2018 jefferson benefits guidebook · 2018-11-20 · 2 human resources new ires: ak ur nrol ithi 30...

2018

Jefferson Benefits Guidebook

IMPORTANT! Benefits Enrollment InformationOpen Enrollment for the 2018 Plan Year is processed exclusively online from October 16–30, 2017.

All employees must go online during Open Enrollment and actively elect benefits even if you want to keep the same level of coverage.

The benefits you elect during open enrollment will remain in effect for the entire plan year unless you experience a qualified life event. It's the employee's responsibility to contact HR Operations to report the qualified event. Changes must be made within 30 days of date of the event.

New hire elections are processed exclusively online and must be made within 30 days of hire.

READY TO ENROLL? Go to page 40 for instructions. 1TABLE OF CONTENTS

TABLE OF CONTENTSHUMAN RESOURCES 2-4

Online 2 Access Employee Self-Service 2 Your Campus Key and Password 2 HR Business Partner 2 Total Compensation Statement 2 Eligibility 3 Part-Time Employee Benefit Program 3 Eligible Dependents 4 Proof of Dependents’ Status 4

HOW AND WHEN TO ENROLL FOR COVERAGE 5-6

Open Enrollment 5 Changing Your Benefits Due to a Life Event 5 Verify Your Elections 5 When Coverage Ends 6

COBRA 6

COBRA Rates 6

LIVEWELL@JEFF 7-8

MEDICAL PLANS 9-16

Medical Plans at a Glance 9 Terms to Know 9 Cost of Coverage 10 Platinum and Gold PPO Plans 11 How the Platinum and Gold Plans Work 11 The JeffCare Hospital Network 11 Livongo for Diabetes 12 What is Not Covered? 12 Platinum PPO Plan Summary 13-14 Gold PPO Plan Summary 15-16

PRESCRIPTION PLAN 17-21

How the Plans Work 17 MedImpact Home Delivery 17 Mandatory Generic Drugs 18 Prescription Management Programs 18 Prescription Benefits at a Glance 19 Save on Prescriptions 19 Domestic Pharmacy Locations 19 Smoking Cessation 20 Filling Prescription While Away 20 Charges Not Covered 20 Out-of-Pocket Maximum 20 Selecting the Right Medical/Rx Plan for You 21

VISION PLAN 23-24

Davis Vision Benefits at a Glance 23 Davis Participating Partners 24 Out-of-Network Benefits 24 Reimbursement Schedule 24 Cost of Coverage 24

DENTAL PLANS 25-26

Dental Plans at a Glance 25 Delta Dental of PA 26 Cost of Coverage 26

LIFE INSURANCE PLANS 27-28

Basic Life and AD&D Insurance 27 Supplemental Life and AD&D Insurance 27 Cost of Coverage 27 Supplemental Insurance Rates 28 Converting to an Individual Policy 28 Age Reduction 28 Medical Evidence of Insurability 28 Imputed Income 28 Long-Term Disability 28

BUSINESS TRAVEL ACCIDENT INSURANCE 28

How the Plan Works 28 Cost of Coverage 28

DISABILITY PLANS 29-31

Short-Term Disability 29 Your Short-Term Disability Choices 29 How the Short-Term Disability Plan Works 29 Cost of Coverage 29 Pre-Existing Conditions 29 Long-Term Disability 30 Your LTD Choices (Except Clinical Faculty) 30 How the Long-Term Disability Plan Works 30 Cost of Coverage 30 Pre-Existing Conditions 30 LTD Benefit Period 31 LTD (Clinical Faculty) 31

FLEXIBLE SPENDING ACCOUNTS 32-33

Flexible Spending Accounts at a Glance 32 Discovery Benefits Debit Card 33 Discrimination 33 FSA Store 33 Additional Information 33

VOLUNTARY BENEFITS 34

YOUR OTHER BENEFITS 35-37

Retirement Plans 35 Tuition Assistance 36 Dependent Scholarship 36 Vacation or Earned Time Off 37

BI-WEEKLY EMPLOYEE CONTRIBUTION RATE SHEET 38

BENEFITS SERVICE PROVIDER CONTACT LIST 39

TO COMPLETE THE ENROLLMENT PROCESS 40

For additional benefits information please view our website, hr.jefferson.edu. Click on benefits located in the menu on the left side of the page.

2 NEW HIRES: Make sure to enroll within 30 days of your hire date.HUMAN RESOURCES

Access Employee Self-ServiceFROM WORK Using Internet Explorer 11 or Google Chrome, go to hr.jefferson.edu and click on Employee Self-Service. Sign on with your campus key and password.

FROM A NON-WORK COMPUTER Go to https://connect.tjuh.org and enter your campus key and password. Click on Employee Self-Service and enter your campus key and password again.

Human ResourcesONLINE

The Human Resources website, hr.jefferson.edu, provides you a wealth of benefit information and tools: • Compare medical plans • View benefit overviews and plan summaries • Print forms • Access policies

Through the website you can access Employee Self-Service (ESS) to: • View your current benefits • Enroll in benefits • Select and update your beneficiary designations • View your pay stub • Review and update your address and phone number

YOUR CAMPUS KEY AND PASSWORD

New employees can call IS&T at 215-955-7975 to obtain their Campus Key and password.

HR BUSINESS PARTNER

Can’t find an answer to your question on the HR website? Contact your HR Business Partner about benefits, policies, employee self-service and general payroll issues. Find out who your HR Business Partner is by visiting Jefferson.edu/HRBP while on the network and then clicking the yellow box that reads, “Who is my HR Business Partner.”

TOTAL COMPENSATION STATEMENT

To see a comprehensive breakdown of the value of your benefits including compensation, retirement savings, medical and time off, visit Employee Self-Service at myhr.jefferson.edu using Internet Explorer 11 or a Google Chrome browser. Click on Payroll and Compensation and then select My Total Rewards. To see the value of your benefits, click on the Health and Wellness tab beneath the pie chart.

3READY TO ENROLL? Go to page 40 for instructions. ELIGIBILITY

EligibilityAll regular full-time employees scheduled to work at least 35 hours per week and regular part-time Jefferson employees scheduled to work 20 or more hours per week but less than 35 in job classifications designated as benefit eligible can participate in the Jefferson Benefits Program. Waiting periods are noted below.

PART-TIME EMPLOYEE BENEFITS PROGRAM

The benefits program includes subsidized benefits for eligible part-time employees who elect to participate. You are eligible if you are a regular part-time employee in a benefit-eligible job classification scheduled to work 20 hours or more per week but less than 35.

Eligible part-time employees may select options for Medical, Dental, Vision coverage, Life and Accidental Death and Dismemberment Insurance, Spousal and Child(ren) Life Insurance and the Flexible Spending Accounts. The medical and dental per pay contributions are higher for part-time employees. Part-time employees are not eligible to participate in Jefferson’s Disability Programs beyond Earned Time Off accruals.

Benefits Waiting Periods

Full-Time Faculty, Full-Time Senior Administrators, Other Benefit Eligible Employees (20–40 hours per week)

Full-Time House Staff and Full-Time Postdoctoral Fellows

• Medical• Vision• Dental• Life and AD&D• Short & Long

Term Disability(full-time only)

• Flexible SpendingAccounts

1st of month on or after date of hire or date you move to an eligible status

1st day at work

Voluntary Benefits Program

When your benefits begin depends on when you enroll. If you enroll between the 1st and 15th of the month, your benefits begin on the first of the following month. If you enroll between the 16th and 31st of the month, your benefits begin on the first of the next following month.

4 NEW HIRES: Make sure to enroll within 30 days of your hire date.ELIGIBLE DEPENDENTS

Eligible DependentsYou may enroll your eligible dependents in a Jefferson medical, dental, vision, life insurance or AD&D plan. Eligible dependents include your spouse and children up to age 26.

The Affordable Care Act regulations require us to report the social security number for all dependents covered under the medical plan. You will not be able to proceed with your online benefit enrollment unless you enter your dependent’s SSN.

PROOF OF DEPENDENT STATUS

If you choose to enroll your dependents in benefits, you will need to submit dependent verification documentation within 30 days from the date you add them as a dependent.

This information should be sent to: [email protected] or Fax: (215) 503-7455

If you do not provide the required documentation within 30 days of enrollment, that dependent will no longer be entitled to benefits and will be removed from coverage.

Who is not eligible for coverage? • A former spouse • A parent or grandchild who resides with you • A legally domiciled adult and/or domestic partner, • Any other person who does not meet the eligibility requirements

See acceptable documentation below.

Legally Married Spouse (any one of these documents)

• Presently valid legal marriage certificate or license (must include date of marriage).

• First page of your prior year Federal income tax return form 1040 that indicates “married filing jointly“ or “married filing separately“ (your spouses name must appear on the tax form on the line provided after the “married filing separately“ status). Financial information may be blocked out.

Natural Child, Adopted Child or Child for whom you are the legal

guardian under age 26* (any one of these documents)

• Legal or hospital birth certificate showing the parent/child relationship with the employee.

• First page of prior year Federal income tax return form 1040 showing the child listed as a dependent (financial information may be blocked out).

• Baptism certificate showing the parent/child relationship with the employee.

• Official court order (divorce decree/custody agreement) showing the parent/child relationship with the employee.

• Legal adoption papers showing the parent/child relationship with the employee.

• Legal guardianship papers issued by the courts showing the guardian/child relationship.

*In addition, for a disabled child age 26 or older, an Application to Continue Coverage for a Handicapped Dependent Child must be submitted to Independence Blue Cross.

Stepchild under age 26* (any one of these documents)

• Legal birth certificate showing parent/child relationship to the spouse of employee and valid legal marriage certificate between the employee and spouse.

• First page of prior year Federal income tax return form 1040 showing the child listed as a dependent (financial information may be blocked out).**

• Court order (divorce decree/custody agreement) showing joint or shared legal custody by your spouse.**

• A Qualified Medical Child Support Order (QMCSO) that identifies the child as requiring benefit coverage through the employee’s spouse.**

*In addition, for a disabled child age 26 or older, an Application to Continue Coverage for a Handicapped Dependent Child must be submitted to Independence Blue Cross.

**If you are an employee providing documentation for a child of your spouse, documentation must also include any one of the documents listed for spouse even if your spouse is not covered by the Jefferson benefit plans.

5READY TO ENROLL? Go to page 40 for instructions. ENROLLMENT

How And When To Enroll For CoverageNew hires must enroll in benefits within 30 days from date of hire. Employees that have a status change must enroll in benefits within 30 days of becoming eligible for benefits. You will need to enroll in benefits online using Employee Self-Service (ESS). The benefits you choose will remain in effect until December 31 of that year.

If you do not want Jefferson medical coverage, you must go online and waive coverage. Otherwise, you will be enrolled in the Gold PPO Plan at employee only coverage.

OPEN ENROLLMENT

Every fall you will have an opportunity to make changes to your benefits during Open Enrollment. Any changes you make at Open Enrollment take effect on the upcoming January 1.

CHANGING YOUR BENEFITS DURING THE YEAR DUE TO A LIFE EVENT

You can only change your benefit elections during the year if you have a life event, as defined by the IRS. That is why it is important to review your choices carefully to ensure the benefits you choose will meet the needs of you and your family throughout the year. If you have a life event, you can only make a change to your coverage that is consistent with the life event. For example, if you get married, you may add your spouse to medical coverage, but may not switch medical plans. Any change you make must be made within 30 days of the event.

