health plan or employer, you can combine it with this program to maximize the benefit and reduce your out-of-pocket expense. How it works Call TruHearing. Call 877.396.7194. You and your family members must mention VSP. Schedule exam. TruHearing will answer your questions and schedule a hearing exam with a local provider. Attend appointment. The provider will make a recommendation, order the hearing aids through TruHearing and fit them for you. Learn more about this VSP Exclusive Member Extra at vsp.truhearing.com or, call 877.396.7194 with questions. 9
LIFE INSURANCE Group Term Life Insurance and AD&D Coverage All Full-time employees are enrolled in Sheridan Memorial Hospital’s employer sponsored group health plan at no cost to the employee. Coverage Amounts Employee Life and AD&D Benefit: 1 times annual salary to a maximum of $300,000. Spouse Life and AD&D Benefit: $2,000 Child (ren) Life and AD&D Benefit: $1,000 Employees cannot be covered as both an employee and a dependent and dependent children cannot be covered by more than one employee on the Employer Paid Life and AD&D Coverage. Reduction: Basic Life/AD&D and Supplemental Life benefits will reduce to 50% of the original amount at age 70. No further reductions will occur after age 70. Voluntary Supplemental Term Life Insurance Coverage Amounts Benefits are available in increments of $10,000 Employee: Guarantee Issue: $80,000 Maximum: The lessor of 5x Basic Annual Salary or $500,000 Benefits are available in increments of $5,000 Spouse: Guarantee Issue: $25,000 Maximum: $250,000 Flat amount $10,000 Child: Maximum: $10,000 IMPORTANT: For 2019 enrollment, you may increase your voluntary life election by one $10,000 increment for employees and/or one $5,000 increment for spouses WITHOUT having to submit evidence of insurability provided your total election remains within the Guarantee Issue amount. *Guarantee Issue amount is the maximum amount of coverage that a newly eligible employee can purchase regardless of medical condition. Any purchase or increase in benefits, which does not take place within 31 days of employee’s or dependent’s eligibility date is subject to evidence of insurability. Coverage is subject to approval by Reliance Insurance Company. Waiver of Premium If you become totally disabled while insured; remain disabled for 6 months and continue to pay premiums during that period; and, are less than age 60, your life insurance will continue until the day you retire or you reach age 65. If total disability ends, you may exercise the conversion privilege. Conversion If your insurance terminates because you are no longer employed full-time, your insurance may be converted to an individual life insurance policy if you apply and include payment of the first premium within 31 days of termination. Conversion does not require proof of medical insurability. 10
RETIREMENT & DEPENDENT CARE FSA 457(b) Retirement Plan Sheridan Memorial Hospital retirement plan offers you a powerful way to save for retirement. Your contributions are pretax, i.e., made directly from your paycheck before income taxes are deducted, and the money grows in your plan tax free until it is withdrawn at retirement. Earnings are not taxable while in the plan, so they have the potential to compound and accumulate substantially over time. Your 457(b) is a great way to establish a disciplined approach to saving. Employees may contribute between 1% and 100% of earnings (limited by IRS regulations). Your contributions to the 457(b) are always yours and are not subject to any vesting or forfeiture provision. 401(a) Retirement Plan To assist our employees in reaching their retirement savings goals, the Hospital matches employee 457(b) retirement plan contributions dollar-for-dollar beginning at 6% (on a per payroll basis). The Hospital’s contribution match grows based on the employee’s years of service (i.e., 0-5 years – 6%; >5 years – 7%; >10 years – 8%; >15 years – 9%; and > 20 years - 10%). Employees are 100% vested at three years of service. If an employee leaves employment before the three year vesting period, all employer contributions in the 401(a) Retirement Plan are forfeited. Dependent Care Flexible Spending Account – Debit Card Included effective Jan. 1, 2019! The Dependent Care account allows you to set aside tax-free income to pay for qualified dependent care expenses, such as day care, that you would normally pay with after-tax dollars. Qualified dependents include children under age 13 and/or dependents who are physically or mentally unable to care for themselves. If your spouse is unemployed or doing volunteer work, you cannot set up a dependent care account. You must meet the following criteria in order to set up this account: • You and your spouse both work; • You are the single head of household; • Your spouse is disabled or a full-time student. Each calendar year the IRS allows you to contribute the following amounts, depending on your family status: • If you are single, the lesser of your earned income or $5,000 • If you are married, you can contribute the lowest of o Your (or your spouse’s) earned income o $5,000 if filing jointly or $2,500 if filing separately Once Enrolled, You May Not Change Your Election You cannot change your annual election after the beginning of the plan year. However, there are certain limited situations when you can change your elections if you have qualified change in status. 11
