mybenefits - login - ssm health
TRANSCRIPT
Caring for our Exceptional EmployeesMyBenefits
Benefit Information2019 2019
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Benefit/HR Contact InformationWe are here to help you!
Technical AssistanceEmployee Self-Service access issues, log-in and password support
Need help with MyHR?
Call the Technology Service Center (TSC) at 1-866-776-4357
Benefits SupportCall our People Services at 1-844-SSM-MyHR (1-844-776-6947) during business hours, Monday – Friday 7 am – 5 pm or submit a question through AskHR 24/7.
Employees based in: Contact Name Email Fax Local Benefits Contacts
St. Louis St. Louis Benefits [email protected] 314-622-6462
IHT, Health at Home,
System OfficeHealth Businesses Benefits
[email protected] 314-989-2877
Audrain Dawn Weber [email protected] 573-582-3725
Jefferson City Lynette Otto [email protected] 573-681-3628
Maryville Ilissa Craig [email protected] 660-562-7978
Oklahoma
Joey Perry Gayle Little Amber Honeas
314-989-6832
Southern Illinois Jennifer Junkins [email protected] 618-899-4873
Wisconsin Wisconsin Benefits [email protected] 608-250-1441
Leave of Absence Contacts
Wisconsin Kristina Samann Pam Achterberg
Illinois, Missouri and Oklahoma Linda Simmons [email protected]
If you choose to fax documents, it is highly recommended that you save a copy of your successful fax confirmation as proof of receipt of your submission.
Table of Contents
A Letter from Carolyn Koenig, Chief Administrative Officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Your Benefit InformationIntroduction to Your Personal Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Logging into MyHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Enrollment Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Your Medical Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Your Pharmacy Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Your Dental Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Your Vision Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Eligible Dependents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Flexible Spending Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Health Care Flexible Spending Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Dependent Care Flexible Spending Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Group Life, AD&D, Long-Term Disability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Voluntary Dependent Term Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Voluntary Short-Term Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Voluntary Enriched Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Notices and Reminders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Additional InformationInterpretation Services and Non-Discrimination Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
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Dear SSM Health employee:We value and appreciate you as a member of our exceptional team at SSM Health. Thank you for being a healing presence to our patients, their families, each other and all those we serve. You are SSM Health!
At SSM Health, we are committed to helping you lead a healthy lifestyle and offer a benefits package that you can personalize to fit your needs and those of your family. You can choose the medical, dental, vision, life, accidental death and dismemberment and long-term disability coverages that are best for you. In addition, health and dependent care flexible spending accounts, dependent term life, short-term disability and supplemental life coverages are available on a voluntary basis. All eligible employees who participate in our Retirement Savings Program may receive a match from SSM Health on a portion of your contribution.
We strive to provide market-based compensation and benefits, and have worked hard to maintain our competitive benefit levels across the system. In fact, we continue to pay a significant portion of the medical insurance premium for our employees and their families.
To understand all the benefit options completely, it is very important that you read the materials outlined in this enrollment guide. The guide is designed with you in mind and includes brief descriptions of the benefits, the enrollment process and contact information for additional questions. This guide and other important benefit information can be found on myhr.ssmhc.com. If you have questions, please contact People Services at 1-844-SSM-MYHR (776-6947).
We hope you find this enrollment guide helpful in planning your benefits package for 2019. Once again, thank you for your commitment and dedication to our Mission and for providing an exceptional experience for our patients and those we serve.
Sincerely,
Carolyn KoenigChief Administrative Officer
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Introduction to Your Personal BenefitsSSM Health is committed to helping employees lead a healthy lifestyle by offering a comprehensive benefits package to fit your needs.
You have the opportunity to design your own personal benefits package at SSM Health. You can choose the medical, dental, vision, life, accidental death and dismemberment and long-term disability coverages that best meet your needs. In addition, health and dependent care flexible spending accounts, dependent term life, short-term disability and supplemental life coverages are available on a voluntary basis.
Another feature of our benefits package is the ability to pay for your share of the insurance costs with pre-tax dollars, before federal, social security and in most cases, state taxes. By paying with pre-tax dollars, it may mean more money in your paycheck.
This informational booklet provides key features of the personal benefits offered at SSM Health and is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Important Benefit Information:The information you need for benefit enrollment are also located in the benefits section of MyHR, located on SSM Health’s intranet along with any necessary forms.
You will not receive a printed confirmation of your elections. You may review your elections online via MyHR at anytime.
After your initial election is made, life insurance may only be increased by one level each year.
Understanding Your OptionsBefore you start the enrollment process, we encourage you to read about the plans we offer so you can make the most informed decision about your coverage. You have 31 days inclusive of date of hire to make your elections and we ask that you please reach out to a People Services at 1-844-SSM-MHYR with any questions you may have. To learn about your options, please locate the following documents applicable to your location:
• This Benefit Overview book
• Summary of Benefits and Coverage (SBC)
• Summary Plan Description
• Glossary of Health Coverage and Medical Terms
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Ready to Enroll: Logging into MyHR1. Launch internet browser.
• If you are accessing MyHR INTERNALLY: Click the MyHR Human Resources Portal icon located on your health ministry’s home page, then click Access Employee Self-Service. If you are accessing MyHR EXTERNALLY: Go to myhr.ssmhc.com. NOTE: Be sure to disable your pop-up blockers or allow pop-ups for SSM Health.
2. Click on Employee Benefits, MyHR - Benefits information. Enter your username and password at the log in screen.
3. Click LOG ON. Your SSM Health Employee Services home screen will appear. NOTE: If you are a manager, you will need to click on the SSM Self-Service tab.
4. Click the Benefits link.
5. Select the New Hire Enrollment link.
6. A Terms and Conditions pop-up will appear. Please click Accept to go to your enrollment. If you do not want to enroll at this time, then click Decline.
Before you get started, please ensure that the Quick Help is displayed to help guide you in the enrollment process. To enable, click in the right hand corner of the page. Choose Display Quick Help.
It’s important to note that this is a 8-step process, and you should not expect to rush through this. In this guide, there is a warning sign at the end of each section to remind you that your data entries ARE NOT saved until you navigate to the Review and Save section and click Save. If you need to pause your enrollment at any time, please remember to navigate to the Review and Save section and click Save to ensure your data saves. Then you can pick up where you left off when you return.
7. You also have the option to opt-in to receive benefits information electronically. If you agree, click submit.
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Enrollment Notice There are times when MyHR will be unavailable during the beginning of the week due to payroll processing. You will not be able to make your elections during this time but instead will receive a message in MyHR letting you know that your information will be view only and uneditable. We ask that you please revisit MyHR at a later time to make your elections. NOTE: If your enrollment period is almost over while MyHR is inaccessible, please contact your benefits specialist immediately.
Personal Profile 1. You will now see the Personal Profile section of benefits enrollment.
2. You can review and edit your personal information by choosing Edit Personal Profile:
Editing your Personal Profile 3. By clicking Edit Personal Profile, it will bring you to a new window.
4. To edit your Personal Data, click the Pencil icon:
5. You will be brought to a new page that looks like this:
6. Please note that you do not have to make any changes on this screen. The only fields you are able to edit are those that are in white. The blue fields are uneditable. If you need to change any information in the blue fields, please contact People Services.
