2015 Employee Benefits Guide

Transcription

1 2015 Employee Benefits Guide November 2014

2 Table of Contents Your MaineHealth Employee Benefits... 1 Eligibility and Enrollment... 2 Medical Plans: Overview... 4 Tobacco Testing... 5 Medical Plans: A Closer Look... 6 Employee Health Improvement Works on Wellness (WOW!) Employee Assistance Program Dental Plan Vision Plan Health Savings Account Flexible Spending Accounts Life and Accidental Death & Dismemberment (AD&D) Insurance Critical Illness Insurance Accident Insurance Disability Coverage Perks Connect MaineHealth Employee Discount Program HearPO Pet Insurance through VPI Worldwide Emergency Travel Assistance Services College Savings Plans Harold Alfond Challenge Benefits Plan Documents and Forms Benefit Plan Contacts Enrolling Online: The MaineHealth Benefits Portal Step-by-Step Enrollment Instructions Reminder: Health Care Reform Legal Notices Your Employee Benefits Guide has been prepared to help you make benefit enrollment decisions for yourself and your family. The information included in this Guide is effective as of November The information provides only highlights of the core benefits program provided by MaineHealth, and is not intended to be a complete plan description. Information in this booklet does not supersede or change any of the terms and conditions of any Plan document, insurance policy, contract, or other legal agreement; the wording in the official documents will govern. This Guide is not a contract of employment between any employee and their employer.

3 Your MaineHealth Employee Benefits As a member of the MaineHealth family, your employer offers a great benefits package along with tools and resources designed to help you make the best choices to care for you and your family s health and wellbeing. This 2015 Employee Benefits Guide includes an overview of many of your benefits programs along with online enrollment instructions. Please read this Guide carefully to learn about your benefit offerings and how to enroll. Have Questions? If you have any questions about what s in this Guide, please call the HR Solution Center at The chart below shows a snapshot of your benefit programs, including contribution requirements, enrollment deadlines and coverage start dates. Your MaineHealth Employee Benefits Benefit You Contribute Your Employer Contributes When You Enroll When You are Eligible for Coverage to Begin Health Insurance Yes Yes Dental Insurance Yes Yes Vision Insurance Yes No Flexible Spending Accounts (FSAs) Healthcare Dependent Care Voluntary Life Insurance Yes Yes Transit FSA Yes No Health Savings Account (HSA) Yes No No Yes, if you enroll in the Healthy Saver Plan You must enroll within the first 31 days of employment otherwise you will have to wait to enroll until the next annual Open Enrollment or until you have a qualified life event or status change. You can contribute to this account within the first 31 days of employment or at any time after that. You can open your HSA during your enrollment process or any time after that. First day of the month on or after your first day of benefit eligibility Basic Life and AD&D Insurance No Yes; employer pays full cost Short-term Disability Coverage No Yes; employer pays full cost Your employer takes care of this for you.you don t need to take any action to enroll. First day of the month on or after six months of employment Long-term Disability Coverage No Yes; employer pays full cost First day of the month on or after six months of employment Critical Illness Insurance Yes No Accident Insurance Yes No You must enroll within the first 31 days of employment otherwise you will have to wait to enroll until the next annual Open Enrollment. First day of the month on or after your first day of benefit eligibility You will also be able to take advantage of several other benefit programs, including the Employee Works on Wellness (WOW!) program, Employee Assistance Program, Worldwide Emergency Travel Assistance Services and the Perks Connect Employee Discount Program. Your eligibility begins the first day of the month on or after your first day of work. 1

4 Eligibility and Enrollment Who is Eligible? To be eligible for coverage under these MaineHealth benefit plans you must be regularly scheduled to work at least 20 hours per week in a single position at a MaineHealth member organization which participates in these MaineHealth benefit plans. If you meet the above rule and work in additional regularly scheduled positions at the same MaineHealth member organization, the hours from all those positions will be combined, up to a maximum of 40 hours for benefit purposes. If you have a regularly scheduled position at more than one MaineHealth member organization which participates in these MaineHealth benefit plans, only the hours from the first organization at which you were hired to work 20 hours or more will be considered in determining your eligibility and the level of benefit that you receive. If you do not meet the above rules for benefit eligibility, you may still qualify for medical coverage under the Affordable Care Act (ACA). MaineHealth will measure your actual hours worked over a 12 month measurement period to determine the average number of hours worked. If it is determined that you worked an average of 30+ hours per week during the measurement period, you will be offered medical insurance and will be eligible for coverage for 12 months, which is referred to as the Stability Period. You will be measured each year to determine eligibility for medical insurance coverage. For more information on the ACA, see page 41 of this Guide. Who Can You Cover? Under the MaineHealth benefit programs, you may cover yourself and your eligible dependents. An eligible dependent is a: Legal spouse Domestic partner Child to age 26 Any unmarried child who is medically certified as disabled and dependent on the parent. A child is defined as a: Biological child Stepchild Domestic partner s child Legally adopted child Legal ward Legally placed foster child up to age 26, who lives with you A child for whom you or your spouse has received a court order requiring you to provide benefit(s). Please refer to the Summary Plan Description for the full definition of an eligible dependent. Contributions and Taxes Your medical, dental, vision, Health Savings Account and Flexible Spending Account contributions are made with pre-tax dollars. The IRS requires that the cost for medical, dental and vision coverage for your domestic partner and your domestic partner s children be deducted from your paycheck after taxes. The IRS also taxes employer contributions (called imputed income) for domestic partner coverage. 2

