be the boss - mission health system
TRANSCRIPT
2018 BENEFITS GUIDE
There is nothing more important than your health. Mission is committed to offering a benefits package that provides options for you and for your family’s health, wellness and financial security. Lifestyle choices are important to our wellbeing; be an advocate for your personal health.
Enrollment is a great time to reflect on your wellness and to make sure you are taking ownership of your benefits. So get started today: it’s all inside….
Wellness begins with us.
What you need to know to enroll 1. Are you eligible for benefits?
Employees: You are eligible if you are budgeted to work 20+ hours per pay week or 40+ hours per pay period. PRN employees and contract or leased employees are not eligible for benefits.
Dependents*: o Legal spouse o Children through the end of the month in which they turn 26 o Children included under a Qualified Medical Child Support Order o Adopted children, stepchildren, foster children or children for whom you are considered their legal guardian o Children age 26 or older who are supported by you and incapable of self-sustaining employment due to a mental or physical handicap * If you elect dependent coverage, you may be asked to provide proof of your dependents’ relationships.
Welcome to Mission Health! This guide is intended for those who become eligible for benefits throughout 2018, and will provide an overview of the available benefits Mission Health provides. For additional details and more information review posted materials, including Summary Plan Descriptions (SPDs) posted on MissionAndMe.com.
Viewing on mobile? Don’t forget you can zoom!
It’s All Inside... Prepare to Enroll. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Own Your Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Health Plan Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Dental + Vision Coverage . . . . . . . . . . . . . . . . . . . . . . . . . 10
ll 2. Guidelines for New Hires and Newly Eligible
Employees You must enroll before your benefits effective date (benefits are effective the 31st day you are in an eligible status).
If you are returning to an eligible benefit status – either with an employment status change or rehire – within 12 months, you are eligible for benefits on the date you return to an eligible status. You must enroll within two weeks of your eligible status.
If you don’t enroll in benefits by the stated deadlines, you will not be eligible to enroll again until the next annual enrollment period unless you experience a Qualifying Life Event (QLE). QLEs include changes such as marriage, divorce, birth or adoption or loss of coverage. You will have 31 days from the date of the QLE to request a change. See the “Experiencing Some Life Changes” tab on Mission&Me for more information.
3. Prepare for Enrollment Before you enroll, make sure you get the facts. Review information in this guide and other information posted on Mission&Me. Decide which benefits are best for you, and remember to take the Personal Health Assessment (PHA) prior to your benefits effective date to receive discounted premiums with your health plan.
Use this worksheet (pictured at right) to jot down some notes to help you keep track of your decisions before you enroll.
2018 Benefits Enrollment Worksheet As you review the eMag, use this worksheet to jot down some notes to help you keep track of your decisions before you enroll.
*Note: Evidence of insurability will be required for increases in coverage.
Plan What I Want for 2018 Notes
€ MissionCare Plan (MCP) € Health Savings Plan (HSP) € No Coverage (pre-tax premium)
Who do I want to cover? (myself; + 1 child; + children; + spouse; family)
What do I contribute to the HSA (if enrolled in HSP)? Do I want to contribute to the FSA (if enrolled in MCP)? If my spouse’s employer offers coverage, it will cost $100 more each pay
period to be on my plan.
Accident € Coverage € No Coverage (aUer-tax premium)
Provides money to help pay for medical and out-of-pocket expenses that result from an accidental injury.
€ $15,000 benefit € $30,000 benefit € No Coverage (aUer-tax premium)
Provides a lump sum payment aUer diagnosis of a covered condiYon. Non-Tobacco & Tobacco User rates (applies to employee's status)
Who do I want to cover? (myself; +children; +family)
€ Coverage € No Coverage (aUer-tax premium)
Provides coverage to help pay for hospitalizaYon. Who do I want to cover? (myself; +child(ren); +spouse; +family)
€ ElecYon: _________ € No Coverage € (pre-tax premium)
May not be used if you sign up for the HSP or are enrolled in another high deducYble health plan. Must enroll each year.
€ Dental € No Coverage (pre-tax premium)
Who do I want to cover? (myself; + 1 child; + children; + spouse; family)
€ Vision € No Coverage (pre-tax premium)
Who do I want to cover? (myself; + 1 child or spouse; family)
€ ElecYon: _________ € No Coverage
(pre-tax premium)
Pay for eligible dependent care expenses by contribuYng to the Dependent
Care FSA. (Not eligible if annual salary is more than $120,000) Must enroll each year.
€ AddiYonal 1 x pay € AddiYonal 2 x pay € AddiYonal 3 x pay € AddiYonal 4 x pay (pre-tax premium)
Mission provides coverage for one Ymes your base pay up to a maximum of $600,000. You can purchase addiYonal coverage in amounts of 1, 2, 3, 4
Ymes your annual base pay up to a maximum of $600,000.
€ $30K Spouse € $40K Spouse € $50K Spouse (aUer-tax premium)
€ $10K Child(ren) € $5K Child(ren) (aUer-tax premium)
Life insurance coverage for your spouse and dependent children up to age 26.
€ 40% Core (Mission provides) € 40% core + 10% (aUer-tax premium)
Consider purchasing 50% so that you are adequately covered in the event
of an emergency.
€ 40% Core (Mission provides) € 40% core + 10% (aUer-tax premium)
Consider purchasing 50% so that you are adequately covered in the event of an emergency.
€ Employee only coverage € Employee/Dependent(s) coverage € No Coverage (aUer-tax premium)
Secure your idenYty with idenYty theU protecYon.
€ Pet Insurance € No Coverage (aUer-tax premium)
If you elect to enroll, you will receive an email with enrollment instrucYons.
Dependent Life*
Long-term Disability
Learn more at missionandme.com > Experiencing Some Life Changes.
O w
n Yo
ur E
nr o
llm en
Online Enrollment Steps
2. Enrollment must be completed through Mission Healthspace.
• From a Mission computer, go to Mission Healthspace icon on your desktop
• From any computer, enter the URL: http://missionhealthspace.msj.org
You must SUBMIT your enrollment elections before your benefits effective date or you will be enrolled only in 40% short- and long- term disability and the core life insurance coverage. If you need to make a change to your elections after you SUBMIT, you will need to contact HR Direct Connect at (828) 213-5600 before your benefits effective date.
Get ready to own your benefits in 2018!
Provider/Contact Information About Phone Website/Email
HR Direct Connect HR questions 828-213-5600 [email protected]
Aflac Accident Insurance Critical Illness Insurance Hospital Indemnity Insurance
800-433-3036
877-226-2058 (Dental) 877-385-8775 (HSA) M-F 9:00a-6:00p
www.healthscopebenefits.com
Liberty Mutual Short-Term and Long Term Disability 800-431-2958 www.MyLibertyConnection.com
Long Term Care Insurance Long Term Care
828-210-3818 Barbara DeBerry 800-681-5824
www.medcost.com Email: [email protected]
Securian Life/AD&D, Dependent Life Customer Service: 877-282-1752 Claims: 888-658-0193 www.lifebenefits.com
Transamerica Retirement Plan 828-213-0680 (on-site) 800-755-5801 mission.trsretire.com
UnitedHealthcare Vision Plan 1-800-638-3120 myuhcvision.com
Who to Contact
Get what you want! Enroll in Mission Healthspace before your benefits effective date.
If you don’t enroll before your benefits effective date, you will be automatically enrolled in benefits as follows:
ns
The MissionCare Plan (MCP) features lower deductibles, copays for office visits and offers you the lowest out-of-pocket amount when you receive treatment with Mission Health Partners providers. You also have the chance to save tax-free money for eligible healthcare expenses by opening a Healthcare Flexible Spending Account (FSA). You pay no deductible at Mission pharmacies for generic and preferred brand drugs with the MCP.