7. If you make a change, click Save and Back. If you do not wish to make a change at this time, click Cancel.
8. Once you return to the Edit Personal Profile page, you may click the Pencil icon next to Addresses to change or add a new address.
9. Be sure to click Save and Back if you make any edits.
10. To return to the New Hire Enrollment page, click Exit.
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Dependent and/or Beneficiary Section1. Navigate to icon 2, labeled Dependents and/or Beneficiaries by either clicking Next (located at the top of the page) or
by clicking on the Dependents and/or Beneficiaries icon.
WARNING: Before you proceed, please make sure that you read the directions carefully. If you need to delete any information (i.e., you add a dependent by mistake, please contact HR to help you fix the issue). You can ONLY add and edit dependents/beneficiaries. You CANNOT delete them once they have been entered.
Adding Dependent and/or Beneficiary Information
2. It is necessary to add your dependent and beneficiary information before continuing the enrollment process. Please only add those individuals you plan to cover under one of our health insurance plans or beneficiaries for Life and AD&D. To add dependents or beneficiaries, choose the Edit Dependents and/or Beneficiaries button.
You will be able to enroll a Spouse, Child, LDA or LDA Child. Please note: additional paperwork is required to cover an LDA or LDA child. Your election will remain in a pending status until the paperwork is received and approved.
In addition, you can designate a beneficiary for Life Insurance and AD&D Insurance Only. If you wish to designate a beneficiary who is not your spouse or dependent (i.e., designate a Trust) you would select the Life Insurance and AD&D Beneficiary Only under the External Organization section.
3. Click Edit Dependents and/or Beneficiaries:
A new window will open. To add a dependent or beneficiary, click
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4. This action will open a new window and all the text fields will be editable. NOTE: All fields with asterisks (*) are required fields. Information must be entered into these fields.
NOTE: The last name of the dependent is defaulted to display the last name of the employee. If the dependent’s name differs from that of the employee, please make corrections as needed. The gender button defaults to display the last gender entered. So if you added a “male” dependent, the next time you try to add a new dependent it will automatically display “male.” Please be cautious of this and enter the correct gender of your dependent.
Saving Dependent and/or Beneficiary Information 5. Once you have verified the information entered, click Save and Back to return to the previous page. To cancel any of
the changes or exit, click either Close or Cancel. You will then return to the previous page.
6. Continue adding dependent/beneficiary records or add an External Organization, (i.e., trust), if applicable. Repeat steps 2-5. Review all dependent/beneficiary records added. Once you have finished making edits to your dependents and/or beneficiaries, exit the window by clicking Close.
7. You will now be back on the New Hire Enrollment Benefit and Dependents page.
IMPORTANT! If you enrolled an LDA or LDA child, you must complete additional paperwork and submit to your benefits specialist in order to obtain coverage. See the LDA Verification form on MyHR for more details.
Selecting Health Plans
1. Navigate to icon 3, labeled Health Plans by either clicking the Next button (located at the top of the page) or by clicking on the Health Plans icon.
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Viewing Health Plans2. You will now be able to view your health plans:
Health Plans - The plans you see below default to “opt out”. Please note the start date of each benefit. You can select a plan in the table to change or skip to the next step in the guided activity. To make a change, choose the pencil icon. You will be able to review your options under each plan and make a new election. You will also have the opportunity to select the dependents you wish to add to the plan. You will be able to save your benefit elections in the Review and Save step of the guided activity.
NOTE: SSM Health has pre-populated the health benefits for which are eligible to participate. If you wish to have medical, dental and/or vision coverage, you must make your selections. If you do not make any changes to the pre-populated fields, you will not be enrolled in SSM Health benefits.
Selecting Health Plans3. To change your health plans, click on Pencil icon next to each of the Benefit type you wish to edit. A new window will
appear with your options to make a new election.
Tier Definitions There is a special column for each plan type called Coverage. Coverage stands for the amount of coverage you want. Do you want to cover just yourself, do you want to cover one (1) dependent, or do you want to cover a family?
1 – EE Only: YOU are the only one electing coverage for this plan. No dependents are covered.
2 – EE + 1: YOU and 1 DEPENDENT can be added to a plan. If you DO NOT have any dependents, then DO NOT select this coverage amount.
3 – EE + F: YOU and 2 or MORE DEPENDENTS can be added to a plan. If you DO NOT have 2 or more dependents that you want to add to a plan then DO NOT select this coverage amount.
4. Select the plan you would like by clicking a plan and the row of information will be highlighted.
5. If you had previously added dependents, they will be available in this list to enroll in a specific plan. To add a dependent to a plan, you must check the box in front of each dependent’s name in order for the dependent to be enrolled in the plan.
6. Click the Add button when you are ready to make this election. Click Cancel if you wish to cancel your election. You will return to the previous page.
7. Check to see the new plan populates correctly with the appropriate dependents.
8. Repeat steps 3-7 for each health plan you would like to update.
WARNING: It is important to remember this system DOES NOT SAVE your selections until you reach the Review and Save step and click Save at the end of the enrollment process.
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Spouse/LDA Surcharge Waiver
The following screens illustrate how you can submit your Spouse/LDA Surcharge Waiver as part of your benefit enrollment process. You only need to complete Step 4 if you are covering an adult on your medical insurance.
Step 4 is shown here:
Select the
and the Sp/LDA Surcharge Plan pop up will appear
Select the gray box next to Spouse/LDA Surcharge in the pop up window and click “Add”.
Select the dot next to the status that applies to your Spouse/LDA and click “Submit”.
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Insurance Plans 1. Navigate to icon 5, labeled insurance Plans by either clicking Next
located at the top of the page or by clicking the Insurance Plans icon.
Adding Insurance Plans 2. You will now be able to view your insurance plans:
Insurance Plans - The plans you see are the default elections. Please note the start date of each benefit. You can select a plan in the table to change or skip to the next step in the guided activity. To make a change, choose the pencil icon. You will be able to review your options under each plan and make a new election. You will also have the opportunity to select the beneficiaries you wish to add to the plan. For Supplemental Life Insurance, you will need to request additional paperwork from Human Resources if you are interested in enrolling. You will be able to save your benefit elections in the Review and Save step of the guided activity.
NOTE: Auto-enrolled plans are the standard plans SSM Health selects for you. YOU ARE ALLOWED TO CHANGE THE AUTO-ENROLLED PLANS. If you do not want to change the plans in which you are auto-enrolled, leave them as is and you will be enrolled in the defaulted value.
3. To change your insurance plan from the standard option, click the pencil icon next to the benefit type you wish to modify. A new window will appear with your options to make a new election.