5 Qualifying Life Events or Status Changes If something in your life changes, you may qualify for different benefits. For example, if you get married during the year, you may switch your health coverage level to include new family members or you may elect voluntary life insurance coverage for your spouse. See the box on this page for a list of qualified life events and status changes. Each qualified life event or status change allows you to make unique changes. When you enter your life event in the Benefits Portal, you will see the plans you are allowed to change. If you have a qualifying life event or status change, you must change your coverage within 31 days from your event. Otherwise, you will have to wait until the next annual Open Enrollment. The changes you make will be effective from the date of the change. Important Notice About Dependent Eligibility If you want to cover dependents on one of your benefit plans, you will have to show that they are eligible. This is called the Dependent Eligibility Audit. You will need to do this for all newly enrolled dependents. You may have to provide documents such as: Marriage certificate Domestic partner documents Birth certificates If this applies to you, you will receive audit materials in the mail after you enroll. Qualified Life Events and Status Changes Change in marital status: You get married You enter a domestic partner relationship You get a divorce Your spouse dies Change in dependent status: Birth of a child Death of a child Adopt a child Placement of foster child Change in employment status for you or your dependents: Dependent leaving a job and losing coverage Dependent starting a new job and gaining coverage Starting or coming back from an unpaid leave of absence A change in employment status that affects your eligibility 3

6 Medical Plans: Overview MaineHealth sponsors two medical plans: the Healthy Saver Plan and the Healthy HMO Plan. Both plans are offered through Anthem Blue Cross and Blue Shield of Maine, cover preventive services at 100% and offer you a tax-advantaged savings opportunity. No matter which plan you choose, you will have high-quality medical coverage and access to a broad network of healthcare providers and facilities. Both plans meet the guidelines under the Health Care Reform law. Healthy Saver Plan Preventive services check-ups, immunizations and routine screenings covered at 100% in-network, meaning you pay nothing Consumer-driven health plan (CDHP) design; compared to HMO, you ll pay less out of each paycheck and pay the full cost when you receive services until you meet your deductible Includes a tax-advantaged Health Savings Account (HSA) with a MaineHealth contribution WOW! Rewards deposited to HSA Lower payroll deductions Higher upfront annual deductible Can receive care from physicians and facilities in either the Preferred Network, the Participating Network or out-of-network Must select a Primary Care Physician (PCP) during Open Enrollment, but do not need PCP referrals to see specialists or other providers Healthy HMO Plan Preventive services check-ups, immunizations and routine screenings covered at 100% in-network, meaning you pay nothing Lowest annual upfront deductible Receive care from physicians and facilities from either the Preferred Network (providers who work with the MaineHealth family) or the Participating Network (providers who are part of the statewide Anthem HMO Maine Network) No coverage for out-of-network services, unless authorized by Anthem and unavailable in-network Must select a Primary Care Physician during Open Enrollment; PCP referral required to see specialists or other providers Our Commitment to Wellness At MaineHealth, we are committed to creating a healthy community. We want our employees to engage in their personal health. That s why we connect our wellness program to our medical plan offerings. Employees who take action to manage their health have a choice of medical plans. Employees who demonstrate that they are living tobacco free pay less for medical insurance. Here s how it works. Each year, if you are a benefits-eligible employee who is enrolled in the medical plan, you must: Complete the WOW! Rewards process, the details of which will be communicated during the year. You must complete the process to be eligible to have medical plan choice and to avoid paying an additional fee for medical coverage the following year. Test negative for tobacco use to avoid paying a $1,200 annual tobacco fee ($46.16 per paycheck) in addition to your regular contribution to the cost of health insurance. Important Information About Your First Year of Employment As a new hire in your first year of employment: You are eligible to enroll in either the Healthy Saver Plan or the Healthy HMO Plan this year. You will be required to participate in WOW! Rewards to continue to have a choice of medical plans. You must test tobacco free within 60 days of enrolling in the MaineHealth medical plan to avoid paying the tobacco fee. Spouses and/or domestic partners enrolled in a MaineHealth medical plan must participate in WOW! Rewards to avoid an additional fee for their medical coverage for the following year. 4

