ASSOCIATE BENEFITS CHOC AND YOU COVERAGE MEDICAL PLANS PROGRAMS INSURANCE SAVINGS

Transcription

1 ASSOCIATE BENEFITS CHOC AND YOU COVERAGE MEDICAL PLANS PROGRAMS INSURANCE SAVINGS

2 Table of Contents TABLE OF CONTENTS CHOC AND YOU: A PARTNERSHIP FOR GOOD HEALTH 3 ELIGIBILITY AND EFFECTIVE DATE OF COVERAGE 3 Qualifying event 4 Section 125 Plan Paying with Pre-Tax Dollars 5 MEDICAL PLANS 5 Aetna Health Maintenance Organization (HMO) Plan 5 Aetna Open Access Managed Choice (POS) Plan 5 DENTAL PLANS 6 DeltaCare Dental (HMO) Plan 6 Delta Dental Preferred Provider Organization (PPO) Plan 6 VISION PLANS 6 Vision Service Plan 6 LIFE AND DISABILITY INSURANCE 7 Life & AD & D Insurance Plan 7 Voluntary Life & AD&D Insurance Plans 7 Disability Insurance 8 Voluntary Short-Term Disability (STD) Insurance 8 Voluntary Long-Term Disability (LTD) Insurance 8 FLEXIBLE SPENDING ACCOUNTS (FSA) 8 Health Care Flexible Spending Account (HCFSA) 9 Dependent Care Flexible Spending Account (DCFSA) 9 CHOC 403(b) RETIREMENT SAVINGS PLAN 9 PAID TIME OFF (PTO) AND HOLIDAYS 10 Accrual Schedule 10 Holidays 10 OTHER BENEFITS AND PROGRAMS 11 Employee Assistance Program (EAP) Hour Fitness 11 Aetna Special Programs 11 Discount Opportunities Available to Associates 11

3 3 CHOC AND YOU: A PARTNERSHIP FOR GOOD HEALTH Through your compassion, the patients at CHOC receive the best care. We appreciate your dedication to CHOC and the families we serve. We believe it is important for us to provide you the support needed not only at work, but in life. As a part of this support, we want to make sure you have what you need to maintain your health. Good health is not just about medicine alone: it s about education, resources, resolution and balance. As managing health care costs continue to be a challenge for all employers across the country, many companies choose to shift their costs to employees. CHOC believes that maintaining health care costs on both your side and ours is a partnership. While CHOC pays for the majority of your benefits, each pay period you make a contribution for the coverage you elect. In the following pages, you will find information on all of the programs that CHOC has available to you and your family. We urge you to learn about all of the programs, ask questions, and make informed choices about what programs will enhance and assist you in maintaining your good health. If at any time you have questions or would like to provide feedback on our programs, please contact a Human Resources Associate. They will be glad to assist you. The cost of your benefit coverage will vary based upon the plan you select and the number of dependents that you choose to cover. Your medical, dental, and vision premiums for you and your eligible dependents will be deducted from your paycheck with pre-tax dollars. Paying for your benefits with pre-tax dollars can lower your taxes, which can increase your take-home pay. The benefit options you choose will remain in effect for the entire calendar year, January 1st through December 31st. Changes made mid-year to your health insurance plan coverage or flexible spending accounts can only be made in the case of a Qualifying Event (see Qualifying Event, page 4). ELIGIBILITY AND EFFECTIVE DATE OF COVERAGE Who is eligible to enroll in the benefit program? You are eligible to enroll in the benefit program if you are a full-time Associate (72-80 hours per pay period) or a regular part-time Associate scheduled to work a minimum of 40 hours per pay period (20 hours per week). Can I enroll my dependents? You can enroll your eligible dependents as follows: Legal spouse Domestic Partner if registered in the State of California Child(ren) (biological, adopted, stepchild(ren), child(ren) of eligible Domestic Partner and any other child(ren) for whom you are a legal guardian) to age 25 Child(ren) over age 25 if incapable of self-care and legally dependent PARTNERSHIP