4. Select the coverage you would like by clicking the option and the row of information will be highlighted.
5. If you have added beneficiaries, you have the option to allocate the percentage each should inherit. For Employee Life Insurance and AD&D, you have the choice to designate each as a primary or contingent. A beneficiary cannot be a primary and a contingent and each column will need to total 100%. The system will help you if you make an error in your totals. Please note: the system only allows whole numbers (i.e., 33%, 33%, 34% = 100%)
6. Click Add to select your plan. Click Cancel to discard the change and return to the previous page.
7. Check to see the new plan populates correctly.
8. Repeat steps 3-6 for each insurance plan you would like to change.
WARNING: It is important to remember this system DOES NOT SAVE your selections until you reach the Review and Save step and click Save at the end of the enrollment process. NOTE: If you do not have a Life/AD&D beneficiary designation on file (paper or electronic), the default beneficiary will be your estate.
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Retirement Savings - 403(b)/401(k) Employee ContributionThis section is where you can elect or make changes to your 403(b)/401(k) contribution.
1. Navigate to icon 6, labeled Savings Plans by either clicking Next located at the top of the page or by clicking on the Savings Plans icon.
2. Click the plus sign to create a new election
3. Enter the percentage or dollar amount you wish to contribute each pay period.
4. Click Add when finished
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Health Care and Dependent Care Flexible Spending Accounts1. Navigate to icon 6, labeled Flexible Spending Accounts by either clicking Next located at the top of the page or
by clicking on the Flexible Spending Accounts icon.
Selecting Health Care or Dependent Care Flexible Spending Accounts2. You will now be able to view your Spending Accounts:
Spending Accounts - You can select a plan in the table or skip to the next step in the guided activity. To make an election, choose the plus sign icon and enter the dollar amount for recurring pay period deductions.
3. To add a spending account, click next to the benefit type. To make a change to a plan, click the pencil icon. A new window will generate for each savings plan when you select the pencil or add icons.
4. You will be able to select the dollar amount you would like to be deducted from your paycheck for the remainder of the year. So if you would like to only deposit $1,000 for the year, your pay period deduction will be based on the number of pay periods remaining in the year.
Please remember that flexible spending accounts are use-or-lose funds. Any money remaining in your account at the end of the eligible period will be forfeited.
Notes: For your Health Care Flexible Spending Account you must select a dollar amount between $52 - $2,650. (Minimum dollar amount of $52 and a maximum of $2,650.) Remember: this amount is based on an annual amount.
For your Dependent Care Flexible Spending Account you must select a dollar amount between $52 – $5,000. (Minimum dollar amount of $52 and a family maximum of $5,000.) Remember: the $5000 family maximum is inclusive of both your election and if applicable, your spouse’s election.
The maximum amount that a new hire can contribute to both the Health Care or Dependent Care Flexible Spending Account is prorated based on your hire date.
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5. Click Add to select your plan. To discard your changes, click Cancel. You will return to the previous page.
6. Check to see the new plan populates correctly.
7. Repeat steps 3-5 for each plan you would like to change.
Warning: It is important to remember this system DOES NOT SAVE your selections until you reach the Review and Save step and click Save at the end of the enrollment process.
Review and Save Section 1. Navigate to icon 8, labeled Review and Save by either clicking Next
located at the top of the page or by clicking the Review and Save icon. You can review your changes, and save them to finalize the enrollment process by choosing Save. You can edit the benefits plans at any time during the enrollment period.
2. You will be able to view all of the plans you have selected.
NOTE: you may see three different sections
- Plans to be Changed - Unchanged Plans - Plans Not Enrolled in
3. All the plans that you have changed will appear in the Plans to be Changed section.
4. All the plans with no changes will appear in the Unchanged Plans section.
5. All the plans that you have chosen no election will appear in the Plans Not Enrolled in section.
6. To SAVE all of your benefits you would like to be enrolled in, click Save:
7. To cancel/change any of the plans, click either Close or navigate back to the individual plan pages using the number icons in the workflow.
Benefit Participation OverviewOnce you have clicked Save, look for the “Data Saved Successfully” icon.
You can navigate back to enrollment and make further changes if you choose the Go to Enrollment link or Go to Benefits Participation Overview to print your Benefits Confirmation Statement.
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Benefits Participation OverviewClick the print icon to populate, view and print your Benefits Confirmation Summary.
Please remember you have 31 days inclusive of date of hire to enroll or make changes to your elections using this online process. Once your enrollment period ends, you will be locked into your elections for the remainder of that year. If you have a qualifying change in status, your elections can be changed accordingly. Please contact a benefits specialist if this is the case. Changes must be made within 31 days of the qualifying event.
Benefits SupportCall our People Services at 1-844-SSM-MYHR (1-844-776-6947) during business hours, Monday-Friday, 7 am-5 pm (CT) or submit a question through AskHR 24/7.
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Your Medical PlanYou may “Opt Out” of Medical Coverage
Please see the Summary of Benefits and Coverage (SBC) information on MyHR located on SSM Health’s Intranet for details of the medical plan options available to you.
Spouse/LDA Surcharge for Medical Coverage - $75.00 There will be an additional $75.00 surcharge added to the first two paychecks each month for covering your spouse/LDA. This applies to either your spouse or Legally Domiciled Adult (LDA) covered under an SSM Health medical plan if that spouse/LDA dependent is eligible for group medical coverage through his/her employer.
To WAIVE the spouse/LDA surcharge, you will need to log into MyHR and answer the waiver question. See Page 8.
Dependent InformationSee Eligible Dependent section for more information - page 16.
Coordinating Medical Benefits and Dental Plan BenefitsIf you and your dependents are enrolled in medical and/or dental coverage under another plan outside of SSM Health, please review the “Coordination of Benefits” section in the Summary Plan Description - restrictions may apply.
Out of Area Dependent Medical CoverageFor employees who have eligible dependents living more than 100 miles from their SSM Health Plan service area, out of area dependent medical coverage is available.
Eligible dependents include:
• The spouse of an eligible employee
• The child/children of an eligible employee up to age 26 (regardless of student status)
To ensure claims are processed appropriately for the out of area dependent, the employee must submit certification of and proof of residence for the out-of-area dependent.
Employees may access the “Out of Area Dependent” form on the benefits pages of MyHR. Instructions for submission will be included on this form.
Out of Area Dependent Coverage Summary
What You Pay 2019 Plan Design
Primary Care Visit 30% after deductible
Specialist Visit 30% after deductible
Urgent Care 30% after deductible
Emergency Room $200 plus 10%
Inpatient 30% after deductible
Outpatient Diagnostic 30% after deductible
Outpatient Procedure 30% after deductible
Prescription $12/$35/$70
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Your Pharmacy Benefit within Your Medical PlanYou cannot “Opt Out” of the Pharmacy Benefit; this benefit is included in your medical plan.
Important Information:Using Navitus Health Solutions navitus.com
866-333-2757
Prescription Co-Pays:Tier 1 Formulary - Generic drugs and some low cost brands reduce your co-pays. If you do not choose a Tier 1 drug when it is available, you will pay the difference between Tier 1 and Tier 2, plus your applicable co-pay.
Mail Order Service - Mail order can be a convenience for members who take maintenance medications. You can receive up to a 90-day supply through your mail order provider, Costco. You may start the process online at pharmacy.costco.com.
NOTE: A Costco membership is not required to participate in the mail order service option.
