Benefits Enrollment Guide 2012

Transcription

1 Benefits Enrollment Guide 2012 for employees of North Carolina Baptist Hospital We are committed to providing cost-efficient benefit plans that can respond to the changing needs of our staff and faculty. Our program recognizes that our staff and faculty are diverse, and everyone s benefit needs are not the same. Because we offer a variety of benefit coverages, as your personal situation changes, you can respond by choosing benefits that are right for you. Enroll November 1 13, 2011 Make Sure You Enroll Take action by enrolling online and on time to get the benefits you want. If You Want to Make Changes: If you want to make changes to your benefit elections and/or enroll in a Health Care, Dependent Care or Medical Center Child Care Spending Account, you must enroll online either at work or from home. If You Don t Want to Make Changes: You do not have to enroll if you want to keep your current elections and you do not want to participate in a spending account. All of your current elections automatically will carry over for 2012, except for any current spending account elections, which will revert to $0 contributions. Take This Opportunity to Review Your Benefits: Even if you want to keep your current benefit elections, it still is a good idea to go online to verify your personal information (address, dependent information, etc.) and make any necessary corrections. Attend the Annual Benefits Fair: Please join us for our annual benefits fair on November 1, 2011, from 7 am to 4 pm. We will be located at the back of the Ardmore Cafeteria. Representatives of employee benefits will be there to answer questions regarding the benefits plans and to help our employees make informed open enrollment decisions. Inside this Guide Your Benefit Guide Benefits at a Glance... 2 Your Choices at Annual Enrollment... 3 Health Plan Highlights... 4 Health Plan Cost... 6 Dental Plan and Cost... 7 Other Benefits... 8 A Final Word About Health Care Coverage... 9 Important Benefit Contacts Remember, you must re-enroll in any spending account elections each year to continue participation. Your new benefit elections will begin on January 1, 2012.

2 Your Benefit Guide The benefits program is designed to provide you and your family with a competitive program of benefits. The program includes health and dental benefits to keep your family healthy. It also offers important financial protection in the event of illness, disability or death, and offers savings opportunities to help you build a financially secure retirement. For more details on how the program works, refer to the plan documents and policies that govern the operation of each plan. The plan documents and policies are available at the Benefits Office and online at the HR website. It s up to you to make the most of what is available. Each year, you have a one-time opportunity to consider your benefit choices and make changes. This guide is designed to make enrollment easy. It includes information on how to enroll and a summary of your benefit choices for You may change these benefits only during annual enrollment. If you have a qualified family status change during the year, you are allowed to add or remove spouses and dependents from your benefits, but you are not allowed to change your level of coverage. If there are differences between this enrollment guide and the official plan documents and policies, the plan documents and policies will govern. This guide is not a contract of employment. Enroll November 1 13, Benefits at a Glance What s the Same? No co-pays for primary care with Wake Forest Baptist Health physicians. Lower co-pays for specialist with Wake Forest Baptist Health. Health insurance costs for 2012 will remain very competitive for Wake Forest Baptist staff and faculty in 2012, with a rate increase well below the national average. What s New? Pharmacy Changes (1st quarter 2012): Main campus pharmacy (in Ardmore Tower) is making major improvements to service and hours Main pharmacy will feature extended hours: Monday-Friday, 7 am to 9 pm; Saturday, 9 am to 5 pm; Sunday, 1 to 5 pm The pharmacy will provide mail order service for maintenance drugs starting in the first quarter of With this service, employees who live outside the Winston-Salem area can get the same discounts, such as a 90-day supply with two copays. Retirement Savings Plan: New Retirement Savings Plan is being announced in November. This new plan will replace the current retirement plans for WFUHS, NCBH, Community Physicians and, next summer, Lexington Hospital. Plan to attend one of the 45 employee meetings scheduled. The Benefits Program provides a variety of benefit coverages and options so you can create a personal benefit program that will meet your needs. Keep reading for an overview of the benefit options available to you. For more detailed information about each benefit area, refer to your summary plan descriptions (SPDs) online at the infinet or call the Benefits Office in Human Resources at The Health Plan is an open access, preferred provider organization (PPO) that is administered by Benefit Services. 2 Benefits Enrollment Guide 2011