4 4 When does my coverage become effective? If you are enrolling in coverage during the Open Enrollment period, coverage begins on January 1st. If you are a newly hired Associate or if you are a current Associate that transfers to a benefits eligible status, coverage begins the first of the month following 30 days of employment or becoming benefits eligible. When do I enroll? New Associates will receive a benefits enrollment package during the Day One New Hire Orientation. Enrollment forms must be completed and returned to Human Resources within 31 days of employment. Current Associates who transfer to a benefits eligible status will receive a notice from Human Resources to pick up a benefits enrollment packet. Enrollment forms must be completed and returned to Human COVERAGE Resources within 31 days of becoming benefit eligible. When can I make changes to my benefit elections? During the annual Open Enrollment period, you will have an opportunity to make new benefit elections that will be effective the following January 1st. Mid-year changes can only be made if you have a Qualifying Event. You must notify Human Resources and make your new benefit election within 31 days of a Qualifying Event. QUALIFYING EVENT The medical, dental, vision and Flexible Spending Account elections you make remain in effect until December 31st. Mid-year changes are only allowed in the case of a Qualifying Event : Marriage, divorce, legal separation, annulment or creation of or dissolution of registered domestic partnership Birth, adoption, placement for adoption, or change in custody of a child Death of a dependent Change in your or your spouse s employment status that makes you eligible or ineligible for benefit coverage IMPORTANT: If a qualifying event occurs, you must notify Human Resources and make your new benefit election within 31 days of the event. Changes not requested within the time frame will not be effective until January 1st in the following plan year and you must make the election during the open enrollment period.

5 PLANS SECTION 125 PAYING WITH PRE-TAX DOLLARS Associate premiums for medical, dental and vision coverage will be deducted from your paycheck on a pre-tax basis. Premiums deducted pre-tax are not subject to Federal or State income taxes. By paying for your premiums with pre-tax dollars, your taxable income is reduced and therefore your take home pay is increased*. Exception: premiums paid by the Associate or the organization for eligible Domestic Partners, children of Domestic Partners, or same sex spouses are subject to Federal Income Tax. Contact Human Resources for more information. 5 *You may choose to pay for your coverage with after-tax dollars by notifying Human Resources in writing at the time of your enrollment. MEDICAL PLANS CHOC offers two different medical plans to meet the needs of its Associates. The following is a brief description of the two. AETNA HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN The HMO plan is the most affordable plan offered. Not only are the premiums lower, but the out of pocket costs when receiving services are usually lower than the Open Access POS plan. In an HMO Plan, you and your dependents: Are required to receive services through a Primary Care Physician (PCP) or to receive a referral to a specialist through the PCP; you can choose a PCP for each member of your family. To view a list of PCP s, visit AETNA s website at Have no deductible or lifetime maximum and minimal out-of-pocket expenses. Will pay a co-pay each time you visit the doctor or for certain services. Your HMO Plan will not provide benefits if you receive services from Non-Network Providers. AETNA OPEN ACCESS MANAGED CHOICE (POS) PLAN The Open Access POS plan provides you the opportunity to have more flexibility in determining where you receive services. You are able to self-refer to any specialist. However, if you receive services from an in-network provider, you will have lower costs than if you receive services from an out-of-network provider. To view a list of Providers, visit AETNA s website at After paying a calendar year deductible, most services will be covered as a percentage of either the contracted amount in network or reasonable and customary (for out-of-network providers). If you receive services from an out-of-network provider, you will be responsible for any amounts charged over reasonable and customary as determined by AETNA.