Medicare: Part D Coverage Notice Requirement - The SSM Health pharmacy benefit meets the definition of “creditable” coverage. SSM Health will provide the Notice for your records when you are age 64 and older by October of the current calendar year and an active participant in an SSM Health medical plan. If you are an SSM Health member enrolled in Medicare, but not due to age (i.e., end stage renal disease, disability), please contact your local Benefits Specialist to request a Notice.
What to do and what to expect from your Pharmacy Benefit1. Prior Authorization - You may be required to receive a prior authorization from your doctor to ensure you are covered
for a certain prescription drug. Please remember that prior authorization letters must be renewed annually.
2. Always identify yourself as a Navitus member - Remember to tell your pharmacist when you pick up your prescription that you are a Navitus member, even if you do not have your I.D. card, to receive the lowest out-of-pocket cost. Only under very rare circumstances can a claim be filed for reimbursement after the service has been provided. Manual claim forms will only be allowed in very unique situations.
3. Updated preferred and non-preferred drug lists - In order to respond to the many advancements in the pharmaceutical industry, our list (called a formulary) of preferred/non-preferred drugs is subject to change. When possible, changes will occur on January 1. You will be informed in advance to ensure there is time to contact your doctor(s). However, changes can also occur at any time during the year.
4. A step therapy program encourages the safe and cost-effective use of prescription drugs. It requires a “step” approach to get coverage for certain high-cost drugs. This means that to get coverage, you may need to first try a proven, safe and cost-effective medication before moving to a more costly treatment, if necessary. If your doctor prescribes that you “skip” steps, your doctor will submit a prior authorization request and receive approval for the drug to be covered. NOTE: The SSM Health Pharmacy Plan does NOT coordinate with other pharmacy plans.
Specialty PharmacyNavitus Specialty Pharmacy, Lumicera, helps members who are taking medications for certain chronic illnesses or complex diseases by providing services that offer convenience and support. This program is part of your pharmacy benefit and is mandatory. Mandatory means your specialty medication must be obtained via a Lumicera pharmacy.
Description 30 Day Supply at Retail90 Day Supply at Retail or Mail Order
Tier 1 - Formulary generics and
low cost brands$12 $30
Tier 2 - Formulary brands and
high cost generics$35 $87.50
Tier 3 - Non-Formulary brands
and generics$70 $175
Out-of-Pocket Maximum: All plans include an out-of-pocket maximum of $1,600 per person or $3,200 per family for prescription drugs.
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Your Dental PlanYou may “opt out” of Dental coverage
The following table summarizes the high/low deductible dental plans that are available. There is not a network of providers; you choose your dental care provider.
Plan Low High
Annual Deductible - You will pay per person. $100 $50
Annual Maximum - Plan will pay per person. $1,000 $1,500
Preventive Services Deductible - does not apply. Plan will pay per person. Routine exam, cleaning, x-rays.
100% 100%
Basic Services - Plan will pay per person. Cavity fillings, tooth extractions, treatment of gum disease.
50% 80%
Major Services Plan - will pay per person. New crowns, dentures, implants, bridge pontics, tooth extractions.
50% 50%
Orthodontic Services - Plan will pay per person (including adults). Pre-existing condition applies. Not Available 50%
Lifetime Ortho Maximum Plan - will pay per person. N/A $2,000
Examples Covered Expenses
Type I Procedures: Diagnostic and Preventive • Routine examinations, limited to two (2) per calendar year• Cleaning, including prophylaxis treatment• X-ray examinations• Space maintainers
Type II Procedures: Basic Services • Regular cavity fillings• Oral surgery and tooth extractions, including pre- and post-operative care• Root canal therapy, including necessary X-rays, cultures and periodontics• Repair and adjustments to dentures• Treatment of periodontal and other diseases of the gums and tissues
of the mouth• Anesthesia and its administration in connection with oral surgery,
extractions or other covered dental services• Repair and re-cementing of inlays, onlays, crowns and bridges
Type III Procedures: Major Services • Gold inlay fillings (three surfaces), new crowns and single crown restorations• Full and partial dentures• Bridge pontics• Implants
Type IV Procedures: Orthodontic Treatments We will pay the reasonable and customary charges of an appropriate provider for orthodontic services and supplies given in connection with a course of orthodontic treatment, including space maintainers in preparation of orthodontic treatment.
Dependent InformationSee Eligible Dependent section for more information - page 16.
Coordinating Dental Plan BenefitsIf you and your dependents are enrolled in dental coverage under another plan outside of SSM Health, please review the “Coordination of Benefits” section in the Summary Plan Description - restrictions may apply.
Your Dental Plan Covered Dental ExpensesPre-existing condition applies.
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Your Vision PlanYou may “opt out” of Vision coverage
Exam OnlyComprehensive vision examination only.
Exam and MaterialsComprehensive vision examination plus lenses, contacts and/or frames. The following chart provides a description of the benefits and co-payments for the vision care benefit:
Basic Plan FeaturesCo-Payment Schedule if you use a Vision Service Plan (VSP) Provider
Allowance Available if you use an Out-of-Network Provider
How Often you Can Use these Services - With or Without a Vision Service Plan (VSP) Provider
Comprehensive Vision ExaminationFully covered after $10 co-payment
$40 Once every 12 months
Lenses Glass or Plastic
• Single• Bi-focal• Tri-focal• Lenticular
Fully covered after $25 co-payment
$40$60$80$125
Once every 12 months
Contact Lenses Evaluation Fee & Fitting Costs (E&F)
• Necessary *• Elective **
15% discount up to $60100%$130 allowance(E&F not included)
$210$105
Once every 12 months
Standard Frames ***
$25 co-payment, if lenses are NOT purchased
$150 allowance
$45 Once every 24 months
* When needed following cataract surgery or to correct extreme visual acuity problems that cannot be corrected with spectacle lenses and/or
certain conditions of Anisometropia and Keratoconus.
** When contacts are chosen in lieu of lenses for eye wear.
*** Certain frames are covered in full by VSP, after the co-payment is met. Those that are not covered in full, are available at a reduced cost.
The materials covered are lenses and standard frames. Additional features such as tinting, scratch coating, designer frames or progressive lenses for bi- or tri-focals will be the member’s responsibility even if a VSP provider performs the services.
NOTE: If you order glasses or contacts online, you can submit your receipts for reimbursement at the out-of-network rate.
Discount for Laser Eye Surgery - Vision Service Plan (VSP) Members may be eligible for laser eye surgery discount. Contact VSP or your VSP provider for details.
To view an informational module on the Vision Plan, click here.
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How the Vision Plan works:1. If you need assistance in locating a VSP participating provider, call Vision Service Plan (VSP) at 800-VSP-7195
(800-877-7195), or visit vsp.com.
2. Call a VSP participating provider to make an appointment. Identify yourself and eligible dependents as VSP members. NOTE: You will NOT receive an identification card for the vision care benefit; however, you can print one at vsp.com.
3. The VSP participating provider will contact the Vision Service Plan to verify your eligibility plan coverage and will obtain authorization so you can receive services and materials.
4. VSP will reimburse you for services received from any licensed optometrist, optician or ophthalmologist.
The following are examples of the employee’s responsibility for both in- and out-of-network.
