2016 Benefits Guide - Adventist HealthCare

2016 Benefits Guide

Welcome to the Team!

The information contained in this Health and Benefits Guide is intended as a summary only to provide you with information as you enroll in benefits. It has been designed to provide you with an overview or high-level summary of the various benefit programs.

This guide does not replace the medical plan booklet, the retirement plan document or component insurance policies or certificates. In case of conflict, the plan document, component insurance policies or certificates govern your benefits. AHC reserves the right to amend, modify or terminate any benefits plans.

Welcome to Adventist HealthCare (AHC), where you are working with thousands of others to deliver quality health services to our community. Our mission is as simple as it is powerful: we demonstrate God's care by improving the health of people and communities through a ministry of physical, mental and spiritual healing. You play a key role in that mission.

We hold ourselves to a high standard when it comes to delivering services to patients and we hold ourselves to that same standard when delivering health benefits to our employees. Your health and that of your dependents is a top priority. AHC is committed to providing you and your family with affordable healthcare and the means and ability to secure savings for retirement.

This guide is designed to assist you in making benefit choices. It provides key information on the various aspects of the plans and helps you sort through your options. Please review the material, discuss it with your family, and make an informed choice when selecting coverage.

Table of Contents

Benefits Overview.......................................................... 2

We've Got You Covered

2

Compare Plan Details

3

Paid Time Off (PTO)

3

Our Plans......................................................................... 5

Medical Plans at a Glance

5

Wellness at Adventist HealthCare.............................. 12

Your Responsibilities Under Your Health Plan

14

Medical Plan Contributions

15

How to Save on Healthcare Costs

16

Prescription Drug Coverage

17

Dental

18

Vision Care

20

Flexible Spending Accounts (FSAs)

21

Other Services.............................................................. 22

Employee Assistance Program

22

Life Insurance Options

23

Disability Insurance Options

24

For Cytology Services Only

24

Voluntary Insurance Options

24

Legal Resources Legal Plan

24

Saving For The Future

25

College Savings Plans

26

Tuition Reimbursement Program

26

Laws + Notices.............................................................. 27

How to Access Your FSA

37

Appeals Request Form

38

Key Terms and Definitions

39

1

Benefits Overview

We've Got You Covered

The Benefits Plan year begins on January 1 and ends the following December 31. You and AHC share the cost of your benefits coverage. AHC pays the majority of the premium for your health benefits. Your cost will vary based on the plan you select and whether you elect single or family coverage. AHC offers you and your eligible dependents a variety of coverage options, including:

? Medical ? Dental ? Vision ? Life Insurance, including:

? Supplemental Life Insurance ? Spouse Life Insurance ? Child Life Insurance ? Accidental Death and Dismemberment Plan (AD&D)

? Flexible Spending Accounts, including: ? Health Care Flexible Spending Account ? Dependent Care Flexible Spending Account

? Short-Term Disability ? Short-Term Disability Buy-Up ? Long-Term Disability ? Employee Assistance Program (EAP) In addition, AHC offers a number of other programs to assist you and your family, including:

? Retirement Savings Plan ? Paid Time Off ? Tuition Assistance ? Travel Assistance ? Legal Plan ? College Savings Plan ? Voluntary Benefits, including:

? Critical Illness and Cancer Insurance Plan ? Accident Insurance Plan ? Long Term Care Insurance ? Hospital Indemnity Plan

2

Compare Plan Details

Make sure to compare deductibles, copayments and coinsurance. Take time to learn about the different options and features so you can select a plan that meets your coverage needs.

FIND A PRIMARY CARE PHYSICIAN (PCP)

You can select a PCP from the AHC network to coordinate all of your health care needs. Your PCP oversees your routine and preventive care, administers your prescriptions, becomes familiar with your medical history and works closely with you to help make your medical decisions.

Take Advantage of Free Benefits

There are free benefits included with your medical plan ? use them! Going to the doctor for preventive visits when you are healthy helps you stay healthy. With AHC's medical plans, you have access to free preventive care at AHC and in-network providers such as:

Ineligible Dependents

It is your responsibility to enroll only your eligible family members. Employees who cover ineligible family members may be subject to disciplinary action, up to and including cancellation of coverage and/or termination of employment. If a family member loses eligibility, you must notify your Human Resources Department within 31 days of ineligibility.

? Your children, stepchildren, foster children, legally adopted children, children placed with you for adoption, and children for whom you have been appointed legal guardianship (including children of a domestic partner) who are: ? Under age 26, ? Physically or mentally disabled, regardless of their age, provided they became disabled before age 26 and they were eligible for coverage as a dependent at the time they became disabled.

? Free annual wellness exams ? Free mammograms ? Free routine baby and child exams and immunizations

Changing Your Benefits

Who is Eligible?

All full and part-time staff regularly scheduled to work at least 20 hours per week are eligible to participate in the Benefits Plan. Coverage begins on the date of hire, provided that you enroll yourself and any eligible dependents within 31 days of your employment date.

DEPENDENT ELIGIBILITY

In addition to electing coverage for yourself, you may enroll eligible family members for coverage. Benefits for covered dependents begin on the same date(s) as coverage for the employee. Under AHC's benefit program, dependents are defined as:

Once you make your election, your benefits will be effective until the end of the Plan Year unless you have a qualifying change in status and you are eligible to make changes. Thereafter, you will have an opportunity to change your coverage during the annual open enrollment period.

Life event changes become effective on the first day of the pay period following your life event date except for birth or adoption of a child. You must provide AHC with written documentation of a qualified life event that may affect your benefits within 31 days of the event. All coverage changes associated with a qualified life event are subject to approval by AHC. Qualifying changes include:

? Marriage

? Your legally married spouse where the marriage is recognized ? Divorce or legal separation

under Maryland law, or any other applicable State law.

? Birth or adoption (including placement for adoption) of a

child, or your appointment as legal guardian for a child or the

placement of a child in your foster care

3

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