The Health Savings Plan (HSP) features lower payroll contributions than the MCP and, like the MCP, will have the lowest out-of-pocket amount when you receive treatment with Mission Health Partners providers. It also allows you to save tax-free money for eligible healthcare expenses through opening a Health Savings Account (HSA). After you meet the plan’s deductible, you pay lower coinsurance at Mission pharmacies.
You have two comprehensive health plan offerings to choose from:
Mission Health Partners: Includes Mission facilities and Mission Health Partners providers
In-Network: Includes other network providers
Lower payroll contributions
Lower annual deductible
Prescription drug coverage**
MissionCare Plan Health Savings Plan
Know the health plan network:
*18-county area includes: Avery, Burcombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey ** MCP – copays and no deductible for Mission Pharmacies, generic and preferred brand, plus low deductible for OptumRx Pharmacies. HSP – must meet health plan deductible, then coinsurance applies. Out-of-Network prescription drugs are not covered.
If you, your spouse or dependent child live outside of the 18-county regional area* you will be assigned to an expanded provider network for in-network benefits. Please note that networks will be assigned based on individuals’ mailing zip codes, so be sure to enter the related address and zip code to your spouse or dependent child’s information in Mission Healthspace® if different from your address.
MedCost is our Third Party Administrator (TPA) for
the health plan.
4
Employee Employee+1 Family
Deductible You pay this amount before Mission shares the cost through coinsurance.
$500 $750 $1,500
Out-of-Pocket Maximum Once you pay up to this amount, Mission pays 100% of the cost for eligible expenses.
$2,500 $3,650 $5,000
Medical Provisions Mission Health Partners In-Network Out-of-Network
Coinsurance (applies after deductible) You 10% Mission 90% You 30% Mission 70% Not Covered
Preventive Care You 0%, no deductible Mission100%
Not Covered
Hospital Outpatient Surgery Facility $500 copay
High-Cost Radiology Facility You 10% Mission 90%
Primary Care Physician (PCP) $30 copay
Specialists $40 copay $60 copay
Urgent Care $50 copay $100 copay
Emergency Room (copay waived if admitted) Non-emergency: $300 copay, then Mission pays 90% • True emergency: $100 copay, then Mission pays 90% Non-emergency: $300 copay, then Mission pays 50%
True emergency: $100 copay, then Mission pays 90%
5
Mission Health Pharmacies OptumRx Network
Deductible None for Generic and Preferred Brand Employee: $100 Family: $200
Generic Less than $75: $4 copay $75 or more: $15 copay
$30 copay
Brand Non- Preferred
Deductible: Employee $500 / Family $1,000, Then You pay 50% with a min $100 and max $200 copay
Deductible will be waived for approved medical exceptions.
Additional Deductible: Employee $500 / Family $1,000, Then You pay 60% with a min $100 and max $300 copay
Deductible will be waived for approved medical exceptions.
Generic** Less than $75: $10 copay / $75 or more: $30 copay
Not covered
Brand Non- Preferred**
Deductible: Employee $500 / Family $1,000, Then You pay 50% with a min $200 and max $400 copay
Deductible will be waived for approved medical exceptions.
Specialty Drugs You 10% Mission 90% Min $75 copay, max $150 copay
Not covered unless referred by Mission pharmacy
* If a brand drug is chosen when a generic drug is available, the covered person must pay the brand drug copay and the difference in cost between the brand drug and the generic drug.
** All maintenance medications must be filled as a 90-day supply under the Mission health plans and filled at a Mission employee mail-order pharmacy.
M ai
er Re
ta il
Chronic Condition Clinic The Mission Employee Health Plan, in partnership with Mission Pharmacy, has put in place an innovative approach to assist employees and their families in managing the cost and complexity of certain medications. There are certain drugs that must be prescribed by the Chronic Condition Clinic and filled at a Mission- owned pharmacy in order to be covered under Mission’s pharmacy benefits. This ensures the lowest possible costs to both you, the patient, as well as our entire health plan. These include medications for Hepatitis C, Chronic Inflammatory conditions, certain diabetes medications and certain specialty medications. There are also some chronic asthma/COPD medications that will continue to be covered if they are received outside the clinic, but you will realize the lowest possible costs when working with our Chronic Condition Clinic. The list of these drugs can be found on MissionAndMe and is subject to change. The Chronic Condition Clinic is not the same as the MyHealthyLife™ Chronic Condition Management Program. Many people can realize benefits from both programs. You can contact MyHealthyLifeTM Chronic Condition Management program @ (828) 213.4648 / [email protected] for more information.
MyHealthyLife™ Chronic Condition Management provides support for you to manage chronic conditions and achieve wellness goals! This benefit is available to you and your covered dependents insured through Mission Health.
The program offers personalized education, flexible scheduling, telephonic and in-person visits with care managers, and innovative programming for the following conditions:
• Asthma • Depression • Diabetes • Pre-diabetes • High blood pressure, high cholesterol, heart disease, and vascular disease • Chronic Obstructive Pulmonary Disease (COPD) • Long-term warfarin (Coumadin®) therapy, in partnership with the Mission
Hospital Outpatient Anticoagulation Service By participating in this program, Mission will pay 100% for disease-specific lab work, appointments with MyHealthyLifeTM clinicians, and education classes. You will benefit by receiving personalized health coaching and support in addition to $0 copays on approved medications used to treat your condition. (HSP members will need to meet the health plan deductible.)
MyHealthyLifeTM WellConnect To care for others, we have to care for ourselves. Mission Health offers the MyHealthyLifeTM WellConnect Program to help you maintain or improve your health:
Earn even more incentives Track what you eat and your cardio activity Join wellness challenges Get support to quit smoking Participate in workshops and wellness events
Log on to mission.wellconnectwnc.org and create a username and password to get started.
Important to know: If you participate in the Diabetes Chronic Condition Management Program, you must enroll with Livongo. Livongo provides state-of-the-art blood glucose monitoring systems along with excellent virtual care at no cost to you. Enroll online at my.livongo.com. Use promo code: MISSION or call 800-945-4355.
Learn More Missionandme.com > Focusing On My Health > Improving My Wellbeing
Plan Information Mission Health Partners In-Network
Deductible You pay this amount before Mission shares the cost through coinsurance.
Employee: $1,500 Family: $3,000
Out-of-Pocket Maximum Once you pay up to this amount, Mission pays 100% of the cost for eligible expenses.
Employee: $6,650 Family: $13,300
Embedded Plan Features: What Do They Mean?
For each plan, there is an overall deductible and out-of-pocket maximum (OOPM) for all of the costs (including prescriptions in the HSP) incurred by covered individuals. An embedded deductible or OOPM means benefits could be paid by coinsurance or at 100% for one family member and not all.
These work differently for each plan:
MCP HSP
Embedded Deductible Yes No
Embedded OOPM Yes Yes
See page 7 for examples of how these work for both plans.
Medical Provisions Mission Health Partners In-Network Out-of-Network
Coinsurance (applies after deductible) You 20% Mission 80% You 30% Mission 70%
Not Covered
Hospital Inpatient Facility
Hospital Outpatient Surgery Facility
Urgent Care You 20% Mission 80%
Emergency Room Non-emergency: You 30% Mission 70% True emergency: You 20% Mission 80%
Non-emergency: You 50% Mission 50%
True emergency:
Prescription Drugs for HSP
Deductible Medical deductible applies to prescription drugs
Generic You 20% Mission 80% You 30% Mission 70%
Brand Preferred You 30% Mission 70% You 40% Mission 60%
Brand Non-Preferred You 50% Mission 50% You 50% Mission 50%
Generic* You 20% Mission 80%
Not coveredBrand Preferred* You 30% Mission 70%
Brand Non-Preferred* You 50% Mission 50%
Specialty Drugs You 30% Mission 70% Not covered unless referred by Mission pharmacy
* All maintenance medications must be filled as a 90-day supply under the Mission health plans and filled at a Mission employee mail-order pharmacy.