7 Tobacco Testing After you enroll in a MaineHealth medical plan, you must test negative for tobacco within 60 days to avoid paying the tobacco fee of $1,200 per year ($46.16 per biweekly paycheck). You can get the tobacco test done for free at one of the participating MaineHealth NorDx facilities. See for a list of testing locations. If you test positive or if you do not take the tobacco test, the tobacco fee will be deducted from your paycheck beginning with the first payroll following 60 days from your enrollment. If you do not test negative for tobacco within 60 days of your enrollment in the MaineHealth medical plan, you will pay $46.16 more biweekly for MaineHealth medical insurance in 2015, no matter which medical plan you choose. If you do not test negative, you will pay the tobacco fee for the remainder of the year. You will have the chance to screen again during the next WOW! Rewards participation period and have the fee removed the following January. Our goal is to help you live tobacco free. See pages 12 and 31 for information about resources to help you quit. Tobacco Testing Steps Follow these steps to complete your tobacco test within 60 days of your enrollment in the medical plan: 1. Enroll in a MaineHealth medical plan within the timeframe allowed. 2. Wait days. 3. Go to to print your tobacco screening form and confirm the participating NorDx locations. 4. Complete the form and take it to a participating NorDx screening location to complete your tobacco test. You will be notified only if your results are positive. If you do not enroll in a MaineHealth medical plan, you do not need to test for tobacco use. 5

8 Medical Plans: A Closer Look Healthy Saver Plan Healthy HMO Plan How Plan Pays Benefits Preferred Network Participating or Out-of-Network Preferred Network Participating Network Office Visit Charges Subject to deductible Apply to the out-of-pocket maximum: Copays: $15 PCP / $40 Specialist Apply to the out-of-pocket maximum: Copays: $30 PCP / $60 Specialist Calendar Year Deductible $1,500 Employee Only Contract $3,000 Employee + Dependent(s) Contract $200 Individual $400 Family $400 Individual $800 Family Aggregate Combined across networks Applies to all services including pharmacy Accumulative No cross-tier accumulation Accumulative No cross-tier accumulation Your Coinsurance (The amount you have to pay after Calendar Year Deductible is met) 0% 30% 10% 30% Out-of-Network Coverage Prescription Drug Coverage <30 day supply >30 day supply Available Copays apply after deductible is met:* Tier 1 Tier 2 Tier 3 $10 $30 $45 $20 $60 $90 (Apply to out-of-pocket maximum) No coverage for out-of-network services, unless authorized by Anthem and unavailable in-network Copays apply until the calendar year prescription copayment maximum is met: Tier 1 Tier 2 Tier 3 $10 $30 $45 $20 $60 $90 (Do not apply to medical out-of-pocket maximum) NEW: Prescription drug copay out-of-pocket maximum is $1,500 individual/$3,000 family Calendar Year Out-of-Pocket Maximum $3,000 Employee Only Contract $6,000 Employee + Dependent(s) Contract $1,700 Individual $3,400 Family $3,400 Individual $6,800 Family Pre-Tax Savings Opportunity Annual MaineHealth Contribution Employee Contributions 2015 Contribution Limit WOW! Rewards Deposited Pre-Tax Yes; Health Savings Account $250 Employee Only Contract $500 Employee + Dependent(s) Contract Elect payroll deductions to HSA at enrollment; can change at any time in 2015 After-tax lump sum contributions at any time, which may be deducted when you file your tax return $3,350 Employee Only Contract** $6,650 Employee + Dependent(s) Contract** Employees age 55+ may contribute an additional $1,000** Yes Yes; Healthcare Flexible Spending Account None Elect payroll deductions to FSA at enrollment; cannot change in 2015 unless qualifying event or family status change $2,550 No Account Balance Rollover to Next Year Yes NEW! Yes, up to $500 * For certain preventive medications, copays apply before the deductible is met. ** The annual HSA contribution limit includes employee plus employer contributions. MaineHealth s contribution to your HSA and any WOW! Rewards deposited to your HSA will apply to the annual IRS HSA contribution limit and reduce the amount that you can contribute on an individual basis Rates You will receive the biweekly employee contribution rates for the MaineHealth medical plans from your Human Resources contact. You can also find them on 6

