Make your benefits a priority

2016 Benefits Guide

Welcome to Carroll Hospital. It’s time to consider electing a benefits package that meets your and your family’s needs.

During your new hire enrollment period, you will have the opportunity to learn about the benefit plans available to you. Benefits elected during this time will be effective the first of the month following 30 consecutive days of employment.

This enrollment guide presents highlights of each of the benefit plans available to you. We hope you will use this information to make informed decisions that make the most sense for you and your family.

Carroll Hospital provides a full range of benefits that address your health and financial needs, now and in the future.

To Your HealTH To Your WealTH

• Medical Insurance • Flexible Spending Accounts • Prescription Drug Benefits • Life Insurance • Dental Insurance • Short-Term Disability • Vision Insurance • Long-Term Disability/LTD Buy-Up • Critical Illness Insurance • Accident Insurance • Legal Plan Benefits

Associate Eligibility*

You are considered a benefits-eligible Associate and able to participate in the benefits program if you are:

• Actively budgeted to work full time (72-80 hours per pay period), or

• Actively budgeted to work part time (48-71 hours per pay period).

*Affordable Care Act employer responsibility applies. You will be notified if you are impacted.

Dependent EligibilityYour eligible dependents include:

• Your legal spouse• Your children up to age 26, regardless of marital

status

– A dependent child may be the natural child, stepchild, legally adopted child, child placed for adoption, or other child for whom you have permanent legal custody.

Only those dependents meeting the eligibility requirements can be enrolled for coverage. Check with your counselor for more information regarding dependent eligibility.

Your 2016 Benefits Overview

How to Enroll

You can enroll for benefits by calling a benefits counselor toll-free directly at 1-888-827-8729 during one of your designated enrollment dates and times shown in the New Hire Enrollment Center schedule below.

Benefits counselors will explain the options available to you, answer your questions, and help you make the benefits choices that are right for you and your family.

2016 New Hire Enrollment Center CalendarToll-Free Phone Number: 1-888-827-8729

Hours of Operation: Weekdays, 9:00am – 6:00pm, ET

If you were hired: Your call-in dates are:10/3/2015 - 11/1/2015 10/12/2015 - 11/16/2015

11/2/2015 - 12/2/2015 11/9/2015 - 12/17/2015

12/3/2015 - 1/2/2016 12/10/2015 - 1/15/2016

1/3/2016 - 1/31/2016 1/11/2016 - 2/15/2016

2/1/2016 - 3/2/2016 2/8/2016 - 3/16/2016

3/3/2016 - 4/1/2016 3/10/2016 - 4/14/2016

4/2/2016 - 5/2/2106 4/8/2016 - 5/16/2016

5/3/2016 - 6/1/2016 5/11/2016 - 6/14/2016

6/2/2016 - 7/2/2016 6/9/2016 - 7/14/2016

7/3/2016 - 8/2/2016 7/11/2016 - 8/15/2016

8/3/2016 - 9/1/2016 8/10/2016 - 9/14/2016

9/2/2016 - 10/2/2016 9/9/2016 - 10/17/2016

10/3/2016 - 11/1/2016 10/10/2016 - 11/16/2016

If you do not enroll during your assigned dates, it will be assumed that all benefits are waived.

Each person’s health care needs are different. That’s why two medical plans are offered – the Health Plus Plan and the Health Saver Plan, administered by UMR, so you can choose the coverage level best-suited to your personal situation. A wellness screening is required to enroll in the Health Plus Plan. The chart below provides a brief outline of the plan options. Both medical plans include prescription drug benefits through Magellan Health.