The Health Savings Account (HSA) The HSP is paired with an HSA to help you save for expenses now and in the future. Learn more at Missionandme.com > Focusing On My Health > Health Through Insurance > Health Accounts
Please note you cannot enroll in the FSA for healthcare if you have an HSA.
Mission Health Contributes to your HSA!
2018 HSA Employee Contribution Limits Mission Health Contribution**
Employee $3,450 $250
Family $6,900 $500
Catch-up Contributions* $1,000
*If you are age 55 or older, you can make catch-up contributions to save more. **Prorated based on the month of your effective date of coverage.
Embedded Deductible and Out-of-Pocket Maximum in the MCP Embedded Out-of-Pocket Maximum in the HSP Tom, a Mission employee, is enrolled in the HSP. He has surgery and meets the individual OOPM of $6,650.
Mary is a Mission employee and is enrolled in the MCP. She gets an x-ray for a foot injury and meets the individual deductible of $500. Additional expenses are paid at coinsurance until she meets her OOPM of $2,500.
His wife and son continue to incur an additional $6,650 in medical expenses until the family all together meets the family OOPM of $13,300.
Her husband and their daughter continue to incur an additional $1,000 in medical expenses until the family all together meets the family deductible of $1,500.
$6,650
After the family OOPM of $13,300 is met, the plan pays any additional medical expenses 100% for the entire family for the rest of the year. $1,000
After the family deductible of $1,500 is met, any additional eligible medical expenses are paid by coinsurance until Mary’s husband or daughter meet their individual OOPM or the family OOPM.
$6,650
This means that all of Tom’s additional medical expenses are covered 100% for the remainder of the year. $2,500
This means that any additional eligible expenses Mary incurs throughout the year are paid at 100%.
M ai
20 18
M ed
ic al
P la
n Pr
em iu
m s
What You Pay in Payroll Deductions Each Pay Period (pre-tax) Your health plan premiums will reflect completion of your Personal HealthAssessment (PHA)** when you log into the enrollment tool. Note that it may take up to 48 hours after PHA completion for your reduced rates to be reflected in the online enrollment tool.
Completed PHA Didn’t Complete PHA
Full-Time Part-Time Full-Time Part-Time
Employee $37.33 $10.07 $74.73 $31.90 $57.33 $30.07 $94.73 $51.90
Employee + Spouse* $147.19 $48.14 $203.55 $70.04 $167.19 $68.14 $223.55 $90.04
Employee + Child $72.55 $22.39 $104.88 $34.85 $92.55 $42.39 $124.88 $54.85
Employee + Children $121.95 $39.18 $176.24 $61.09 $141.95 $59.18 $196.24 $81.09
Family* $218.68 $72.77 $292.36 $94.65 $238.68 $92.77 $312.36 $114.65 *$100 spousal surcharge not included ** If your health plan coverage was effective one or after June 1, 2017, you only need to complete the PHA by your benefits effective date to get the reduced premiums for 2018. Watch for more information about 2019 wellness incentives.
Wellness begins with us
Covering a Spouse? If you are covering a spouse on your Mission Health plan and he/she has coverage available with their employer, you will pay an additional surcharge of $100 per pay period.
Receive Reduced Premiums! You must complete the Personal Health Assessment (PHA) before your benefits effective date to receive a reduced premium in 2018.
Know Healthcare Reform:
You must have healthcare coverage or pay a penalty to the IRS
If you are eligible for Mission Health benefits, you are not eligible for subsidies from the government
If you are NOT eligible for Mission Health benefits, you can access coverage through the federal government’s healthcare exchange, or consider other sources of coverage like your spouse’s plan, your parent’s plan, Medicaid or Medicare (if applicable)
Yes! No...
Hospital Indemnity (Administered by AFLAC*)
This benefit pays cash when you are admitted to the hospital, and when you remain hospitalized, including for pregnancy. Review rates and enroll in the enrollment tool.
Critical Illness (Administered by AFLAC*)
You can receive a lump-sum cash benefit of $15,000 or $30,000 following diagnosis of a covered condition like a heart attack, cancer or stroke. Review rates and enroll in the enrollment tool.
Accident Insurance (Administered by AFLAC*)
Provides cash to help pay for the medical and out-of-pocket costs that add up after an accidental injury. Even with health insurance, you may not be adequately prepared for expenses that result from an accident.
Learn more at Missionandme.com > Total Rewards > Managing My Financial Security > Protecting My Finances
*Underwritten by Continental American Insurance Company (CAIC). Refer to materials for limitations and exclusions.
Healthcare FSA Save for healthcare expenses! You are eligible if you don’t participate in the HSP or another high-deductable plan.
Use your FSA debit card to pay for eligible healthcare expenses for yourself and dependents with tax-free funds from your FSA. Contribute up to $2,600 annually. The minimum pre-tax contribution per bi-weekly pay period is $10.
If you don’t use your Healthcare FSA funds by the end of the year, you will lose them (unless you qualify to carry over $500 to the following plan year).
Learn More Missionandme.com > Managing My Financial Security > Savings and Financial Incentives > Pay Expenses with Tax-Free Dollars
Dependent Care FSA Pay for eligible dependent care expenses. Contribute up to $5,000 per calendar year if single or married and filing a joint return, or $2,500 per calendar year for married participants who file federal income tax returns separately. The minimum pre-tax contribution per bi-weekly pay period is $10. If your annual salary is more than $120,000, you are not eligible to participate.
Learn More Missionandme.com > Total Rewards > Focusing on My Health > Health Through Insurance > Health Accounts
g e Dental (Administered by HealthSCOPE Benefits)
Getting regular dental care is an important part of overall health.
Annual Deductible $100 individual $300 family
Individual Annual Maximum Non-orthodontia services, preventive, diagnostic, basic, major services $1,500
Preventive and Diagnostic Services Exams and cleanings, fluoride treatments, x-rays for diagnosis, sealants 100%, no deductible
Basic Services Fillings and extractions, periodontics, repairs to crowns or dentures, endodontics, oral surgery
After deductible
After deductible
Orthodontia Services No age limit
Orthodontia Individual Lifetime Maximum $1,500
Premiums (pre-tax) What you will pay in payroll deductions each pay period:
Full-Time Part-Time
Vision (Administered by United Healthecare)
You’re the boss…only you can take care of your eyes!
Covered Benefits (per covered member) In-Network Out-of-Network
Allowance
Routine Vision Exam (once per calendar year) 100% after $15 copay
$60 Refraction Only in Lieu of Routine Vision Exam (once per calendar year) $0 allowance
Lenses (once per calendar year)1
• Single Vision • Lined Bifocal • Lined Trifocal and Lenticular
100% after $15 copay There is a surcharge for progressive lenses.
$40 $60 $80
Frames (once per calendar year)2 $250 allowance after $15 copay $45
Contact Lenses (once per calendar year in lieu of glasses)3
• Up to 10 boxes from the covered contact lens selection list: Covered after $15 copay
• Contacts not on the lens selection list: $250 allowance
$250
Necessary Contact Lenses4 (once per calendar year in lieu of glasses) $15 copay $210
Laser Vision Correction 15% off usual and customary price for Laser Vision Network of America providers N/A
1You are eligible to select either eyeglasses or contact lenses — only one service will be covered. 2 If you purchase eyeglass lenses and eyeglass frames at the same time from the same network provider, only one copay will apply to the lenses and frames together.
3The allowance for lenses not from the covered contact lens selection will apply at Walmart, Sam’s Club and Costco locations. 4Determined at the provider’s discretion. See plan details.
Premiums (pre-tax) What you will pay in payroll deductions each pay period:
Employee $4.04
You 50% Mission 50%
LifeLife, Accidental Death and Dismemberment (AD&D) (Administered by Securian) To help protect you and your family financially, Mission Health automatically pays for Basic Life and Basic AD&D coverage of:
Basic Life and Basic AD&D Annual base pay (up to $600,000)
You may also choose Supplemental Life and AD&D coverage of:
Supplemental Life and AD&D Annual base pay (up to $600,000)
Premiums* (pre-tax) Rate: $0.173 per $1,000 Calculate your bi-weekly cost: (Your annual base pay ÷ 1,000) x $0.173 x 12 ÷ 26
*The cost of your supplemental life insurance is paid with pre-tax dollars.