9 Provider Networks Both of our medical plans offer access to quality healthcare providers, hospitals and other healthcare facilities. Depending on the medical plan you choose and your specific healthcare needs, you may choose to get care from a Preferred, Participating, in-network or out-of-network provider or facility. Generally, the plan will pay more of the cost of care when you use a provider or facility within the MaineHealth family. Here s an overview of each network. Preferred and Participating Networks The Participating level of coverage is our standard level of coverage. Richer benefits are available in the Preferred Network because services are performed within the MaineHealth family or by providers who have a strategic relationship with MaineHealth. Although you may not always have a choice as to which physicians provide services, physicians do have the ability to become Preferred providers of MaineHealth by joining our Physician Hospital Organization (PHO). The providers listed in the Participating level of coverage have made a business decision not to do so. Employees should not assume that their Preferred providers will always use Preferred facilities. If your Preferred provider uses a Participating facility, it is your responsibility to pay the facility charges at the Participating level. Preferred Hospitals within the Preferred Network include: Franklin Memorial Hospital Lincoln Health (Miles and St. Andrews campuses) Maine Medical Center MaineGeneral Medical Centers Memorial Hospital (New Hampshire) Mid Coast Hospital New England Rehabilitation Hospital Pen Bay Medical Center St. Mary s Regional Medical Center Southern Maine Health Care (Biddeford and Sanford Medical Centers) Spring Harbor Hospital Stephens Memorial Hospital Waldo County General Hospital Other facilities within the Preferred Network* include: Independent Labs Free Standing Imaging and Surgical Facilities Home Health Providers Coastal Women s Health Care Lab NorDx Lab work performed at a Preferred facility or provider will pay at the Preferred benefit level Central Maine Orthopaedics PA Eye Care & Surgery Center Generations Surgery Center Insight Premier Health InterMed Imaging/Radiology Maine Centers for HealthCare Maine Eye Center Maine Medical Partners Neurosurgery & Spine Associates Maine Molecular Imaging LLC Marshwood Imaging Center OA Centers for Orthopedics Orthopedic Surgery Center Portland Endoscopy Center SMHC Diagnostic Services (Biddeford, Kennebunk, Saco, Sanford and Waterboro) Western Ave Day Surgery Center Wolf Ambulatory Surgery Unit Androscoggin Home Care & Hospice Community Health and Nursing Service Cove s Edge D/B/A Miles and St. Andrews Home Health and Hospice Healthreach Homecare HomeHealth Visiting Nurses Hospice of Southern Maine Kno-Wal-Lin Home Care & Hospice New England Life Care (Home Infusion Therapy) Waldo County Home Healthcare Services * For a list of providers that participate in the Preferred Network, go to 7

10 Participating Participating Network providers in the Healthy Saver Plan are part of the Anthem PPO network. Participating Network providers in the Healthy HMO Plan are part of the Anthem HMO Maine network. Participating Network hospitals are hospitals (other than those listed previously in the Preferred Network) that are part of the Anthem HMO Maine network or Anthem PPO network. In-Network (for Healthy Saver Plan) In-network providers and hospitals are those that are part of the Anthem Maine statewide PPO network and the BlueCard national network. Out-of-Network (for Healthy Saver Plan) Out-of-network providers, hospitals and facilities are all those outside of the MaineHealth family and Anthem network. Away from Home Care (for Healthy HMO Plan) The Away from Home Care program grants a temporary courtesy enrollment in a Host HMO that enables members who are living away from home, for example, a child going to college, to receive a comprehensive range of benefits, including routine and preventive services. There is no additional premium charge for participating in this program. Participating members receive the Host HMO s benefit plan and follow the referral and authorization guidelines of the Host HMO while within that area. This may differ from the Home HMO benefits and guidelines. The program is only available in select areas in the United States. It is not available outside the United Sates. For questions regarding coverage areas please contact Anthem. Prescription Drug Benefit Both medical plans provide three-tiered coverage for prescription drugs. Tier 1: Generic Tier 2: Formulary (Brand Name) In the Healthy HMO Plan, you pay the copays (shown above) for prescriptions. The deductible does not apply. Copays do not count toward meeting your medical out-of-pocket maximum but do apply towards a separate prescription drug out-of-pocket maximum. With the Healthy Saver Plan, you pay the full cost of prescription medicines until you meet your annual deductible, then you pay copays until you meet the annual out-of-pocket maximum. For certain preventive medicines, you pay only a copay even before you meet Tier 3: Non-formulary (Speciality Drugs) 30-day supply $10 $30 $45 >30-day supply $20 $60 $90 For more information about your prescription drug coverage, the formulary and how to access the mail-order program, contact Anthem at your deductible. Once your out-of-pocket maximum is met, there are no copays for the rest of the year. You can find the list of preventive medicines in the Library on the Employee Benefits Portal at It s important to note that the on-site hospital pharmacies at Maine Medical Center, Pen Bay Healthcare and Southern Maine Health Care are available to fulfill your prescription needs. Mandatory Generic Program MaineHealth encourages the use of less costly generic prescription drugs when they are available. If you choose a brand-name drug when a generic drug is available, you must pay the difference in cost between the generic drug and the brand-name drug in addition to your copay. If you are unable to take a generic medication, your doctor should contact Anthem for review. For more information about your prescription drug coverage and the formulary, contact Anthem. Mail-order Anthem s mail-order program provides the benefit of home delivery and saves you both time and money on prescriptions you take regularly. 8