Service Retail CostEmployee’s Co-Payment/
Responsibility
In-Network
Exam $80 $10
Contacts Fitting Fee $50 $42.50
Contact Lenses $130 $0
Total $260 $52.50
Service Retail Cost VSP AllowanceEmployee’s
Responsibility
Out-of-Network
Exam $80 $40 $40
Frames $120 $45 $75
Bi-Focal Lenses $80 $60 $20
Total $280 $145 $135
Notes:
• Employee responsibility is the retail cost minus the VSP out-of-network allowance.
• The SSM Health Vision Plan does NOT coordinate with other vision plans.
Dependent InformationSee Eligible Dependent section for more information - page 16.
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Eligible Dependent InformationDependent children are eligible through age 25. Coverage ends on the last day of the month in which the child turns 26. At that time, you will receive a letter and your age 26 dependent will be removed from your coverage.
NOTE: Your coverage level may change depending on the total number of dependents you are covering. If you want to maintain your child’s coverage as an LDA, you must notify us within 31 days from your child’s 26th birthday. Remember, you may only cover one adult (either a spouse or LDA) on medical, dental and vision plans. Additional LDA requirements must be met.
Dependent Definition for Medical, Dental and Vision1. An eligible child up to age 26 (your child(ren): biological, foster, adopted, step or legal guardian)
2. A disabled child (regardless of his/her age) who is not able to support himself/herself because he/she is physically or mentally incapable of self-care or employment, provided that the disability began before he/she reached his/her nineteenth (19th) birthday
3. The spouse of an eligible employee
4. A Legally Domiciled Adult (LDA)
• NOTE: Only ONE adult (spouse or LDA) may be covered on all plans.
5. The dependent child(ren) of an LDA
Legally Domiciled Adult (LDA) Employees have an opportunity to cover one adult that may not be his/her spouse, known as a Legally Domiciled Adult (LDA).
NOTE: One adult plus the employee allowed - total of two adults. The employee and LDA must reside in the same household full-time.
A legally domiciled adult could be an adult child who no longer meets the definition of eligible child, a parent, relative or another adult. The LDA’s dependent child(ren), even if the child(ren) reside in another household, can also be covered.
For the LDA to qualify for coverage, the LDA must:1. Reside in the same household with the employee, with the exception of child(ren) of an LDA who reside in the other
parent’s home or a child who is older than the age stated in the Eligible Child definition; and
2. Be a member of the employee’s household - not an employee (i.e., nanny); and
3. Be 19 years of age or older.
A different adult dependent cannot be covered under the various plans. For example, if an LDA is covered under a medical plan, a spouse cannot be covered under the employee’s dental plan. However, the employee could elect plus one coverage under the dental plan and cover a child.
In order to qualify for pre-tax deductions, the LDA must be considered a dependent under IRS regulations.
Tax Form Documentation RequirementIn order to classify an LDA as a pre-tax dependent, the tax form required for review for the entire calendar year is the IRS 1040 form (or equivalent), two (2) calendar years prior to the effective date, (i.e., during 2019, the 2017 form will be required).
Legally Domiciled Adult Tax Implications If your LDA is NOT a dependent as defined by the IRS, there are tax implications for your election. The deductions for your portion of the elections will continue to be made on a pre-tax basis. In addition, your paycheck will also contain a tax adjustment (imputed income) for the value of the benefit you are receiving. The value of the benefit is based on total monthly premium amounts.
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An LDA is NOT considered a qualified dependent under the Health Care Flexible Spending Account (HCFSA).
See calculation example on the next page. The actual number will vary depending on the plan you elect and your tax bracket. If you have any questions about your coverage, please contact your Benefits Specialist.
Assumptions1. Elected employee plus family medical coverage
2. Total monthly premium (employer & employee portion)
Employee Only $700
Family $2,000
3. 20% tax bracket
TOTAL family premium minus total employee ONLY premium = Value of the Benefit or $2,000 - $700 = $1,300
ESTIMATED taxes = taxable benefit times tax bracket or $1,300 x .20 = $260 per month/$130 per pay period
If you elected dental and/or vision coverage for an LDA, the total premium amounts for those benefits will also be included in the calculation.
A qualified LDA may or may not qualify as a dependent on the employee’s federal tax return. The reason this is important is two-fold:
First, a dependent that meets the IRS Section 152 definition (defines a qualified dependent) will allow the employee’s deduction to be taken on a pre-tax basis. If the LDA DOES NOT meet Section 152, then the premium associated with ALL dependents, even those that do qualify, will be taxed on an after-tax basis. A copy of page 1 from the employee’s tax filing from the previous year must be placed in the employee’s file.
Second, the tax status also has an impact on whether a mid-year election change is permitted:
• If the dependent qualifies under IRS Section 152, the LDA is treated like all other dependents, except only ONE LDA can be covered during a calendar year. The IRS 152 and HIPAA change in status guidelines will apply (as detailed in the Summary Plan Descriptions).
• If the LDA is not an IRS 152 dependent, the LDA and/or the LDA’s dependents can be dropped at any time during the year. HOWEVER, adding a non-IRS 152 dependent is restricted to ONCE PER YEAR. It should be noted, two (2) different LDAs cannot be covered during one calendar year. Therefore, if an employee begins a year covering an LDA and coverage for the LDA ends, an LDA cannot be added until the next January 1.
IMPORTANT NOTE: COBRA coverage WILL NOT be offered to an LDA and/or the LDA’s dependent(s). However, in the event of an employee’s death, three (3) months of “transitional” coverage will be allowed based on COBRA premium rates.
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Flexible Spending Accounts
Health Care Flexible Spending Account
The Health Care Flexible Spending Account (HCFSA) allows you to set aside money on a pre-tax basis through payroll deductions (minimum of $52 and maximum $2,650 annually) for qualified health care expenses for yourself, spouse and eligible dependents. An eligible dependent is defined as your child, stepchild, parent and others who are claims as a dependent for income tax purposes as outlined under Section 152 of the Internal Revenue Tax Code. Please note: After-tax LDAs and their dependents do not meet the requirements of the Internal Revenue Service (IRS) to qualify as eligible dependents. Because this money is deposited before taxes, the account is subject to IRS regulations and the guidelines created by SSM Health.
Employee Benefit Corporation (EBC) is the administrator for the HCFSA Plan. EBC is responsible for verifying eligibility on Benefits Card transactions, and processing reimbursement for qualified health care claims. For additional information regarding the HCFSA, please visit ebcflex.com or call 800-346-2126.
The Benefits Card The Benefits Card makes using your HCFSA easy! Your card gives you instant access to your HCFSA funds to pay for eligible expenses. Always save your receipts from your purchases with your Benefits Card in case EBC requests validation.
Your Benefits Card may be used at medical, dental and vision care providers, as well as participating IIAS (Inventory Information Approval System) retailers and pharmacies. This system verifies eligible HCFSA expenses at the point of sale. You can view a full list of merchants that use the IIAS at ebcflex.com.
Three things you should understand before you use the Benefits Card:
1. EBC may ask you to submit a receipt to substantiate your Benefits Card purchase. This is why it is important to always save the receipts from these transactions.