Now is your opportunity to elect up to 4X supplemental life and AD&D coverage for yourself, or $30,000 coverage for your spouse, without Evidence of Insurability (EOI). If you request to increase your life covereage or your spouse’s life coverage during annual enrollment, you will be required to complete EOI and the increased coverage will not be effective until approved.
1x 2x 3x 4x
1x
You can purchase additional coverage for dependents. Child Life coverage available for dependent children up to age 26.
Spouse $30,000, $40,000 or $50,000 Child(ren) $5,000 or $10,000 per child
Evidence of Insurability (EOI) Requirements • All new plan enrollees will require
EOI for coverage amounts of $40,000 or $50,000
• All plan enrollees will require EOI if requesting to increase covereage amounts during an annual enrollment.
EOI Requirements • Not required for any coverage
amount
Spouse Life
$30,000 $4.64
$40,000 $6.18
$50,000 $7.73
$10,000 $0.52
*The cost of your Dependent Life insurance is paid with after-tax dollars. **Rate is per family unit, regardless of number of children covered.
Questions about EOI? Find out what’s required on page 12.
nc e Disability Benefits (Administered by Liberty Mutual)
Life sometimes doesn’t go as planned…so it’s important to be prepared! You never know when you may need to take time away from work to recover from an illness or injury — so Mission Health offers both Short-term (STD) and Long-term Disability (LTD) benefits just in case.
Both of your disability benefits include:
A core benefit of 40% pay replacement covered by Mission
Additional coverage purchase option of up to 50% pay replacement
Premiums paid with after-tax contributions (after applicable income taxes have been deducted), which means if you are paid an STD or LTD benefit, the money you receive will be tax-free
Short-Term Disability If you are absent from work due to illness or injury for more than 14 calendar days, you may be eligible for STD coverage. There is a maximum 14-day waiting period before you will start to receive this benefit. The maximum benefit period is 24 weeks, excluding the 14-day waiting period.
Premiums (after-tax) What you will pay in payroll contributions:
Coverage Biweekly Cost Weekly Maximum Benefit
40% Mission pays the cost No limit
50% (Biweekly covered base pay ÷100) x $0.370 No limit
Long-term Disability (LTD) If you are absent from work due to illness or injury beyond the time covered by STD (180 days), you may be eligible for LTD coverage.
Premiums (after-tax) What you will pay in payroll contributions:
Coverage Biweekly Cost Monthly Maximum Benefit*
40% Mission pays the cost $6,500
50% (Biweekly covered base pay ÷100) x $0.55 $10,000
* The monthly benefit caps for physicians are $15,000 for 40% coverage and $20,000 for 50% coverage (subject to 3/12 pre-existing clause).
Learn More Missionandme.com > Managing My Financial Security > Protecting My Finances
This guide provides a summary of benefits available. It is not a legal plan document or contract, and is not intended to present all final details of the benefit plans described. Mission Health may amend or terminate its plans at any time by its sole discretion. The descriptions of these programs, the plans themselves or participation in the plans are not an employment contract or any type of employment guarantee and should not be considered as such. In addition to your SPDs, you can find all Summaries of Benefits and Coverage (SBCs) and Important Notices in the Resources section of MissionandMe.com. If you need assistance or want to request printed copies of these, contact HR Direct Connect at 828-213-5600. This guide gives highlights of the Mission Health benefit programs. It is not intended to be a Summary Plan Description (SPD) or Plan Document. If there are differences between the Guide and the SPD or Plan Document, the terms of the SPD or Plan Document will control.
Este folleto contiene un resumen en inglés de los beneficios disponibles en el Hospital Mission para los empleados. El resumen de todos los documentos del plan también está disponible en el Internet y puede también obtener una copia impresa en la oficina de Recursos Humanos. Si usted tiene dificultad para entender cualquiera de estos documentos del plan, por favor póngase en contacto con el departamento de intérpretes al teléfono (828) 213-0289.
Know what’s required: Evidence of Insurability (EOI), or proof of good health, is required if you request to increase your coverage for Life, STD, LTD or Spouse Life after your initial enrollment.
Adoption Assistance Receive a one-hour telephonic adoption consultation to learn more about the process, timeline and costs for adoption, locate support groups and more. You also may be eligible to receive up to $3,500 in reimbursement of direct adoption expenses. Call 800-454-1477 or learn more at Missionandme.com > Total Rewards
Identity Theft Secure your identity with identity theft protection. Receive identity monitoring, credit monitoring and restoration services for you and your family. Review rates and enroll in the Infor enrollment tool. Learn more at Missionandme.com > Total Rewards
Phased Retirement Ease into what’s next for your life, while staying engaged at Mission. Continue working by changing to part-time as you transition into retirement. Contact your manager to learn more or go to Missionandme. com > Managing My Financial Security > Preparing for Retirement
Pet Insurance We want to help protect all those who are most important to you – including your best-pet, furry friends! When you are enrolling, indicate interest in pet insurance via the Mission Healthspace® enrollment tool and you will receive an email on how to enroll via the Nationwide portal Review information at Missionandme.com > Total Rewards
M o
re Valuab le B
enefits Mission Health’s Retirement Plan You are immediately eligible to participate in the Mission Health 403(b) retirement plan – there is no waiting period. If you do not elect to participate earlier, all new employees will automatically be enrolled in the plan with a 2% deferral after 90 days. If you have .5 FTE status or greater, you receive a matching contribution from Mission after 12 months of service and 1,000 hours. (PRN employees are not eligible to receive the matching contribution.) You will become 100% vested in the matching contributions after 3 years. Learn more at Missionandme.com > Managing My Financial Security > Preparing for Retirement
To access your Transamerica account, learn more about maximizing your retirement savings, name your beneficiary and more, visit mission.trsretire.com or call 800-755-5801.
Missionandme.com > Quick Links > Questions? Who to Contact Questions about your 2018 Mission benefits?
Paid Time Off (PTO) — Relax and Recover! You must be a full-time or part-time employee budgeted to work 20 hours
or more per week or 40 hours or more per pay period to be eligible for PTO
PTO is available to use the pay period of your 90th day of employment
You may use PTO to increase STD coverage to 100% for the first two months of disability (including the 14-day waiting period)
PTO Accrual
Annual Accrual
Date of hire to 2 years 52 6.77 hours 22 days (176 hours)
2 – 5 years 53 – 130 8.31 hours 27 days (216 hours)
5 – 10 years 131 – 260 9.85 hours 32 days (256 hours)
Year 10+ 261+ 11.39 hours 37 days (296 hours)
If hired prior to January 1, 2003: Year 14+ 365+ 12.31 hours 40 days (320 hours)
If you are a Physician or Advanced Practitioner, you receive a Time Away From Practice benefit.
Employees Care — PTO Donation Employees can donate hours to a PTO Donation Fund, which will be used to
provide PTO time to other employees who have depleted their own hours and meet eligibility requirements.
To be eligible to donate, employees must have used at least one week’s worth of PTO in the prior 12-month period.
The recipient must qualify for a medical emergency (terminal and/or life threatening) for themselves or a family member — it is not intended for short-term illnesses, or those that don’t meet this criteria. The recipient must also not have enough time to either cover the two-week waiting period before Short-term Disability benefits begin, or they need two weeks of PTO under a continuous leave to care for a family member.
A PTO Donation Review Committee will review requests for donations and make determinations based on a de-identified review of the requestor’s documentation.
The maximum amount of donated time a qualified employee may receive is up to 80 hours, and based on FTE status and availability of donated hours.
Learn more Missionandme.com > Living My Life > Taking Time Away from Work
There’s Long-term care
AREN’T YOU GLAD YOU’RE THE BOSS ?
There is nothing more important than your health. Mission is committed to offering a benefits package that provides options for you and for your family’s health, wellness and financial security. Lifestyle choices are important to our wellbeing; be an advocate for your personal health.
Enrollment is a great time to reflect on your wellness and to make sure you are taking ownership of your benefits. So get started today: it’s all inside….
Wellness begins with us.
What you need to know to enroll 1. Are you eligible for benefits?
Employees: You are eligible if you are budgeted to work 20+ hours per pay week or 40+ hours per pay period. PRN employees and contract or leased employees are not eligible for benefits.
Dependents*: o Legal spouse o Children through the end of the month in which they turn 26 o Children included under a Qualified Medical Child Support Order o Adopted children, stepchildren, foster children or children for whom you are considered their legal guardian o Children age 26 or older who are supported by you and incapable of self-sustaining employment due to a mental or physical handicap * If you elect dependent coverage, you may be asked to provide proof of your dependents’ relationships.
Welcome to Mission Health! This guide is intended for those who become eligible for benefits throughout 2018, and will provide an overview of the available benefits Mission Health provides. For additional details and more information review posted materials, including Summary Plan Descriptions (SPDs) posted on MissionAndMe.com.
Viewing on mobile? Don’t forget you can zoom!
It’s All Inside... Prepare to Enroll. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Own Your Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Health Plan Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Dental + Vision Coverage . . . . . . . . . . . . . . . . . . . . . . . . . 10
ll 2. Guidelines for New Hires and Newly Eligible
Employees You must enroll before your benefits effective date (benefits are effective the 31st day you are in an eligible status).
If you are returning to an eligible benefit status – either with an employment status change or rehire – within 12 months, you are eligible for benefits on the date you return to an eligible status. You must enroll within two weeks of your eligible status.
If you don’t enroll in benefits by the stated deadlines, you will not be eligible to enroll again until the next annual enrollment period unless you experience a Qualifying Life Event (QLE). QLEs include changes such as marriage, divorce, birth or adoption or loss of coverage. You will have 31 days from the date of the QLE to request a change. See the “Experiencing Some Life Changes” tab on Mission&Me for more information.
3. Prepare for Enrollment Before you enroll, make sure you get the facts. Review information in this guide and other information posted on Mission&Me. Decide which benefits are best for you, and remember to take the Personal Health Assessment (PHA) prior to your benefits effective date to receive discounted premiums with your health plan.
Use this worksheet (pictured at right) to jot down some notes to help you keep track of your decisions before you enroll.
2018 Benefits Enrollment Worksheet As you review the eMag, use this worksheet to jot down some notes to help you keep track of your decisions before you enroll.
*Note: Evidence of insurability will be required for increases in coverage.
Plan What I Want for 2018 Notes
€ MissionCare Plan (MCP) € Health Savings Plan (HSP) € No Coverage (pre-tax premium)
Who do I want to cover? (myself; + 1 child; + children; + spouse; family)
What do I contribute to the HSA (if enrolled in HSP)? Do I want to contribute to the FSA (if enrolled in MCP)? If my spouse’s employer offers coverage, it will cost $100 more each pay
period to be on my plan.
Accident € Coverage € No Coverage (aUer-tax premium)
Provides money to help pay for medical and out-of-pocket expenses that result from an accidental injury.
€ $15,000 benefit € $30,000 benefit € No Coverage (aUer-tax premium)
Provides a lump sum payment aUer diagnosis of a covered condiYon. Non-Tobacco & Tobacco User rates (applies to employee's status)
Who do I want to cover? (myself; +children; +family)
€ Coverage € No Coverage (aUer-tax premium)
Provides coverage to help pay for hospitalizaYon. Who do I want to cover? (myself; +child(ren); +spouse; +family)
€ ElecYon: _________ € No Coverage € (pre-tax premium)
May not be used if you sign up for the HSP or are enrolled in another high deducYble health plan. Must enroll each year.
€ Dental € No Coverage (pre-tax premium)
Who do I want to cover? (myself; + 1 child; + children; + spouse; family)
€ Vision € No Coverage (pre-tax premium)
Who do I want to cover? (myself; + 1 child or spouse; family)
€ ElecYon: _________ € No Coverage
(pre-tax premium)
Pay for eligible dependent care expenses by contribuYng to the Dependent
Care FSA. (Not eligible if annual salary is more than $120,000) Must enroll each year.
€ AddiYonal 1 x pay € AddiYonal 2 x pay € AddiYonal 3 x pay € AddiYonal 4 x pay (pre-tax premium)
Mission provides coverage for one Ymes your base pay up to a maximum of $600,000. You can purchase addiYonal coverage in amounts of 1, 2, 3, 4
Ymes your annual base pay up to a maximum of $600,000.
€ $30K Spouse € $40K Spouse € $50K Spouse (aUer-tax premium)
€ $10K Child(ren) € $5K Child(ren) (aUer-tax premium)
Life insurance coverage for your spouse and dependent children up to age 26.
€ 40% Core (Mission provides) € 40% core + 10% (aUer-tax premium)
Consider purchasing 50% so that you are adequately covered in the event
of an emergency.
€ 40% Core (Mission provides) € 40% core + 10% (aUer-tax premium)
Consider purchasing 50% so that you are adequately covered in the event of an emergency.
€ Employee only coverage € Employee/Dependent(s) coverage € No Coverage (aUer-tax premium)
Secure your idenYty with idenYty theU protecYon.
€ Pet Insurance € No Coverage (aUer-tax premium)
If you elect to enroll, you will receive an email with enrollment instrucYons.
Dependent Life*
Long-term Disability
Learn more at missionandme.com > Experiencing Some Life Changes.
O w
n Yo
ur E
nr o
llm en
Online Enrollment Steps
2. Enrollment must be completed through Mission Healthspace.
• From a Mission computer, go to Mission Healthspace icon on your desktop
• From any computer, enter the URL: http://missionhealthspace.msj.org
You must SUBMIT your enrollment elections before your benefits effective date or you will be enrolled only in 40% short- and long- term disability and the core life insurance coverage. If you need to make a change to your elections after you SUBMIT, you will need to contact HR Direct Connect at (828) 213-5600 before your benefits effective date.
Get ready to own your benefits in 2018!
Provider/Contact Information About Phone Website/Email
HR Direct Connect HR questions 828-213-5600 [email protected]
Aflac Accident Insurance Critical Illness Insurance Hospital Indemnity Insurance
800-433-3036
877-226-2058 (Dental) 877-385-8775 (HSA) M-F 9:00a-6:00p
www.healthscopebenefits.com
Liberty Mutual Short-Term and Long Term Disability 800-431-2958 www.MyLibertyConnection.com
Long Term Care Insurance Long Term Care
828-210-3818 Barbara DeBerry 800-681-5824
www.medcost.com Email: [email protected]
Securian Life/AD&D, Dependent Life Customer Service: 877-282-1752 Claims: 888-658-0193 www.lifebenefits.com
Transamerica Retirement Plan 828-213-0680 (on-site) 800-755-5801 mission.trsretire.com
UnitedHealthcare Vision Plan 1-800-638-3120 myuhcvision.com
Who to Contact
Get what you want! Enroll in Mission Healthspace before your benefits effective date.
If you don’t enroll before your benefits effective date, you will be automatically enrolled in benefits as follows:
ns
The MissionCare Plan (MCP) features lower deductibles, copays for office visits and offers you the lowest out-of-pocket amount when you receive treatment with Mission Health Partners providers. You also have the chance to save tax-free money for eligible healthcare expenses by opening a Healthcare Flexible Spending Account (FSA). You pay no deductible at Mission pharmacies for generic and preferred brand drugs with the MCP.
The Health Savings Plan (HSP) features lower payroll contributions than the MCP and, like the MCP, will have the lowest out-of-pocket amount when you receive treatment with Mission Health Partners providers. It also allows you to save tax-free money for eligible healthcare expenses through opening a Health Savings Account (HSA). After you meet the plan’s deductible, you pay lower coinsurance at Mission pharmacies.