11 Step Therapy Step therapy provides safe, effective treatment while helping keep costs low by ensuring you try a first line or less expensive choice before a more expensive brand-name drug can be dispensed. Specialty Pharmacies A specialty pharmacy provides support and drugs for people with complex, long-term health conditions. Specialty drugs come in different forms like pills or liquids, or they may be injected, infused or inhaled. These drugs often need special storage and handling and may be administered by a doctor or nurse. The MaineHealth medical plan requires employees to use one of our specialty pharmacies, Maine Medical Center (coming in 2015), Accredo or Apothecary by Design, when purchasing specialty drugs. For more information regarding the use of the specialty pharmacies, please contact Anthem. Paying for Services With the Healthy Saver Plan At Your Provider s Office Remember to always show your medical plan ID when you receive services. For medical expenses at an in-network provider you do not pay at the time of your visit. Your provider will send the bill to Anthem so that Anthem can apply the charges to your deductible and out-of-pocket maximum, as applicable. Anthem will then send you an Explanation of Benefits (EOB). The EOB will describe your claim, what the provider charged, what Anthem will pay and what you should expect to pay. If you owe a balance, you should receive a bill directly from the provider. Once you meet the annual out-of pocket maximum, MaineHealth pays 100% of the costs for covered services and you will not be charged for the remainder of the year. Note: If you use an out-of-network doctor or hospital, you should pay at the time services are received and submit a claim form to Anthem. At the Pharmacy Remember to always show your medical plan ID when you receive services. You will pay for prescription drugs at the point of sale. Anthem will track your deductible and out-of-pocket amounts at the time of the transaction and immediately provide the information to your pharmacist so he or she can tell you how much you need to pay. Once you meet the annual out-of pocket maximum, the Plan pays 100% of the costs for covered prescription drugs and you will not be charged for the remainder of the calendar year. Using Your HSA Use your HSA like a checking account with a debit card attached. You can use your HSA debit card to pay a provider bill, to pay for a prescription at the pharmacy or to place an online pharmacy order. When you use your HSA debit card, the money will be automatically withdrawn from your HSA. If you pay with cash or a personal debit or credit card, you can reimburse yourself from your HSA later through HealthEquity s website. You are responsible for maintaining the documents associated with paying your claims. Paying for Services with the Healthy HMO Medical Plan At Your Provider s Office Remember to always show your medical plan ID when you receive services. Medical services are only covered when provided by a Preferred or Participating provider. You will pay copays for PCP and Specialist office visits until you meet your annual out-of-pocket maximum. Once you meet your deductible you will pay co-insurance on any additional covered services you receive. Once you meet the annual medical out-of-pocket maximum, MaineHealth pays 100% of the medical costs for covered services and you will not be charged for the remainder of the year. 9

12 At the Pharmacy Remember to always show your medical plan ID when you receive services. For covered prescriptions you will pay copays at the time of purchase until you meet your prescription out-of-pocket maximum. Once you meet your prescription out-of-pocket maximum, MaineHealth pays 100% of the cost and you will not be charged for covered prescriptions for the remainder of the calendar year. These copays do not apply towards your medical out-of-pocket maximum. Using your Healthcare FSA If you elect to contribute to a Healthcare Flexible Spending Account (FSA) you can use your Healthcare FSA to pay a provider bill, prescription copays and other eligible health care expenses. There are two ways to use your FSA: 1. When you use your FSA debit card, the money will be automatically withdrawn from your Healthcare FSA. 2. If you pay with cash or a personal debit or credit card you can submit a claim with your receipts to EBPA for reimbursement. You should save receipts from purchases made with your Healthcare FSA debit card because you may be asked to prove these purchases were eligible health expenses. For more information on how a Healthcare FSA works go to page 18. Deciding Which Plan Is Best for You As you review your medical plan options, think about cost, cash flow, and your current and future healthcare needs. Keep in mind that preventive care is covered at 100% under both plans when you stay in-network. Here are some questions to get you started. How would you prefer to pay for your healthcare? Would you rather pay less from each paycheck and save the difference to pay for an office visit or prescription? Or would you rather pay more per paycheck and then, if you go to the doctor, know you ll just need to pay a copay? Do you have the cash flow to pay for services as you use them? With the Healthy Saver Plan, you do need to have the money to pay the full cost of medical expenses upfront until you reach the deductible. Are you comfortable with the role of healthcare consumer? Since you re paying the full cost of services until you reach your deductible in the Healthy Saver Plan, if you can find ways to save on healthcare services, the savings go right into your wallet. Do you need or want access to care from healthcare providers outside the Preferred or Participating Networks? The Healthy Saver Plan covers out-of-network services, but the Healthy HMO does not, unless authorized by Anthem and not available in-network. Do you want to start saving a nest egg for future healthcare expenses? If you d like to begin putting aside funds for future healthcare expenses, you may want to enroll in the Healthy Saver Plan which offers the HSA. 10