UHC = United HealthcareUMR Medical Plans

Health Saver Plan (with HSA) Health Plus PlanSummary of Benefits

Carroll PHO Plus Network

UHC Options PPO Network

Out-of- Network

Carroll PHO Plus Network

UHC Options PPO Network

Out-of- Network

Annual Deductible Per Person $2,600* $2,800* $3,000* $300 $400 $600

Per Family $5,200* $5,600* $6,000* $600 $800 $1,200

Coinsurance Plan Pays 80% 60% 50% 90% 75% 60%

Annual Out-of-Pocket Maximum Per Person $4,000 $5,000 $6,600 $2,000 $4,000 $5,600

Per Family $8,000 $10,000 $13,200 $4,000 $8,000 $11,200Routine Wellness Services 100% 100% 50%** 100% 100% 60%*

Physician Office Visit

Primary Care 80% 60% 50%**

100% after $10 copay

(deductible waived)

100% after $15 copay

(deductible waived)

60% after deductible**

Specialist 80% 60% 50%** 100% after $25 copay

75% after $25 copay

60% after deductible**

Urgent Care Co-pay 80% 60% 50%**

100% after $35 copay

(deductible waived)

100% after $75 copay

(deductible waived)

100% after $75 copay

(deductible waived)**

Emergency Room 80% 60% 50%**

90% after $150 copay (deductible

waived)

90% after $150 copay (deductible

waived)

90% after $150 copay (deductible waived)**

Hospital 80% 60% 50%**

90% after $500 per

confinement copay

(deductible waived)

75% after $500 per

confinement copay

(deductible waived)

60% after $500 per

confinement copay

(deductible waived)**

Inpatient Surgery 80% 60% 50%**90%

(deductible waived)

75% (deductible

waived)

60% (deductible waived)**

Surgery Center 80% 60% 50%** 90% 75% 60%**

* Annual deductible applies to Medical and Prescription Drug claims. Deductible is embedded, which means the money you pay towards the individual deductible will be applied toward the family deductible.

** Represents coverage of the usual and customary charge for the services rendered. If your out-of-network provider charges more than the usual and customary limit, those charges will not be covered by the plan, and you may be balance billed.

Medical Insurance

HealTH SavingS accounT (HSa)The Health Savings Account allows you to save pre-tax money to pay for qualifying health care expenses that your plan does not cover. It is only available to Associates who enroll in the Health Saver Plan.Here’s how it works: • You make tax-free contributions to your account through payroll deduction up to the 2016 IRS limits:

$3,350 for individual coverage or $6,750 for family coverage. • Carroll Hospital also provides a Company contribution: $600 for individual coverage or $1,200 for family

coverage. Contributions will be made in two installments, with the first pay in January and July. This reduces your current contribution limit. You must be employed on 1/1/2016 to receive the full amount.

• The money in your account can be used to pay for qualified medical expenses, such as copays, deductibles, coinsurance, prescriptions and dental and vision expenses. Refer to IRS Publication 502 at www.irs.gov for a complete list of eligible expenses.

• The money in your account is yours to keep, even if you leave the Company. Any unused funds remain in the account and roll over from year to year.

PreScriPTion PlanWhen you enroll in the Health Plus Plan or Health Saver Plan, you automatically receive prescription drug benefits administered by Magellan Health.

Mandatory Generic Program - This program mandates automatic generic substitution for brand-name medications when a generic is available. If a plan participant chooses to fill the brand medication instead of the generic, an ancillary charge will be passed on. The ancillary charge is the difference between the cost of the brand-name medication and the generic, and will be added to the brand co-pay.

90-Day Supply at Retail – Anchor Pharmacy located in the Hospital can fill your 90-day supply of maintenance medications.

Mail Order – This program allows maintenance prescriptions to be filled by Magellan Health. By utilizing this benefit, a three-month supply of medications is received for the cost of two and a half months.

Step-Therapy Program – This program is for newly prescribed medications to assist users in accessing the most cost-efficient, effective medications possible.

WellneSS PlanThe Hospital has a formal wellness program to encourage participation in activities and behaviors that improve health and well-being, and to provide the resources and education to do so. Throughout the year, there will be activities, educational sessions and information fairs to provide Associates with opportunities to learn more about health issues and how to bring balance to their lives. These opportunities are open to all Associates. Participating in the Wellness program can also provide Associates with incentives on medical premiums or cash rewards for those not carrying medical benefits.

A wellness screening will be required of all Associates who want to participate in the Wellness program or who carry the Health Plus Plan. Based on your wellness screening, a personalized goal will be set for you. Please see the wellness website for more details. This can be found on the intranet under Human Resources.