3 Your Choices at Annual Enrollment A Note About Your Eligible Dependents You can enroll your eligible dependents for certain coverages. These dependents include your spouse and your children under age 26. Children who are mentally or physically handicapped may remain covered beyond the normal age limits if they have not been married, cannot support themselves and rely on you for primary support and care. Making a Change During the Year After November 13, 2011, you may not make changes in your benefit elections until the next annual enrollment period. If you have an IRS-qualified family or employment status change you are allowed to add or remove a spouse or dependents. Because of the way certain benefits are deducted from your salary before being taxed, the Internal Revenue Service only allows changes after enrollment for family status changes such as divorce, marriage, the birth of a child, adoption, a child s aging-out of your coverage or death. If you have a status change, you may be allowed to change your benefit choices within 31 days of the change. Any change in your election must be consistent with your family status change. After you have completed this process, your new elections will remain in effect until the following annual enrollment period or until you make another family status change request, whichever comes first. Enroll Online at Work or at Home You can enroll from any internet capable computer by going to WakeHealth.edu > Employees > HR Self Service (NCBH), Internal. After you log into Self Service and select Open Enrollment, you ll see the benefit options based on your job status. Another enrollment option is to come to Reynolds Tower at the location and times listed below. There will be benefit enrollment specialists to assist you. You can also come to the Benefits Department located at Piedmont Plaza 1, 4th floor, between 7:30 am and 5 pm, Monday Friday. Need Help Enrolling Online? We have enrollment assistants ready to guide you through the process: Where: IS Training Room, located beside Reynolds Tower Ground Floor Elevators Phone Numbers: Open Enrollment Help Line Monday 10/31 No Schedule Tuesday 11/01 Benefits Fair Ardmore Cafeteria Wednesday 11/02 7 am to 5 pm Thursday 11/03 7 am to 5 pm Friday 11/04 7 am to 2 pm Saturday 11/05 9 am to 2 pm Monday 11/07 Noon to 7 pm Tuesday 11/08 No Schedule Wednesday 11/09 7 am to 5 pm Thursday 11/10 7 am to 5 pm Friday 11/11 7 am to 2 pm Saturday 11/12 9 am to 2 pm Benefits Enrollment Guide

4 Health Plan Highlights Deductibles Plan Benefits Individual $300 $300 $300 $600 $300 $600 Family $750 $750 $600 $1,200 $600 $1,200 Annual Out-Of-Pocket Maximum Plan Benefits Individual $1,000 $1,000 $2,500 $4,000 $4,500 $6,000 Family $2,500 $2,500 $4,500 $7,500 $6,500 $9,500 includes deductibles and and excludes co-pays Physician Office Visits Co-Pay Plan Benefits Primary Care Physician /CP/LexMed Other PCP s $0 $30 $0 $25 $0 $30 Specialist /CP/LexMed Other Specialist $20 $60 $20 $60 $20 $60 General Pediatrician /CP/LexMed Other Pediatrician $0 $15 $0 $10 $0 $10 Maternity Physician The expectant mother is responsible for one co-pay at the initial OB/GYN visit $20 $60 $20 $60 $20 $60 Maternity Hospital charges if enrolled in Smart Starts prenatal program in the first trimester. 10% 10% Maternity Hospital charges if not enrolled in Smart Starts prenatal program in the first trimester. Mental Health & Substance Abuse You must call for coverage Inpatient 10% Inpatient Inpatient Inpatient Outpatient: Medcost PCP co-pay applies in CBHA network Inpatient Inpatient 4 Benefits Enrollment Guide 2011