You have two comprehensive health plan offerings to choose from:
Mission Health Partners: Includes Mission facilities and Mission Health Partners providers
In-Network: Includes other network providers
Lower payroll contributions
Lower annual deductible
Prescription drug coverage**
MissionCare Plan Health Savings Plan
Know the health plan network:
*18-county area includes: Avery, Burcombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey ** MCP – copays and no deductible for Mission Pharmacies, generic and preferred brand, plus low deductible for OptumRx Pharmacies. HSP – must meet health plan deductible, then coinsurance applies. Out-of-Network prescription drugs are not covered.
If you, your spouse or dependent child live outside of the 18-county regional area* you will be assigned to an expanded provider network for in-network benefits. Please note that networks will be assigned based on individuals’ mailing zip codes, so be sure to enter the related address and zip code to your spouse or dependent child’s information in Mission Healthspace® if different from your address.
MedCost is our Third Party Administrator (TPA) for
the health plan.
4
Employee Employee+1 Family
Deductible You pay this amount before Mission shares the cost through coinsurance.
$500 $750 $1,500
Out-of-Pocket Maximum Once you pay up to this amount, Mission pays 100% of the cost for eligible expenses.
$2,500 $3,650 $5,000
Medical Provisions Mission Health Partners In-Network Out-of-Network
Coinsurance (applies after deductible) You 10% Mission 90% You 30% Mission 70% Not Covered
Preventive Care You 0%, no deductible Mission100%
Not Covered
Hospital Outpatient Surgery Facility $500 copay
High-Cost Radiology Facility You 10% Mission 90%
Primary Care Physician (PCP) $30 copay
Specialists $40 copay $60 copay
Urgent Care $50 copay $100 copay
Emergency Room (copay waived if admitted) Non-emergency: $300 copay, then Mission pays 90% • True emergency: $100 copay, then Mission pays 90% Non-emergency: $300 copay, then Mission pays 50%
True emergency: $100 copay, then Mission pays 90%
5
Mission Health Pharmacies OptumRx Network
Deductible None for Generic and Preferred Brand Employee: $100 Family: $200
Generic Less than $75: $4 copay $75 or more: $15 copay
$30 copay
Brand Non- Preferred
Deductible: Employee $500 / Family $1,000, Then You pay 50% with a min $100 and max $200 copay
Deductible will be waived for approved medical exceptions.
Additional Deductible: Employee $500 / Family $1,000, Then You pay 60% with a min $100 and max $300 copay
Deductible will be waived for approved medical exceptions.
Generic** Less than $75: $10 copay / $75 or more: $30 copay
Not covered
Brand Non- Preferred**
Deductible: Employee $500 / Family $1,000, Then You pay 50% with a min $200 and max $400 copay
Deductible will be waived for approved medical exceptions.
Specialty Drugs You 10% Mission 90% Min $75 copay, max $150 copay
Not covered unless referred by Mission pharmacy
* If a brand drug is chosen when a generic drug is available, the covered person must pay the brand drug copay and the difference in cost between the brand drug and the generic drug.
** All maintenance medications must be filled as a 90-day supply under the Mission health plans and filled at a Mission employee mail-order pharmacy.
M ai
er Re
ta il
Chronic Condition Clinic The Mission Employee Health Plan, in partnership with Mission Pharmacy, has put in place an innovative approach to assist employees and their families in managing the cost and complexity of certain medications. There are certain drugs that must be prescribed by the Chronic Condition Clinic and filled at a Mission- owned pharmacy in order to be covered under Mission’s pharmacy benefits. This ensures the lowest possible costs to both you, the patient, as well as our entire health plan. These include medications for Hepatitis C, Chronic Inflammatory conditions, certain diabetes medications and certain specialty medications. There are also some chronic asthma/COPD medications that will continue to be covered if they are received outside the clinic, but you will realize the lowest possible costs when working with our Chronic Condition Clinic. The list of these drugs can be found on MissionAndMe and is subject to change. The Chronic Condition Clinic is not the same as the MyHealthyLife™ Chronic Condition Management Program. Many people can realize benefits from both programs. You can contact MyHealthyLifeTM Chronic Condition Management program @ (828) 213.4648 / [email protected] for more information.
MyHealthyLife™ Chronic Condition Management provides support for you to manage chronic conditions and achieve wellness goals! This benefit is available to you and your covered dependents insured through Mission Health.
The program offers personalized education, flexible scheduling, telephonic and in-person visits with care managers, and innovative programming for the following conditions:
• Asthma • Depression • Diabetes • Pre-diabetes • High blood pressure, high cholesterol, heart disease, and vascular disease • Chronic Obstructive Pulmonary Disease (COPD) • Long-term warfarin (Coumadin®) therapy, in partnership with the Mission
Hospital Outpatient Anticoagulation Service By participating in this program, Mission will pay 100% for disease-specific lab work, appointments with MyHealthyLifeTM clinicians, and education classes. You will benefit by receiving personalized health coaching and support in addition to $0 copays on approved medications used to treat your condition. (HSP members will need to meet the health plan deductible.)
MyHealthyLifeTM WellConnect To care for others, we have to care for ourselves. Mission Health offers the MyHealthyLifeTM WellConnect Program to help you maintain or improve your health:
Earn even more incentives Track what you eat and your cardio activity Join wellness challenges Get support to quit smoking Participate in workshops and wellness events
Log on to mission.wellconnectwnc.org and create a username and password to get started.
Important to know: If you participate in the Diabetes Chronic Condition Management Program, you must enroll with Livongo. Livongo provides state-of-the-art blood glucose monitoring systems along with excellent virtual care at no cost to you. Enroll online at my.livongo.com. Use promo code: MISSION or call 800-945-4355.
Learn More Missionandme.com > Focusing On My Health > Improving My Wellbeing
Plan Information Mission Health Partners In-Network
Deductible You pay this amount before Mission shares the cost through coinsurance.
Employee: $1,500 Family: $3,000
Out-of-Pocket Maximum Once you pay up to this amount, Mission pays 100% of the cost for eligible expenses.
Employee: $6,650 Family: $13,300
Embedded Plan Features: What Do They Mean?
For each plan, there is an overall deductible and out-of-pocket maximum (OOPM) for all of the costs (including prescriptions in the HSP) incurred by covered individuals. An embedded deductible or OOPM means benefits could be paid by coinsurance or at 100% for one family member and not all.
These work differently for each plan:
MCP HSP
Embedded Deductible Yes No
Embedded OOPM Yes Yes
See page 7 for examples of how these work for both plans.
Medical Provisions Mission Health Partners In-Network Out-of-Network
Coinsurance (applies after deductible) You 20% Mission 80% You 30% Mission 70%
Not Covered
Hospital Inpatient Facility
Hospital Outpatient Surgery Facility
Urgent Care You 20% Mission 80%
Emergency Room Non-emergency: You 30% Mission 70% True emergency: You 20% Mission 80%
Non-emergency: You 50% Mission 50%
True emergency:
Prescription Drugs for HSP
Deductible Medical deductible applies to prescription drugs
Generic You 20% Mission 80% You 30% Mission 70%
Brand Preferred You 30% Mission 70% You 40% Mission 60%
Brand Non-Preferred You 50% Mission 50% You 50% Mission 50%
Generic* You 20% Mission 80%
Not coveredBrand Preferred* You 30% Mission 70%
Brand Non-Preferred* You 50% Mission 50%
Specialty Drugs You 30% Mission 70% Not covered unless referred by Mission pharmacy
* All maintenance medications must be filled as a 90-day supply under the Mission health plans and filled at a Mission employee mail-order pharmacy.
The Health Savings Account (HSA) The HSP is paired with an HSA to help you save for expenses now and in the future. Learn more at Missionandme.com > Focusing On My Health > Health Through Insurance > Health Accounts
Please note you cannot enroll in the FSA for healthcare if you have an HSA.
Mission Health Contributes to your HSA!
2018 HSA Employee Contribution Limits Mission Health Contribution**
Employee $3,450 $250
Family $6,900 $500
Catch-up Contributions* $1,000
*If you are age 55 or older, you can make catch-up contributions to save more. **Prorated based on the month of your effective date of coverage.
Embedded Deductible and Out-of-Pocket Maximum in the MCP Embedded Out-of-Pocket Maximum in the HSP Tom, a Mission employee, is enrolled in the HSP. He has surgery and meets the individual OOPM of $6,650.
Mary is a Mission employee and is enrolled in the MCP. She gets an x-ray for a foot injury and meets the individual deductible of $500. Additional expenses are paid at coinsurance until she meets her OOPM of $2,500.
His wife and son continue to incur an additional $6,650 in medical expenses until the family all together meets the family OOPM of $13,300.
Her husband and their daughter continue to incur an additional $1,000 in medical expenses until the family all together meets the family deductible of $1,500.
$6,650
After the family OOPM of $13,300 is met, the plan pays any additional medical expenses 100% for the entire family for the rest of the year. $1,000
After the family deductible of $1,500 is met, any additional eligible medical expenses are paid by coinsurance until Mary’s husband or daughter meet their individual OOPM or the family OOPM.
$6,650
This means that all of Tom’s additional medical expenses are covered 100% for the remainder of the year. $2,500
This means that any additional eligible expenses Mary incurs throughout the year are paid at 100%.
M ai
20 18
M ed
ic al
P la
n Pr
em iu
m s
What You Pay in Payroll Deductions Each Pay Period (pre-tax) Your health plan premiums will reflect completion of your Personal HealthAssessment (PHA)** when you log into the enrollment tool. Note that it may take up to 48 hours after PHA completion for your reduced rates to be reflected in the online enrollment tool.
Completed PHA Didn’t Complete PHA
Full-Time Part-Time Full-Time Part-Time
Employee $37.33 $10.07 $74.73 $31.90 $57.33 $30.07 $94.73 $51.90
Employee + Spouse* $147.19 $48.14 $203.55 $70.04 $167.19 $68.14 $223.55 $90.04
Employee + Child $72.55 $22.39 $104.88 $34.85 $92.55 $42.39 $124.88 $54.85
Employee + Children $121.95 $39.18 $176.24 $61.09 $141.95 $59.18 $196.24 $81.09
Family* $218.68 $72.77 $292.36 $94.65 $238.68 $92.77 $312.36 $114.65 *$100 spousal surcharge not included ** If your health plan coverage was effective one or after June 1, 2017, you only need to complete the PHA by your benefits effective date to get the reduced premiums for 2018. Watch for more information about 2019 wellness incentives.
Wellness begins with us
Covering a Spouse? If you are covering a spouse on your Mission Health plan and he/she has coverage available with their employer, you will pay an additional surcharge of $100 per pay period.
Receive Reduced Premiums! You must complete the Personal Health Assessment (PHA) before your benefits effective date to receive a reduced premium in 2018.
Know Healthcare Reform:
You must have healthcare coverage or pay a penalty to the IRS
If you are eligible for Mission Health benefits, you are not eligible for subsidies from the government
If you are NOT eligible for Mission Health benefits, you can access coverage through the federal government’s healthcare exchange, or consider other sources of coverage like your spouse’s plan, your parent’s plan, Medicaid or Medicare (if applicable)
Yes! No...
Hospital Indemnity (Administered by AFLAC*)
This benefit pays cash when you are admitted to the hospital, and when you remain hospitalized, including for pregnancy. Review rates and enroll in the enrollment tool.
Critical Illness (Administered by AFLAC*)
You can receive a lump-sum cash benefit of $15,000 or $30,000 following diagnosis of a covered condition like a heart attack, cancer or stroke. Review rates and enroll in the enrollment tool.
Accident Insurance (Administered by AFLAC*)
Provides cash to help pay for the medical and out-of-pocket costs that add up after an accidental injury. Even with health insurance, you may not be adequately prepared for expenses that result from an accident.
Learn more at Missionandme.com > Total Rewards > Managing My Financial Security > Protecting My Finances
*Underwritten by Continental American Insurance Company (CAIC). Refer to materials for limitations and exclusions.
Healthcare FSA Save for healthcare expenses! You are eligible if you don’t participate in the HSP or another high-deductable plan.
Use your FSA debit card to pay for eligible healthcare expenses for yourself and dependents with tax-free funds from your FSA. Contribute up to $2,600 annually. The minimum pre-tax contribution per bi-weekly pay period is $10.
If you don’t use your Healthcare FSA funds by the end of the year, you will lose them (unless you qualify to carry over $500 to the following plan year).
Learn More Missionandme.com > Managing My Financial Security > Savings and Financial Incentives > Pay Expenses with Tax-Free Dollars
Dependent Care FSA Pay for eligible dependent care expenses. Contribute up to $5,000 per calendar year if single or married and filing a joint return, or $2,500 per calendar year for married participants who file federal income tax returns separately. The minimum pre-tax contribution per bi-weekly pay period is $10. If your annual salary is more than $120,000, you are not eligible to participate.
Learn More Missionandme.com > Total Rewards > Focusing on My Health > Health Through Insurance > Health Accounts
g e Dental (Administered by HealthSCOPE Benefits)
Getting regular dental care is an important part of overall health.
Annual Deductible $100 individual $300 family
Individual Annual Maximum Non-orthodontia services, preventive, diagnostic, basic, major services $1,500
Preventive and Diagnostic Services Exams and cleanings, fluoride treatments, x-rays for diagnosis, sealants 100%, no deductible
Basic Services Fillings and extractions, periodontics, repairs to crowns or dentures, endodontics, oral surgery
After deductible
After deductible
Orthodontia Services No age limit
Orthodontia Individual Lifetime Maximum $1,500
Premiums (pre-tax) What you will pay in payroll deductions each pay period:
Full-Time Part-Time
Vision (Administered by United Healthecare)
You’re the boss…only you can take care of your eyes!
Covered Benefits (per covered member) In-Network Out-of-Network
Allowance
Routine Vision Exam (once per calendar year) 100% after $15 copay
$60 Refraction Only in Lieu of Routine Vision Exam (once per calendar year) $0 allowance
Lenses (once per calendar year)1
• Single Vision • Lined Bifocal • Lined Trifocal and Lenticular
100% after $15 copay There is a surcharge for progressive lenses.
$40 $60 $80
Frames (once per calendar year)2 $250 allowance after $15 copay $45
Contact Lenses (once per calendar year in lieu of glasses)3
• Up to 10 boxes from the covered contact lens selection list: Covered after $15 copay
• Contacts not on the lens selection list: $250 allowance
$250
Necessary Contact Lenses4 (once per calendar year in lieu of glasses) $15 copay $210
Laser Vision Correction 15% off usual and customary price for Laser Vision Network of America providers N/A
1You are eligible to select either eyeglasses or contact lenses — only one service will be covered. 2 If you purchase eyeglass lenses and eyeglass frames at the same time from the same network provider, only one copay will apply to the lenses and frames together.
3The allowance for lenses not from the covered contact lens selection will apply at Walmart, Sam’s Club and Costco locations. 4Determined at the provider’s discretion. See plan details.
Premiums (pre-tax) What you will pay in payroll deductions each pay period:
Employee $4.04
You 50% Mission 50%
LifeLife, Accidental Death and Dismemberment (AD&D) (Administered by Securian) To help protect you and your family financially, Mission Health automatically pays for Basic Life and Basic AD&D coverage of:
Basic Life and Basic AD&D Annual base pay (up to $600,000)
You may also choose Supplemental Life and AD&D coverage of:
Supplemental Life and AD&D Annual base pay (up to $600,000)
Premiums* (pre-tax) Rate: $0.173 per $1,000 Calculate your bi-weekly cost: (Your annual base pay ÷ 1,000) x $0.173 x 12 ÷ 26
*The cost of your supplemental life insurance is paid with pre-tax dollars.