Prescription Drug BenefitsHealth Plus Plan Health Saver Plan

Retail Anchor Pharmacy* (90-day supply)

Magellan Health Mail Order Retail Mail Order

Annual Deductible $75 per person / $225 per family Integrated with MedicalAnnual Out-of-Pocket Maximum $1,000 per person / $2,000 per family Integrated with MedicalGeneric $10.00 $20.00 $25.00 20% 20%Formulary $35.00 $70.00 $87.50 30% 30%Non-formulary $50.00 $100.00 $125.00 40% 40%Specialty 50% with $75 maximum N/A 50% 50%* Stoner Avenue (East Pavilion) location only

Cigna Preferred Dental PlanService DPPO Advantage DPPO In-Network Out-of-NetworkAnnual Deductible Individual $25 $25 $50 Family $75 $75 $150Annual Maximum $1,200 per person $1,200 per person $1,200 per personPreventive* & Diagnostic CareOral Exams, Routine Cleanings, X-rays (Bitewing, Full Mouth, Panoramic, Periapical), Flouride Appli-cation, Sealants, Emergency Care to Relieve Pain, Space Maintainers

100% 100% 80%**

Basic Restorative Care Fillings, Oral Surgery – Simple Extractions, Periodontal Scaling and Root Planing

80% after deductible 80% after deductible 60% after deductible**

Major Restorative CareOsseous Surgery, Root Canal Therapy/Endodon-tics, Oral Surgery – all except simple extractions, Surgical Extractions of Impacted Teeth, Anesthetics

80% after deductible 80% after deductible 50% after deductible**

Orthodontia - Dependents under age 19 ($1,200 maximum lifetime benefit)

50% 50% 40%**

SurgicalRepairs to Bridges, Crowns and Inlays, Dentures and Denture Repairs, Inlays/Onlays, Denture Relines, Rebases and Adjustments, Crowns, Bridges, Prosthesis Over Implant

50% 50% 40%**

*Additional cleanings covered during pregnancy**For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule, but the dentist may balance bill up to their usual fees.

VSP Vision PlanService Co-pay FrequencyEye Exam No co-pay Once every 12 months

Frames No co-pay; 20% discount on any balance over $150 Once every 12 months

Lenses (may be combined with frames) No co-pay Once every 12 months

Contacts No co-pay; $130 allowance Once every 12 months

$100 allowance for additional pair with adjustment for advanced computer visionLaser vision correction discounts available

A list of participating providers can be found at www.vsp.com.

Dental and Vision

Rates

Medical

Nicotine Surcharge adds $30 per pay to rates shown below.

Bi-weekly Payroll ContributionsStandard Rates

Health Saver Plan Health Plus PlanFull Time Part Time Full Time Part Time

Individual $32.72 $44.32 $68.05 $99.55

Associate and Child $62.16 $84.21 $129.30 $191.74

Associate and Spouse $68.71 $93.07 $169.16 $235.29

Family w/2 Dep $100.16 $134.95 $232.93 $327.61

Family w/3 Dep $108.51 $146.19 $250.15 $352.73

Family w/4 Dep $116.85 $157.44 $267.37 $377.85

Family w/5 Dep $126.91 $169.22 $285.40 $401.43

denTal

Dental Insurance Bi-Weekly PremiumsLevel of Coverage Full Time Part TimeIndividual $7.70 $9.13Associate and Child $9.05 $13.57Associate and Spouse $12.06 $18.10Family $17.02 $25.50

viSion

Vision Insurance Bi-Weekly PremiumsLevel of Coverage Full or Part TimeIndividual $4.21Associate and Spouse $7.43Associate and Child(ren) $7.88Family (3 or more) $12.01

Flexible Spending Accounts (FSAs) allow you to set aside money on a pre-tax basis to pay for qualified out-of-pocket health care or dependent care expenses. Because the money is deducted from your paycheck on a pre-tax basis, you will reduce the amount of your taxable income and increase your take home pay.

Carroll Hospital offers a Health Care FSA and a Dependent Care FSA.

How Flexible Spending Accounts Work

1. Each year during the open enrollment period, you decide how much to set aside for health care and/or dependent care expenses.

2. Your contributions are deducted from your paycheck on a before-tax basis in equal installments throughout the calendar year.