6 6 DENTAL PLANS DENTAL PLANS CHOC offers two dental plans to choose from. The health maintenance organization (HMO) plan offers lower cost and the preferred provider organization plan (PPO) offers more flexibility. DELTACARE DENTAL (HMO) PLAN With the dental HMO plan, you and your dependents: Are required to receive services through a Primary Care Dentist. Select a dentist or dental group from a list of DeltaCare member dentists to perform all covered dental services for you and your covered dependents. To view a list of Primary Care Dentists, visit Delta Care s website at deltacareusa. Have no deductible, annual maximum or claim forms to submit Pay a co-pay based on the dental procedure (refer to the schedule of benefits, certain limitations apply) Pay a co-pay for child or adult orthodontia DELTA DENTAL PREFERRED PROVIDER ORGANIZATION (PPO) PLAN Under the PPO plan, you and your dependents: Will have lower out of pocket expenses when receiving dental services from a Delta Premier dentist. To view a list of Dentists, visit Delta Dental s website at Can receive services from any licensed dentist Child orthodontia benefit of 50% up to a lifetime maximum of $1,500 VISION PLAN Vision benefits are provided through Vision Service Plan (VSP). With the VSP plan, you and your dependents: Pay a co-pay for eye exam, lenses and frames Can receive an exam every 12 months, new lenses every 12 months, and new frames every 24 months Receive vision services from participating VSP doctors. To view a list of providers, visit VSP s website at * You will be responsible for any additional costs related to cosmetic items such as blended, coated or oversized lenses and designer frames.

7 7 LIFE AND DISABILITY INSURANCE LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT PLAN CHOC provides Life Insurance and Accidental Death & Dismemberment (AD&D) Insurance at no cost to you. Basic Life and Accidental Death and Dismemberment (AD&D) Insurance Coverage is equal to one times your annual base salary with a minimum of $10,000 to a maximum benefit of $50,000 (coverage reduction rules apply if you are age 70 or above) 100% paid by CHOC You may supplement this Life and AD&D coverage by purchasing additional coverage for you, your spouse/ eligible Domestic Partner, or child(ren). VOLUNTARY LIFE AND AD&D INSURANCE PLANS Eligible Associates may purchase additional Life and AD&D insurance for themselves, as well as Life Insurance for their spouse, domestic partner and children. Premiums are deducted on an after-tax basis each pay period. For new Associates or newly eligible Associates, you are pre-approved for amounts up to $100,000. If purchased, coverage will become effective on the first of the month after 30 days of eligibility. Amounts purchased above $100,000 require Evidence of Insurability and will not be effective until approved by the insurance company. For current Associates who waived coverage at initial enrollment, Associates may request enrollment or make changes to existing coverage only during Open Enrollment and Evidence of Insurability is required. Coverage will not be effective until approved by the insurance company. Evidence of Insurability forms can be obtained from the HR/ Department. Associate Life & AD&D Insurance: Insurance may be purchased in increments of $10,000 not to exceed 5 times your annual salary (maximum $500,000). For newly eligible Associates, the guarantee issue amount is $100,000 if purchased within 30 days. Coverage reduction rules apply if you are age 70 or above. Spouse Life & AD&D Insurance: If you purchase supplemental Life insurance for yourself, then you may purchase supplemental Life insurance for your spouse/eligible Domestic Partner (DP) in increments of $5,000 not to exceed 50% of the amount purchased for yourself (maximum $250,000). For newly eligible Associates, the guarantee issue amount is 50% of the Associate amount purchased (maximum $50,000). Coverage reduction rules apply if your spouse is age 70 or above. Child Life Insurance: If you purchase supplemental Life for yourself, then you may purchase coverage for your child(ren) in increments of $2,000 not to exceed $10,000. Coverage reduction rules apply for children less than 14 days of age. Premiums: Premiums for the supplemental Life and AD&D plans are determined based upon your age, the age of your spouse/dp (if supplemental insurance purchased for spouse/dp) and the amount of insurance purchased. The premium for the supplemental child insurance is based upon the amount purchased and is the same if you cover one child or more. Premiums are deducted from each paycheck with after-tax dollars. LIFE INSURANCE

8 8 DISABILITY INSURANCE In addition to the California State Disability Insurance plan that all Associates participate in by California State law, CHOC offers you the opportunity to supplement your disability coverage by purchasing Short-Term Disability and/or Long-Term Disability insurance. Voluntary Short-Term Disability (STD) Insurance Pays a benefit after you are disabled for 14 calendar days or more. The benefit amount equals 60% of your weekly earnings up to a maximum of $1,000 per week for 24 weeks. The benefit amount will be REDUCED by any payments from California State Disability Insurance (SDI) and/or other income benefit payments. The premium is calculated based on your base annual salary and age. Premiums are deducted each pay period with after-tax dollars. To enroll, you must enroll during Open Enrollment and provide Evidence of Insurability. Coverage will not be effective until approved by the insurance company. Evidence of Insurability forms can be obtained from the HR/ Department. If you are a new Associate or are newly eligible for benefits, Evidence of Insurability will be waived if you elect this coverage within the first 30 days you become eligible. Coverage will then be effective on the 1st of the month following 30 days of employment. Voluntary Long-Term Disability (LTD) Insurance Pays a benefit after you have been totally disabled for six (6) consecutive months (180 days). The benefit amount equals 60% of your monthly earnings up to a maximum of $5,000 per month. The benefit amount will be REDUCED by any payments from California State Disability Insurance and/or other income benefit payments. The premium is calculated based on your base annual salary and age. Premiums are deducted each pay period with after-tax dollars. To enroll, you must enroll during Open Enrollment and provide Evidence of Insurability. Coverage will not be effective until approved by the insurance company. Evidence of Insurability forms can be obtained from the HR/ Department. If you are a new Associate or are newly eligible for benefits, Evidence of Insurability will be waived if you elect this coverage within the first 30 days you became eligible. Coverage will then be effective on the 1st of the month following 30 days of employment. FLEXIBLE SPENDING ACCOUNTS (FSA) CHOC offers two Flexible Spending Account Plans, the Health Care Flexible Spending Account and the Dependent Care Flexible Spending Account. FSA plans save you money on health care and dependent care expenses by allowing you to pay for IRS-approved expenses through payroll deduction of pre-tax dollars. The election you make remains in effect for the entire calendar year. Mid-year enrollment or changes can only be made in the case of a Qualifying Event. To participate in the FSA plans, you must enroll at the beginning of each calendar year or during initial enrollment (new hire or newly eligible). Participation does not carry over from one calendar year to the next. INSURANCE

9 9 Health Care Flexible Spending Account (HCFSA) Estimate the annual cost of the out-of-pocket medical, dental, and vision expenses for you and your eligible dependents. The amount you elect will be deducted in equal payments from each paycheck during the calendar year. Minimum annual election of $52.00 to a maximum annual election of $3,000 per year. Dependent Care Flexible Spending Account (DCFSA) Estimate the annual cost of dependent care expenses. The amount you elect will be deducted in equal payments from each paycheck during the calendar year. Eligible expenses include dependent care expenses for children under the age of 12 or elder/adult day care expenses when both you and your spouse work or attend school full-time. Minimum annual deduction of $52.00 to a maximum annual election of $5,000 per year. CHOC 403(B) RETIREMENT SAVINGS PLAN The CHOC 403(b) Retirement Savings Plan is a plan designed to help you achieve your retirement goals. The 403(b) plan includes Associate contributions and CHOC matching contributions for those Associates that meet the eligibility. Associate contributions are made on a pre-tax basis and elections are made as a percentage of pay each pay period. Associates can contribute to the plan immediately upon hire and may enroll at any time during the year. Upon meeting the eligibility requirements, CHOC will match the Associates contributions based on years of service: 1-5 years of service: 50% match on the first 4% the Associate contributes 6-9 years of service: 100% match on the first 3% the Associate contributes 10+ years of service: 200% match on the first 3% the Associate contributes Eligibility for matching contributions is met when an Associate has worked 1,000 hours in his/her first year of service (12 consecutive months). You may choose from among several mutual plans as investment options for both your contributions and the matching contributions. AIG Retirement representatives will be available in the cafeteria to assist you in enrolling in the plan or making changes to your current participation. A schedule of visits by our AIG Retirement Representatives can be found on PAWS. SAVINGS