2. Do NOT submit receipts unless EBC requests you to do so. If any transactions require substantiation, you will be notified by EBC. If after three requests you do not provide appropriate documentation to EBC, your Benefits Card will be suspended.
3. If substantiation of a Benefits Card purchase was requested and you were not able to provide proper documentation or if the item was not a qualified expense, you must repay the amount of that transaction. You may either submit documentation for other eligible expenses, authorize EBC to debit your account (if signed up for direct deposit), or mail a check.
Submitting Claims You may submit claims for reimbursement online, via mobile app or by completing a claim form and sending by email, fax or mail. Your documentation must include all of the following:
• Name of patient
• Name of provider or merchant
• Date the service was received or purchase was made
• Service received or item(s) purchased
• Cost of the expense
Submitting Claims Online1. Visit ebcflex.com and log in as a participant; registration is required for first-time users.
2. Click “Submit a New Claim,” complete information and upload scanned documentation.
To view an informational module on the Flexible Spending Accounts, click here.
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Smart Phone (Available for iPhone® and Android™)1. Download the “My Mobile Account Assistant” app on your phone.
iPhone
Android
2. Complete claim information and upload a photo of the required documentation.
Manual Claim Form1. Print and complete the claim form from ebcflex.com
2. Attach supporting documentation and send via email or fax as outlined at top of form.
Reminders• Reimbursement from the HCFSA is based on the date the expense is incurred, not when you are billed or when a
payment is made.
• If you terminate employment or lose eligibility in the HCFSA Plan, you will have 90 days from the date your coverage ended to submit claims. The HCFSA is terminated as of the date coverage is lost; it does not carry to the end of the month.
• There is a 2½ month “grace period” that allows you to incur expenses past the end of the Plan Year, to help you make full use of your account.
• While the grace period extends through March 15 of the following Plan Year, you will have until March 31 to submit eligible claims for the prior Plan Year.
• Claims not incurred by March 15 and submitted by March 31 will be forfeited.
Your reimbursement check can be mailed directly to your home or deposited into your bank account on file with EBC.
For a list of HCFSA Eligible Expenses, click here or see list below:
Examples Of Eligible ExpensesList is not inclusive
• Co-payments
• Prescription Drugs (within USA)
• Prescription Eyeglasses/Contacts
• Lasik Vision Services
• Non-Cosmetic Dental Services
• Chiropractic Adjustments
• Physical Therapy
• Deductibles and Co-Insurance
• Diabetic Supplies
• Hearing Aids
• Orthodontia Services
• Acupuncture
• Infertility Services
• Over-the-Counter Medicines/Items may require prescription
Google Play and the Google Play logo are trademarks of Google LLC.
Examples Of Non-Eligible Expenses List is not inclusive
• Cosmetic Surgery
• Teeth Whitening
• Drugs from Other Countries
• Nutritional/Dietary Supplements
• Late Payment/Missed Appointment Fees
• Services Paid or Payable by Insurance
• Electrolysis/Laser Hair Removal
• Toiletries
• Health Club Dues
• Warranties/Service Agreements
• Insurance Premiums
• Exercise/Fitness Programs
For a more complete list, please see the Eligible Expenses list available on ebcflex.com.
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Estimating Your Health Care ExpensesThe guide below can help you estimate your health care expenses not covered under your insurance plan(s). All eligible out-of-pocket expenses for you, your spouse and your eligible dependents are reimbursable from your Health Care Flexible Spending Account.
Medical Expenses Estimated Plan Year Expenses
Deductibles $_______________________
Copayments $_______________________
Prescription Drugs $_______________________
Other $_______________________
Subtotal $_______________________
Dental Expenses Estimated Plan Year Expenses
Deductibles $_______________________
Copayments $_______________________
Coinsurance $_______________________
Other $_______________________
Subtotal $_______________________
Vision Expenses Estimated Plan Year Expenses
Copayments $_______________________
Contact Lenses $_______________________
Eyeglasses $_______________________
Other $_______________________
Subtotal $_______________________
Other Expenses Estimated Plan Year Expenses
Medical Supplies $_______________________
Hearing Aids $_______________________
Other $_______________________
Subtotal $_______________________
Total Estimated Expenses $_______________________
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Dependent Care Flexible Spending AccountPlease note: This flexible spending account is NOT for health care expenses for your dependent.
The Dependent Care Flexible Spending Account (DCFSA) allows you to set aside money on a pre-tax basis through payroll deductions (minimum of $52 and a maximum of $5,000 per year) for qualified dependent care services such as day care, preschool, etc., for your eligible dependents. The Internal Revenue Service (IRS) sets the annual contribution limits for the DCFSA, which is $5,000 a year for participants who are single or married filing jointly or $2,500 if married and filing separately. Because the money is deposited before taxes, the account is subject to IRS regulations and the guidelines created by SSM Health.
Employee Benefits Corporation (EBC) is the administrator for the DCFSA Plan. EBC is responsible for verifying eligibility on claims and processing reimbursements for qualified expenses. For additional information regarding DCFSA, please visit ebcflex.com or call 800-346-2126.
EligibilityYour DCFSA expenses need to be “work-related.” This means that the expenses must be incurred while you are working and your spouse (if applicable) is working, looking for work or attending school full time. If you are absent from work longer than two weeks, your participation in the DCFSA will be terminated. During your absence, you may not make contributions to the DCFSA and claims incurred during this time are not eligible for reimbursement. You may re-enroll in the Plan upon your return to work.
Qualified DependentsYou may use your DCFSA to pay for eligible dependent care expenses of a qualifying child, spouse or relative as defined under Section 152 of the Internal Revenue Code. Generally speaking, a qualified dependent for this program is your child or stepchild under the age of 13, or your spouse, adult relative, or adult child who is physically or mentally incapable of self care. Qualifying dependents must reside with you for more than half the year and may not be claimed by another taxpayer for the calendar year.
If you have questions about the Dependent Care Flexible Spending Account, click here for a list of FAQs.
For a list of DCFSA Eligible Expenses, click here or see list below:
Examples of Eligible Expenses• Preschool
• Summer day camp
• Before and after school care
• Child day care (while you work)
• Day nursing care for dependent adults
• Adult/Senior day care center (while you work)
Examples of Non-Eligible Expenses• Babysitting (not work-related)
• Health care expenses
• School supplies
• Late payment fees
• Nursing home care
• Overnight camps/field trips
• Meals, food or snacks
• Dance and piano lessons
• School tuition
• TutoringSubmitting ClaimsYou may submit claims for reimbursement online, via mobile app, or by completing a claim form and sending by email, fax or mail. Your documentation must include all of the following:
• Name of dependent
• Name of provider or merchant
• Dates of service
• Service received
• Payment amount
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Submitting Claims Online1. Visit ebcflex.com and log in as a participant; registration is required for first-time users.
2. Click “Submit a New Claim,” complete information and upload scanned documentation.
Smart Phone (Available for iPhone® and Android™)1. Download the “My Mobile Account Assistant” app on your phone.
iPhone
Android
2. Complete claim information and upload a photo of the required documentation.
Manual Claim Form 1. Print and complete the claim form from ebcflex.com
2. Attach supporting documentation and send via mail or fax as outlined at top of form.
Reminders:• Reimbursement from the DCFSA is based on the date the services were incurred, not when you are billed or when a
payment is made.