3. As you incur health care or dependent care expenses throughout the year, submit a claim form for reimbursement. Your claim will be processed and you will be reimbursed from your account. Or use your flexible spending debit card to pay for eligible expenses at the point of service. You will not be paying out of pocket, so there’s no need to fill out a claim form and wait for reimbursement.

Please note that these accounts are separate — you may choose to participate in one, both, or neither. You cannot use money from the Health Care FSA to cover expenses eligible under the Dependent Care FSA or vice versa.

Additionally, if you are enrolled in the Health Saver Plan with the HSA, you cannot enroll in the Health Care FSA.

You must actively re-enroll in the FSAs each year.You are not automatically re-enrolled.

* See IRS Publications 502 and 503 for a complete list of covered expenses.

Plan Annual Maximum Contribution

Examples of Covered Expenses

Health Care Flexible Spending Account $2,550 Copays, deductibles, orthodontia,

prescription medications, etc.*

Dependent Care Flexible Spending Account

$5,000 ($2,500 if married and filing separate tax returns)

Day care, nursery school, elder care expenses, etc.*

Flexible Spending Accounts

No More “Use It or Lose It”If you enroll in a Health Care FSA, you no longer have to forfeit your full remaining balance at the end of the year. The “use it or lose it” rule has been amended, and you will now be able to carry over up to $500 of your unused balance to the next plan year. Please note, this is not available for the Dependent Care FSA, and we still encourage you to calculate your expenses conservatively when making your FSA elections.

You and your family depend on your income for a comfortable lifestyle, now and for the future. Carroll Hospital knows how difficult it can be to provide peace of mind on your own, which is why we have made it a priority to offer financial protection in the event of your death or disability.

life inSuranceLife insurance protects your loved ones financially if something happens to you. It pays a benefit that can allow them to continue their way of life.

Basic Life Insurance/Accidental Death & Dismemberment (AD&D)Full time and part time benefits-eligible Associates are provided with Basic Life and Accidental Death & Dismemberment (AD&D) coverage at no cost to you. Full time coverage is equal to one times your basic annual salary rounded to the nearest $1,000, up to a maximum of $200,000. Part time coverage is equal to $10,000. Enrollment is automatic.

Supplemental Life InsuranceSupplemental Life Insurance provides Associates with coverage in addition to the Company-paid benefit. You pay the total cost of this benefit through convenient payroll deductions. • You can elect coverage in $10,000 increments up to five times your annual salary or up to a maximum of

$750,000, whichever is least. • If you do not enroll when you are first eligible, and you choose to enroll in coverage at a later date,

Evidence of Insurability will be required.

Dependent Life InsuranceYou may also purchase life insurance for your spouse and dependent children. You pay the full cost for this benefit. • You can choose from the following coverage options: – Spouse coverage: $15,000, $25,000, $50,000 – Child(ren) coverage: $10,000 • Coverage on a spouse cannot total more than basic plus supplemental life insurance coverage on

the Associate.

diSabiliTY inSuranceAn injury or illness that keeps you out of work can significantly impact your way of life. Disability insurance provides a source of income to help you maintain your household and living expenses.

Short-Term DisabilityThe short-term disability plan replaces a portion of your income if an injury or illness keeps you away from work for more than 21 days. The benefit replaces 60% of your base weekly earnings, up to a maximum of $1,000 per week. Benefits begin on the 22nd day of disability and are payable up to the 89th day.

Long-Term DisabilityLong-term disability protects your finances when your disability continues beyond the period covered by the short term disability plan. Carroll Hospital provides long-term disability coverage for full time and part time Associates. The benefit replaces 60% of your base monthly pay, up to a maximum of $3,000 per month. Benefits begin on the 90th day of disability and normally continue until: • The date you are no longer disabled, • The date you reach Social Security age, or • The date of your death.

Long-Term Disability Buy-UpWhile your employer covers the first $3,000 per month maximum long-term disability benefit, you also have the opportunity to elect a long-term disability buy-up benefit. This benefit replaces 60% of your base weekly earnings, up to a maximum of $5,000 per month. Benefits begin on the 90th day of disability.

Speak with a benefits counselor for help calculating the cost of these benefits.