OTHER BENEFITS Employee Assistance Program Sheridan Memorial Hospital provides an Employee Assistance Program called LifeMatters® for all employees and their household members. This free and confidential program provides access to resources for maintaining a healthy work/life balance. When you face challenges, LifeMatters can help. Caring professional are available 24/7 every day of the year to help you address concerns both big and small. Call 1-800-634-6433 or visit LifeMatters online (mylifematters.com) to receive expert assistance with: • Relationships • Distress • Substance Use • Wellbeing • Legal/Finances • Child and Elder Care • Emotional • Stress • Any other concern Short Term Disability Disability Income protection insurance provides a benefit for ‘short term’ disability resulting from a covered injury or sickness. Benefits begin at the end of the elimination period and continue during disability up to a maximum benefit duration. The weekly benefit amount is an amount equal to 60% covered earnings, up to a maximum benefit of $1,500 per week, minimum benefit of $25. Hospital Services Discount All employees and their family members are eligible for a discount up to 40% (including any benefit plan related contractual discounts) on all SMH-billed services provided by the hospital and Big Horn Health Network. The employee is not required to participate in our comprehensive health insurance plan to receive the discount. Paid Time Off (PTO) SMH has a generous time off benefit that is flexible and rewards full-time and part-time employees for using it well. A first year full-time (2080 hours) employee will accrue 20 days, 1 to 5 years 22 days, 6 to 10 years 25 days, and 10+ years 30 days. PTO is available to use for vacation, holidays, and personal time. Employees can accrue up to 320 hours of PTO that carry over from year to year. Effective January 1, 2019 the 90 Day waiting period for new employees to use PTO will be eliminated. 12
OTHER BENEFITS Extended Illness Bank (EIB) In addition to PTO, full-time and part-time employees accumulate .0346 hours per hour worked (up to 720 hours) to be used for your own sick time. To use this time, you must first use one of your PTO days, then you can use your available EIB hours as you need or have accrued. In the event an employee requires a hospital procedure or is hospitalized, accrued EIB may be used immediately. Tuition Reimbursement Continuing education is important for individual growth and the growth of the healthcare system. When you are considering working on a degree at an accredited school, check with Human Resources and your manager to complete an education plan and tuition reimbursement request. There are dollars available to help reimburse tuition expenses after you complete one year of full-time service. Onsite Fitness Center In support of a healthy workplace, the Employee Fitness Center is available for employees 24/7. In order to utilize the facility, you need to go through the orientation process with the Wellness Manager and sign an employee waiver for badge access. Gym Membership Employees qualify for gym reimbursement paid on a quarterly basis. Simply bring in a copy of your first gym receipt to Human Resources for processing. $20 Reimbursement for initial membership fee and $19 per month. 13
Premiums Effective January 1, 2019 Employee Bi-Weekly Premium Traditional PPO Medical Plan Full-Time Part-Time Single $ 37.43 $174.93 Employee + Spouse $178.74 $347.15 Employee + Child(ren) $124.43 $270.42 Family $238.82 $445.78 2 Full-Time Employees $ 74.86 N/A High Deductible Health Plan/HSA Full-Time Part-Time Single $ 35.14 $173.08 Employee + Spouse $167.50 $335.24 Employee + Child(ren) $ 116.67 $262.93 Family $223.60 $429.70 2 Full-Time Employees $ 70.28 N/A Dental Full-Time and Part-Time Single $3.63 Employee + Spouse $7.27 Employee + Child(ren) $5.95 Family $9.29 2 Full-Time Employees $7.26 Vision – Basic Plan Full-Time and Part-Time Single $4.02 Employee + 1 (Spouse or Child) $6.43 Employee + Children $6.57 Family $10.60 Vision – Premium Plan Full-Time and Part-Time Single $7.12 Employee + 1 (Spouse or Child) $11.39 Employee + Children $11.63 Family $18.75 Wellness Credits (for medical plan Full-Time Part-Time participants – quarterly cash benefit) Single $37.50 $37.50 Employee + Spouse, Employee + Child(ren) and Family $75.00 $75.00 Medical Opt Out (quarterly cash benefit) Full-Time Part-Time SMH provides a quarterly cash benefit for employees who Opt Out of Medical coverage AND participate in the WOW $150.00 $75.00 Wellness Program See PlanSource Employee Benefits Portal or Voluntary Supplemental Term Life Human Resources for age-banded rates 14
2019 Benefits Guide Important Contacts UMR Medical & Dental & Flexible Spending Account (800) 826-9781 P.O. Box 30541 Group #76-412618 www.UMR.com SLC, UT 84130-0541 Eligibility and claims questions Magellan Rx Prescription Benefit Manager (800) 424-6817 www.MagellanRx.com UMR Care Management Medical Management (866) 494-4502 Call before any inpatient stays UnitedHealthCare Options PPO Network (800) 826-9781 www.UMR.com VSP Vision Plans (800) 877-7195 www.vsp.com Reliance Standard Life Life Insurance (630) 285-4365 Jennifer Chassay Jennifer_Chassay@AJG.com Principle Investments Retirement Plans (800) 547-7754 www.principle.com D.A. Davidson Retirement Services Facilitator (307) 674-6288 Sheridan Memorial Hospital Sandy Fuller (307) 675-5846 1401 W. 5th Street Wellness Manager sandyfuller@sheridanhospital.org Sheridan, WY 82801 Sheridan Memorial Hospital Dixie Kansala (307) 673-4294 1401 W. 5th Street HR Benefits Coordinator dixiekansala@sheridanhospital.org Sheridan, WY 82801 Health Savings Account Assistance
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