• Claims not incurred by Dec. 31 and submitted by March 31 will be forfeited.
• If you terminate employment or you lose eligibility in the DCFSA Plan, you will have 90 days from the date your coverage ended to submit claims.
• Per IRS regulations, you cannot claim the Dependent Care Tax Credit (DCTC) for any expenses that are reimbursed through the DCFSA program. The employee is responsible for determining whether the DCFSA program, the DCTC, or a combination of both, would produce the greatest savings. More information on the DCTC can be found in IRS Publication 503 at IRS.gov.
Google Play and the Google Play logo are trademarks of Google LLC.
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Group Life, AD&D, Long-Term Disability
Group Term LifeYou may not “opt out” of life insurance if you meet eligibility requirements; however, there is an option offered that has no cost to you.
If you select a life insurance option that provides you with more than $50,000 in life insurance, IRS regulations require you to pay a small amount of added income tax, based on an estimated value for that coverage.
NOTE: There is a one-level increase limitation that will be applied during open enrollment and qualified changes in status. The following options are available to choose from:
Coverage Options• $5,000
• $50,000
• One (1) times annual base pay
• Two (2) times annual base pay
• Three (3) times annual base pay
• Four (4) times annual base pay
• Maximum $1,000,000; EOI* limit is $750,000
*Evidence of Insurability (EOI) means a statement or proof of a person’s medical history upon which acceptance for insurance will be
determined by Unum.
Travel Assistance Included with the Group Term Life Insurance Options
Whether you travel to a foreign country or more than 100 miles away from home, you may be eligible for assistance in the event of a medical emergency.
Emergency travel assistance is a service provided under your life insurance plan and is available 24-hours-a-day, 365-days-a-year for you and your family members. This program includes:
• Hospital admission assistance
• Emergency medical transportation
• Prescription replacement assistance
• Multilingual crisis management professionals
• Referrals to Western-trained, English-speaking medical providers
• Care and transport of unattended children
For more information about this service, visit unum.com/travelassistance or review the policy information on MyHR.
Within the U.S.: 1-800-872-1414
Outside the U.S.
• Via email: [email protected]
• Via telephone: U.S. access code + 609-986-1234; Ref # 01-AA-UN-762490
To view an informational module on Group Life/AD&D, click here.
To view an informational module on Long-Term Disability, click here.
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Accidental Death & Dismemberment (AD&D)You may not “opt out” of AD&D; however, there is an option offered that has no cost to you
The AD&D benefit will pay your beneficiary the elected AD&D amount if your death is a result of an accident. If you are injured, your AD&D insurance may pay you a portion of the benefit amount.
Eligible employees can choose from the following AD&D options:
Coverage Options• $5,000
• $50,000
• One (1) times annual base pay
• Two (2) times annual base pay
• Three (3) times annual base pay
• Four (4) times annual base pay
• Maximum coverage amount is $1,000,000
Long-Term Disability (LTD)You may not “opt out” of LTD
If you are eligible for this benefit, the SSM Health pay-all LTD benefit provides you with important income protection if you become disabled. Options are listed below (excluding physicians and executives).
• Option 1: 50% of monthly earnings, to a maximum of $10,000 per month
• Option 2: 60% of monthly earnings, to a maximum of $10,000 per month
There is a 90-day elimination period which means the long-term disability benefit will begin on the 91st day of total disability. Your monthly payment may be reduced by other sources of income.
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Voluntary Dependent Term Life (VDTL)
You may “opt out” of Voluntary Dependent Term Life (VDTL); participation is voluntary
There are four (4) options offered to eligible employees. These options will be available as “units,” taken through payroll deductions on an employee-pay-all, after-tax basis.
Coverage Pay Period Rates
Opt Out .00
$5,000 spouse/$1,000 per child .89
$15,000 spouse/$2,000 per child 2.63
$25,000 spouse/$3,000 per child 4.37
NOTE: Since these are “units,” it does not matter how many children an employee has as long as they are “eligible” for coverage. In addition, if the employee elects the coverage and has a spouse or child(ren) only, the rate will not be adjusted.
Below please find six (6) major features of the Voluntary Dependent Term Life Plan:
1. Only those eligible for the employer-sponsored group life plan will be eligible to elect dependent life coverage.
2. The coverage level for the spouse or child cannot exceed the employee’s level of life coverage. For example, if the employee has elected $5,000 of life coverage only dependent life option 1 can be selected. If the employee has elected one times his/her salary for life coverage and makes $22,000, only option 1 or 2 will be allowed.
3. Coverage for a totally disabled dependent cannot begin until the dependent is no longer deemed totally disabled.
4. Employees will have the opportunity to continue this benefit at the time of termination (personal conversion).
5. The beneficiary is automatically the employee.
6. Under this plan, the definition of dependent child is:
• Unmarried natural offspring, lawfully adopted children and step-children. They also include an unmarried foster child(ren) and other child(ren) who are dependent on the employee for main support and living with the employee in a regular parent-child relationship. A child will be considered adopted on the date of placement in the employee’s home.
• Unmarried child(ren) from live birth but less than age 19. Stillborn children are not eligible for coverage.
• Unmarried full-time student at an accredited school, age 19 or over until his/her 26th birthday. Accredited schools means an accredited post-secondary institution of higher learning for full-time students beyond the 12th grade level.
NOTE: More than one employee may not cover a dependent child, and a dependent may not be covered as an employee and a dependent.
Guidelines for Making Changes to your Dependent Term Life ElectionElection changes, as a result of a qualified change in status or during benefits open enrollment, will be limited to the “one-up” provision if you had a dependent that was previously eligible for this coverage but chose not to participate. The coverage level for the spouse or child cannot exceed the employee’s level of life coverage.
Domestic Partner DeclarationA Unum form titled “Domestic Partner Statement” must be completed before coverage will be in effect. The definition of Domestic Partner for Dependent Term Life Insurance is DIFFERENT than an LDA.
Unum includes “Domestic Partner” in the definition of a spouse. LDAs cannot be covered unless they meet the definition of a domestic partner. Your domestic partner is the person named in the Domestic Partnership Statement. The employee must comply, sign and provide the Human Resources Department this Statement which requires proof that the domestic partner has had the same permanent residence as the employee for six consecutive months prior to the date insurance would be effective for that domestic partner. The employee must not have signed a Domestic Partnership Statement with anyone else within the last six months of signing the latest statement. Also, the domestic partner must be at least 18 years of age, competent to contract, not related by blood that would bar marriage, the sole named domestic partner, not married to anyone else and the declaration of domestic partnership must be approved and recorded by the plan administrator.
To view an informational module on Voluntary Dependent Term Life, click here.
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Voluntary Short-Term Disability (VSTD) You may “opt out” of Voluntary Short-Term Disability (VSTD); participation is voluntary
There are two options to choose from:
• Option 1: 50% of your weekly base pay, to a maximum of $500/week
• Option 2: 60% of your weekly base pay, to a maximum of $2,500/week
Important Notes:• You will not be eligible to receive the VSTD benefit for a pre-existing condition, up to three months prior to the effective
date of coverage.