Life & Disability Insurance

Voluntary Benefits

Protecting your financial well-being is just as important as taking care of your health. That’s why Carroll Hospital offers these voluntary benefits which are designed to help protect your and your family’s lifestyle.

grouP accidenT inSuranceAccidents happen. You can’t always prevent them, but you can take steps to reduce the financial impact. Accident Insurance is designed to help cover the out-of-pocket medical expenses and extra bills that can follow an accident. The plan pays benefits for injuries and accident-related expenses, such as fractures and dislocations, hospitalization, physical therapy, emergency room treatment, transportation, lodging and more. The plan pays a benefit directly to you – not a doctor or hospital – and you can use the money however you choose. Benefit amounts are based on the type of injury and treatment needed.Plan Features: • Benefits are paid for accidents that occur off the job. • You can also elect to cover your spouse and children. • There are no health questions or physical exams required. • Coverage is individually owned, so you can take your policy with you if you change jobs or retire.

grouP criTical illneSS inSuranceThe out-of-pocket costs of a serious illness can be catastrophic, even with medical insurance. Critical Illness Insurance helps provide financial protection in the event of a covered serious illness. The policy pays a lump sum benefit directly to you if you are diagnosed with a covered condition. You can use this benefit any way you choose – deductibles and coinsurance, expenses your family incurs to be by your side, or simply to replace your lost earnings from being out of work. You choose the benefit amount when you enroll.Covered illnesses include: • Heart attack • End stage renal (kidney) failure • Carcinoma in situ* • Blindness • Occupational HIV • Coronary artery bypass surgery* • Major organ failure • CancerPlan Features: • You do not have to be terminally ill to receive benefits. • Family coverage is available. • Coverage is portable – you can take your policy with you if you change jobs or retire. • A Wellness Benefit is included, which pays an annual benefit if a covered health screening test is

performed (blood test, stress test, colonoscopies, chest X-rays, mammograms, etc.).*The coverage pays 25% of the face amount of the policy once per lifetime for coronary artery bypass surgery and carcinoma in situ.

WHole life inSuranceCan your family maintain their lifestyle without you? Whole Life Insurance helps ensure they can. Whole Life Insurance is designed to pay a death benefit to your beneficiaries if something should happen to you. It can also build cash value that you can use while you are still living. At an affordable premium, you can have the added financial protection you and your family may need during times of uncertainty. You may purchase coverage for yourself, your spouse, your children and/or your grandchildren. Whole Life Insurance is voluntary, which means you purchase the amount that is right for you, and the policy is portable.

The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations that may affect any benefits payable.

Accident and Critical Illness Insurance - Complements to Your Health PlanAccident and Critical Illness Insurance are excellent complements to your medical plan. Both plans help absorb the out-of-pocket medical expenses that arise when a severe illness or injury strikes, such as deductibles, copays and prescription drugs.

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

Employee Assistance Program (EAP)The EAP through Carebridge provides professional support services to help Associates, their household members and dependent children cope with a variety of personal and career-related issues, such as will preparation, credit issues, child or elder care and other personal services. The program is available 24 hours a day, seven days a week, and is completely confidential and offered at no cost to you.

Retirement Savings PlanYour employer has established a retirement savings plan in the form of a 403b or 401K to allow you to save for retirement using pre-tax contributions. A discretionary employer match is provided for all eligible Associates. This program is offered through Transamerica. Mutual funds using different styles of investment, including lifestyle funds, are offered. For more information, contact your Human Resources Department.

Tuition Assistance ProgramFinancial assistance with Tuition Reimbursement and Certification Reimbursement is available to benefits-eligible Associates pursuing a degree or certification. For more information, refer to the Tuition Assistance Programs policy or contact Human Resources.

Auto/Home InsuranceCompare your current auto, renter’s and home insurance rates to the group rates available to you through MetLife. By calling 1-800-GET-MET8 or visiting www.metlife.com/mybenefits, you can obtain a real-time quote based on your personal situation.

Credit Union MembershipAll Associates have the opportunity to join First Financial Federal Credit Union. The credit union offers many free, no-hassle products and services, such as access to a free checking account (no minimum balance and pays you interest on all monies in the account), as well as various savings options and loan services. To open an account, you must complete the membership application and make a $5 deposit. Membership applications can be obtained by contacting First Federal Financial Credit Union at 410-321-6060 or the Human Resources Department. For more information, visit www.firstfinancial.org.