5 Health Plan Highlights (continued) Hospital and Surgical Fees Plan Benefits Inpatient Hospital Care 10% Outpatient Hospital Care 10% 50% Surgeon/Physician Fees 10% 50% Emergency Room Co-Pay If not admitted $130 $130 $130 $130 $130 $130 If admitted $0 $0 $0 $0 $0 $0 Urgent Care Center $45 $45 $45 $45 $45 $45 Please Note: Out of Network Pediatricians For all Primary Pediatric visits, your copay is $15, $10 & unless you utilize a /Community Physicians/LexMed pediatrician then you have $0 co-pay. There is no co-pay for well baby check-ups up to age 16 under the, and Plans. Pediatric specialists Co-pays for visits to pediatric specialists are the same as the specialist co-pay: $20 for and Community Physicians, and $60 for non-. OB/GYN physicians For routine care (such as PAP smears), the plan pays 100%. For non-routine care, OB/GYN physicians are considered specialists and have a $20 or $60 co-pay. Pregnancy is considered a specialist visit and one co-pay is charged with no co-pays on repeat visits. Inpatient care requires pre-certification Infertility services $15,000 Lifetime Maximum Dollar limit applies to Medical and Rx combined. Member pays of contracted price of prescriptions, which must be filled at a medical center pharmacy. Covered as other medical conditions except for dollar limits. Services must be through the Wake Forest Baptist Health Program. Must have three years of continuous service at the medical center and the patient must be insured by this health insurance plan for three continuous years. Benefits Enrollment Guide

6 Health Plan Costs Bi-Weekly Active Regular Full-Time (Minimum of 60 hours per pay period) Bi-Weekly Bi-Weekly You only $41.50 $36.50 $18.75 You plus child(ren) $ $ $69.00 You plus spouse $ $ $74.50 You plus family $ $ $ Active Regular Part-Time (Minimum of 40 hours per pay period) You only $ $ $ You plus child(ren) $ $ $ You plus spouse $ $ $ You plus family $ $ $ Smart Starts Prenatal Program If you or your spouse are pregnant, you probably have many questions and need sound medical advice. offers a special program for patients who are pregnant by answering difficult questions. This program can also help prevent complications by teaching patients healthy habits and providing practical tips. Registered nurses with a wealth of experience work to identify an expectant mother s risk factors and minimize those risks through follow-up calls during pregnancy and after the baby is born. Only 9.3% of babies born to Smart Starts participants are considered premature versus the national average of 12.3%. And, only 7.1% of Smart Starts babies have low birth weights as compared to the national average of 8.2%. If the mother-to-be enrolls in the Smart Starts Prenatal Program during the first trimester of pregnancy, plan benefits are as follows: Under the Plan You pay 10% coinsurance for maternity services received from any network provider after you meet the deductible. If you do not enroll in Smart Starts, you pay for network maternity services after deductible. Under the & Plans You pay for maternity services received from any network provider after you meet the deductible. If you do not enroll in Smart Starts, you pay for network maternity services after deductible. For more information about the Smart Starts Prenatal Program, call Benefits Enrollment Guide 2011