Life Events include: • Marital status change (marriage, divorce, death of spouse) • Change in number of dependents (birth, adoption, death of dependent) • You or one of your covered dependents gain or lose other benefits coverage • Any other event recognized under applicable law and regulations as a reason

to change an election under the Benefits Program

Marriage, birth or adoption life events can be submitted through Employee Self-Service. Any required documentation must be submitted to HR Operations within 30 days of the event. Contact HR Operations at 215-503-4772, press Option 8, and then Option 1 to report other life event changes.

Verify Your ElectionsYou will be able to verify your elections one business day after submitting an event by logging into Employee Self Service.

• Click on Benefits • Click on Benefits Summary • Fill in applicable date, i.e. for future coverage, you must enter future date • Click Go

6 NEW HIRES: Make sure to enroll within 30 days of your hire date.COVERAGE

When Coverage EndsFOR YOU

Jefferson benefit coverage ends for you upon the following events: • Medical, vision and dental benefits end on the last day of the

month in which your employment ends or you no longermeet the applicable eligibility requirements of the plans

• Life insurance, disability and FSA benefits end on the dateyour employment ends or you no longer meet the applicableeligibility requirements of the plans

FOR YOUR DEPENDENTS

Jefferson benefit coverage ends for your dependents on the date: • Your coverage ends• Your dependent no longer meets the definition of an

eligible dependent• You remove a dependent from coverage due to a life event

Coverage may also end if you stop making required payments, you misrepresent your dependent’s eligibility status or the plan ends.

COBRACOBRA requires continuation coverage to be offered to covered employees, their spouses, their former spouses and their dependent children when group health coverage would otherwise be lost due to certain specific qualifying events. The chart below shows the specific qualifying events, the qualified beneficiaries and maximum coverage period.

Once the qualifying event has been reported to HR Operations, the qualified beneficiary will receive a COBRA notice in the mail to the home address on record by our third party administrator, Discovery Benefits. For more information on COBRA, visit the DOL website, “An Employees’ Guide to Health Benefits under COBRA” at www.dol.gov/ebsa/pdf/cobraemployee.pdf, contact Discovery Benefits at 866-451-3399 or your HR Business Partner.

Qualifying EventQualified Beneficiaries

Maximum Period of Continuation Coverage

Termination (for reasons other than gross misconduct) or reduction in hours of employment

Employee, Spouse, Dependent Child

18 months

Employee enrollment in Medicare Spouse, Dependent Child 36 months

Divorce or legal separation Spouse, Dependent Child 36 months

Death of employee Spouse, Dependent Child 36 months

Loss of “dependent child” status under the plan Dependent Child 36 months

Monthly Cost Platinum PPO Gold PPO Davis VisionPlatinum Dental

Gold Dental

Beneficiary Only $551.82 $524.28 $6.32 $31.89 $27.75

Beneficiary + Spouse $1,241.34 $1,179.12 $10.85 $63.77 $55.52

Beneficiary + Child(ren) $1,048.56 $995.52 $10.85 ($15.67) $71.74 $62.45

Beneficiary + Family $1,765.62 $1,676.88 $15.67 $95.65 $83.27

7READY TO ENROLL? Go to page 40 for instructions. LIVEWELL@JEFF

Livewell@JeffREDBRICK HEALTH

The LiveWell@Jeff program was established to enhance the quality of life of Jefferson employees by promoting healthy lifestyles and reducing the risk of illness by using Jefferson’s wide range of educational and clinical resources. Jefferson has partnered with RedBrick Health to create a rewards program with an interactive online employee portal.

ELIGIBILITY

All benefits-eligible employees of Jefferson, and members of 1199C enrolled in a Jefferson-sponsored medical plan, are eligible to participate in the LiveWell@Jeff program.

2018 WELLNESS CREDITS

For employees and spouses who completed LiveWell@Jeff wellness program requirements by September 1, 2017, you will receive a wellness credit of $15 per pay. Your covered spouse can earn an additional $10 per pay, regardless of which medical plan you enroll in beginning January 2018.

NEW PROGRAM YEAR: OCTOBER 1, 2017 – SEPTEMBER 1, 2018

We are excited to introduce a new way to earn financial rewards beginning October 1, 2017. Real-Time Rewards allows employees to earn wellness points for completing healthy activities throughout the year. Once you complete your health assessment and biometric screening, you can instantly redeem your points for up to $60 in gift cards (1 point = $1). Additionally, employees who complete the online health assessment and biometric health screening by September 1, 2018 will be eligible for wellness credits in 2019.

PROGRAM REQUIREMENTS

Step 1: Tell Us More About Yourself Complete your online health assessment by September 1, 2018. It’s a short questionnaire about your health that only takes a few minutes to complete. You’ll see your strengths and identify areas where you can improve.

Step 2: Know Your Numbers Get a health screening to get a better picture of your health and submit your records to RedBrick Health by September 1, 2018. These will remain confidential and Jefferson will not have access to any individual’s health records. It may take up to two weeks for your screening results to appear on your wellness portal.

Step 3: Real-Time Rewards (optional) Earn wellness dollars throughout the year when participating in healthy activities. Once you complete your online health assessment and biometric health screening, you can instantly redeem up to $60 in gift cards.

Redbrick Health Mobile AppTake RedBrick Health with you on the go! The RedBrick App gives you a fast and easy way to track your daily activities, make progress on your health improvement journey, and earn all the rewards of better health. The activation code is: “jefferson”

How the Portal WorksBenefits-eligible employees, and members of 1199C enrolled in a Jefferson-sponsored medical plan, can create an account at MyRedBrick.com/Jefferson. The RedBrick wellness portal is where you will complete the Health Assessment, record your healthy activities, and access health information and tools.

8 NEW HIRES: Make sure to enroll within 30 days of your hire date.LIVEWELL@JEFF

Information on Health ScreeningsThere are four ways to complete your Health Screening:

Information on Real-Time RewardsIn addition to earning wellness credits for 2019, employees can qualify for gift cards by participating in healthy activities. Earn wellness points for each activity and instantly redeem up to $60 in gift cards once you complete your two program requirements.

Some activities are self-reported, while others will be awarded by RedBrick upon completion of a program. Visit www.jefferson.edu/livewell for more information.

Your Own ProviderComplete your Health Screening using your own provider. Have your provider complete the Health Screening Form (available on your wellness portal) and submit to RedBrick.

Onsite at Jefferson LabsYou can schedule your health screening at any time throughout the year at the Jefferson Outpatient Lab by calling 1-800-JEFF-NOW. The lab will submit your results directly to RedBrick.

LabCorpComplete your health screening at a participating LabCorp. Print a prepaid voucher and search for a participating LabCorp lab on your wellness portal.

Onsite Screenings Onsite health screenings at Jefferson will be available every spring.

Examples of Healthy Activites (1 point = $1)

Annual Physical = 10 points EXOS Program = 15 points RedBrick Track = 1 point/day

Dental Exam = 10 pointsBehavior Modification Program = 15 points

Lunch & Learn = 5 points

Vision Exam = 10 points Nutrition Program = 15 points Financial Wellness = 5 points

Preventative Screenings = 10 points RedBrick Journey = 15 points Health/Wellness Fair = 5 points

RedBrick Challenge = 10 points Community Walks/Runs = 15 points Volunteer/Donate Blood = 5 points

9READY TO ENROLL? Go to page 40 for instructions. MEDICAL PLANS

Terms to Know

Medical PlansMEDICAL PLANS AT A GLANCE

Jefferson gives you a choice of two medical plans administered through Independence Blue Cross:

• Platinum PPO • Gold PPO

In 2018, you have a choice of four coverage categories. This is a change from our previous structure.

• Employee only • Employee + Spouse • Employee + Child(ren) • Family

Here are some important terms to help you understand how the plans pay benefits.

Allowable Amount

Our benefit plans pay expenses based on the allowable amount. This is the average charge, or “going rate” for a specific service in a geographic area. Network providers have agreed to accept the allowable amount, while out-of-network providers may charge above the allowable amount. With an Out of Network provider, you may be responsible for the amount over the allowable amount, in addition to any deductibles, coinsurance or copays your plan requires.

CoinsuranceThe percentage of an eligible expense the plan pays (such as 70%). You pay the remaining percentage (such as 30%) and this counts toward the out-of-pocket maximum.

CopayThe flat dollar amount you pay for some services (such as $20) at the time care is received. Copays count toward the out-of-pocket maximum.

DeductibleThe amount of eligible expenses you pay before the plan pays benefits. The deductible counts toward the out-of-pocket maximum.

Out of Pocket Maximum

This is the maximum amount you or your family must pay in coinsurance, copays and deductibles toward eligible expenses in a calendar year. Generally, when you reach the out-of-pocket maximum the plan will pay 100% for most eligible expenses.

Pre-existing Limitations

The medical plans do not restrict benefits based on pre-existing conditions.

10 NEW HIRES: Make sure to enroll within 30 days of your hire date.COST OF COVERAGE

Cost of CoverageThe bi-weekly cost varies based on the: • Medical option you choose • Number of dependents you choose to cover • Smoker status for you and your spouse • Wellness program participation for you and your spouse • Whether or not your covered spouse is eligible for medical coverage through another employer

Research shows that there is a growing trend for employer plans to charge more to cover spouses who have access to health insurance through another employer. In reviewing our plans, we’ve found that Jefferson covers more spouses — taking on a larger medical responsibility than other employers. If your spouse has medical coverage available through another employer and you choose to cover your spouse under a Jefferson medical plan, you will pay an additional $40 per pay for the coverage. During the online enrollment process, you’ll be asked if your spouse has coverage available through another employer. The charge will only apply if your spouse has other available coverage or if you do not answer the question, and enroll your spouse in medical.

Your cost for the medical plan is deducted from your pay on a pre-tax basis. The rates shown here are prior to any credits or premiums.

If you’re enrolled in the medical plan and attest to being a smoker, you will be charged a $25 per pay premium. If your spouse smokes, a $25 per pay smoker premium will apply for spouses enrolled in the medical plan. During the online enrollment process, you will answer questions regarding you and your spouse’s smoker status. The premiums will apply if you indicate you or your spouse smokes or if you do not answer the question, and enroll your spouse in the medical plan.

MEDICAL CONTRIBUTION RATES—PER PAY PERIOD

Full-Time Employees PLATINUM PPO GOLD PPO

Employee Only $48 $39

Employee + Spouse $109 $90

Employee + Child(ren) $99 $75

Family $170 $140

Part-Time Employees PLATINUM PPO GOLD PPO

Employee Only $115 $100



Family $362 $314

11READY TO ENROLL? Go to page 40 for instructions. MEDICAL PLANS

Platinum and Gold PPO PlansHOW THE PLATINUM AND GOLD PLANS WORK

The Platinum and Gold PPO medical plans allow complete freedom of choice of providers. Research shows that a patient with a relationship with a PCP has better coordinated care, better outcomes, with less cost and waste. For both the Platinum and the Gold Plans, Primary Care Office copays under Tier 1 (Home) are free. Referrals are not required with the medical plans.

The Platinum PPO plan provides a high level of comprehensive coverage, with 100% coverage for services through Home facilities. You will pay more per pay period for the Platinum PPO plan.

The Gold PPO plan is a lower-level coverage option that still provides important protections and costs less per pay period. You will pay a modest deductible for Home facility services and pay overall higher out-of-pocket costs when you go to the doctor. It is important to note that infertility and hearing aid services are not covered by the Gold PPO plan.

You decide which network to choose a provider from when seeking medical care. • Tier 1 Home ($): You receive care from a home JeffCare network provider • Tier 2 Non-Home ($$): You receive care from a non-home JeffCare network provider • Tier 3 ($$$): You receive care from a Personal Choice provider • Tier 4 ($$$$): You receive care from an out-of-network provider

If you receive care at a JeffCare network facility or a JeffCare network provider, you receive the highest level of benefits. This higher level of benefit is only available if the service is available through a JeffCare network provider.

The JeffCare Hospital NetworkThe network of providers is identical in both plans. Visit www.jeffnetworks.org and click on 2018 for the most up-to-date listing of facilities and providers in Tiers 1 and 2. Go to www.ibx.com to search for providers in the Personal Choice network.

HOSPITAL NETWORK

Tier 1 (Home) Tier 2 (Non-Home)

• TJUH, JHN, Methodist • Abington, Lansdale • Aria • Kennedy • Bala Endoscopy Center • Rothman Orthopedic Specialty Hospital • Main Line Health Hospitals

• Nemours • Wills Eye (Center City only) • Doylestown • Magee

12 NEW HIRES: Make sure to enroll within 30 days of your hire date.MEDICAL PLANS

Livongo for DiabetesEmployees and dependents enrolled in a Jefferson medical plan, and are diagnosed with type 1 or type 2 diabetes can enroll in the Livongo for Diabetes program at no cost.

Benefits • Unlimited Test Strips at no cost shipped to your home with no copays • The Livongo connected meter provides real time tips and uploads readings • Livongo coaches are Certified Diabetes Educators who can assist you with nutrition and lifestyle changes.

To join or learn more: welcome.livongo.com/JEFF or call Livongo Member Support at (800) 945-4355

*At this time the Livongo meter does not integrate with insulin pumps. If you use an insulin pump, please discuss the use of Livongo with your healthcare team.

JeffConnectFast easy way to see a Jefferson Doctor! Go to jeffconnect.org to enroll. Initiate a video visit on your computer or mobile device. Available 24/7/365.

What is Not Covered?• Services not medically necessary • Services or supplies which are experimental or investigative except routine costs associated with clinical trials • Reversal of voluntary sterilization • Expenses related to organ donation for non-member recipients • Alternative therapies/complementary medicine • Dental care, including dental implants, and non-surgical treatment of temporomandibular joint syndrome (TMJ) • Music therapy, equestrian therapy, and hippotherapy • Treatment of sexual dysfunction not related to organic disease except for sexual dysfunction resulting from injury • Routine foot care, unless medically necessary or associated with the treatment of diabetes • Foot orthotics, except for orthotics and podiatric appliances required for the prevention of complication associated with diabetes • Routine physical exams for non-preventative purposes such as insurance of employment applications, college, or premarital examinations • Immunizations for travel or employment • Service or supplies payable under Workers’ Compensation, Motor Vehicle Insurance, or other legislation of similar purpose • Cosmetic services/supplies • Self-injectable drugs • Infertility Treatment under the Gold PPO Plan • Hearing aid services under the Gold PPO Plan

READY TO ENROLL? Go to page 40 for instructions. 13MEDICAL PLANS

Platinum PPO Plan | 2018 Plan Summary

Benefits JeffCare Home JeffCare Non-Home Personal Choice Network Out-of-Network*

Deductible (Individual) None $100 $1,000 $1,500

Deductible (Family) None $300 $3,000 $4,500

Benefit Period Calendar Year Calendar Year Calendar Year Calendar Year

Coinsurance (percentage paid by plan except hearing aid benefit)

100% unless otherwise noted


70% after deductible unless otherwise noted


Out-of-Pocket Maximum*** (Individual)

$2,000 $2,5004 $3,5004 $5,000

Out-of-Pocket Maximum*** (Family)

$4,000 $5,0004 $7,0004 $10,000

Lifetime Maximum Unlimited Unlimited Unlimited Unlimited

Doctor’s Office Visits (Primary Care Services)

$0 Copayment $15 Copayment $30 Copayment 60% after deductible

Doctor’s Office Visits (Specialist Services)


Preventative Care for Adults & Children

100% 100% 100% 60% after deductible

Pediatric Immunizations 100% 100% 100% 60% after deductible

Routine Gynecological Exam/Pap (1 routine exam/pap test per calendar year for women of any age1)


Mammogram 100% 100% 100% 60%

Nutrition Counseling for Weight Management (6 visits per calendar year1)


Outpatient Diagnostic Services (Routine Radiology)

$15 Copayment $20 Copayment 70% 60% after deductible

Outpatient Diagnostic Services (Advanced Radiology – MRI/MRA/CAT/PET)

$40 Copayment $60 Copayment 70% after deductible 60% after deductible

Outpatient Diagnostic Services (Laboratory)

100% $10 Copayment$25 Copayment per occurrence

60% after deductible

Allergy Testing 100% 100% 70% after deductible 60% after deductible

Allergy Extract / Injections 100% 100% 70% after deductible 60% after deductible

Maternity (First OB Visit) $30 Copayment $45 Copayment $60 Copayment 60% after deductible

Maternity (Hospital)6 100%$350 Copayment per admission3 70% after deductible3 60% after deductible2

Contraceptives 100% 100% 100% 60% after deductible

Infertility Diagnosis and Treatment ($20,000 per lifetime1)

100% after applicable copayment

70% after deductible and applicable copayment

70% after deductible and applicable copayment


Elective Abortion6 100% $250 Copayment 70% after deductible 60% after deductible

Inpatient Hospital Services**

• Facility 100%$350 Copayment per admission3 70% after deductible3 60% after deductible2

• Professional/Physician6 100% 100% 70% after deductible 60% after deductible

Inpatient Hospital Days1 365 365 365 702

Emergency Care$150 Copayment (copayment waived if admitted)

$150 Copayment (copayment waived if admitted)



Urgent Care Center $45 Copayment $55 Copayment $70 Copayment 60% after deductible

Retail Clinic $20 Copayment $25 Copayment $30 Copayment 60% after deductible

Telemedicine5 $5 Copayment Not Covered Not Covered Not Covered

Outpatient Surgery (Voluntary sterilization procedures included; Reversal of sterilization procedures excluded)

• Facility 100%$250 Copayment per occurrence

70% after deductible 60% after deductible


Ambulance (Emergency) 100% 100% 100% 100%

Ambulance (Non-Emergency) 80% 80% 80% 50% after deductible


Platinum PPO Plan | 2018 Plan Summary, Continued


Therapy Services (Physical, Speech and Occupational; 60 visits per calendar year1)


• Cardiac Rehabilitation (36 visits per calendar year1)


• Pulmonary Rehabilitation (12 visits per calendar year1)


• Respiratory Therapy $15 Copayment $20 Copayment $40 Copayment 60% after deductible

• Orthoptic/Pleoptic (8 sessions lifetime1)


Hearing Aid Exam 100% 100% 100% 60% after deductible

Hearing Aid Reimbursement (2 hearing aids every 36 months1)

25% 25% 25% after deductible 25% after deductible

Cranial Prosthesis (only covered for members receiving cancer treatment, one per year1)


Restorative Services, including Chiropractic Care (30 visits per calendar year1)

Not Available $40 Copayment $40 Copayment 60% after deductible

Chemo / Radiation / Dialysis 100% 100% 70% after deductible 60% after deductible

Outpatient Private Duty Nursing (360 hours per calendar year1)


Skilled Nursing Facility (120 days per calendar year1)

100% $350 Copayment per admission3 70% after deductible3 60% after deductible

• Professional/Physician 100% 100% 70% 60% after deductible

Home Health Care (120 days per calendar year1)


Hospice 100% $350 Copayment per admission3 70% after deductible3 60% after deductible

• Professional/Physician 100% 100% 70% after deductible 60% after deductible

Infusion Therapy 100% 100% 70% after deductible 60% after deductible

Mental Health Care/Serious Mental Illness Care

• Outpatient Services $0 Copayment $15 Copayment $30 Copayment 60% after deductible

• Inpatient Facility Services 100% $350 Copayment per admission3 70% after deductible3 60% after deductible2


Substance Abuse Treatment

• Outpatient/Partial Services $0 Copayment $15 Copayment $30 Copayment 60% after deductible

• Inpatient Rehabilitation 100% $350 Copayment per admission3 70% after deductible3 60% after deductible2

• Detoxification 100% $350 Copayment per admission3 70% after deductible3 60% after deductible2

Oral Surgery/Dental Care (for the removal of impacted wisdom teeth, which are partially or totally covered by bone; must coordinate through dental plan covered)

100% after deductible$250 Copayment per occurrence after deductible



Durable Medical Equipment Not Available Not Available 70% 60% after deductible

Prosthetics Not Available Not Available 70% 60% after deductible

Outpatient Diabetic Education 100% 100% 100% Not Covered

Transplant Services Professional Services


Medical Foods and Nutritional Formulas


Blood 100% 100% 70% after deductible 60% after deductible

Diabetic Equipment & Supplies 100% 100% 100% 60% after deductible

*Non-Preferred Providers may bill you the differences between the Plan allowance, which is the amount paid by Independence Blue Cross (IBC), and the actual charge of the provider. This amount may be significant. Claims for Non-Preferred Professional Providers (physicians) are based on the lesser of the Medicare Professional Allowable Payment or the actual charger or the provider. For covered services that are not recognized or reimbursed by Medicare, payment is based on the lesser of the Independence Blue Cross (IBC) applicable proprietary fee schedule or the actual charge of the provider. For covered services not recognized or reimbursed by Medicare or IBC’s fee schedule, payment is 60% of the actual charger of the provider. It is important to note that all percentages for out-of-network services are percentages of the Plan allowance, not the actual charge of the provider.

**NOTE: Impatient copay is waived for admissions to JeffCare Non-Home facilities through the emergency room. For inpatient hospital admissions through the emergency room at Personal Choice and BlueCard facilities, the claim is to be processed as a JeffCare Non-Home admission (deductible and coinsurance are waived, Non-Home copayment applies.)

***In-network out-of-pocket maximum includes deductible, copays and coinsurance. Out-of-network out-of-pocket maximum includes deductible and coinsurance.

1 Combined all networks 2 Inpatient hospital day limit combined for all out-of-network inpatient medical, maternity, mental health, serious mental illness and substance abuse services 3 Inpatient Copayment waived if readmitted within 10 days of discharge 4 Combined JeffCare Home, JeffCare Non-Home and Personal Choice Network 5 Telemedicine is a carved out benefit through JeffConnect. Copayments do not count toward the out-of-pocket maximum. 6 Not all anesthesia providers utilized in JeffCare Home or JeffCare Non-Home facilities are JeffCare providers. You may incur a higher member responsibility.

READY TO ENROLL? Go to page 40 for instructions. 15MEDICAL PLANS

Gold PPO Plan | 2018 Plan Summary


Deductible (Individual) $200 $300 $1,500 $3,000

Deductible (Family) $600 $900 $4,500 $9,000

Benefit Period Calendar Year Calendar Year Calendar Year Calendar Year

Coinsurance (percentage paid by plan except hearing aid benefit)





Out-of-Pocket Maximum*** (Individual)

$3,500 $4,0004 $5,0004 $7,000

Out-of-Pocket Maximum*** (Family)

$7,000 $8,0004 $10,0004 $14,000

Lifetime Maximum Unlimited Unlimited Unlimited Unlimited

Doctor’s Office Visits (Primary Care Services)


Doctor’s Office Visits (Specialist Services)


Preventative Care for Adults & Children


Pediatric Immunizations 100% 100% 100% 50% after deductible

Routine Gynecological Exam/Pap (1 routine exam/pap test per calendar year for women of any age1)


Mammogram 100% 100% 100% 50%

Nutrition Counseling for Weight Management (6 visits per calendar year1)


Outpatient Diagnostic Services (Routine Radiology)

$25 Copayment $40 Copayment 60% 50% after deductible

Outpatient Diagnostic Services (Advanced Radiology – MRI/MRA/CAT/PET)

$75 Copayment $100 Copayment 60% after deductible 50% after deductible

Outpatient Diagnostic Services (Laboratory)

100% $25 Copayment$40 Copayment per occurrence


Allergy Testing 100% 100% 60% after deductible 50% after deductible

Allergy Extract / Injections 100% 100% 60% after deductible 50% after deductible

Maternity (First OB Visit) $45 Copayment $60 Copayment $75 Copayment 50% after deductible

Maternity (Hospital)6 100% after deductible$500 Copayment per admission after deductible3 60% after deductible3 50% after deductible2

Contraceptives 100% 100% 100% 50% after deductible

Infertility Treatment Not Covered Not Covered Not Covered Not Covered

Elective Abortion6 100% after deductible $350 Copayment after deductible 60% after deductible 50% after deductible

Inpatient Hospital Services**

• Facility 100% after deductible$500 Copayment per admission after deductible3 60% after deductible3 50% after deductible2


Inpatient Hospital Days1 365 365 365 702

Emergency Care$160 Copayment (copayment waived if admitted)




Urgent Care Center $65 Copayment $75 Copayment $85 Copayment 50% after deductible

Retail Clinic $30 Copayment $35 Copayment $40 Copayment 50% after deductible

Telemedicine5 $15 Copayment Not Covered Not Covered Not Covered

Outpatient Surgery (Voluntary sterilization procedures included; Reversal of sterilization procedures excluded)

• Facility 100% after deductible$350 Copayment per occurrence after deductible



Ambulance (Emergency) 100% 100% 100% 100%

Ambulance (Non-Emergency) 70% 70% 70% 50% after deductible


Gold PPO Plan | 2018 Plan Summary, Continued

Benefits JeffCare Home6 JeffCare Non-Home6 Personal Choice Network Out-of-Network*

Therapy Services (Physical, Speech and Occupational; 60 visits per calendar year1)


• Cardiac Rehabilitation (36 visits per calendar year1)


• Pulmonary Rehabilitation (12 visits per calendar year1)


• Respiratory Therapy $20 Copayment $30 Copayment $45 Copayment 50% after deductible

• Orthoptic/Pleoptic (8 sessions lifetime1)


Hearing Aid Exam Not Covered Not Covered Not Covered Not Covered

Hearing Aid Reimbursement (2 hearing aids every 36 months1)

Not Covered Not Covered Not Covered Not Covered

Cranial Prosthesis (only covered for members receiving cancer treatment, one per year1)


Restorative Services, including Chiropractic Care (30 visits per calendar year1)

Not Available $50 Copayment $50 Copayment 50% after deductible

Chemo / Radiation / Dialysis 100% after deductible 100% after deductible 60% after deductible 50% after deductible

Outpatient Private Duty Nursing (360 hours per calendar year1)

100% after deductible 100% after deductible 60% after deductible 50% after deductible

Skilled Nursing Facility (120 days per calendar year1)

100% after deductible$500 Copayment per admission after deductible3 60% after deductible3 50% after deductible


Home Health Care (120 days per calendar year1)

100% after deductible 100% after deductible 60% 50% after deductible

Hospice 100%$500 Copayment per admission after deductible3 60% after deductible3 50% after deductible


Infusion Therapy 100% after deductible 100% after deductible 60% after deductible 50% after deductible

Mental Health Care/Serious Mental Illness Care

• Outpatient Services $0 Copayment $25 Copayment $40 Copayment 50% after deductible

• Inpatient Facility Services 100% after deductible$500 Copayment per admission after deductible3 60% after deductible3 50% after deductible2


Substance Abuse Treatment

• Outpatient/Partial Services $0 Copayment $25 Copayment $40 Copayment 50% after deductible

• Inpatient Rehabilitation 100% after deductible$500 Copayment per admission after deductible3 60% after deductible3 50% after deductible2

• Detoxification 100% after deductible$500 Copayment per admission after deductible3 60% after deductible3 50% after deductible2

Oral Surgery/Dental Care (for the removal of impacted wisdom teeth, which are partially or totally covered by bone; must coordinate through dental plan covered)

100% after deductible$350 Copayment per occurrence after deductible



Durable Medical Equipment Not Available Not Available 60% 50% after deductible

Prosthetics Not Available Not Available 60% 50% after deductible

Outpatient Diabetic Education 100% 100% 100% Not Covered

Transplant Services Professional Services

100% after deductible$500 Copayment per admission after deductible


Medical Foods and Nutritional Formulas


Blood 100% 100% 60% after deductible 50% after deductible

Diabetic Equipment & Supplies 100% 100% 100% 50% after deductible

*Non-Preferred Providers may bill you the differences between the Plan allowance, which is the amount paid by Independence Blue Cross (IBC), and the actual charge of the provider. This amount may be significant. Claims for Non-Preferred Professional Providers (physicians) are based on the lesser of the Medicare Professional Allowable Payment or the actual charger or the provider. For covered services that are not recognized or reimbursed by Medicare, payment is based on the lesser of the Independence Blue Cross (IBC) applicable proprietary fee schedule or the actual charge of the provider. For covered services not recognized or reimbursed by Medicare or IBC’s fee schedule, payment is 60% of the actual charger of the provider. It is important to note that all percentages for out-of-network services are percentages of the Plan allowance, not the actual charge of the provider.

**NOTE: Impatient copay is waived for admissions to JeffCare Non-Home facilities through the emergency room. For inpatient hospital admissions through the emergency room at Personal Choice and BlueCard facilities, the claim is to be processed as a JeffCare Non-Home admission (deductible and coinsurance are waived, Non-Home copayment applies.)

***In-network out-of-pocket maximum includes deductible, copays and coinsurance. Out-of-network out-of-pocket maximum includes deductible and coinsurance.

1 Combined all networks 2 Inpatient hospital day limit combined for all out-of-network inpatient medical, maternity, mental health, serious mental illness and substance abuse services 3 Inpatient Copayment waived if readmitted within 10 days of discharge 4 Combined JeffCare Home, JeffCare Non-Home and Personal Choice Network 5 Telemedicine is a carved out benefit through JeffConnect. Copayments do not count toward the out-of-pocket maximum. 6 Not all anesthesia providers utilized in JeffCare Home or JeffCare Non-Home facilities are JeffCare providers. You may incur a higher member responsibility.

READY TO ENROLL? Go to page 40 for instructions. 17PRESCRIPTION PLANS

Prescription Plans

GETTING STARTED WITH MEDIMPACT DIRECT HOME DELIVERY IS EASY

Choose one of these ways to fill your first prescription using MedImpact Direct Home Delivery:

There are two prescription plans in 2018. You will automatically be enrolled in the Platinum or Gold prescription plan based on which medical plan you select. MedImpact administers the plans. Visit their website at: www.medimpact.com. The prescription drug program offers three ways to obtain your medications – at Abington, Aria, and Jefferson Outpatient Pharmacies (Domestic), at your local retail pharmacy or the MedImpact Direct Home Delivery Pharmacy.

HOW THE PLANS WORK

Jefferson uses the MedImpact Portfolio Formulary. The formulary is a list of preferred medications developed by MedImpact and a group of independent doctors and pharmacists. They look at how new and existing drugs should be covered by the plan. They review drug safety and effectiveness and recommend quality drugs that provide the best value. The formulary is updated several times a year and is available on the MedImpact website – www.medimpact.com. You will pay less for preferred medications.

You can receive up to a 30 day supply of medication at any of the domestic pharmacies or at a retail pharmacy. You pay less out of pocket when you use a domestic pharmacy. Medications that you take on a regular long-term basis (“maintenance medications”) must be filled at a domestic pharmacy or the MedImpact Direct Home Delivery Pharmacy after the first refill. You can receive up to a 90-day supply of medication for one maintenance copay. Domestic pharmacies will mail prescriptions upon request.

Specialty drugs are high-cost oral or injectable medications used to treat complex chronic conditions. It is the fastest growing, most costly area of pharmacy care. You can receive up to a 30-day supply of specialty medications for the copays listed in the last column of the chart below. Specialty medications must be filled at a Domestic Pharmacy from the first fill. If a specialty medication cannot be filled at the Jefferson Specialty Pharmacy, they will work with you to transfer it to the MedImpact Direct Specialty Pharmacy.

Online• Login to medimpactdirect.com• Select ‘Get Started‘ or ‘Transfer Prescriptions‘• Select the medication you would like to switch to home delivery

By Mail

• Get a prescription from your doctor for up to a 90-day supply, plus refills forup to one year (if needed)

• Go to medimpact.com and download an order form

• Mail the new prescription and order form to the address provided on the form

With Your Doctor


• Ask your doctor to electronically submit your prescription to MedImpactDirector fax it to 1-888-783-1773.

MedImpact App• Download the MedImpact App from the Apple App Store or Google Play• Transfer a retail prescription to home delivery

Initial Script for Maintenance Medications

(30–90 day fills)


• Ask your doctor to fax your prescription to your Home pharmacy or drop off your prescription

Home Pharmacies

• Pick up or have your prescription mailed to you (usually within 24–48 hours)

18 NEW HIRES: Make sure to enroll within 30 days of your hire date.PRESCRIPTION PLANS

TIMING

Once MedImpact receives your order, your medication should arrive within 10 business days. Completed refill orders should arrive in about seven business days. To fill a maintenance medication faster, use a Domestic pharmacy. You can also get your 90-day prescription filled at a Domestic Pharmacy.

Have your doctor or you send your 90 day prescription to one of our Domestic pharmacies for quick turn around, usually within 24-48 hours.

MANAGE YOUR HOME DELIVERY PRESCRIPTIONS ON THE MEDIMPACT

WEBSITE OR APP

Once you have submitted a home delivery prescription, you can use the MedImpact website or App to:

• Refill prescriptions: Refill current MedImpact home delivery prescriptions. All eligible refills will be automatically checked. Deselect any medications you do not want to refill at this time.

• Renew prescriptions: Request to renew a home delivery prescription if you are out of refills.

• Check order status: Check the status of your home delivery medication orders.

MANDATORY GENERIC DRUGS

You are required to purchase generic drugs when they are available. If you or your doctor chooses a brand name drug when a generic is available, you will be required to pay the difference in cost between the generic and the brand, along with the applicable brand copay.

If you need to file an appeal to the Mandatory Generic program, you, or your covered dependent, must try a full prescription of the generic drug before requesting a brand name replacement. You, your pharmacist or your doctor can start the review process by contacting the prior authorization department at MedImpact.

PRESCRIPTION MANAGEMENT PROGRAMS

The prescription plan has several management programs to improve care and help manage costs:

• Prior Authorization Program: requires authorization for some medications that are only approved or effective in treating specific illnesses, cost more or may be prescribed for conditions for which safety and effectiveness have not been well-established.

• Quantity Limit Program: sets limits based on the FDA approved indications, the manufacturer’s package labeling instructions and well-accepted or published clinical recommendations.

• Step Therapy Program: encourages you to try first-line medications that deliver similar value, safety and effectiveness, but cost less than others.

19READY TO ENROLL? Go to page 40 for instructions. PRESCRIPTION PLANS

Prescription Benefits at a Glance

Save on PrescriptionsREDUCE YOUR OUT-OF-POCKET EXPENSE WHEN YOU USE A DOMESTIC PHARMACY.