Discount Tickets The Human Resources Department offers discount tickets to several of the area’s most popular theme parks, lift tickets and ski rentals, and movie passes to AMC Theaters (Owings Mills) and Regal Cinemas (TownMall of Westminster). All of these tickets can be purchased with credit card or check from the Human Resources Department. For information and pricing, refer to the Hospital’s intranet.

MetDESKMetDESK is a free service that provides support, referrals and resources to parents and families of special needs children. This program is available to all Associates who have a special needs child and need assistance in planning for the future. For details, call 1-800-GETMET8 or visit www.metlife.com/mybenefits.

MetLife AdviceMetLife Advice is a free service that uses an educational approach to help Associates make informed benefits and finan-cial decisions regarding retirement, college funding strategies, financial management, estate conservation and investment fundamentals. Simply contact a dedicated MetLife Advice specialist at 1-800-GET-MET8 or visit www.metlife.com/mybenefits.

Pet InsuranceWe are excited to offer affordable veterinary insurance for your pets. This coverage is available for dogs, cats (beginning at six weeks of age), and a variety of other pets, including birds, snakes and potbelly pigs. Obtain more information on this insurance by calling 1-800-GET-MET8 or by visiting www.metlife.com/mybenefits.

Pharmacy Discount BenefitsAssociates receive a 10% discount on over-the-counter items at all Anchor Pharmacy locations when they present their badge.

Pre-Paid LegalFor less than $1 per day, you can have legal advice and access to an attorney at your fingertips through Hyatt Legal. By visiting www.metlife.com/mybenefits or calling 1-800-GET-MET8, you can learn more about the pre-paid legal plan and services available to you.

Other Benefits

Contact Information

HUMAN RESOURCESHospital’s Intranet: www.intra.CarrollHospitalCenter.org

Extranet: extra.CarrollHospitalCenter.org

HUMAN RESOURCES – BENEFITS: Main HR: 410-871-7072 Benefits Team: 410-871-6108

410-871-7409 410-871-7071

Required NoticesRequired Notices are available on the Extranet at extra.carrollhospitalcenter.org. Select Human Resources, Benefits Information then Associate Benefit Plan Required Notices.

NOTE: This booklet is intended to summarize the benefits you receive from Carroll Hospital. The actual determination of your benefits is based solely on the plan documents provided by the carrier of each plan. This booklet is not legally binding, is not a contract, and does not alter any original plan documents. For additional information, please contact the Human Resources department.

BENEFIT CARRIER PHONE NUMBER WEBSITE

Auto/Home Insurance MetLife 1-800-GET-MET8 www.metlife.com/mybenefits

Credit UnionFirst Financial

Federal Credit Union

410-321-6060 www.firstfinancial.org

Dental Insurance Cigna 1-800-CIGNA24 www.cigna.com

Disability Programs (STD and LTD) Unum 1-800-605-2802 www.unum.com

Policy # 601748

Life Insurance MetLife 1-800-438-6388 www.metlife.com/individual/ employeebenefits

Employee Assistance Program (EAP) Carebridge 1-800-437-0911 www.liferesource.com

Access Code: KKNH3

Flexible Spending Accounts Conexis 1-888-347-5193 https://mybenefits.conexis.com

FMLA Requests Unum 1-800-605-2802 www.unum.com

Medical Insurance UMR 1-800-826-9781 www.umr.com

Pet Insurance MetLife 1-800-GET-MET8 www.metlife.com/mybenefits

Pre-Paid Legal Services Hyatt Legal1-800-GET-MET8

Company Access Code: 571687

www.metlife.com/mybenefits

Prescription Coverage Magellan Health 1-800-711-4550 www.magellanrx.com

Retirement Savings Plan Transamerica Advisors 1-888-676-5512 www.mytrsretire.com

Vision Insurance VSP 1-800-877-7195 www.vsp.com

Voluntary Benefits (Accident, Critical Illness & Whole Life Insurance)

Unum 1-866-679-3054 www.unum.com