13 Mental Health and Substance Abuse Care You can use your mental health or substance abuse benefits without a referral from your primary care provider. To get care, call the Behavioral Health Care Program (BHCP) at The BHCP will approve eight counseling sessions and help you find an in-network provider. If you need more than eight sessions, your provider must request them from the BHCP. Under the Healthy HMO, non-authorized services will not be covered unless provided by your PCP. Under the Healthy Saver Plan, services authorized by BHCP will be covered at the highest level. If you do not get an authorization from BHCP, then any covered services will be paid at the lower level. Plan deductibles and copays apply. For more specific details about coverage, please go to to view the plan documents. IN AN EMERGENCY: If you have an emergency and need to go to the emergency room, call the BHCP at for approval within 48 hours of getting emergency care. Compare Plans with the bestfit Plan Advisor Tool As you consider your 2015 medical plan options, take advantage of the bestfit Plan Advisor tool on the MaineHealth Employee Benefits Portal. To use the tool: 1. Once you get to the enrollment screen for medical coverage, choose Help Me Decide. 2. Choose a health status for yourself and covered dependents. 3. Enter the care you will use and your coverage level. 4. You will see a graphic comparing the out-of-pocket costs you are likely to have for each plan. Use the bestfit Plan Advisor Tool to compare estimated 2015 out-of-pocket costs under the MaineHealth medical plans. 11

14 Employee Health Improvement Works on Wellness (WOW!) Your health is a priority to MaineHealth. Achieving health and remaining healthy is an active process that s why MaineHealth s Works On Wellness (WOW!) offers many programs to help you maintain and improve your health. WOW! has resources and programs to help you in your daily efforts to keep you and your family healthy. You can get started right away and participate throughout the year. Below is an overview of just a few of the programs available. For more information and to use interactive tools, visit our website at WOW! Healthy Paybacks You can get $50 rebates for attending Weight Watchers meetings, and $50 rebates for other eligible programs such as health education classes, community supported agricultural shares, healthy food purchases and much more! There are two six-month eligibility periods: April to September and October to March. For more details on WOW! Healthy Paybacks, visit Cash for Your Cart Good health pays off! You have more energy You take fewer or no medications You are at lower risk for developing a chronic health condition like diabetes or heart disease Cash for Your Cart is another way to earn rewards for making healthy choices under the Healthy Paybacks program. You can earn your $50 rebates by buying healthy foods at the grocery store. It s easy! All food items are scored from 0 to 100 based on nutritional value. If you have a grocery cart score of 60 or higher for at least 2 shopping trips in a month you will earn $10 per month up to $50 (for the six month eligibility period). You can also earn additional savings on offers featured on the Cash for Your Cart site. Go to to learn more about how to register and get started. Tobacco Treatment MaineHealth is committed to creating a tobacco-free community. When you are ready to quit, MaineHealth offers resources to help. Resources available to all MaineHealth employees: see tobacco treatment specialists at on-site facilities, where available, at no cost. Call MaineHealth Central Scheduling at (toll-free) to find a free tobacco cessation class or treatment group near you. You can also go to and click on Tobacco Treatment for more information about resources to help you quit. Resources available to Maine residents: call the Maine Tobacco HelpLine, available 24/7 at (free to all Maine residents) or visit Resources available to New Hampshire residents: call the New Hampshire Tobacco HelpLine at (free to all NH residents) or visit WOW! Rewards Participating in the WOW! Rewards program provides benefits-eligible employees a choice in medical plan options plus the opportunity to earn cash rewards for meeting health targets. Participation requirements for employees and covered spouses/domestic partners will be communicated on an annual basis. 12

15 Care Management The Care Management program is designed to help you become as healthy as possible and to connect to resources and information to help you manage your health. Care Management can be provided to you as part of the healthcare team, or through your MaineHealth health insurance administered by Anthem. The Care Manager will provide you education and information specific to your health condition and any other identified needs. Care Managers can meet with you over the phone when it is convenient for you, or with you at the doctor s office or at home. The Care Management program is free to you. If you are interested, ask your Primary Care Physician for a referral or call the MMC PHO Care Management Department at You can also call the Anthem Customer Service Department at the number listed on the back of your ID card to request a Care Manager. Future Moms Expecting a baby? If so, and if you are enrolled in a health plan through MaineHealth, you can enroll in Anthem s Future Moms program. By signing up, you gain access to a toll-free 24/ 7 registered nurse line, a childhood immunization schedule, a best-selling book that details what you can expect for you and your baby during your pregnancy, nutritional counseling, breastfeeding advice, postpartum support and much more. To enroll, contact Anthem at Once you enroll, you can receive a $50 Babies R Us gift card through the WOW! Healthy Paybacks program. For more information, visit and click on Healthy Pregnancy & Newborns. Health Coaching A health coach is your personal trainer outside the gym. You can call a Health Coach for help with a chronic issue such as diabetes, breathing problems or a heart condition, or if you simply want reliable information on general health topics. To learn more about this service, go to and click on the Ask a Health Coach section. Learning Resource Center The MaineHealth Learning Resource Center is a place to find health information you can trust. Visit for tools, tips and information on: How to be savvy about finding trustworthy health information. Common health concerns, like heart health, diabetes, cancer, mental health and more. Healthy living at all ages. Finding quality healthcare and being a prepared patient. Using resources like our online library and health educators. 13

