Employee Health and Welfare Benefits Guide 2013

Employee Health and Welfare Benefits Guide 2013

PROPRIETARY NOTICE This publication and its contents are proprietary to Adventist HealthCare. No part of this publication may be reproduced in any form or by any means without the written permission of

Adventist HealthCare,1801 Research Blvd, Rockville, MD 20850.

1

Table of Contents

Table of Contents .................................................................................................................................................... 2

................. 4 2013 Benefit Plan Highlights .................................................................................................................................. 4 Benefits Contacts..................................................................................................................................................... 5 Your Benefits Package ............................................................................................................................................. 6

Who Is Eligible?................................................................................................................................................................. 7 ? Your legally married spouse ................................................................................................................................. 7

If you do not enroll for additional optional benefits you will automatically receive the following AHC Paid Benefits coverage by default: ................................................................................................................ 8 What If I Want To Make a Change? ................................................................................................................................ 9 Once you make your elections, your benefit coverage remains the same for the remainder of the calendar year. You may not make changes until the next annual Open Enrollment, unless you experience a "qualified life event" (see examples below) or qualified work status change. If you experience a qualified life event or a qualified work status change, you may be allowed to make changes to certain benefit elections within 31 days of the occurrence........................................................ 9 Changes must be consistent with the life event. For example, if you have a baby, you may add a new dependent, but you would not be allowed to drop dependents currently covered by the Plans. This is because dropping dependents is not a change consistent with having a baby. ............................ 9 Paying for Your Coverage ............................................................................................................................................... 9 What Steps Can You Take To Save?.............................................................................................................. 11 Best Health Choice PPO Plan ........................................................................................................................................12 Best Health Plus PPO Plan ............................................................................................................................................12 Wellness Discount, Tobacco Free/PWP........................................................................................................ 13 Best Health Choice - 2013..................................................................................................................................... 14 Best Health Choice - 2013 (cont.) ......................................................................................................................... 15 Best Health Plus - 2013 ......................................................................................................................................... 16 Best Health Plus - 2013 (cont.) ............................................................................................................................ 17 Your Responsibilities Under Your Health Plan .................................................................................................... 21 PreNotification Requirement for All Inpatient Hospital Admissions .........................................................21 PreApproval Requirements On Certain Treatments* ......................................................................................21 Preventive Services Covered Under The Affordable Care Act .........................................................................24 The following services will be covered subject to Plan Copayments, Coinsurance, Deductibles, and Limitations. ......................................................................................................................................................................27 27. Dialysis and End Stage Renal Disease .............................................................................................................36 Medical Plan Exclusions ....................................................................................................................................... 37 Prescription Drug Coverage........................................................................................................................................40 Vision Care ........................................................................................................................................................................42 Dental PPO Offered Through CIGNA ........................................................................................................................43 Dental Health Maintenance Organization (DHMO) ...........................................................................................43 Life Insurance Options ............................................................................................................................................. 45 AHC provides several life insurance options through Hartford Life, including: .................................................. 45 Travel Assistance Services ............................................................................................................................ 46

2

Saving For The Future ............................................................................................................................................ 48 Changing Your Contributions..................................................................................................................... 48 Changing Your Investments........................................................................................................................ 48

2013 403(b) Plan Limits ..............................................................................................................................................48 457(b) Plan:................................................................................................................................................. 49 401(k) Plan (Cytology or AMG Employees Only): ............................................................................... 49 This plan is only available for employees working for Cytology Services or AMG (Adventist Medical Group). Please see Exhibit B for information on the 401(k) plan. .................................................. 49

College Savings Plans through Wealth Advisors Group ...................................................................................49 Health and Wellness.............................................................................................................................................. 52 Voluntary Insurance Options................................................................................................................................... 55 Paid Time Off (PTO) Benefits and Holidays ........................................................................................................ 56 AHC provides various options for events that require time away from work. The Paid Time-Off Program, or PTO, places into an annual account all of your paid days off, including holidays, vacation, sick time, and personal days taken for family illnesses or other reasons. It provides all employees with a number of paid time-off days, based on your years of service, to use for time away from work for any reason. PTO allows you to be paid for time off based on your personal needs and preferences. ................................................................ 56 Tuition Reimbursement Program ........................................................................................................................... 56 Continuation Coverage .......................................................................................................................................... 57

Qualifying Events...........................................................................................................................................................57 HIPAA?Certificate of Creditable Coverage .......................................................................................................... 60 Maternity and Newborn Infant Coverage............................................................................................................. 60 Women's Health and Cancer Rights Act............................................................................................................... 60 Qualified Medical Child Support Orders.............................................................................................................. 60 Mental Health Parity and Addiction Equity Act ..................................................................................................... 61 Coordination of Benefits (COB) ...................................................................................................................... 62 Medicare Creditable Coverage Disclosure ........................................................................................................... 63 Claim Filing Instructions....................................................................................................................................... 65 Medical Claims Appeal Process............................................................................................................................ 66 Family and Medical Leave..................................................................................................................................... 68

Military Family Leave Entitlements.........................................................................................................................68 Notice of Privacy Practices ..........................................................................................................................................71 2013 Supplemental Life and Buy-Up Disability Insurance (Hartford)............................................................. 79 Definitions ............................................................................................................................................................ 80 Appendix A: Summary of Benefits Coverage .................................................................................................. 89 Exhibit B ................................................................................................................................................................ 90

3

2013 Benefit Plan Highlights

Best Health Choice & Best Health Plus PPO Medical Plans

Tier One: AHC Network (AHC Facilities, privileged physicians and AMG)

Tier Two: Networks are: o Multiplan Network (National) o CHP Network (Maryland, Delaware, Southern Pennsylvania, West

Virginia, Virginia)

Find Tier One and Tier Two network providers online by logging onto:

Tier Three: All Other Providers Out of Network

*100% Coverage for Inpatient stays at AHC Facilities

100% Coverage for Preventive Care from Network Providers

100% Coverage for Urgent Care nationwide after a $50 Copay including:

o Free-Standing Urgent Care Centers o CVS "minute clinics" o Target "minute clinics"

Medical Flexible Spending Account maximum effective January 1, 2013 will be $2,500 per year

Visit My Health Place and use the Personal Wellness Profile to help you identify your health risks

* AHC offers many comprehensive medical services in the Tier One AHC Network. Please be advised that we can't guarantee that every medical service will be available within the Adventist HealthCare Network.

4

Benefits Contacts

CONTACTS

AHC Human Resources and Provider Contact Information

Adventist Home Health Services 301-592-4467 Cytology Services

301-891-6656

Adventist Rehab Hospital MD Adventist Behavioral Health ABH at Eastern Shore Customer Service

AHC Employee Self Service

240-864-6035 Shady GroveAdventistHospital

240-826-6363

301-217-5415 SupportCenter

301-315-3204

410-901-4333 WashingtonAdventistHospital

301-891-6652

Customer Service Phone

Website

AHC Group Number



AHC Employee Self Service Password Re-set InforMed Medical

Network Provider Directories

Flexible Spending Accounts Express Scripts/MEDCO Prescription Drug

301-826-6440

1-800-459-2110

1-800-459-2110

1-800-459-2110 1-800-711-0917 TTY 1-800-759-1089

Anthelios Help Desk





Listing of allowable FSA expenses publications/p502



8002 8002

CIGNA Dental HMO

1-800-367-1037



3215816

CIGNA Dental PPO

1-800-244-6224



3215816

United HealthCare Vision

1-800-638-3120



College Savings Plan

Hartford Life & Disability

Employee Assistance Plan (EAP) LifeWork Strategies Wellness Programs Tobacco Cessation Hotline Travel Assistance Services

Personal Wellness Profile

301-279-0501 1-877-534-6206 1-800-964-3577

1-877-252-8550

1-877-252-8550 1-866-734-7848 1-800-243-6108 pwp@

Larry Paul, Raymond James

1-866-945-7781 employee telephonic claim

submission or online at

675328

Login: AHCEAP



Password:

employee



health/index.aspx

tobacco@

You can also collect if needed 202-828-5885

GLD-09012



Lincoln Retirement Savings

1-800-234-3500



EOI Voluntary Benefit Plans

1-800-229-3641

`

5

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download