7 Dental Plan We offer two dental coverage options: Dental High Option or Dental Low Option. Both options cover services up to the reasonable and customary charge. The Dental High plan has increased the annual maximum from $1,500 to $1,750, is now covering dental implants and has increased the lifetime orthodontics amount from $1,500 to $2,000. Plan Feature High Option Low Option Annual Deductible (does not apply to preventive care or orthodontia) $50 Individual; $150 Family $50 Individual; $150 Family Annual Maximum (does not include orthodontia) $1,750 $750 Orthodontia Lifetime Maximum $2,000 Not covered Preventive Care (includes: oral exams [2 per year], prophylaxis [2 per year], topical fluoride up to age 15 [2 per year], emergency treatment of pain, bitewing X-rays [1 per year], full mouth services [once every 3 years], sealants, space maintainers) Restorative and Surgical Services (includes: anesthesia, office visits, pulp cap, root canal, periodontal scaling, replantation, oral surgery) Prosthetics (includes: bridges, dentures, partials, inlays, onlays, crowns) Orthodontia and Dental Implants (includes: treatment plan, retention appliance, full-banded orthodontia, and fixed or removable appliance for tooth guidance) 100%, no deductible 100%, no deductible 80% after deductible 80% after deductible 50% after deductible Not covered 50%, no deductible Not covered Dental Plan Costs Full-Time Bi-Weekly (Minimum of 60 hours per pay period) Part-Time Bi-Weekly (Minimum of 40 hours per pay period) Dental High Option You only $6.00 $21.75 You & 1 Dependent $14.75 $42.25 You & 2 Dependents $25.50 $63.75 You & 3 Dependents $38.50 $85.25 You & 4+ Dependents $53.00 $ Dental Low Option You only $2.50 $12.00 You & 1 Dependent $6.25 $25.00 You & 2 Dependents $11.00 $36.75 You & 3 Dependents $17.50 $49.75 You & 4+ Dependents $25.00 $61.50 Benefits Enrollment Guide

8 Vision Plans An annual eye exam is provided to all staff and faculty and dependents enrolled in either the, or medical plans with a $15 co-pay at a Superior Vision network provider. Use your Superior Vision Card when you seek services at a Superior Vision network provider. If you are not enrolled in either health plan, you are still eligible to enroll in the Vision plan, which will provide you with an annual eye exam and the same eyewear benefit for glasses and contact lenses. Finding Providers For a list of providers in your area, visit Superior Vision s website at Health Plan Enrollees Bi-Weekly Cost Non Health Plan Enrollees Bi-Weekly Cost Plus Standard Plus Standard You only $3.68 $2.73 $4.66 $3.71 You plus child(ren) $5.98 $4.43 $6.96 $5.41 You plus spouse $7.92 $5.88 $8.90 $6.86 You plus family $10.88 $8.06 $11.86 $9.04 Spending Accounts Wake Forest Baptist Health offers two spending accounts that let you pay for certain out-of-pocket health care and dependent care expenses with tax-free dollars. Health Care Spending Account covers any IRS-approved health care expenses not paid by any other health care plans, such as deductibles, co-pays, eyeglasses and hearing aids. You can contribute up to $8,000 annually. Dependent Care Spending Account covers child or elder dependent care expenses incurred so that you (and your spouse, if you are married) can work or attend school full-time. This includes care for your children under age 13 (or an elderly parent) in your home, an individual s home, or a licensed day care center. You can contribute up to $5,000 a year (or up to $2,500 if you are married and file separate tax returns). To participate in a spending account, you must enroll each year during annual enrollment. Spending account elections do not roll over to the next plan year. A direct deposit option is available for the flexible spending accounts. Health Care Flex Spending Debit Card If you participate in the Health Care Flex Spending Account in 2012, you automatically will receive a Benefits Debit Card that lets you pay eligible health care expenses with a simple swipe of the card. If you currently have a debit card please do not discard. Your 2012 election will be automatically added to your existing card. Life and AD&D As Wake Forest Baptist Health employees, you automatically receive basic life insurance and accidental death and dismemberment (AD&D) coverage at no cost to you equal to one times your annual salary, rounded up to the next $1,000 (up to $200,000). 8 Benefits Enrollment Guide 2011