Prescription Program

PLATINUM GOLD

GenericBrand

FormularyBrand

Non-FormularyGeneric

Brand Formulary

Brand Non-Formulary

Deductible None None None $100 per individual

Domestic Non-Maintenance

(30 day)$10 $20 $30 $15

$40 after deductible

$60 after deductible

Retail Non-Maintenance

(30 day)$15

20% ($30 min–$50 max)

40% ($50 min–$100 max)

$20

20% ($40 min–$100

max) after deductible

40% ($60 min–$150

max) after deductible

Maintenance Jefferson or MedImpact Home Delivery (90 day)

$25 $50 $75 $3020%

($100 max) after deductible

40% ($150 max) after

deductible

Specialty (30 day) $20 $30 $50 $40$60

after deductible$100

after deductible

Out-of-Pocket Max $1,500 individual / $3,000 family $2,000 individual / $4,000 family

Facility Location Address PhoneHours M–F

Hours SAT

Jefferson Apothecary

Gibbon Building Lobby

111 South 11th Street 215-955-8845 7 a.m.–6 p.m. 9 a.m.–4 p.m.

Jefferson Pharmacy

1st Floor Lobby 833 Chestnut Street 215-955-4400 8:30 a.m.–5:30 p.m. 9 a.m.–1 p.m.

Jefferson Pharmacy

Walnut Street 908 Walnut Street 215-503-1135 8:30 a.m.–5:30 p.m. 9 a.m.–1 p.m.

Methodist Hospital Apothecary

Broad Street2301 South Broad Street

215-952-9385 8:30 a.m.–5 p.m. NA

Jefferson Specialty Pharmacy

Medications are hand-delivered to your home or office, as requested; remote locations are shipped.

215-955-8154 8 a.m.–5 p.m. NA

Aria Pharmacy

MOB Torresdale 1st Floor

10800 Knights Road 215-612-4949 8:30 a.m.–5 p.m. NA

Alliance Pharmacy

AJH Main Campus 1245 Highland Avenue 215-481-4318 7:30 a.m.–5:30 p.m. NA

20 NEW HIRES: Make sure to enroll within 30 days of your hire date.PRESCRIPTION PLANS

GETTING PRESCRIPTION FILLED WHILE AWAY FROM HOME

MedImpact is affiliated with over 65,000 pharmacies nationwide. You should have no problem filling a prescription at a participating pharmacy anywhere in the U.S. Simply present your I.D. card. MedImpact participating pharmacies are online via computer with MedImpact and will submit your claim electronically at the time the prescription is filled. You pay only your applicable copayment or coinsurance.

If you do not use a participating pharmacy, you must pay the full cost of the prescription, usually at the full retail cost – you will not benefit from the “plan discount.” You must complete and send a claim form to MedImpact no later than 180 business days from the date the prescription was dispensed. You will then be reimbursed only for the amount that MedImpact would have covered.

CHARGES NOT COVERED

Some prescription drugs and supplies are not covered under this plan. The plan does not cover: • Allergy serum (covered under the medical plan if administered

in your physician’s office)• Dietary aids, cosmetic or other health and beauty aids• Over-the-counter drugs• Non-legend vitamins• Medical appliances, such as back braces, bandages, cervical collars• Ostomy products (covered under the medical plan)• Charges for the administration of any drug

DEDUCTIBLE

The Platinum Rx plan has no deductible. The Gold Rx plan has a deductible of $100 per person. The deductible only applies to brand (formulary or non-formulary) prescriptions. It does not apply to generic prescriptions.

OUT-OF-POCKET MAXIMUM

The out-of-pocket maximum in the Platinum Rx plan is $1,500 per person

or $3,000 per family. The out-of-pocket maximum in the Gold Rx plan is $2,000 per person or $4,000 per family. Once you reach the out-of-pocket limit, all covered prescriptions will be paid by Jefferson at 100%.

There is a $5,000 lifetime maximum on non-formulary infertility medications in the Platinum Rx plan. The Gold Rx plan does not cover any infertility medications.

Smoking CessationSupport is available to help you and your family members quit smoking. Over-the-counter (OTC) and prescription smoking cessation products will be available at no cost. OTC products will require a prescription from your provider.

21PLAN SELECTIONREADY TO ENROLL? Go to page 40 for instructions.

Selecting The Right Medical/Rx Plan For YouUnderstanding the differences between the plans and the things to consider when selecting your plan can help make your decision easier. The examples on the next page illustrate how the plans work in real life and can serve as a guide as you estimate your expenses.

THINGS TO CONSIDER

When deciding which medical plan makes the most sense for you and your family, consider:

• Your share of the cost—your medical premium contribution (including the working spouse premium), deductible, copays and coinsurance. • How often you or your family members go to the doctor or fill prescriptions. • Any planned procedures, surgeries or chronic conditions you need to manage. • Who do you receive care from—Tier 1, Tier 2, Personal Choice or out-of-network providers. • How do you prefer to pay for your health care – pay more up front through higher per pay premiums or pay more when you use health care services.

You cannot anticipate every healthcare cost, but by estimating how much you usually spend annually and adding any services you know are coming up during the next year, you can better decide which plan is right for you.

If you need more help choosing a medical plan, visit ALEX. www.myalex.com/my-benefits/2018/benefits

How the features of the two plans compare PLATINUM GOLD

Premium Contributions You’ll pay more You’ll pay less

Out of pocket costs when you go to the doctor You’ll pay less You’ll pay more

Plan administered by IBC with the Personal Choice Network for Tier 3 ✓ ✓

No referral requirement ✓ ✓

Lower costs when you use Tier 1 & 2 providers ✓ ✓

$0 copay for Primary Care Physicians in Tier 1 ✓ ✓

Infertility Treatment and Medications Covered up to lifetime Not covered

Hearing Aids Covered at 25% Not covered

22 NEW HIRES: Make sure to enroll within 30 days of your hire date.PLAN SELECTION

MEDICAL PLAN COST CALCULATION SAMPLES

Zach has a family of three with a baby on the way. His spouse does not have other employer healthcare coverage available to her. Zach sees Jefferson doctors. His spouse and child use mostly Personal Choice providers and will deliver the baby at a Personal Choice hospital.

Donna has employee only coverage. She uses all Jefferson doctors. She does not have any chronic conditions. She is athletic and may need PT for a sports injury.

Sample One PLATINUM GOLD ANNUAL

Per pay deduction $170 $140 $780

3 Preventative Exams $0 $0 $0

4 PCP Visits in Personal Choice $120 $160 -$40

4 Specialist Visits in Personal Choice $240 $300 -$60

3 lab tests in Personal Choice $75 $120 -$45

4 Brand Formulary Rx’s – 90 day $200 $400 -$200

3 Brand Formulary Specialty Rx’s $120 $240 -$120

1 Hospital Stay in Personal Choice $3,500 $5,000 -$1,500

Over the course of a year, if he chooses the Platinum plan he will spend $780 more in payroll contributions but will save $1,965 in healthcare.

Sample Two PLATINUM GOLD ANNUAL

Per pay deduction $48 $39 $234

1 Preventative Exam $0 $0 $0

1 Telehealth Visit $5 $15 $10

1 Urgent Care Visit at Jefferson $45 $65 $20

2 Specialist Visits at Jefferson $60 $90 $30

9 PT Visits at Jefferson $135 $180 $45

3 Generic Rx’s filled at Jefferson $30 $45 $15

Over the course of a year, if she chooses the Gold plan she will save $234 in payroll contributions and will spend $120 more in healthcare expenses.

23READY TO ENROLL? Go to page 40 for instructions. VISION PLAN

Vision PlanDavis Vision administers the vision plan. You can elect vision coverage for yourself and your eligible dependents and pay for that coverage with pre-tax deductions.

DAVIS VISION PREMIER

PLAN BENEFITS

AT A GLANCE

BENEFIT FREQUENCY IN-NETWORK COVERAGE

Eye Examination once every yearCovered in full after $10 copayment. Includes dilation when professionally indicated.

Spectacle Lenses once every yearClear plastic lenses in any single vision, bifocal, trifocal or lenticular prescription. Covered in full after $25 copayment.

Frame once every year

Covered in Full Frames: Any Fashion, Designer or Premier level frame from Davis Vision’s Collection2 (retail value, up to $195).

OR, Frame Allowance: $150 toward any frame from provider plus 20% off any balance.1 No copay required.

OR, Visionworks Frame Allowance: $200 allowance plus 20% off any balance toward any frame from a Visionworks family of store location.4 No copay required.

Contact Lens Evaluation, Fitting &

Follow Up Careonce every year

Davis Vision Collection Contacts: Covered in full.

Non Collection Contacts3: $60 allowance plus 15% off balance.1

Contact Lenses (in lieu of eyeglasses)

once every year

Covered in Full Contacts: From Davis Vision’s Collection2, up to: Planned Replacement Two boxes/multi-packs* Disposable Four boxes/multi-packs*

OR, Contact Lens Allowance: $150 allowance toward any contacts from provider’s supply plus 15% off balance.1 No copay required.

OR, Visually required Contacts: Covered in full with prior approval.

*Number of contact lens boxes may vary based on manufacturer’s packaging.

1 Additional discounts not applicable at Walmart or Sam’s Club locations

2 The Davis Vision Collection is available at most participating independent provider locations. Collection is inclusive of select toric and multifocal contacts.

3 Including, but not limited to toric, multifocal and gas permeable contact lenses.

4 Allowance is available at these Visionworks family of store locations: Davis Vision, Empire Vision Centers, Total Vision Care, EyeMasters, Cambridge Eye Doctors, Vision World, Dr. Bizer’s Vision World, Eye Dr, Dr. Bizer’s Valu Vision, Doctor’s Valu Vision, Hour Eyes, Visionworks.

24 NEW HIRES: Make sure to enroll within 30 days of your hire date.VISION PLAN

DAVIS PARTICIPATING PROVIDERS

When you use a Davis Participating Provider, the plan provides a higher level of benefits. To locate a participating provider go to www.davisvision.com. You can also call Davis Vision at 800-999-5431.

For more information, such as savings on optional frames, lens types and coatings and other discounts, visit the Benefits page on hr.jefferson.edu for a Davis Vision brochure.

OUT-OF-NETWORK BENEFITS

You may receive services from an out-of-network provider, although you will receive the greatest value and maximize your benefit dollars if you select a provider who participates in the network. If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for reimbursement.

COST OF COVERAGE

FULL & PART-TIME EMPLOYEES BI-WEEKLY EMPLOYEE CONTRIBUTION

Employee Only $2.86

Employee +1 $4.91

Family $7.09

OUT-OF-NETWORK REIMBURSEMENT SCHEDULE

Eye Examination up to $40; Frame up to $50

Spectacle Lenses (per pair) up to: Single Vision $40, Bifocal $60, Trifocal $80, Lenticular $100, Elective Contacts up to $105,

Visually required Contacts up to $225

25DENTAL PLANSREADY TO ENROLL? Go to page 40 for instructions.

Dental PlansDENTAL PLANS AT A GLANCE

Jefferson gives you a choice of two PPO dental plans administered by Delta Dental of Pennsylvania.

• Platinum Dental • Gold Dental

In 2018, you have a choice of four coverage categories. This is a change from our previous structure.

• Employee only • Employee + Spouse • Employee + Child(ren) • Family

Both dental plans cover preventive, basic and restorative, and major services. The Platinum plan offers a higher level of coverage. You will pay more per paycheck for the Platinum plan. The Gold plan is a lower level plan with higher out-of-pocket costs at the time of service; however, you will pay less per pay period. Orthodontia is not covered under the Gold plan.