10 10 PAID TIME OFF (PTO) AND HOLIDAYS CHOC provides you with Paid Time Off (PTO) benefits to be used for holidays, vacations, sick days, personal days, or leave of absence. Eligible Associates accrue PTO hours each pay period. Eligibility: Full-time and regular part-time Associates scheduled to work a minimum of 40 hours per pay period (20 hours per week). Accrual: Associates accrue hours each pay period based on hours worked and years of service. Total PTO hours accrued cannot exceed 480 hours at one time. Accrual for Full-Time Associates is as follows (regular part-time Associates accrual is prorated based on actual hours worked). Non-Management Full-Time Accrual Schedule (1.0 FTE) Length of Service Earnings Per Pay Period 0 3 months hours 4 months through the end of the 4th year hours 5 years through the end of the 9th year hours 10 years and over hours Non-Management Regular Part-Time Accrual Schedule (.5-.9 FTE) Length of Service Earnings Per Pay Period 0 3 months hour for every hour paid up to max hrs 4 months through the end of the 4th year hour for every hour paid up to max hrs 5 years through the end of the 9th year hour for every hour paid up to max hrs 10 years and over hour for every hour paid up to max hrs Holidays: PTO is used for days the hospital observes or any other day that your department closes in observance of a holiday. Associates who are required to work on one of the following national holidays will receive one and one-half times the regular rate of pay for hours worked: New Year s Day (7:00 p.m. 12/31 through midnight 1/1) Memorial Day (7:00 p.m. the day before to midnight the day of the holiday) Fourth of July (7:00 p.m. 7/3 through midnight 7/4) Labor Day (7:00 p.m. the day before to midnight the day of the holiday) Thanksgiving Day (7:00 p.m. the day before to midnight the day of the holiday) Christmas Day (7:00 p.m. 12/24 through midnight 12/25) HOLIDAYS

11 11 OTHER BENEFITS AND PROGRAMS These are only a few of the many benefits available to CHOC Associates. Please contact Human Resources for more information. EMPLOYEE ASSISTANCE PROGRAM CHOC provides a free confidential counseling program to all Associates and their immediate family members. The Employee Assistance Program (EAP) provides one to three sessions, per problem, per calendar year by an on-site EAP professional. Please contact Human Resources for more information. 24 HOUR FITNESS CHOC has purchased a corporate benefit with 24 Hour Fitness so that our Associates and their families can join for a discounted monthly rate. A rate schedule can be found on PAWS under the Human Resources, page. You can take your CHOC ID badge to any 24 Hour Fitness facility and receive the CHOC Corporate discount rate. AETNA SPECIAL PROGRAMS For those Associates who enroll in an Aetna Medical plan, Aetna offers the following resources and discount programs. To find out more, visit Aetna s website at Discounted rates at health clubs within the GlobalFit network. Informed Health Line 24/7 access to speak to a nurse Alternative Health Care Programs Chiropractic, Acupuncture, Massage Therapy, Nutritional Counseling, Natural products discounts Hearing discount program Vision One discount program Wellness and Prevention Programs Member Health Education Reminders, Healthy Outlook Program, Weight Management Discount Program with Jenny Craig Moms to Babies Maternity Management Program Disease Management Program Discount on Sonicare toothbrushes and Epic Dental products Aetna Navigator Member Website Review your benefits, check on claims, print your health history report, communicate with Member Services, change your PCP, replace your ID cards DISCOUNT OPPORTUNITIES AVAILABLE TO ASSOCIATES In addition to free parking for our Associates, several discounted items or services are also available. Please contact Human Resources for information and current programs. Membership at the Health Associates Federal Credit Union Discounts on movie tickets (purchase in the Gift Shop) Discounts to various theme parks (pick up coupons in Human Resources) Discounts from Verizon Wireless

12 choc BENEFITS 455 South Main Street Orange, CA (714) Medical Center Road Mission Viejo, CA (949) /2008