Summary of Employee Benefits

Eligibility & Enrollment

Huntsville Memorial Hospital Benefits Program July 2017 ? June 2018

Summary of Employee Benefits

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Health Care

Income Protection

And More...

At Huntsville Memorial Hospital (HMH), we know how important it is to have good, affordable health and group benefits. That's why we offer competitive benefits that can provide protection, peace of mind, and savings. Whether it's health care, income protection, or other benefits, we've got you covered.

This guide provides a general overview of your benefit choices and enrollment information to help you select the coverage that is right for you.

Know Enrollment.

Do I Need to Enroll?

There are lots of good reasons to enroll. For starters, there are probably changes to your benefits--including what you pay for coverage. Also, you may have experienced changes in the past year, so it's a good idea to make sure your benefits still fit you--and that you're not paying for more coverage than you need. Take a close look at all the benefits and options Huntsville Memorial Hospital offers you. You must enroll if you want to: ? Change your medical, dental, or vision coverage for next year.

-- Keep in mind, if electing spouse coverage, you must complete the Spouse Medical Plan Affidavit through the HMH BenefitsNow enrollment system.

-- If you are a tobacco user, or believe you are eligible for the health premium for non-tobacco users, you must confirm your tobacco usage status through the HMH BenefitsNow enrollment system.

? Specify your Health Savings Account election contributions, if enrolling in the OAP $2,000 with HSA medical plan.

? Contribute to the Health Care and/or Dependent Care Flexible Spending Accounts (FSAs).

? Change your optional employee or dependent life insurance. ? Change your disability elections. If you don't enroll, you may be assigned coverage that won't meet your needs. To enroll, or make changes, be sure to visit the HMH BenefitsNow enrollment site, review your current elections and make changes as necessary, by the enrollment deadline.

When Can I Enroll?

New Employees

As a new employee of Huntsville Memorial Hospital, you become eligible for benefits on the first of the month coinciding with or following your date of hire and you must enroll within 30 days of becoming eligible. Our benefits plan year runs from July 1 through June 30.

Annual Enrollment

As a benefits-eligible employee, you have the once-a-year opportunity to enroll in or make changes to your benefit plans during our annual benefits enrollment period, unless you experience a qualifying life event. Annual enrollment is typically held in May, with elections effective July 1.

Contents

Know Enrollment..........................................................................2 Do I Need to Enroll? ....................................................... 2 When Can I Enroll? ........................................................ 2

Know Who is Eligible..................................................................3 Who Can I Cover? .......................................................... 3 What if Things Change During the Year? ........................ 3

Know Your Medical and Prescription Drug Benefits...... 4

Know Your Dental Benefits.......................................................6

Know Your Vision Benefits.......................................................6

Know Your Income Protection Benefits...............................7 Life Insurance ................................................................ 7 Disability ....................................................................... 8 403(b) Retirement Savings Plan..................................... 8

Know Your Additional Benefits...............................................9 Health Savings Account (HSA) ....................................... 9 Flexible Spending Accounts .......................................... 9 Elective Benefits ........................................................... 9 Wellness........................................................................ 10 Employee Assistance Program...................................... 10

Know Your Rights........................................................................11

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Benefits: 936.435.2293 | Wellness: 936.435.7933

Know Who is Eligible.

Who Can I Cover?

You can enroll in the benefits listed in this guide as a full-time or part-time benefits-eligible employee working 20 hours or more per week. You can also cover certain dependents (in other words, family members or loved ones) under the plans. Eligible dependents include:

? Your legal spouse; ? For medical: your child(ren) up to age 26 regardless of marital or student status for whom you have legal

guardianship; or -- Your child who is 26 or more years old, unmarried, and primarily supported by you and incapable of self-

sustaining employment by reason of mental or physical disability that arose while the child was covered as a dependent under this plan. -- Anyone who is eligible as an Employee will not be considered as a Dependent spouse. A child under age 26 may be covered as either an Employee or as a Dependent child. You cannot be covered as an Employee while also covered as a Dependent of an Employee. ? For dental and vision insurance: your unmarried child(ren) up to age 25; or -- Your unmarried child, 25 years of age or older, who is not self-supporting because of mental or physical disability and is chiefly dependent upon you for support and maintenance. Proof must be provided within 31 days of turning age 25. -- Anyone who is eligible as an Employee will not be considered as a Dependent. No one may be considered as a Dependent of more than one Employee. ? For optional life and AD&D insurance: your child who is 14 days of age but less than 21 years old or 25 if a full-time student; or -- Your child who is 21 or more years old, primarily supported by you and incapable of self-sustaining employment by reason of mental or physical disability. Proof must be submitted within 31 days after the date the child ceases to qualify as a dependent. Please refer to the plan summaries or contact the Huntsville Memorial Hospital Human Resources for additional information on benefits and eligibility.

What if Things Change During the Year?

The benefits you choose will be effective through the end of the plan year. You cannot make changes to your coverage during the year unless you have a qualifying life event, which includes but is not limited to:

? Marriage, legal separation, or divorce; ? Birth, legal adoption of a child, or placement of a child with you for legal adoption; or ? Death of your spouse or dependent child. After a qualifying life event occurs, you must notify and submit any applicable forms and/or documentation to Human Resources within 30 days* of the event. Human Resources will review your request and determine whether the change you are requesting is allowed. Only benefit changes that are consistent with the qualifying life event are permitted.

*60 days if you, your spouse, or eligible dependent child loses coverage under Medicaid or a state Children's Health Insurance Program (CHIP) or becomes eligible for state-provided premium assistance.

All HMH Medical Plan Options

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Spousal Surcharge

The Working Spouse Surcharge is $100 per bi-weekly pay and is charged to employees who enroll a spouse who has access to other group medical benefits (such as through work or military service) in an HMH medical plan.

When considering whether to cover your spouse, compare the cost of your spouse's plan and HMH's plan, including the surcharge.

The spousal surcharge does not apply if your spouse:

? Does not work; ? Works part time; ? Is not eligible/has lost

coverage as an active employee, but has been offered COBRA; or ? Is covered by Medicare.

If your spouse experiences a qualified change in status (loss of job, etc.) during the year, he or she can be added to your coverage with no surcharge, provided notification and proof is submitted within the time-frame allowed for a qualifying life event.

Tobacco User Surcharge

If you and/or a family member are tobacco users, a tobacco user surcharge of $23.08 per bi-weekly pay, per each family member who is a tobacco user, will be added to your premium contributions. HMH will require confirmation of your tobacco usage status at the time of enrollment through the HMH BenefitsNow enrollment system.

For those participating in Wellness, free tobacco usage cessation resources are available, which may include personal coaching and free nicotine replacement. HMH encourages you to take advantage of this wellness benefit. If you complete the tobacco cessation program, you may be eligible to convert to the non-tobacco premium plan contributions. Contact your Human Resources Representative for more information about changing your tobacco status.

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Benefits: 936.435.2293 | Wellness: 936.435.7933

Know Your Medical and Prescription Drug Benefits.

Providing comprehensive and high-quality medical coverage at a reasonable cost is a challenge for all employers. HMH meets this challenge by providing employees with two medical plan options that include prescription drug coverage. The information below is a summary of medical coverage only. Please visit Cigna at or contact Human Resources for plan summaries detailing coverage information, limitations, and exclusions. Any deductibles, copays, and coinsurance percentages shown in the chart below are amounts for which you are responsible.

Medical Benefits Summary

Key Features

Plan Year Deductible

Individual Family

Plan Year Out-of-Pocket Max

Individual Family

Lifetime Maximum Coinsurance (percent you pay)

Physician Services Doctor's office visit Specialist Urgent care

HMH Clinics Doctor's office visit Specialist

Preventive Care

Cigna OAP $750

Participating HMH

In-Network Cigna OAP

Out-ofNetwork1

No member of the family will need to meet more than the individual deductible

amount.