Dental Plans PLATINUM GOLD

Annual Deductible (Individual / Family) $50 / $150 $50 / $150

Annual Maximum (per person)

$2,000 PPO network

$1,700 Premier network or out of network providers

$1,250 PPO network

$1,000 Premier network or out of network providers

Preventative and Diagnostic 100% (no deductible) 100% (no deductible)

Basic and Restorative Services 80% (after deductible) 70% (after deductible)

Major Services 60% (after deductible) 50% (after deductible)

Orthodontia50% (after separate $50 deductible)

($2,000 separate lifetime maximum)Not covered

26 NEW HIRES: Make sure to enroll within 30 days of your hire date.DENTAL PLANS

DELTA DENTAL OF PA

The Delta Dental Plan allows you to use a dentist of your choice. You have lower out-of-pocket costs when using a provider who participates in the Delta Dental network. Delta Dental dentists charge you a discounted amount for services—so you generally pay less than you would when using a non-Delta Dental dentist.

Search for Delta Dental providers at www.deltadentalins.com or call 800-932-0783.

DENTAL CONTRIBUTION RATES—PER PAY PERIOD

Full-Time Employees PLATINUM GOLD

Employee Only $5 $4



Family $16 $12

Part-Time Employees PLATINUM GOLD

Employee Only $12 $8.50



Family $34 $27

27LIFE INSURANCEREADY TO ENROLL? Go to page 40 for instructions.

Life Insurance PlansBASIC LIFE AND AD&D INSURANCE COVERAGE

Jefferson provides eligible employees with Basic Life Insurance and Accidental Death and Disability (AD&D) at no cost to you. The amount of coverage varies depending upon your position and base pay as shown on the chart below. Reliance Standard administers the plans.

SUPPLEMENTAL LIFE AND AD&D INSURANCE COVERAGE

You can supplement the basic insurance with the following insurance options: • Supplemental employee life insurance combined with Basic life for a total of 4x pay, to a maximum of $1,000,000. • Spouse life insurance: $10,000, $20,000 or $50,000 (coverage terminates at 70th birthday) • Child life insurance: $5,000 or $10,000 (coverage from age 14 days to 26th birthday) • Supplemental employee or family AD&D insurance: $50,000–$500,000. Amounts above $300,000 may not exceed lesser of ten times annual salary or $500,000. Family coverage provides a spouse’s benefit equal to 60% of yours; each dependent child’s benefit equals 30% of yours.

Cost of Coverage Jefferson pays the full cost of basic life and basic AD&D insurance. You pay the cost of any supplemental coverage you choose. The cost of supplemental coverage depends on the amount of coverage, and for supplemental employee life insurance it depends on your age. When you enter a new age bracket, the cost of your optional life insurance will change to reflect your new age in the pay period containing your birthday. If your salary increases, or decreases, the cost of your optional life insurance will change to reflect your new rate in the pay period containing the change. Basic and Optional coverage reduce by one-half on your 70th birthday. The cost of your optional life insurance will change to reflect the reduced age 70 rate and coverage level in the pay period containing your birthday.

Your cost for additional AD&D Insurance depends on the amount of coverage you elect and whether you include your dependents. The bi-weekly costs for supplemental AD&D, Spouse and Child Life coverage will be indicated on the enrollment website.

Employee Classification

Basic Life Basic AD&D

Faculty and Senior Administrators

2x base annual salary1x base annual salary up to $50,000

House Staff, Postdoctoral Fellows

1.5x base annual salary1x base annual salary up to $50,000

All Other Employees, including part-time

1x base annual salary1x base annual salary up to $50,000

SUPPLEMENTAL INSURANCE OPTIONAL COVERAGE—2018 RATES

Employee’s Age

Per $1,000 Unit of Coverage

Employee’s Age

Per $1,000 Unit of Coverage

under 30 .019 50 to 54 .109

30 to .032 55 to 59 .191

35 to .032 60 to 64 .293

40 to 44 .045 65 to 69 .471

45 to 49 .057 70+ .503

28 NEW HIRES: Make sure to enroll within 30 days of your hire date.LIFE INSURANCE

CONVERTING TO AN INDIVIDUAL POLICY

Request for conversion of Life or AD&D Insurance should be made within 30 days of termination of coverage/employment. Insurance company must receive completed application within 60 days of termination of coverage/employment. Contact HR Operations at 215-503-4772, press Option 8, and then Option 1 for a conversion application.

Age Reduction • Life insurance coverage reduces by one-half for employees age 70+ • Spousal eligibility terminates at spouse’s 70th birthday • Dependent child eligibility terminates at 26th birthday

Medical Evidence of Insurability (MEOI) You will have to complete a MEOI questionnaire and submit it directly to our life insurance carrier for review and approval before your coverage becomes effective if:

• Your Basic life insurance exceeds $500,000 • Your Supplemental life insurance exceeds $250,000 • You did not elect any additional level of employee life insurance during any previous election in which you were eligible and are now making your first election • You were previously declined for additional coverage or withdrew an application for additional coverage • You wish to increase your current level of additional employee life insurance by more than one level or the additional level results in an amount over $250,000 • You did not elect Spousal Life Insurance during your initial period of eligibility and are now making your first election or increasing by more than one level

Note: Basic Life amounts over $500,000 will not be effective until MEOI is approved.

Imputed Income The IRS requires employers who provide more than $50,000 of life insurance coverage to calculate the value of the coverage over $50,000 and report it as taxable income. This is called imputed income.

Life Insurance while on Long Term Disability In the event of long term disability, Jefferson will continue the life insurance selected on the most recent election while disability income is being received for up to one year from date of illness or injury, provided employee pays active employee premium rate (If employee payment is not remitted, coverage will be at Basic Amount.)

Business Travel Accident InsuranceHOW THE PLAN WORKS

Business Travel Accident insurance provides additional coverage when Full-Time employees regularly scheduled to work at least 35 hours a week travel off Jefferson premises on Jefferson business. If an eligible employee is injured or killed while traveling on Jefferson business, his/her beneficiary may receive an additional benefit based upon the nature of the injury.

COST OF COVERAGE

Jefferson pays the full cost of business travel accident insurance. For more information on plan features see the Business Travel Accident Insurance Coverage Summary and brochure on hr.jefferson.edu

Supplemental AD&D Insurance

Loss AD&D Benefit

LifeFull amount of your coverage

paid to your beneficiary

Both hands, feet, sight of both eyes or any combination of these losses

Full amount of your coverage paid to you

One hand, foot, or sight of one eyeOne-half the amount of your

coverage paid to you

29DISABILITYREADY TO ENROLL? Go to page 40 for instructions.

Disability PlansThe Benefits Program offers you protection from income loss while you are out of work for a non-work related illness or injury. You are considered to be disabled when a treating health professional certifies that your illness, injury or medical condition keeps you from working. Disability benefits at Jefferson are made up of different programs, depending upon your position, including:

• Earned Time Off (ETO), Sick Pay or Salary Continuation • Short Term Disability • Long Term Disability

SHORT-TERM DISABILITY

Eligibility Full-time employees and full-time Postdoctoral Fellows regularly scheduled to work at least 35 hours a week are eligible for short-term disability insurance. For regular staff, benefits begin on the first of the month on or after date of hire. House Staff and Postdoctoral Fellows are eligible date of hire. Full-time Faculty and full-time Senior Administrator benefits begin on or after date of hire, however, they have a separate salary continuation program.

Your Short-Term Disability Choices • Basic STD Plan that pays 50% of your weekly pay. No premium cost to the employee. • Optional STD Plan pays 66 2/3% of your weekly pay. Employee pays cost of additional 16 2/3%.

How the Short-Term Disability Plan Works The Short-Term Disability (STD) plan provides benefits after seven consecutive calendar days of disability. All disabilities must be approved by Cigna, our third party administrator. STD continues for 26 weeks as long as you continue to be disabled. For the first seven calendar days of a disability, employees use Earned Time Off (ETO) or Sick Time based upon their position. Employees who have an Extended Illness Bank (EIB) will then be paid 100% of base pay until the bank is exhausted. If the employee remains on leave after EIB is exhausted, benefits will then be paid from the STD Plan(s). To qualify for short or long term disability you must be actively at work prior to your date of disability.

How Salary Continuation Works for Full-time Faculty, Senior Administrators and House Staff Full-time faculty, senior administrators and house staff will receive salary continuation of 100% of base salary for up to 26 weeks in the event of disability. All salary continuations must be approved by Cigna for any absences over three calendar days under FMLA.

Cost of Coverage (Except Clinical Faculty) Jefferson pays the full cost of Basic STD. You pay the cost of supplemental coverage. The cost of supplemental coverage depends on your salary. You can see the cost of optional STD when you enroll in benefits in Employee Self-Service.

You may wish to elect the Optional STD benefit if: • The 50% Basic STD benefit will not meet your income needs while disabled; or • You do not have enough EIB time to carry you in the event of a disability that lasts up to 26 weeks (6 months)

Pre-Existing Conditions Pre-existing condition limits apply to the Optional STD Plan. A pre-existing condition exists if you have received medical treatment, consultations, diagnostic services or have taken prescription drugs for a condition in the three month period before your effective date of coverage. The pre-existing condition limitation applies for the next 12 months, unless you go without treatment or medication for any three month period within the same 12 month period. If you have a pre-existing condition, Optional STD benefits (66 2/3%) will be paid for the first four weeks of disability; then Basic STD benefits (50%) will be paid.

Filing an STD Claim All employees covered by one of the STD plans; salary continuation, sick time or ETO must file an STD claim with Cigna, our Third Party Administrator. Cigna determines if the disability qualifies and initiates STD payments for employees covered by that plan. There are two ways to file a claim with Cigna: 1. Call 855-689-6673 2. File online at mycigna.com

You must file a claim as soon as you are aware that you will be out of work for an extended period of time, preferably within the first 30 days, but no later than 12 months after the date of disability. You may file an STD claim with Cigna at the same time you apply for FMLA or another leave. STD benefits may apply independent of the type of leave you qualify for. In all instances Cigna will review your application for STD and notify you whether your disability is approved or denied.

Attention employees working in New Jersey:

If you work in New Jersey, both you and Jefferson pay a tax to fund the New Jersey short-term disability plan. The New Jersey State Disability Plan is mandatory and covers approximately 66 2/3% of your salary up to a maximum of $633 per week. If you work in New Jersey, you may elect to waive the Jefferson optional short-term disability option on your online election due to coverage from the New Jersey State Plan, or you may choose to make a selection if you desire coverage over and above the New Jersey Plan limits. The benefit you receive from Jefferson will be offset automatically by your New Jersey State benefit. For example, if you choose option B, which is 66 2/3% of your weekly salary, and your present weekly salary is $1,000 you would be entitled to a benefit of $667 per week. You would receive the maximum benefit from the State of New Jersey which is presently $633 per week. The additional $34 per week would be paid to you from Jefferson’s Disability Plan.

30 NEW HIRES: Make sure to enroll within 30 days of your hire date.DISABILITY

LONG-TERM DISABILITY

Eligibility Full-time employees, Postdoctoral Fellows, House Staff, Faculty and Senior Administrators regularly scheduled to work at least 35 hours a week are eligible for long-term disability insurance. For regular staff, Faculty and Senior Administrators, benefits begin on or after date of hire. Postdoctoral Fellows and House Staff are eligible date of hire. Clinical full-time Faculty has a separate Long-Term Disability program.

Your Long-Term Disability Choices (Except Clinical Faculty) • Basic LTD that pays 50% of your base monthly salary. This plan is provided by Jefferson. • Optional LTD that pays 60% of your base monthly salary if you elect optional coverage. • Optional LTD Plan pays 66 2/3% of your base monthly salary if you elect optional coverage. (For this option House Staff is 70% coverage.)

How the Long-Term Disability Plan Works (Except Clinical Faculty) The Long-Term Disability (LTD) plan provides benefits after 180 initial days of disability. LTD benefits may continue for as long as you remain totally disabled until age 65 or older. To qualify for long term disability, you must be actively at work prior to your date of disability.