16 Employee Assistance Program The Employee Assistance Program (EAP), LifeBalance offers counseling, online screening tools, self-help tools and information on a wide range of issues. This confidential counselling can help you and your family members deal with life s challenges. LifeBalance can help you with: Stress Anxiety Depression Family or parenting issues Marital or relationship issues Adjusting to change Self-improvement Child and elder care Legal issues Grief Work/life balance Financial concerns Your contact with EAP services is completely confidential. No information will be released about your call or the nature of your call, without your written permission. In addition, you can find helpful information at LifeBalance s website, including LifeArticles, books, booklets, audiotapes, CDs and language translation services. Call , available 24 hours a day. For more information, visit User ID: mainehealth Password: lifebalance Life changes Life challenges LifeBalance 14

17 Dental Plan Good oral health is an important part of your general health. Delta Dental manages our dental program and offers a network of Participating dentists. The dentists that participant in the PPO Network or the Premier Network will submit a claim to Delta on your behalf. The dentist typically cannot require payment from you at the time of service, with the exception of non-covered services and coinsurance amounts. By choosing a dentist from the PPO Network you will have fewer out-of-pocket expenses. When looking for a Participating Dentist on the Delta website, select Premier Plan or PPO type. Plan Overview Dental Services Annual Deductible Annual Maximum Diagnostic and Preventive Services Oral exams and dental cleanings (2 in any period of 12 months) X-Rays Fluoride Treatments (One every 12 months up to age 19) Space maintainers (Up to age 15) Sealants (Up to age 14) Basic Services Fillings and Extractions Endodontics Periodontics Root Canals Oral Surgery Major Services Crowns Dentures Bridgework Inlays and Onlays Implants Orthodontia (Dependent Children to Age 19) Subject to a lifetime maximum of $1,250 Plan Pays $50 per person up to a maximum of $100 per family $1,500 per covered person 100% (annual deductible waived) 80% 50% 50% (annual deductible waived) 2015 Rates 2015 Dental Plan Biweekly Rates Coverage Level Pre-tax After-tax Total Employee Only $8.91 $0.00 $8.91 Employee and Spouse/Family $24.50 $0.00 $24.50 Employee and Domestic Partner $8.91 $15.59 $24.50 Employee, Domestic Partner and Domestic Partner s Child(ren) Employee, Domestic Partner and Employee s Child(ren) $8.91 $15.59 $24.50 $24.50 $0.00 $

18 Vision Plan Our Vision Plan is managed by Anthem Blue View Vision. With this plan, you can get your vision care from an in-network or out-of-network provider. As you can see below, you will receive a higher level of coverage if you go to an in-network provider. You can find an in-network provider at Plan Overview Vision Services In-network Benefits Out-of-network Benefits Annual deductible None None Routine eye exam (Once every calendar year) $15 copay $85 allowance Eyeglass frames (Once every other calendar year) $150 allowance then 20% off remaining balance $64 allowance Eyeglass lenses (Once every calendar year) Single lenses Bifocal lenses Trifocal lenses Lenticular lenses $25 copay $25 copay $25 copay $25 copay $36 allowance $54 allowance $69 allowance $88 allowance Contact Lenses* (elective conventional) (Once every calendar year) $130 allowance then 15% off remaining balance $105 allowance *Contact lenses are in lieu of eyeglass lenses Rates 2015 Vision Plan Biweekly Rates Coverage Level Pre-tax After-tax Total Employee Only $2.24 $0.00 $2.24 Employee and Spouse $3.80 $0.00 $3.80 Employee and Child(ren) $4.03 $0.00 $4.03 Family $6.05 $0.00 $6.05 Employee and Domestic Partner $2.24 $1.56 $3.80 Employee, Domestic Partner and Domestic Partner s Child(ren) Employee, Domestic Partner and Employee s Child(ren) $2.24 $3.81 $6.05 $4.03 $2.02 $