• It is extremely important for employees to evaluate their personal situation and determine if this plan could be beneficial. Consider the number of hours in your PTO/EMTO bank, the impact to your family of an unpaid leave due to your personal illness or injury.
This VSTD income will begin after 14 calendar days or when you have exhausted all PTO/EMTO hours; whichever is later. The Plan requires that all PTO and EMTO hours be paid prior to receiving VSTD payments. Your payments will stop once Long Term Disability benefits begin. You may be eligible to receive VSTD income for up to a maximum of 11 weeks per disability. The benefit premiums are paid on an after-tax basis from 24 paychecks (first two paychecks of each month). Any VSTD benefits you may receive will be income-tax free. The VSTD payment will be sent weekly from Unum.
VSTD benefits may be reduced by the amount of other income replacement benefits you receive for the same disability, such as benefits from state-mandated disability.
You will be eligible to receive a weekly VSTD benefit based on the option you elect when you are deemed disabled by Unum due to your sickness (including pregnancy) or injury and you are:
1. Unable to perform the material and substantial duties of your regular occupation; and
2. On an unpaid leave with SSM Health; and
3. Not working in any occupation; and
4. Are under the regular care of a physician.
Reminders:• A work-related injury or any other type of NON-MEDICAL leave of absence will not meet the definition of disabled under
this program.
• Standard medical guideline for a normal childbirth or for a C-Section is 6 weeks (industry standard). If there are complications, an extension may be granted with medical documentation.
To view an informational module on the Voluntary Short-Term Disability, click here.
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Check your PTO/EMTO BankIf you have enough hours earned to cover the unpaid portion of a Leave of Absence (LOA) time, you may want to consider opting out of VSTD.
IMPORTANT NOTE: There will be limited opportunities to enroll and/or drop this coverage. The standard qualified change in status does NOT apply to this benefit.
You will only be able to enroll in the VSTD Plan:
• During the annual open enrollment; or
• Mid-year if your scheduled hours increase up to the minimum hour requirement.
During the initial offering or the first time you become eligible for VSTD (increase number of scheduled hours to become eligible for medical coverage), you can elect either option.
This Plan does have a pre-existing condition limitation which applies if:
• You received medical treatment, consultation, care or services including diagnostic measures or took prescribed drugs or medicines in the three months just prior to your effective date of coverage; or
• You had symptoms for which an ordinarily prudent person would have consulted a health care provider in the three months just prior to your effective date of coverage; AND
• The disability begins in the 12 months after your effective date of coverage.
NOTE: You may still qualify for coverage for any other personal illness or injury that may occur. There are other instances when benefits will not be paid, please see the Summary Plan Description for details.
Contact Unum at 866-240-5800 to begin the VSTD process. If you qualify for VSTD benefits and are also a participant in the LTD plan, the information that is submitted will also begin the LTD process.
VSTD Deduction Calculation Example:
Annual Salary $35,000
Divide Annual Salary by 52 - to get the weekly salary $673.08
Choose Your Election Option 50% 60%
Weekly Salary x Election Option (50% or 60%) $336.54 $403.85
Divide by 10 for Dollar Amount. Round to the nearest cent $33.65 $40.39
Multiply by .40 - Monthly cost $13.46 $16.16
Divide by 2 - Pay period amount $6.73 $8.08
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Voluntary Enriched Life (VEL)
Supplemental Life Participation in the program is voluntary
Highlights of this enhanced life insurance program include:
• Employee and/or spouse ($5,000 child rider available)
• Ease and convenience of automatic payroll deduction
• Interest-bearing account
• Portability
• Potential tax-deferred growth
• Tax-free withdrawals up to the total premiums paid (withdrawals will reduce your cash value and death benefit)
When making your life insurance election, consider the SSM Health Voluntary Enriched Life Insurance Plan (VEL) offered through MetLife.
After new hire eligibility has expired (31 days from your date of hire), employees may apply during open enrollment only. MetLife can accept or deny coverage. New hires have guaranteed issue.
Voluntary Enriched Life provides permanent coverage that goes beyond life insurance protection to include a tax-deferred way to build your assets. The flexible options within VEL can make it a valuable part of your family’s financial plan. Through automatic payroll deduction, you can elect life insurance coverage for you and/or your spouse at the group rate. For the cost of your VEL coverage, contact MetLife at 1-800-846-0124 and mention the SSM Health Voluntary Enriched Life Insurance Plan (VEL).
Domestic Partner DeclarationDomestic Partner is included in the definition of spouse, if all the following criteria is met:
• Same residence as employee for at least 6 months;
• 18 years of age or older;
• Unmarried (both employee and domestic partner); and
• Not related by blood.
Additional information is available online via MyHR. You are not able to enroll in this benefit using online enrollment.
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Notices and Reminders
Making Changes to Your Benefits
Qualified Change in StatusIf you have a qualified change in status during the Plan Year, you may be allowed to change your level of coverage before December 31. IRS guidelines limit the type of election change that can be made following each type of change in status. Report ANY qualified changes in status to your Human Resources Department within 31 days of the event if you want to change your benefit election(s) to reflect the change. Eligible changes in status include, but are not limited to:
• Family changes such as marriage, divorce, legal separation, annulment, death of your spouse or dependent, birth, adoption or placement for adoption of your child, your dependent child ceases to satisfy the Plan’s eligibility requirements.
• Changes in employment status by you or your family member such as termination or commencement of employment, strike or lockout, commencement of or return from an unpaid leave of absence, change in worksite, or a switch from full-time to part-time or from salaried to hourly employment (or vice versa) that causes you or your family member to lose or gain eligibility for coverage.
Loss of Medicaid or Children’s Health Insurance Program (CHIP) EligibilityNotification to Human Resources must be within 60 days after the Medicaid or CHIP coverage terminates.
Open Enrollment The other opportunity to make changes to your benefits is during the benefits open enrollment period. This gives you a chance to re-evaluate your benefit needs and make changes. You will receive open enrollment materials in October for elections to be effective on Jan. 1.
Notice of Privacy PracticesThis notice explains how your medical information is used and the rights you have under the Health Insurance Portability and Accountability Act (HIPAA). It can be found in the most recent Summary Plan Description (SPD) for the medical option you elected.
Summary Plan Descriptions (SPDs)SPDs are available in your Human Resources Department and also on MyHR on SSM Health’s Intranet; they explain the benefits in detail. This benefits information booklet was designed to summarize your personal benefits. If there is a discrepancy, the Summary Plan Descriptions will prevail.
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Non-Discrimination Statement: SSM Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. SSM Health provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, and other formats). SSM Health provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services , contact your health care professional. If you believe that SSM Health has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance. If you need help filing a grievance, the SSM 24 hour equal rights helpline is available to help you. You can file a grievance in person or by mail, email, or website:
Scott Didion, System Director, Corporate Responsibility 10101 Woodfield Lane St. Louis, MO 63132 Phone: (844) 719-2850 E-Mail: [email protected] Website: SSM.EqualRights.EthicsPoint.com
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD)