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April 21, 2017.

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Presentation on theme: "April 21, 2017."— Presentation transcript:

1 April 21, 2017

2 Benefits for 2014 Health Protection Securing Your Retirement
Medical and Prescription Drug Coverage Health Reimbursement Arrangement (HRA) with SmartHealth Plan Socially Just Medical Benefits Dental Care Coverage Vision Care Coverage Tax-Advantaged Spending Accounts Healthcare Flexible Spending Account (FSA) Dependent Day Care Flexible Spending Account (FSA) Income and Survivor Protection Short Term Disability (STD) Long Term Disability (LTD) Basic Life and AD&D Insurance Supplemental Term Life Insurance Supplemental AD&D Business Travel Accident Insurance Legal Services Plan Securing Your Retirement Voluntary Employee Retirement Savings Plan Contributions Employer-Paid Retirement Benefits (Eligible Employees) Enriching Self and Spirit Employee Assistance Program (EAP) SmartHealth Wellness Program Tuition Reimbursement Paid Time Off (PTO) Thank you for making time to learn about the associate benefits that we offer. We are making some changes so it’s important to take this time to learn about the changes but also just to understand that we do offer a great benefit package. As you can see from this list, our total benefit package for 2014 includes Health Protection, Tax-Advantaged Spending Accounts, Income and Survivor Protection….as well as retirement benefits, and programs to support personal enrichment. We are continuing to offer a competitive benefit package – one that meets the needs of a diverse group of associates – but it will be more in line with benefits offered by other employers in our community. For example, like other employers, we are moving to medical benefit options with higher deductibles. And we are making other changes…and will give you details today.

3 What’s changing and why? Who is eligible for benefits?
Let’s Discuss Be sure to enroll by October 15, 2013 What’s changing and why? Who is eligible for benefits? How do my benefits work? What do I need to do? Today, we’ll be focusing on what’s changing, eligibility for benefits, how to use your benefits, and steps that you may take before you enroll in benefits

4 What’s changing and why
Why benefits are changing What’s changing We are adjusting to a changing healthcare environment and must work together to slow down the rising cost of benefits Lourdes Health Network is aligning with the Ascension Health benefit platform, along with other Health Ministries – gaining access to competitive programs while saving administrative costs We are continuing to offer a competitive package to meet the needs of a diverse group of associates – but a package that is more in line with benefits offered by other employers New Eligibility Classifications New SmartHealth medical plans offering access to new Ascension Health network as well as the BCBS network New Medical Plan Administrator Prescription Drug Program through Lourdes Rx and MedImpact Health Reimbursement Arrangement (HRA) to pay for medical, pharmacy, dental or vision expenses Employer paid Long Term Disability and Short Term Disability, EIB no longer accruing Basic, Supplemental and Spouse Life Coverage We are updating a few benefit provisions. We will offer benefits that are aligned with Ascension Health benefit platform. This gives us access to competitive programs while saving on administrative costs. This is part of our effort to provide you with competitive benefit and support programs while adjusting to a changing healthcare environment. We are continuing to offer a competitive benefit package – one that meets the needs of a diverse group of associates – but it will be more in line with benefits offered by other employers in our community. For example, like other employers, we are moving to medical benefit options with higher deductibles. And we are making other changes…and will give you details today.

5 Who Is Eligible for Benefits?
Benefit Eligibility (non-union) Full Time Associates 32-40 standard hours per week Part Time Associates standard hours per week Non Benefit Eligible less than 20 standard hours per week Dependent Eligibility Spouse Legally married spouse Child Less than 26 years old (whether living with you or not, whether single or married) Over 26 years old (if became totally and permanently disabled while covered under the plan) Eligibility will be based on the following classifications. Hourly associates with standard hours per week are newly eligible for benefits. Associates with less than 20 standard hours per week are eligible for voluntary and EAC retirement benefits and EAP only.

6 Medical Benefits SmartHealth Medical Benefits including
Prescription Drug Program through MedImpact Now let’s focus on medical benefits – the benefit that’s probably most important to you

7 SmartHealth Medical Benefits
SmartHealth is… Ascension’s system-wide medical plan for associates.  On the forefront of adopting all healthcare reform initiatives Offers both comprehensive and cost-effective health care through benefit designs and networks Creation of our own Ascension network of providers Access to a National Network of Blue Cross providers for services that are not provided by Health Ministry facilities and contracted physicians. While being good stewards of our healthcare spending, promotes prevention and wellness in mind, body and spirit, to further our mission of treating the whole person This year we are changing medical coverage to… …SmartHealth, Ascension’s system-wide medical plan for associates. SmartHealth offers comprehensive, cost-effective, care that gives you access to the Ascension Health network and a National Network of Blue Cross providers. Regardless of the network, preventive care is covered at 100%. And you may also participate in an optional wellness program that will encourage you to become as healthy as you can be in mind, body and spirit. This is all part of our mission of treating the whole person.

8 SmartHealth Medical Benefits
Our partners National Network (Tier 2) Ascension Health network (Tier 1) In addition to our National Network partner, Blue Cross, we also partner with ABS – our third party administrator of claims and participant services -- and MedImpact, our pharmacy benefit manager. Prescription Drug coverage is included with Medical coverage – there’s one ID card for both. Watch for an ID card to be mailed to your home in late December. Keep in mind the card will only list the associate name and will not list dependents or copayments. This information will be verified at the time of service. Claims administered by ABS Coverage includes Rx through MedImpact Contact ABS when you have questions.

9 SmartHealth Medical Benefits
Each option offers the same network access Ascension Health Network (Tier 1) You get the best value and highest level of benefits when you receive care from Ascension Health Ministries and their contracted providers Since we are providing the care within our own system, the cost is less You share in the cost savings when our own facilities and physicians provide services National Network (Tier 2) You get preferred pricing and a competitive level of benefits when you receive care from Blue Cross providers Out-of Network (Tier 3) If you use providers who are not members of either the Ascension Health Network or the National Network… you will get a lower benefit level and will be responsible for higher out-of-pocket costs. You will have access to three Tiers of networks when you need care. You do not select a network or a doctor when you enroll. You choose a network when you need care and you receive the level of benefits provided through that network. You get the highest level of benefits when you use Ascension Health providers. Since we are providing the care within our own system, the cost is less…and you share in the cost savings when you use our own facilities or physicians. If you are unable to receive care from Ascension Health providers, you get preferred pricing and a competitive level of benefits when you use the National Network. But your out of pocket costs will be greater. You still have some coverage if you are not able to use a network provider but you’ll pay at least half of the cost, maybe more, if you go out of network.

10 How my plan works Take time to understand your medical coverage
Preventive Care is covered at 100% in network Doctor Visits go to Deductible in Tier 2 – except Preventive Care is covered 100% Comprehensive covered benefits – Prior Authorization may be required Check exclusions and annual maximums Contraceptives are excluded for 2014 The network you choose determines how much you pay Take time to understand your medical coverage before you need to use it It’s always a good idea to make sure you understand how your plan works before you have an accident or get sick… If additional services are provided by the doctor during the visit, the charges will go to the deductible (or you’ll pay Coinsurance after the deductible is satisfied). Some examples of extra services are lab tests, immunizations, x-rays, EKGs, and sometimes cardiac stress tests.

11 2014 SmartHealth Medical Benefit Plans
My Plan Details Medical Plan $200 Deductible/0% Coinsurance Ascension Health Network (Tier 1) National Network (Tier 2) Out-of-Network (Tier 3) Lifetime Maximum Unlimited Annual Deductible All Deductibles and OOP Maximums are satisfied by Coinsurance expenses from all Tiers. Single $200 $400 $3,000 Family $800 $6,000 OOP Max including Deductible All Tier expenses apply to all OOP Maximums. Co-pays do not accrue toward OOP Maximum. $1,450 $1,650 $9,000 $2,900 $3,300 $18,000 Hospital Services Co-pay/Coinsurance Inpatient 0% 25% 50% Outpatient Urgent Care $5 30% after Tier 2 ded ER Services $75 + Tier 1 ded Office Visit Primary Care Specialist Specialist-Pediatrics Mental Health 2014 SmartHealth Medical Benefit Plans We’ve been talking about how each option is the same, now let’s start to compare differences. This chart compares your options. It shows that each option offers the same networks. And you can compare Deductibles, Out of Pocket Maximums, and Co-Pays. But let’s talk about what those terms mean. If a covered member becomes ill or is injured away from home and is taken to a Tier 3 ED and is admitted, benefits will pay at Tier 2.

12 Prescription Drug Benefits
Prescription Drugs In-House Pharmacy 30-day Supply Co-Pay 60-90 day Supply Retail Pharmacy day Supply Generic $5 $12.50 $10 Preferred Brand Name (on formulary) $15 $37.50 $25 Non-Preferred Brand Name $35 $87.50 $50 We’ve been talking about how each option is the same, now let’s start to compare differences. This chart compares your options. It shows that each option offers the same networks. And you can compare Deductibles, Out of Pocket Maximums, and Co-Pays. But let’s talk about what those terms mean. MedVantx program discontinued, mail order through Lourdes Rx only.

13 Biweekly Medical Plan Premiums $200 Deductible/10% Coinsurance
Biweekly Payroll Contributions Classification Biweekly Medical Plan Premiums $200 Deductible/10% Coinsurance Full Time Single: Associate + One: Associate & Child(ren): Family Plan: $28.44 $112.07 $86.87 $144.23 Part Time $71.09 $168.11 $130.30 $216.35 The true cost of your medical plan includes not just your out of pocket expenses, but also your payroll contributions This chart compares your payroll contributions. Remember the true cost of your medical plan includes your payroll contributions.

14 Prior Authorization – New Process
All services received from the following providers must receive Prior Authorization: Kadlec Health System, Richland, WA Kennewick General Hospital, Kennewick, WA Tri-City Orthopedic, Richland, WA Benton Franklin Orthopaedic Associates, Kennewick, WA Tri-City Radiology, Kennewick, WA Northwest Cancer Clinic, Kennewick, WA Services will be approved for Tier 2 coverage include: Brain Heart Obstetrics/Labor and Delivery Newborn Care No benefits will be payable by the Plan if Prior Authorization is not obtained for services received at the providers shown above. Authorization to receive care at the facilities listed above will ONLY be granted if the service is not available at Lourdes Health Network. No benefits will be payable by the Plan if Prior Authorization is not obtained. You no longer have to worry about WHICH services need prior authorization, you just need to remember which FACILITIES require prior authorization. Important to recognize that any service at these providers must have prior authorization or the service will not be covered. Services that Lourdes provides, such as a colonoscopy or MRI, will NOT be given authorization.

15 SmartHealth Medical Benefits
Terms to know Deductible: You pay this amount each year before Coinsurance starts Satisfied by all services, excluding Co-Pays and non-covered services With Family Coverage, each individual satisfies their own Deductible but once the family deductible is satisfied, benefits can start for all covered family members Coinsurance: After satisfying the deductible, you and the Plan pay a % up to the Out-of-Pocket Maximum (OOP Max) OOP Max: After your Coinsurance reaches the OOP Max, the Plan pays 100% for the rest of the calendar year Co-Pay: A fixed dollar amount that you pay for non-hospital services – Co-Pays do not apply to OOP Max So let’s talk terms… Deductible – this is the amount you pay each year before Coinsurance starts. All services except Co-Pays go to satisfy the deductible. And Coinsurance is the percentage of covered charges that you pay after you satisfy the deductible. So if your Coinsurance is 10%, the Plan’s Coinsurance is 90% of the whole amount. Or if your Coinsurance is 20%, the Plan pays 80% of costs after you satisfy the deductible. OOP Max…stands for Out of Pocket Maximum. After you pay Coinsurance up to this amount, then the Plan pays 100% of covered charges. Co-Pay: this is a fixed amount that you pay for non-hospital services doctor.