19 Health Savings Account An HSA is an interest-earning, tax-advantaged account. It s a valuable financial tool that helps you make the most of the dollars you spend on current and future healthcare expenses for yourself or your tax dependents. Building Your HSA Your HSA may be funded in four ways: 1. MaineHealth contributions. Healthy Saver Plan participants will receive a start-up HSA contribution $250 for Employee Only coverage and $500 for Employee + Dependent(s) coverage. 2. Your contributions. You can contribute to your HSA, either through pre-tax payroll deductions or as a lump sum deposit during the year. For 2015, the total combined limit for your and MaineHealth s contributions is $3,350 for Employee Only coverage or $6,650 for Employee + Dependent(s) coverage. And if you will be age 55+ by Dec. 31, 2015, you can contribute $1,000 more in The maximum contribution amount may change if you change your level of coverage during the year due to a qualified life event. When deciding how much to contribute to your HSA, it is your responsibility to make sure you do not go over your personal annual maximum contribution allowed by the IRS. You need to take into account any employer contributions including annual start-up contributions, WOW! Rewards contributions, WOW! Healthy Payback contributions, and also any deposits or contributions you decide to make directly to your account outside of the payroll process. All money deposited into your HSA counts toward your annual maximum allowed contribution. 3. Interest and investment earnings. Like a traditional bank account, your HSA balance will earn interest over time. And once your account reaches a minimum amount, you can invest it among a variety of options. 4. WOW! Rewards. If you enroll in the Healthy Saver Plan, any future WOW! Rewards earned will be deposited directly into your HSA to avoid paying taxes and make your dollars go further. 5. WOW! Healthy Paybacks. If you participate in the Healthy Paybacks Program, you can elect to have your rebates deposited into your HSA. Rollovers The funds in your HSA roll over and continue to grow from year to year. You can continue to make the full HSA contribution each year, provided all eligibility requirements are met. Because an HSA is intended to serve, at least in part, as a long-term savings vehicle, you can save funds over a long period of time. There is no time limit for claiming a reimbursement from your account as long as you incur the expense after the HSA was set up. HSA Eligibility You are NOT eligible to open or contribute to an HSA if: Using Your HSA When you open your HSA, you will receive an HSA debit card from HealthEquity. You can use your debit card to pay for qualified healthcare expenses at retail locations, over the phone or on the Internet, just like any other debit card. You are covered under any other medical plan, unless it s also a CDHP You are participating in a Healthcare FSA, either yours or your spouse s You are claimed as a dependent on another person s tax return You are enrolled in Medicare (when you start receiving Social Security benefits, you are automatically enrolled in Medicare Part A unless you actively decline this coverage. If your spouse is enrolled in Medicare but you are not, you can contribute to the HSA and use it to pay for qualified medical expenses for you, your spouse and your tax dependents). If you are not eligible to contribute to an HSA, you may be eligible to contribute to a Healthcare Flexible Spending Account (FSA) instead. For more information, go to or call HealthEquity at

20 Flexible Spending Accounts You must re-enroll in the Healthcare and Dependent Flexible Spending Accounts (FSAs), administered by EBPA, allow you Care FSAs each year during to pay certain out-of-pocket healthcare, dependent care and transit annual Open Enrollment. expenses with pre-tax dollars. When you enroll, you elect the amount you want to contribute from each paycheck. Your contributions are not taxed when they are deducted from your pay or when the money is reimbursed to you. This means these dollars are essentially tax-free! 2015 Flexible Spending Accounts Annual Pre-tax Deferral Maximums Healthcare Flexible Spending Account... $2,550 Dependent Care Flexible Spending Account... $5,000* Transit Flexible Spending Account... $1,560 Healthcare FSA You can use the money you contribute to your Healthcare FSA to pay for certain expenses that are not fully covered by your medical, dental or vision plans. This includes services for you and eligible dependents. Please note that the IRS does not consider domestic partners or children you do not claim on your tax return to be eligible dependents for purposes of the Healthcare FSA. Eligible Healthcare Expenses You can be reimbursed for any eligible medical, vision and dental expenses that are medically necessary, but are not covered by your insurance, such as: Medical and dental deductibles or copayments Vision care expenses including eye exams, prescription eyeglasses, contact lenses, and contact lens solutions Hearing exams and hearing aids For a list of eligible expenses go to Expenses reimbursed through the Healthcare FSA cannot be claimed as a deduction on your federal or state income tax return. Dependent Care FSA You can use the money you contribute to the Dependent Care FSA to pay for childcare and other dependent services. This allows you (and your spouse, if you are married) to work while your dependent is cared for. You can contribute to the Dependent Care FSA if: You are a single parent with primary responsibility for child care You and your spouse both work You work and your spouse is a full-time student for at least five months of the year You work and your spouse is physically or mentally incapable of self-care Changes to the use it or lose it rule for the Healthcare FSA! You may carry over a maximum amount of $500 from year to year in the Healthcare FSA, effective January 1, * Highly compensated individuals are limited to a maximum contribution of $2,000 in