The maximum monthly benefit is $12,500 for most employees. $15,000 is the maximum for House Staff.

Cost of Coverage Jefferson pays the full cost of Basic LTD. You pay the cost of any optional coverage you choose. The cost of supplemental coverage depends on your salary. You can see the cost of optional when you enroll in benefits in Employee Self-Service.

Pre-Existing Conditions Pre-existing condition limits apply to the LTD options. A pre-existing condition means any sickness or injury for which you received medical treatment, consultation, care or services, including diagnostic procedures, or took prescribed drugs or medicines, during the ninety (90) days immediately prior to your effective date of insurance.

LTD benefits will not be payable for any disability that results from a pre-existing medical condition, unless the disability begins: • After the last day of 90 consecutive days during which you have received no medical care for the pre-existing condition; OR • After the last of 12 consecutive months during which you have been continuously insured under this plan.

LTD Benefit Period LTD benefits are reduced by income from other sources of disability income such as Social Security, other government programs and Workers Compensation so that no more than 100% of the benefit due under the plan is paid when considering other payments.

All LTD benefits, except those for House Staff, have a 24 month own occupation and mental illness limit. The chart on the next page shows the maximum length of time you may receive benefits through the LTD plan.

31DISABILITYREADY TO ENROLL? Go to page 40 for instructions.

LTD Maximum Benefit Period** Based on your age at disability, the maximum benefit period will be the later of your SSNRA* or the maximum benefit period listed below.

*SSNRA means the Social Security Normal Retirement Age in effect under the Social Security Act on the Policy Effective Date. **This chart does not apply to JUP clinicians.

YOUR LONG-TERM DISABILITY CHOICES (CLINICAL FACULTY)

Three levels of benefits available: • Base benefit: Employer paid Group LTD 50% of pay up to $15,000

monthly benefit

Optional individual policies:

• Employer paid individual disability 60% less LTD to $2,500monthly benefit

• Employee paid optional individual disability 60% less LTDto $7,500 monthly benefit. Eligibility subject to compensation.

Aon, our broker for the individual policies, will be in touch with newly eligible JUP Clinicians to offer more information and help with enrollment.

How the Long-Term Disability Plan Works (Clinical Faculty) The Long-Term Disability (LTD) plan provides benefits after 180 initial days of disability. To qualify for long term disability, you must be actively at work prior to your date of disability.

Pre-Existing Conditions (Clinical Faculty) Pre-existing conditions may apply.

LTD Benefit Period (Clinical Faculty) The maximum benefit period is age 65. For disabilities occurring between ages 65 and 75, the maximum benefit period is 24 months. For disabilities occurring after age 75, the maximum benefit period is 12 months.

Age When Disability Begins

Maximum Benefit Period

62 or underThe Employee’s 65th birthday or the date the 42nd Monthly

Benefit is payable, if later

63The date the 36th Monthly

Benefit is payable


Benefit is payable


Benefit is payable


Benefit is payable

67 The date the 18th Monthly

Benefit is payable


Benefit is payable

69 or olderThe date the 12th Monthly

Benefit is payable

32 NEW HIRES: Make sure to enroll within 30 days of your hire date.FLEXIBLE SPENDING ACCOUNTS

Flexible Spending AccountsJefferson offers two types of Flexible Spending Accounts (FSAs) to help you save tax dollars on certain healthcare and dependent care expenses. Based upon your annual election for contributions, money is deducted each pay from your paycheck, before taxes are calculated. This saves you money because you do not pay certain state and federal income tax on the contributions.

Flexible Spending Accounts at a Glance

HEALTHCARE FSA DEPENDENT CARE FSA

How it works Enables you to use pre-tax earnings to pay for certain healthcare expenses for you and your eligible dependents.

Helps you pay for dependent care services that make it possible for you and your spouse, if applicable, to work. You can use your pre-tax earnings to pay for eligible child and adult day care services.

How much can you

contribute each year

Minimum: $30 per year Maximum: $2,600 Minimum: $30 per year Maximum: Generally, $5,000:

• If your annual earnings exceed $120k, you can only contribute $2,400

• If you are married and your spouse also has a dependent care FSA, the combined limit is $5,000

• Married and file a separate tax return, your limit is $2,500

• Married, you cannot contribute more than the lower of your or your spouse’s annual salary

Getting reimbursed

• Pay for services with your Discovery Benefits debit card

• Prepay for the service and submit a claim form for reimbursement with proof of payment as well as an Explanation of Benefits from your health insurance company to Discovery Benefits for reimbursement

• You may choose to receive a check or have money direct deposited to your bank account

• Submit a claim form with a copy of the paid receipt showing the Social Security number or tax ID number of the provider

• You may choose to receive a check or have money direct deposited to your bank account

Unused dollars

In accordance with IRS regulations, if you have money left in your spending accounts at the end of the year, you will lose it. You have until March 15th of the following plan year to incur expenses. You have until March 31st of the following plan year to submit expenses for reimbursement.

Use the FSA accounts only if you can anticipate your qualified expenses for the coming Plan Year. If you are certain that you will have qualified expenses during the Plan Year, but are unsure of the amount, be conservative in the amount of salary you direct to your FSAs.

IRS regulations currently require that all salary directed to your FSA in any one year must be used to reimburse you for qualified expenses incurred during that plan year.

READY TO ENROLL? Go to page 40 for instructions. 33FLEXIBLE SPENDING ACCOUNTS

Discovery Benefits Debit Card When you sign up for a Healthcare FSA, you will receive a Discovery Benefits debit card that you can use to pay for eligible expenses. You may choose to order a debit card for your spouse by calling Discovery Benefits at 866-451-3399 or by accessing your online account at discoverybenefits.com.

In most cases you will not have to provide evidence of your purchase with your debit card, but should Discovery Benefits, our FSA administrator, request proof of purchase you must respond to their request in order for your purchase to be approved. We recommend you save receipts and Explanation of Benefit statements so you can establish proof of your purchase if it is required.

Discrimination IRS regulations require us to perform annual nondiscrimination testing on Dependent Care FSA’s. It ensures highly compensated employees who participate in the plan are not receiving more than the legally allowed portion of this qualified benefit. We may be required to reduce the contribution for all highly compensated employees. Impacted employees will be notified.

FSA Store Discovery Benefits has a relationship with FSA Store. If you shop at the FSA Store you will have access to thousands of FSA-eligible products. You can pay for your purchases with your FSA debit card, or other major credit card. FSA Store is exclusively stocked with FSA eligible products so there are no guessing games about what is and is not reimbursable by an FSA. The site also offers tools and resources to help you better understand and use your funds. Visit fsastore.com/discbene to claim your discount.

ADDITIONAL INFORMATION

• You must re-enroll for FSA account(s) every plan year during open enrollment.

• You cannot change the amount of your contribution during the plan year unless you have a life event such as marriage, birth, or change of job that impacts benefits.

• You cannot be reimbursed for dependent care (i.e. daycare) from your Healthcare FSA nor can you be reimbursed for medical expenses from your Dependent Care account.

• Expenses are considered incurred on the date the services are provided, not when paid.

• For more information on FSAs consult discoverybenefits.com or call Discovery Customer Service at 866-451-3399

• Once you are enrolled in an FSA, you can manage your account online at www.discoverybenefits.com, which includes filing claims online and setting up direct deposit.

HEALTHCARE FSA DEPENDENT CARE FSA

Eligible Expenses

View a list of eligible expenses at: www.discoverybenefits.com/employees/eligible-expenses

Generally you can use the Healthcare FSA to pay for out-of-pocket medical, dental, vision and Rx expenses, or any healthcare item that is not paid for by a healthcare plan. Over-the-counter medicines are not an eligible expense unless doctor prescribed (except insulin).

Examples: • Deductible for medical or dental plan • Copays or coinsurance for medical, dental, vision or Rx plans • Vision care expenses

The expenses can be for you or an eligible dependent.

To be eligible for reimbursement from the Dependent Care FSA, your expenses must be incurred because you and, if you are married, your spouse is gainfully employed or attends school full-time.

Examples: • Adult day care centers • Before or after school programs • Child care • Elder care • Nursery schools • Preschool • Sick child care • Summer day camp

Eligible Dependents Your spouse and children up to age 26

• A child under 13 who qualifies as a dependent on your Federal Income Taxes

• Any other dependents, including a disabled spouse, disabled children over age 13 and elderly parents who depend on you for financial support, qualify as dependents for tax purposes, and are incapable of self-care.

34 NEW HIRES: Make sure to enroll within 30 days of your hire date.VOLUNTARY BENEFITS

Voluntary BenefitsBENEFITS PLUS

Benefits Plus is a voluntary benefits program that provides employees with access to group rates on insurance and discounts — with the convenience of a single payroll deduction. The program offers:

• Critical Illness Insurance • Accident Insurance • Auto and Home Insurance • Identity Theft Insurance • Pre-paid Legal • Pet insurance

• Purchasing Power for big-ticket items • Shopping Discounts • Membership Discounts at local gyms. Visit the Benefits Plus website and click on Sports & Fitness.

COST OF COVERAGE

You pay the full cost of coverage, but benefit from group discounted rates. You will have one Jefferson payroll deduction for all of the plans you choose through Benefits Plus. The cost of each coverage is available on the Benefits Plus website: www.jeffersonbenefitsplus.com.

HOW TO GET MORE INFORMATION

For more information, call Benefits Plus Customer Care at (855) 515-5800.

Plan summaries and detailed information are available at www.jeffersonbenefitsplus.com.

READY TO ENROLL? Go to page 40 for instructions. 35OTHER BENEFITS

Your Other BenefitsOther benefits may include the following, depending on your employment status: • Retirement Plan • Tuition Assistance Program • Dependent Scholarship for Faculty and Senior Administrators • Vacation or Earned Time Off

Retirement Plans Jefferson provides Retirement Plans for eligible employees.

Auto-Enrollment/Employee Contributions All new employees will be automatically enrolled to make a biweekly employee contribution equal to 6% of base plus incentive compensation to the Jefferson Defined Contribution Retirement Plan or Jefferson University Physicians Voluntary 403b Program, unless the employee instructs TIAA otherwise.

Once notified of eligibility following receipt of first paycheck, employees will have thirty days (30) from date of receipt of letter from TIAA to contact TIAA to waive, reduce, or increase this contribution level before auto-enrollment takes effect. Future contribution level may also then be changed at any time by contacting TIAA online or by phone.

All employees are eligible to make biweekly employee tax deferred contributions to the Jefferson Defined Contribution Retirement Plan or the Jefferson University Physicians Voluntary 403b Program.

Employer Contributions The Jefferson Defined Contribution Retirement Plan and Jefferson University Physicians Retirement Plan provide biweekly employer contributions toward retirement to TJU Faculty, TJU/TJUH Senior Administrators, and JUP Employees and Clinicians.

The Jefferson Defined Contribution Retirement Plan provides annual fixed employer contributions and biweekly partial matching of employee contributions to eligible non-bargaining employees after one year of service.

The Jefferson Employees’ Pension Plan for other eligible non-bargaining employees hired prior to 2014 provides monthly benefits when an eligible participant reaches retirement age. Benefits are determined by the Plan’s formula, which takes into account earnings and length of service with Jefferson.

Tax Deferred Annuity ProgramsAll employees are eligible to participate in Jefferson’s Tax Deferred Annuity Programs. Voluntary pre-tax contributions may be made to a 403(b) account to supplement your retirement income. For more information, please contact TIAA at 800-842-2888.

36 NEW HIRES: Make sure to enroll within 30 days of your hire date.OTHER BENEFITS

For additional information, contact HR Operations or your HR Business Partner. The Tuition Assistance Program application, which also provides detailed program information, can be found on the HR website at hr.jefferson.edu.