16 New Wellness Program – Simple & Effective
Earn Health Reimbursement Arrangement (HRA) dollars for wellness participation. Activities & Rewards Biometric Screening Health Risk Questionnaire Primary Care Provider (PCP) Visit Total FSA Contributions/Year $125 $100 $350 No more quarterly classes! Watch for more information through your Outlook about dates and times for your annual biometric screen, more information on how to complete your Health Risk Questionnaire, and how to submit your PCP visit verification to receive your Wellness HRA dollars.

17 HRA and FSA—what’s the difference?
COMPARISON OF TAX- ADVANTAGED ACCOUNTS Account FSA HRA Who owns the account Associate Ascension Health Who funds the account What plans are offered with the account Traditional PPO Traditional PPO with HRA Limits $2,500 $350 in annual wellness rewards Fund availability Immediate As earned Use it or lose it Yes No Portable Interest bearing So this compares ….

18 The difference a network makes: An example
FT Associate with Associate + 1 coverage Medical Care Ascension Health Network (Tier 1) Blue Cross Blue Shield (Tier 2) Hospitalization for $10,000 I meet individual deductible…..$200 And I pay 0% of the rest While the plan pays …………….$9,800 You satisfy the deductible…………. $400 25% Cost-Share ……………………….$2,400 Capped at OOP Max ……………… $1,650 So I only owe…………………………..$1,650 2nd hospitalization $20,000 Already met deductible 0% Cost-Share I already paid……………………..…..$200 While the plan pays ……………$20,000 I owe .………..…………………………..$0 25% Cost-Share = $5,000 but I met my OOP Max I already paid…………………..….…$1,650 So I owe only.………..…………...…..$0 Hospitalization for spouse of $18,000 He meets deductible…..……......$200 I already paid ………………......….$200 While the plan pays …………….$18,000 Spouse pays only……………………$200 He satisfies the deductible..…………... $400 25% Cost-Share = $4,400 but Capped at family OOP Max $3,300 And I already paid …………………...….$1,650 So he pays …….……………………………..1,650 Bottom line Annual premium……………….. …$2,913 Deductible………………………… $ 400 Out of Pocket Max……………… …..$0 I pay…………………….. $3,313 Plus Doctor/ER/Urgent Care co-pays and Rx co-pays. Annual premium……………………$2,913 Deductibles………………………… ..$800 Out of Pocket Max…………….. $3,300 I pay…………………………. $7,013 Plus Doctor/ER/Urgent Care Co-Pays and Rx Co-Pays. Here is an example showing that it pays to use Tier 1 providers. This is an example for a FT associate who has Associate + One coverage with premiums in Pay Band 2. You can see the out-of-pocket costs as the associate is hospitalized twice…and the spouse is hospitalized. The bottom line includes the annual premium.

19 Tips to Avoid Unnecessary Costs
Be a wise healthcare consumer Choose Ascension Health Network (Tier 1) for all care if you can and verify network affiliation by using the Provider Directory available on our intranet or at MySmartHealth.org (during open enrollment) Have all ancillary testing done at our hospitals/facilities. Remind your physician’s office to refer your lab/pathology specimens to our facilities – don’t assume they will Understand your benefits Verify prior authorizations Remember to choose the Ascension Health network when you need care. Remind your physician’s office to refer your lab tests to our facilities The ordering physician is responsible for obtaining the prior authorization according to the guidelines set by the Third Party Administrator who handles your claims Always ask whether or not a prior authorization is needed for services Note: Bariatric Surgery is only covered in Tier 1 if it’s available from a Health Ministry within 100 miles

20 Women’s Preventive Services
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 preventive services that must be included in health plans without cost sharing to covered participants. The regulations contain an accommodation for eligible non-profit religious organizations that oppose providing contraceptive coverage. As a healing ministry of the Catholic Church, Ascension Health does not promote or condone contraceptive practices and objects to providing such coverage. Therefore, as the plan sponsor of both our self-insured Ascension Health SmartHealth Medical Plan (“SmartHealth Plan”) and our self-insured Ascension Health Prescription Drug Program (“Rx Plan”), Ascension Health qualifies as an eligible organization that is entitled to the accommodation. As a result, neither the SmartHealth Plan nor the Rx Plan will provide coverage for contraceptive benefits that are in conflict with our Catholic Identity and the Ethical and Religious Directives for Catholic Health Care Services. As part of the accommodation, third party administrators of our SmartHealth and Rx plans are required to provide this coverage to covered members at no cost, independently of Ascension Health and consistent with the authority given them by the final regulation. You will receive information directly from those Administrators about the coverage that may be available to you for those “preventative services.” 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 preventive services that must be included in health plans without cost sharing to covered participants. The regulations contain an accommodation for eligible non-profit religious organizations that oppose providing contraceptive coverage. As a healing ministry of the Catholic Church, Ascension Health does not promote or condone contraceptive practices and objects to providing such coverage. Therefore, as the plan sponsor of both our self-insured Ascension Health SmartHealth Medical Plan (“SmartHealth Plan”) and our self-insured Ascension Health Prescription Drug Program (“Rx Plan”), Ascension Health qualifies as an eligible organization that is entitled to the accommodation. As a result, neither the SmartHealth Plan nor the Rx Plan will provide coverage for contraceptive benefits that are in conflict with our Catholic Identity and the Ethical and Religious Directives for Catholic Health Care Services. As part of the accommodation, third party administrators of our SmartHealth and Rx plans are required to provide this coverage to covered members at no cost, independently of Ascension Health and consistent with the authority given them by the final regulation. You will receive information directly from those Administrators about the coverage that may be available to you for those “preventative services.”

21 Socially Just Health Benefits Subsidy
Ensuring access to care for all Offered to FT associates Income must be less than 200% of the Federal Poverty Level based on family size If eligible, associates must enroll in the PPO $200 deductible/ 0% cost-share plan Associates may be eligible for 100% waiver or a discount of 25%, 50% or 75% on associate premiums, inpatient and outpatient service co-pay/cost-share at our facilities only Lourdes Health Network offers a Health Benefits Subsidy to assist associates who may not have affordable access to healthcare. You are eligible if you are a FT associate, eligible for our medical plan at the time of open enrollment, and your family income and size qualifies you for a subsidy; that is, if your prior year family income is less 200% of the Federal Poverty level, based on family size, provided your current year base pay is also less than 200% of the Federal Poverty level, based on family size. More information regarding SJB can be found in the application or the benefit handbook.

22 Non-Medical Benefits Flexible Spending Accounts (FSAs)
Delta Dental Coverage Vision Service Plan (VSP) Life, Disability, and More OK, so let’s consider other benefits.

23 Flexible Spending Accounts
Administered by ADP Be sure to elect your contribution amount before deadline Remember: if you don’t use it, you lose it Healthcare FSA Minimum $ 260 Maximum $2,500 Your Health Ministry deposits your annual contribution amount in your FSA debit card at first of year You will receive new debit card the for 2014 Dependent Day Care FSA $260 $5,000 for married associates $2,500 for single associates You pay bills, then submit them for reimbursement The maximum you can contribute for 2013 in the Medical Flexible Spending account will be lowered to $2,500, consistent with recent legislation. The limits for Dependent Day Care are the same as last year.

24 Delta Dental of Missouri
Dental Plan Your Delta Dental plan provides comprehensive coverage Delta Dental of Missouri Service Comprehensive Plus Traditional Deductible $50 per person $150 family maximum Does not apply to Preventative services. Preventative 100% Basic 80% Major 50% Orthodontia 50% child coverage to age 19; $1,500 lifetime maximum No adult coverage unless you are currently enrolled in a dental plan that covers adult orthodontia, the banding is applied by December 31, 2013, and you are enrolled in this Delta Dental plan after January 1, 2014 Annual Maximum $1,500 - Excludes Preventative (w/MAXAdvantage) and Orthodontia You will have the option to sign up for Dental coverage through Delta Dental. This plan will cover preventative services at 100% as long as you choose a in-network provider. You will see that basic and major services are covered at different percentages. Please notice that adult ortho is not covered. Any treatment in service on or before 12/31 will continue to be covered up until you reach the lifetime maximum. Keep in mind that preventative services do not go towards the annual maximum. Watch for a new Delta Dental card coming in the mail before 1/1 24

25 Vision Service Plan – Full Coverage
Vision Services Plan You may elect Full Coverage with VSP Vision Service Plan – Full Coverage  Service VSP Network Out-of-Network Exam 100% 1 in 12 months after $10 Co-Pay Up to $45 Prescription Glasses Lenses Single vision Lined bifocal Lined trifocal Lenticular Lenses 100% 1 in 12 months, after $25 Co-Pay Up to $65 Up to $85 Up to $125 Frame OR Contacts Elective* *If you choose contact lenses instead of glasses, you will be eligible for a frame 12 months from the date the contact lenses were obtained. $130 after $25 Co-Pay, plus 20% off any out- of-pocket costs, every 12 months $130 allowance after $25 Co-Pay, every 12 months Up to $47 Up to $105 Diabetic Eyecare Program 100% supplemental services for Type 1 diabetics after a $5 Co-Pay Lasik Surgery For details about benefits for laser vision correction surgery contact VSP directly Vision coverage is offered through VSP. If you enroll in Vision coverage you will not receive a card you simply tell the provider that coverage is through VSP and they will submit the claim under the SSN. 25

26 Disability Coverage Short Term Disability Long Term Disability
Eligibility Lourdes Health Network pays the full cost for FT and PT non-union associates Elimination Period 7 days Coverage Covers a percentage of weekly base pay for 180 days Workers’ Compensation injuries are excluded from STD benefits. After qualifying for EIB and STD due to illness or injury, you must exhaust EIB before STD benefits begin. Long Term Disability Lourdes pays the full cost for FT and PT associates. Covers a percentage of monthly base pay from the 181st day until recovery or age 65 LTD benefits for Mental Health conditions are limited to 24 months. STD and LTD benefits are offset by any other income you may receive EIB plans will stop accruing at the first of the year – balances may be used through June 2015 Union associates refer to contract for eligibility. The STD plan provides a basic level of protection if you are disabled due to sickness or injury for more than 7 days. EIB plans will stop accruing at the first of the year – balances may be used through June EIB will be exhausted before STD benefits begin. LTD covers a percentage of monthly income after you’re totally and permanently disabled for 181 days. Disability benefits are offset by any other income benefits you receive, such as Workers’ Compensation. See your Summary Plan Description for more details.

27 Other protection Legal Services Plan
Low-cost legal assistance is available to you through Hyatt Legal, including assistance with adoption services, wills, trusts, living wills, and identity theft, etc. You may enroll during any open enrollment period if you think you’ll need a lawyer in the year ahead. You may also purchase a Legal Services Plan in any open enrollment period. You must keep the plan in effect for the full year in which you are enrolled. Supplemental Life When you first become eligible, you may purchase coverage on yourself in amounts up to 2 times your annual base pay without proof of good health.  With proof of good health, you may purchase coverage on yourself equal to as much as 7 times your annual base pay, up to a maximum of $5,000,000. Your spouse may purchase $10,000 or $25,000 of coverage without proof of good health, if coverage is elected when first eligible. Coverage elected after the first opportunity, and additional amounts up to $250,000 purchased at any time, require proof of good health. You may also purchase $5,000 or $10,000 of child-only term life coverage. 27

28 Enriching Self and Spirit
Lourdes Health Network provides additional benefits to support associates in meeting goals for personal development and well-being, including: Employee Assistance Program – support is available to you and covered dependents through LifeWorks for assistance with managing stress, relationships, and financial issues. You can talk to someone 24/7 by phone or in person by appointment. Educational Assistance – please see newly revised policy on Ellucid. We encourage you to use the Employee Assistance Program – offered at no cost to you – and to review the educational assistance policy. 28

29 Available on our Intranet – click on
Open Enrollment Resources Available on our Intranet – click on 2014 Benefits Handbook Benefit FAQs 29

30 Take time to consider your options
Next Steps Take time to consider your options Open enrollment begins October 1, 2013 Remember: This is an “active enrollment” – all benefits eligible associates must re-enroll in all benefits for 2014 Enroll before October 15, 2013 Thank you for coming. I will be here after the meeting for a few minutes if you have additional questions. 30

31 Thanks for listening!


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