9 Supplemental Life Insurance If you think you need more coverage than the basic coverage provides, you may buy supplemental life and AD&D insurance equal to one, two, three or four times your basic annual salary, rounded up to the next $1,000, subject to approval by Standard Life. Dependent Life Insurance You also may purchase life insurance for your spouse and your eligible children in the amount of: $10,000 or $25,000 spouse or child/children, subject to approval by Standard Life. Disability Disability coverage pays a benefit if you are sick or injured and unable to work. Short Term Disability (STD) pays a weekly benefit of 60% of your pay. Benefits begin after 31 or 61 consecutive days of hospitalization, sickness or injury and continues (as long as you are disabled) for up to 26 weeks. STD benefits will end on the date LTD benefits become payable to you. Short term disability is an employee-paid option. Long Term Disability (LTD) benefits begin after you have been disabled for more than 180 days. The coverage ensures that you will receive 60% of your pay for the duration of your disability until age 65 (or older, if your disability begins on or after age 62) or until other plan limitations have been met. LTD coverage is a paid benefit for eligible employees. Annual Influenza Inoculation Influenza vaccination is a proven way to protect our patients, and we are pleased to be at the forefront of inoculation compliance among health care workers. Wake Forest Baptist Health now requires annual influenza inoculation for all faculty, staff, students, volunteers, trainees and anyone else entitled to wear our identification badge. Please check the infinet for more details. A Final Word About Health Care Coverage The Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, requires employers who offer group health coverage to provide certain rights for staff and faculty, as described below. Children s Health Insurance Program Reauthorization Act If you are eligible for health coverage, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance with the premiums. If you or your dependents are not currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible, you can contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, you can ask the state if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer s health plan is required to permit you and your dependents to enroll in the plan as long as you and your dependents are eligible, but not already enrolled in the employer s plan. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. Health Certificates If your health coverage under the Wake Forest Baptist Health Benefit Program ends, you and your covered dependents will receive a certificate that shows your period of health coverage. You may need to furnish the certificate to another employer if you become eligible for another group health plan that excludes coverage for certain medical conditions that you have before you enroll (called preexisting conditions). You also may need the certificate to buy an insurance policy for yourself or your family that does not exclude coverage for pre-existing conditions. (continued) Benefits Enrollment Guide

10 A Final Word About Health Care Coverage (continued) You and your dependents may also request a certificate within 24 months of losing medical coverage through by calling , option 3. Mastectomy Breast Reconstruction The Women s Health and Cancer Rights Act of 1998 guarantees coverage to any health plan member who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with that surgery. Patients are entitled to coverage for: Reconstruction of the breast on which the mastectomy has been performed. Surgery and reconstruction of the other breast to produce symmetrical appearance. Prostheses and treatment of physical complications in all stages of the mastectomy, including lymphedemas (swelling associated with the removal of the lymph nodes). These services will be provided in a manner determined in consultation with the attending physician and the patient. Coverage for these services is subject to applicable deductibles, or co-pays. Newborn Mothers Health Protection Act Under federal law, we may not restrict health plan benefits for the mother or newborn child to less than: 48 hours for any childbirth-related hospital stay following a vaginal delivery 96 hours following a delivery by caesarian section. However, the mother s or newborn s attending physician may discharge the mother or newborn earlier than 48 hours (or 96 hours as applicable) after consulting with the mother. Also, under federal law, we may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated less favorably for the mother or newborn than any earlier portion of the stay. In addition, we may not, under federal law, require that a physician or other health care provider obtain authorization to prescribe a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-ofpocket costs, you may be required to obtain precertification. Qualified Medical Child Support Orders If a qualified medical child support court order (QMCSO) issued in a divorce or legal separation proceeding requires you to provide health coverage to a child who is not in your custody, you may do so. To be considered qualified, a medical child support order must include: name and last known address of the parent who is covered under this plan. name and last known address of each child to be covered under this plan. type of coverage to be provided to each child. period of time the coverage is to be provided. QMCSOs should be sent to the plan administrator. Upon receipt, the plan administrator will notify you and describe the plan s procedures for determining if the order is qualified. If the order is qualified, you may cover your children under the plan. As a beneficiary covered under the plan, your child will be entitled to information that the plan provides to other beneficiaries under ERISA s reporting and disclosure rules. Prescription Drug Coverage and Medicare Again on Jan. 1, 2011, prescription drug coverage will be available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans will provide at least a standard level of coverage set by Medicare. Some plans might also offer more coverage for a higher monthly premium. Because the Wake Forest Baptist Health plan s coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep the Wake Forest Baptist Health coverage and not pay extra if you later decide to enroll in Medicare coverage. However, because you have existing prescription drug coverage that, on average, is as good as Medicare coverage, you can choose to join a Medicare prescription drug plan later. Each year, you will have the opportunity to enroll in a Medicare prescription drug plan between Nov. 15 and Dec. 31. Dependent Coverage to Age 26 A Provision of the Patient Protection and Affordable Care Act The Patient Protection and Affordable Care Act (Public Law ), which was passed on March 23, 2010, as part of Health Care Reform, contains a provision requiring health plans that offer dependent coverage to provide coverage for all children to age 26. The law is effective for plan years beginning on or after September 23, 2010 (six months following the date of enactment of the law). This notice is being furnished to you in compliance with the requirements of the law. Children under age 26 who were not eligible, or whose coverage ended due to an age limitation, are now eligible to enroll or re-enroll in the plan. A special enrollment period is being offered for this purpose; contact your Plan Administrator for the dates of the special enrollment period. Coverage begins on the first day of the plan year beginning thereafter. Children under age 26 are eligible for coverage without regard to student status, marital status, primary residence status, tax dependent status, or the amount of financial support from the parent. 10 Benefits Enrollment Guide 2011