Dependent Scholarship Program Full-time Faculty and Senior Administrators are eligible for Jefferson’s Dependent Scholarship Program, which provides eligible, unmarried dependent children up to age 30 with yearly assistance for educational expenses as undergraduate students at any CHEA accredited college, university or school of nursing. Dependent scholarship benefits are payable for up to four years of study towards an undergraduate degree.

INTERNAL EXTERNAL

Eligibility Benefit eligible full and part time, non-bargaining employees are eligible after 60 days of benefit eligible service prior to the start of the class.

% Eligible for Payment

90% 80%

Calendar Year Maximum

(Jan 1–Dec 31)

Undergraduate Full-time: $5,000 Part-time: $2,500

Graduate Full-time: $7,500 Part-time: $3,750

Undergraduate Full-time: $3,200 Part-time: $1,600

All courses that begin in the current calendar year are considered when calculating the maximum amount for the year.

Requirements • Tuition charges only

• Credited courses offered in a degreeor certificate program

• Courses must be related to position at Jefferson

• Tuition charges only

• Credited courses offered in a degree program

• Certificate programs with classroom component

• Courses must be related to position at Jefferson

• Sponsored by an accredited institutionthrough the Council for Higher EducationAccreditation list

Payment Options• Pre-pay or reimbursement • Reimbursement after successful completion

of course with a grade of C or better.

Documentation • For prepayment, please attach an itemized bill indicating the tuition charge for the course.

You are required to submit to HR a copy of your final grade within 30 days of course completion. Failure to submit your grade will result in suspension of the tuition assistance benefit and you will need to repay Jefferson for benefits paid on your behalf.

• For reimbursement, applications must be submitted within 6 months of course completion.

Please attach an itemized bill, paid receipt and grade report.

• If you are receiving tuition assistance, we will require documentation from the educational institutionindicating the amount of the scholarship, grant or award that is applied towards the tuition amount for thecourses on your application. This amount will reduce what would otherwise be covered by this program.

Repayment Terms • If you do not remain in the employ of Jefferson or move to a non-benefit eligible position within six months after completing a course, you will be required to reimburse Jefferson. See Tuition Policy #200.62 for more details.

• If you do not satisfactorily complete all courses with a grade C or better, you will be required to reimburseJefferson either through payroll deductions for the amount of tuition benefits received. No additionaltuition benefit will be paid by Jefferson until class is fully repaid.

All courses that begin in the current calendar year are considered when calculating the maximum amount for the year.

In accordance with IRS regulations, any tuition benefit in excess of the Federal tax exempt limit (currently $5,250 in a calendar year) will be treated as regular taxable wages and the employee will be responsible for all applicable taxes. For taxation purposes only, tuition benefit amounts will be applied to the calendar year in which they are paid.

Tuition Assistance ProgramRegular full-time and part-time benefit eligible non-bargaining employees are eligible for the Tuition Assistance Program.

Graduate

Full-time: $5,000 Part-time: $2,500

37OTHER BENEFITSREADY TO ENROLL? Go to page 40 for instructions.

EARNED TIME OFF (ETO)

All eligible non-bargaining employees receive ETO based upon their job title and length of service. Generally, ETO is allotted to the following schedules:

Service ETO up to 5 years 23 days up to 10 years 28 days 10 or more years 33 days

ETO does not apply to Full-Time Faculty, Full-Time Senior Administrators, Postdoctoral Fellows and House Staff.

VACATIONS Full-Time Faculty, Senior Administrators, Postdoctoral Fellows and House Staff receive vacation time based upon their job title and length of service. Generally, vacation time is allotted according to the following schedules:

• Faculty and Senior Administrators: 20 days a year • House staff G-1 level, 10 days per year. All others, 20 days per year • Postdoctoral Fellows, 10 days per year

OTHER VOLUNTARY PROGRAMS AND

FACILITIES OFFERED BY JEFFERSON More information on the following benefits can be found on the HR website at hr.jefferson.edu

• Adoption Assistance • Blood Donor Club • Campus Currency • Carebridge (Work/Life Balance assistance) • Cell Phone Discounts • Commuter Services and Discounts • Daycare Services and Discounts • Direct Payroll Deposit • Discount Entertainment Tickets • EXOS • First Call (Employee Assistance Program) • Freedom Credit Union • JeffConnect (telehealth) • Jefferson Fitness & Recreation Center • Library Privileges

Please Note: Specific eligibility requirements apply to the benefit plans identified in this booklet. Your entitlement to any of the benefits listed herein is expressly conditioned upon, and subject to, your meeting such eligibility requirements as provided in the plans. You may not rely upon this booklet as a determination as to your qualification or eligibility for such benefits. Detailed information is provided during the benefits orientation and enrollment session. If there is a difference between the statements in this booklet and in the contracts regarding the nature and extent of the benefits, the benefits will be determined in accordance with the language of the insurance contracts.

38 NEW HIRES: Make sure to enroll within 30 days of your hire date.BENEFITS PROGRAM

January 1, 2018—Jefferson’s Benefits ProgramBI-WEEKLY EMPLOYEE CONTRIBUTIONS FOR MEDICAL, DENTAL & VISION COVERAGES • Contribution Rates—Per Pay Period

Credits: Employees and spouses that complete the wellness program requirements will earn wellness credits in their paycheck the following year. The current wellness year is October 1, 2017–September 1, 2018*. If all requirements are met in this wellness year, credits will be applied in 2018.

*Health Screening (biometrics) must be submitted to RedBrick by September 1, 2018

Independence Blue Cross Delta Dental of PA

Full-Time Employees

PLATINUM PPO

GOLD PPO

DAVIS VISION

PLATINUM DENTAL

GOLD DENTAL

Employee Only $48 $39 $2.86 $5 $4

Employee + Spouse

$109 $90 $4.91 $13 $9

Employee + Child(ren)

$99 $75$4.91 (child)

$13 $9$7.09 (children)

Family $170 $140 $7.09 $16 $12

Part-Time Employees

PLATINUM PPO

GOLD PPO

DAVIS VISION

PLATINUM DENTAL

GOLD DENTAL

Employee Only $115 $100 $2.86 $12 $8.50

Employee + Spouse

$241 $214 $4.91 $27 $20

Employee + Child(ren)

$220 $200$4.91 (child)

$26 $19$7.09 (children)

Family $362 $314 $7.09 $34 $27

COBRA RatesPLATINUM PPO

Monthly CostGOLD PPO

Monthly CostDAVIS VISION Monthly Cost

PLATINUM DENTAL Monthly Cost

GOLD DENTAL Monthly Cost

Beneficiary Only $551.82 $524.28 $6.32 $31.89 $27.75

Beneficiary + Spouse

$1,241.34 $1,179.12 $10.85 $63.77 $55.52

Beneficiary + Child(ren)

$1,048.56 $995.52$10.85 (child)

$71.74 $62.45$15.67 (children)

Family $1,765.62 $1,676.88 $15.67 $95.65 $83.27

ADDITIONAL CREDITS AND PREMIUMS—PER PAY PERIOD

Wellness Credit (Full and Part-Time) Premiums (Full and Part-Time)

Employee $15 Working Spouse $40

Spouse $10 Employee Smoker $25

Spouse Smoker $25

Premiums: • The Working Spouse premium will apply if you enroll a spouse in medical who has access to health insurance through another employer.

• The Employee Smoker premium will apply if you’re enrolled in the medical plan and attest to using tobacco products.

• The Spousal Smoker premium will apply if your spouse is enrolled in the medical plan and uses tobacco products.

39BENEFITS SERVICE PROVIDER CONTACT LISTREADY TO ENROLL? Go to page 40 for instructions.

VENDOR PHONE WEBSITE

BANKING

Freedom Credit Union 215-612-5900 www.freedomcu.org

COBRA

Discovery Benefits 866-451-3399 www.discoverybenefits.com

DENTAL

Delta Dental (group #2564) 800-932-0783 www.deltadentalins.com

DISABILITY

CIGNA (Short & Long Term Disability) 855-689-6673 mycigna.com

Unum/Aon (Long Term Disability for Physicians) 877-815-6366

FAMILY MEDICAL LEAVE ACT (FMLA)

CIGNA 855-689-6673 mycigna.com

FLEXIBLE SPENDING ACCOUNT

Discovery Benefits 866-451-3399 www.discoverybenefits.com

LIFE INSURANCE

Reliance Standard (Life Insurance and AD&D) 800-351-7500 www.reliancestandard.com

MEDICAL

Independence Blue Cross Health Plans 800-ASK-BLUE www.ibx.com

JEFF NOW (Physician Referral Service for Employees) 800-JEFF-NOW www.jeffersonhospital.org/finddoctor

JeffCare Network www.jeffnetworks.org

Blue Card PPO Network (National Blue Cross Network) 800-810-BLUE www.bcbs.com

PRESCRIPTION

MedImpact 844-401-2052 www.medimpact.com

RETIREMENT

TIAA (TDAs and Retirement Plans) 800-842-2888 www.tiaa.org/jefferson

TIAA (to schedule individual counseling sessions) 800-842-2888 www.tiaa.org/schedulenow

Alight Solutions Your Pension Resources™ (DB Pension Plans)

855-354-6942 www.yourbenefitresources.com/jeffersonretirement

Social Security Administration/Medicare 800-772-1213 www.ssa.gov

VISION

Davis Vision 800-999-5431 www.davisvision.com

WELLNESS (LIVEWELL@JEFF)

Redbrick Health 877-263-3554 www.myredbrick.com/jefferson

OTHER VALUABLE BENEFITS

Benefits Plus (Voluntary Benefits) 855-515-5800 www.jeffersonbenefitsplus.com

Carebridge (Work-Life Support Services | Access Code W7SDF)

800-437-0911 www.myliferesource.com

FirstCall Employee Assistance Program 800-382-2377 www.firstcallleap.org

LegalEase 888-416-4313 www.jefferson.vsc-legalease.com

2018 Benefits Service Provider Contact ListHuman Resources Operations | 215-503-4772,press Option 8, then Option 1 | [email protected]

40 NEW HIRES: Make sure to enroll within 30 days of your hire date.ENROLLMENT PROCESS

To Complete The Enrollment ProcessMake sure you have all the information you need to make the elections right for you and your family by:

• Reading this guide

• Checking out the interactive ALEX portal at myalex.com/my-benefits/2018/benefits

• Visiting the HR website at jefferson.edu/benefits

Once you’re ready to make your benefits elections, make sure you are on the Jefferson network or RAP (connect.tjuh.org) and visit jefferson.edu/benefits. This should take you to the

“Current Employees” benefits section of the HR website.

• Select the blue box that reads “Enroll in benefits & make life event changes online”

• Sign into Employee Self Service with your Campus Key and Password

• Verify your home address and contact information by clicking on “Personal Information Summary” and “Home and Mailing Address” in the Personal Information section

• Then, select the “Benefits” section in Employee Self Service

• Choose “Benefits Enrollment”

• Next to each Plan, click “EDIT” and select your coverage for 2018

• After you have selected all your benefits, scroll to the bottom of the screen and click “Save and Continue”

• Last step! Click “SUBMIT” to confirm your selections.

This will complete the enrollment process to ensure you have the benefits you want and need for 2018.

QUESTIONS?

Contact the HR Operations Center at 215-503-4772 or at [email protected].

IIIREADY TO ENROLL? Go to page XX for instructions. SECTION NAME HERE

Notes

This Guidebook does not imply a guarantee of current or future benefits.

2018 jefferson benefits guidebook · 2018-11-20 · 2 human resources new ires: ak ur nrol ithi 30...

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