$750

$750

$2,500

$2,250

$2,250

$7,500

Includes deductible, copay, coinsurance. No member of a family will

need to meet more than the individual out-of-pocket maximum amount.

$3,250

$3,250

Unlimited

$9,750

$9,750

Unlimited

Unlimited

10%

30%

50%

$25 copay4 $35 copay4 $75 copay4

$45 copay4 $55 copay4 $75 copay4

50%3 50%3 $75 copay4

$25 copay4 $35 copay4

No charge

Not applicable Not applicable

No charge

Not applicable Not applicable

50%3

Cigna OAP $1,250

Participating HMH

In-Network Cigna OAP

Out-ofNetwork1

No member of the family will need to meet more than the individual deductible

amount.

$1,250

$1,250

$3,750

$3,750

$3,750

$11,250

Includes deductible, copay, coinsurance. No member of a family will

need to meet more than the individual out-of-pocket maximum amount.

$5,000

$5,000

Unlimited

$12,700

$12,700

Unlimited

Unlimited

10%

30%

50%

$25 copay4 $35 copay4 $75 copay4

$45 copay4 $55 copay4 $75 copay4

50%3 50%3 $75 copay4

$25 copay4 $35 copay4

No charge

Not applicable Not applicable

No charge

Not applicable Not applicable

50%3

Lab and Radiology Services Independent Lab

Outpatient Lab and X-ray

Advanced Radiology Imaging

No charge No charge $150 copay per scan4

20%3 30%3 $1,500 copay per scan, then 30%3

50%3 50%3 Not covered

No charge No charge $150 copay per scan4

20%3 30%3 $1,500 copay per scan, then 30%3

50%3 50%3 Not covered

Hospital Facility Services Inpatient

Outpatient surgery

Inpatient/Outpatient professional

$150 copay, then 10%2 $150 copay, then 10%2

10%3

$1,500 copay, then 30%3 $2,000 copay, then 50%3

$1,500 copay, then 30%3 $2,000 copay, then 50%3

20%3

50%3

Emergency Room

$300 copay, then 20%2 (copay waived if admitted within 24 hours)

Prescription Drug

Retail (30-day supply)5 Generic

Preferred brand

Non-preferred brand

Not available

$7 copay $40 copay $60 copay

Not covered

Retail - 90 day supply available for maintenance medications at 3x retail copay.

Mail Order (90-day supply)5 Generic

Preferred brand

Non-preferred brand

Not available

$18 copay $100 copay $150 copay

Not covered

All Specialty Medications must be obtained through Cigna Specialty Pharmacy.

$150 copay, then 10%2 $150 copay, then 10%2

10%3

$1,500 copay, then 30%3 $1,500 copay, then 30%3

20%3

$2,000 copay, then 50%3 $2,000 copay, then 50%3

50%3

$300 copay, then 20%2 (copay waived if admitted within 24 hours)

Not available

$7 copay $40 copay $60 copay

Not covered

Not available

$18 copay $100 copay $150 copay

Not covered

1If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference. This is called balance billing.

2Coinsurance, deductible is waived. 3Coinsurance after deductible. 4Copay no deductible. 5If you request your prescription be filled with the brand name drug, when there is a generic equivalent available, an additional charge of the difference in cost between the generic and the brand name drug will apply.

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Benefits: 936.435.2293 | Wellness: 936.435.7933

Medical Benefits Summary -- Continued

Key Features

Cigna OAP $2,000 with HSA

Participating HMH

In-Network - Cigna OAP

Out-of-Network1

Plan Year Deductible Individual

Family

All family members contribute towards the family deductible. An individual cannot have claims covered under the plan coinsurance until the total family deductible has been satisfied.

$2,000 $4,000

$2,000 $4,000

$4,000 $8,000

Plan Year Out-of-Pocket Max

Individual Family Lifetime Maximum Coinsurance (percent you pay)

Includes deductible, copay, coinsurance. All family members contribute towards the

family out-of-pocket. An individual cannot have claims covered at 100% until the

total family out-of-pocket has been satisfied.

$4,000

$4,000

Unlimited

$6,850

$6,850

Unlimited

Unlimited

10%

30%

50%

Physician Services Doctor's office visit Specialist

Urgent care

Deductible/10% Deductible/10% Deductible/10%

Deductible/20% Deductible/20% Deductible/20%

Deductible/50% Deductible/50% Deductible/50%

HMH Clinics Doctor's office visit

Specialist

Deductible/10% Deductible/10%

Not applicable Not applicable

Not applicable Not applicable

Preventive Care

No charge

No charge

Deductible/50%

Lab and Radiology Services Independent Lab Outpatient Lab and X-ray Advanced Radiology Imaging

Hospital Services Inpatient Outpatient surgery Outpatient professional

Emergency Room

Deductible/10% Deductible/10% Deductible/10%

Deductible/10% Deductible/10% Deductible/10%

Deductible/20% Deductible/30% Deductible then $1,500 per scan and 30%

Deductible/30% Deductible/30% Deductible/20%

Deductible/20%

Deductible/50% Deductible/50%

Not covered

Deductible then $2,000 per admission and 50% Deductible/50% Deductible/50%

Prescription Drug

Retail (30-day supply)2 Generic

Preferred brand

Non-preferred brand

Not available

(not subject to coinsurance) $7 copay after ded. $40 copay after ded. $60 copay after ded.

Not covered

Retail - 90 day supply available for maintenance medications at 3x retail copay.

Mail Order (90-day supply)2 Generic

Preferred brand

Non-preferred brand

Not available

(not subject to coinsurance) $18 copay after ded. $100 copay after ded. $150 copay after ded.

Not covered

All Specialty Medications must be obtained through Cigna Specialty Pharmacy.

1If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference. This is called balance billing. 2If you request your prescription be filled with the brand name drug, when there is a generic equivalent available, an additional charge of the difference in cost between the generic and the brand name drug will apply.

Know How to Choose.

When you think about your health care costs, the first thing that comes to mind is probably your premium--the amount that comes out of every paycheck for coverage. But to see the total picture, you also have to consider what you're likely to pay out of your pocket, such as when you go to the doctor or get a prescription. Keep this in mind as you review the following health care plan sections. Remember, take what you'll pay for the different coverage options and then add what you think you'll pay for health care services during the year. Estimating your health care costs this way could give you an idea which option will be the best total value for your family.

Know Your Terms.

Coinsurance: A percentage of costs you pay out of your pocket for covered expenses after you meet the deductible. Copay (Copayment): A fee you have to pay out of your pocket for certain services, such as a doctor's office visit or prescription drug. Deductible: The amount you pay out-of-pocket before the health plan will start to pay its share of covered expenses. Network: Doctors, pharmacists, and other health care providers who make up the plan's preferred providers. When you use in-network providers, you pay less because they have agreed to negotiated pricing. Out-of-Pocket Maximum: The most you pay each year out of your pocket for covered expenses. Once you've reached the out-of-pocket maximum, the health plan pays 100% for covered expenses. Preventive Care: Services you receive when you are not sick or injured--so that you will stay healthy. Preventive care services include annual physicals, wellness screenings, and well-baby care.

How do I find out if my doctor is in Cigna's Network?

? Visit ? Select "Find a Doctor" ? Choose the directory "If your insurance plan is offered through work or

school" ? Enter your location

? Select Medical Plan: "Open Access Plus, OA Plus, Choice Fund OA Plus" ? Enter your search criteria (Name, Type of Doctor, Hospital, etc.) ? Select "Search" Remember to review the HMH intranet site for up-to-date information about HMH facilities and physicians participating in the HMH benefits level.

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Benefits: 936.435.2293 | Wellness: 936.435.7933

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