Now is your opportunity to elect up to 4X supplemental life and AD&D coverage for yourself, or $30,000 coverage for your spouse, without Evidence of Insurability (EOI). If you request to increase your life covereage or your spouse’s life coverage during annual enrollment, you will be required to complete EOI and the increased coverage will not be effective until approved.
1x 2x 3x 4x
1x
You can purchase additional coverage for dependents. Child Life coverage available for dependent children up to age 26.
Spouse $30,000, $40,000 or $50,000 Child(ren) $5,000 or $10,000 per child
Evidence of Insurability (EOI) Requirements • All new plan enrollees will require
EOI for coverage amounts of $40,000 or $50,000
• All plan enrollees will require EOI if requesting to increase covereage amounts during an annual enrollment.
EOI Requirements • Not required for any coverage
amount
Spouse Life
$30,000 $4.64
$40,000 $6.18
$50,000 $7.73
$10,000 $0.52
*The cost of your Dependent Life insurance is paid with after-tax dollars. **Rate is per family unit, regardless of number of children covered.
Questions about EOI? Find out what’s required on page 12.
nc e Disability Benefits (Administered by Liberty Mutual)
Life sometimes doesn’t go as planned…so it’s important to be prepared! You never know when you may need to take time away from work to recover from an illness or injury — so Mission Health offers both Short-term (STD) and Long-term Disability (LTD) benefits just in case.
Both of your disability benefits include:
A core benefit of 40% pay replacement covered by Mission
Additional coverage purchase option of up to 50% pay replacement
Premiums paid with after-tax contributions (after applicable income taxes have been deducted), which means if you are paid an STD or LTD benefit, the money you receive will be tax-free
Short-Term Disability If you are absent from work due to illness or injury for more than 14 calendar days, you may be eligible for STD coverage. There is a maximum 14-day waiting period before you will start to receive this benefit. The maximum benefit period is 24 weeks, excluding the 14-day waiting period.
Premiums (after-tax) What you will pay in payroll contributions:
Coverage Biweekly Cost Weekly Maximum Benefit
40% Mission pays the cost No limit
50% (Biweekly covered base pay ÷100) x $0.370 No limit
Long-term Disability (LTD) If you are absent from work due to illness or injury beyond the time covered by STD (180 days), you may be eligible for LTD coverage.
Premiums (after-tax) What you will pay in payroll contributions:
Coverage Biweekly Cost Monthly Maximum Benefit*
40% Mission pays the cost $6,500
50% (Biweekly covered base pay ÷100) x $0.55 $10,000
* The monthly benefit caps for physicians are $15,000 for 40% coverage and $20,000 for 50% coverage (subject to 3/12 pre-existing clause).
Learn More Missionandme.com > Managing My Financial Security > Protecting My Finances
This guide provides a summary of benefits available. It is not a legal plan document or contract, and is not intended to present all final details of the benefit plans described. Mission Health may amend or terminate its plans at any time by its sole discretion. The descriptions of these programs, the plans themselves or participation in the plans are not an employment contract or any type of employment guarantee and should not be considered as such. In addition to your SPDs, you can find all Summaries of Benefits and Coverage (SBCs) and Important Notices in the Resources section of MissionandMe.com. If you need assistance or want to request printed copies of these, contact HR Direct Connect at 828-213-5600. This guide gives highlights of the Mission Health benefit programs. It is not intended to be a Summary Plan Description (SPD) or Plan Document. If there are differences between the Guide and the SPD or Plan Document, the terms of the SPD or Plan Document will control.
Este folleto contiene un resumen en inglés de los beneficios disponibles en el Hospital Mission para los empleados. El resumen de todos los documentos del plan también está disponible en el Internet y puede también obtener una copia impresa en la oficina de Recursos Humanos. Si usted tiene dificultad para entender cualquiera de estos documentos del plan, por favor póngase en contacto con el departamento de intérpretes al teléfono (828) 213-0289.
Know what’s required: Evidence of Insurability (EOI), or proof of good health, is required if you request to increase your coverage for Life, STD, LTD or Spouse Life after your initial enrollment.
Adoption Assistance Receive a one-hour telephonic adoption consultation to learn more about the process, timeline and costs for adoption, locate support groups and more. You also may be eligible to receive up to $3,500 in reimbursement of direct adoption expenses. Call 800-454-1477 or learn more at Missionandme.com > Total Rewards
Identity Theft Secure your identity with identity theft protection. Receive identity monitoring, credit monitoring and restoration services for you and your family. Review rates and enroll in the Infor enrollment tool. Learn more at Missionandme.com > Total Rewards
Phased Retirement Ease into what’s next for your life, while staying engaged at Mission. Continue working by changing to part-time as you transition into retirement. Contact your manager to learn more or go to Missionandme. com > Managing My Financial Security > Preparing for Retirement
Pet Insurance We want to help protect all those who are most important to you – including your best-pet, furry friends! When you are enrolling, indicate interest in pet insurance via the Mission Healthspace® enrollment tool and you will receive an email on how to enroll via the Nationwide portal Review information at Missionandme.com > Total Rewards
M o
re Valuab le B
enefits Mission Health’s Retirement Plan You are immediately eligible to participate in the Mission Health 403(b) retirement plan – there is no waiting period. If you do not elect to participate earlier, all new employees will automatically be enrolled in the plan with a 2% deferral after 90 days. If you have .5 FTE status or greater, you receive a matching contribution from Mission after 12 months of service and 1,000 hours. (PRN employees are not eligible to receive the matching contribution.) You will become 100% vested in the matching contributions after 3 years. Learn more at Missionandme.com > Managing My Financial Security > Preparing for Retirement
To access your Transamerica account, learn more about maximizing your retirement savings, name your beneficiary and more, visit mission.trsretire.com or call 800-755-5801.
Missionandme.com > Quick Links > Questions? Who to Contact Questions about your 2018 Mission benefits?
Paid Time Off (PTO) — Relax and Recover! You must be a full-time or part-time employee budgeted to work 20 hours
or more per week or 40 hours or more per pay period to be eligible for PTO
PTO is available to use the pay period of your 90th day of employment
You may use PTO to increase STD coverage to 100% for the first two months of disability (including the 14-day waiting period)
PTO Accrual
Annual Accrual
Date of hire to 2 years 52 6.77 hours 22 days (176 hours)
2 – 5 years 53 – 130 8.31 hours 27 days (216 hours)
5 – 10 years 131 – 260 9.85 hours 32 days (256 hours)
Year 10+ 261+ 11.39 hours 37 days (296 hours)
If hired prior to January 1, 2003: Year 14+ 365+ 12.31 hours 40 days (320 hours)
If you are a Physician or Advanced Practitioner, you receive a Time Away From Practice benefit.
Employees Care — PTO Donation Employees can donate hours to a PTO Donation Fund, which will be used to
provide PTO time to other employees who have depleted their own hours and meet eligibility requirements.
To be eligible to donate, employees must have used at least one week’s worth of PTO in the prior 12-month period.
The recipient must qualify for a medical emergency (terminal and/or life threatening) for themselves or a family member — it is not intended for short-term illnesses, or those that don’t meet this criteria. The recipient must also not have enough time to either cover the two-week waiting period before Short-term Disability benefits begin, or they need two weeks of PTO under a continuous leave to care for a family member.
A PTO Donation Review Committee will review requests for donations and make determinations based on a de-identified review of the requestor’s documentation.
The maximum amount of donated time a qualified employee may receive is up to 80 hours, and based on FTE status and availability of donated hours.
Learn more Missionandme.com > Living My Life > Taking Time Away from Work
There’s Long-term care
AREN’T YOU GLAD YOU’RE THE BOSS ?