11 Coverage/premiums for children under age 26 will be the same as that offered to other dependent children. If the parent/employee is not enrolled in the plan but is otherwise eligible, and a child qualifies for this new enrollment opportunity, the parent may enroll along with the child. The child may enroll in any benefit package option that is offered under the plan, thereby allowing the parent to switch benefit package options. If both parents of the eligible child have employer-sponsored coverage, the child may enroll in either plan. Neither plan can deny enrollment. A child who qualifies for this new enrollment opportunity and is currently covered under COBRA may terminate COBRA coverage and enroll as a dependent of an active staff and faculty. A child who enrolls under this provision will be required to provide proof of Creditable Coverage, and will be subject to the pre-existing condition limitations of the plan if there has been a lapse in coverage of more than 63 days. Coverage will end on the child s 26th birthday, or until coverage otherwise terminates as defined by the plan (refer to the summary plan description). Since this plan is considered a grandfathered plan under this law, adult children under age 26 who are eligible for other employer-sponsored health coverage (even if not enrolled) are not eligible for coverage under this plan. Staff and faculty who wish to enroll their adult child must sign an attestation form stating that the adult child is not eligible for other employersponsored health coverage. Grandfathered Plan Status A Provision of the Patient Protection and Affordable Care Act The Patient Protection and Affordable Care Act (PPACA), which was passed on March 23, 2010, as part of Health Care Reform, contains a provision that permits a health plan that was in effect on the date of passage to deem itself grandfathered and preserve certain basic health care coverage. This notice is being furnished to you in compliance with the requirements of the law. The group health plan offered by Wake Forest Baptist Health believes it is a grandfathered health plan under PPACA. As permitted by PPACA, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of PPACA that apply to other plans; for example, the requirement for the provision of certain preventive health services without any cost sharing. Grandfathered health plans must, however, comply with certain other consumer protections in PPACA; for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan, and what might cause a plan to change from grandfathered health plan status can be directed to your plan administrator. Contact the benefits department at The following website contains answers to frequently asked questions about grandfathered plan status: grandfathering.html. Benefits Enrollment Guide

12 Important Benefit Contacts If you have questions about enrollment or need help enrolling online, you can visit one of the on-site enrollment centers or contact the Benefits Department in Human Resources at Benefit Provider Contact Information Benefit Provider Telephone Web Address Health and Dental Customer Service Carolina Behavioral Health Spending Accounts Retirement Investment Sponsors TIAA-CREF Diversified Investment Advisors Credit Unions Allegacy Federal Credit Union or Summit Credit Union or Forsyth County Child Care Referral Davidson County or Elder Care Choices Senior Services or Benefits Enrollment Guide 2012 Enroll November 1 13, 2011 Human Resources Medical Center Boulevard Winston Salem, NC