2014 Employee Benefits Guide

Transcription

1 2014 Employee Benefits Guide

2 Table of Contents Your MaineHealth Employee Benefits...1 Eligibility and Enrollment...2 Health Plans: Overview...4 Tobacco Testing...5 Health 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 Disability Coverage Employee Discount Program Worldwide Emergency Travel Assistance Services College Savings Plans Benefits Plan Documents and Forms Benefit Plan Contacts Enrolling Online: The MaineHealth Benefits Portal Step-by-Step Enrollment Instructions Health Care Reform in Legal Notices Your Employee Benefits Guide has been prepared to help you make benefit enrollment decisions for yourself and your family. 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 2014 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 Solutions 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 Yes No Voluntary Life 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 or until you have a qualified life event or status change. First day of the month on or after your first day of work Transit FSA Yes No You can contribute to this account within the first 31 days of employment or at any time after that. Health Savings Account (HSA) Yes Yes, if you enroll in the Healthy Saver Plan You can open your HSA during your enrollment process or any time after that. 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 or 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 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 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? You can participate in the MaineHealth benefit programs if you hold an approved benefits-eligible position and are regularly scheduled to work 20 or more hours per week. Per diem employees can participate in the Employee Discount Program. 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 definition of 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 from individual coverage to employee/ child(ren) or family coverage 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 Dependent starting a new job Starting or coming back from an unpaid leave of absence A change in employment status that affects your eligibility 3

6 Health Plans: Overview MaineHealth sponsors three health plans: the Healthy Saver Plan, the Healthy HMO Plan and the Basic Plan. All three 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. All three plans meet the guidelines under the Health Care Reform law. Healthy Saver Plan Healthy HMO Plan Basic Plan Consumer-driven health plan (CDHP) design; compared to HMO, you ll pay less out of each paycheck and more out of pocket at the time you receive services Includes a tax-advantaged Health Savings Account with a MaineHealth contribution WOW! Rewards deposited to HSA Lowest 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 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 Consumer-driven health plan design Includes a tax-advantaged HSA with no MaineHealth contribution Highest payroll deductions Highest upfront annual deductible and out-of-pocket maximum Does not require you to select a PCP or to get referrals for care Can receive care from physicians and facilities either in-network or out-of-network 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 health plan offerings. Employees who take action to manage their health status have more choice of health plans. Employees who demonstrate that they are living tobacco free pay less for health insurance. Here s how it works. Each year, benefits-eligible employees must: Complete the WOW! Rewards process, which includes a fasting health screening and online health assessment, to be eligible to enroll in the Healthy Saver Plan and the Healthy HMO Plan the following year. Test negative for tobacco use to avoid paying a $1,200 annual tobacco fee ($46.16 per paycheck) in addition to their 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 the Healthy Saver Plan and the Healthy HMO Plan this year. In future years, you will be required to participate in WOW! Rewards to maintain your eligibility for these plans. You must test tobacco free within 60 days of your effective date of coverage in the MaineHealth health plan to avoid paying the tobacco fee. 4

7 Tobacco Testing After you enroll in a MaineHealth health 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). 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 health plan, you will pay $46.16 more biweekly for MaineHealth health insurance in 2014, no matter which health plan you choose. You can get the tobacco test done for free at one of the MaineHealth NorDx facilities. See for a list of testing locations. 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 2014 WOW! Rewards participation period or during the February 2015 rescreening period and have the fee removed in January Our goal is to help you live tobacco free. See pages 12 and 28 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 health plan: 1. Enroll in a health plan. 2. Wait 7-10 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 health plan, you do not need to test for tobacco use. 5

8 Health Plans: A Closer Look Healthy Saver Plan Healthy HMO Plan Basic Plan How Plan Pays Benefits Preferred Participating or Preferred Participating Network Out-of-Network Network Network In-Network Out-of-Network Office Visit Charges Subject to deductible Apply to the out-ofpocket maximum: Copays: $15 PCP / $30 Specialist Apply to the out-ofpocket maximum: Copays: $30 PCP / $60 Specialist Subject to deductible Calendar Year Deductible $1,500 Employee Only Contract $3,000 Employee + Dependent(s) Contract Aggregate Combined across networks Applies to all services including pharmacy $150 Individual $300 Family Accumulative No cross-tier accumulation $300 Individual $600 Family Accumulative No cross-tier accumulation $2,000 Employee Only Contract $4,000 Employee + Dependent(s) Contract Aggregate Combined across networks Applies to all services including pharmacy Your Coinsurance (The amount you have to pay after Calendar Year Deductible is met) 0% 30% 10% 30% 30% 50% Out-of-Network Coverage Available No coverage for Out-of-Network services, unless authorized by Anthem and unavailable In-Network Available Prescription Drug Coverage <30 day supply >30 day supply Copays apply after deductible is met:* Tier 1 Tier 2 Tier 3 $10 $30 $45 $20 $60 $90 Copays always apply: Tier 1 Tier 2 Tier 3 $10 $30 $45 $20 $60 $90 Copays apply after deductible is met: Tier 1 Tier 2 Tier 3 $10 $30 $45 $20 $60 $90 (Apply to out-of-pocket maximum) (Do not apply to out-of-pocket maximum) (Apply to out-of-pocket maximum) Calendar Year Out-of-Pocket Maximum $3,000 Employee Only Contract $6,000 Employee + Dependent(s) Contract $1,650 Individual $3,300 Family $3,300 Individual $6,600 Family $4,000 Employee Only Contract $8,000 Employee + Dependent(s) Contract Pre-Tax Savings Opportunity Yes; Health Savings Account Yes; Healthcare Flexible Spending Account Yes; Health Savings Account Annual MaineHealth Contribution $250 Employee Only Contract $500 Employee + Dependent(s) Contract None None Employee Contributions Elect payroll deductions to HSA at enrollment; can change at any time in 2014 After-tax lump sum contributions at any time, which may be deducted when you file your tax return Elect payroll deductions to FSA at enrollment; cannot change in 2014 unless qualifying event or family status change Elect payroll deductions to HSA at enrollment; can change at any time in 2014 After-tax lump sum contributions at any time, which may be deducted when you file your tax return 2014 Contribution Limit** $3,300 Employee Only Contract $6,550 Employee + Dependent(s) Contract Employees age 55+ may contribute an additional $1,000 $2,500 $3,300 Employee Only Contract $6,550 Employee + Dependent(s) Contract Employees age 55+ may contribute an additional $1,000 WOW! Rewards Deposited Pre-Tax Account Balance Rollover to Next Year Yes No No Yes No Yes * For certain preventive medications, copays apply before the deductible is met. ** The annual HSA contribution limit includes employee plus employer contributions. For 2014, the contribution limit is $3,300 for Employee Only coverage and $6,550 for Employee + Dependent(s) coverage. 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 health plans from your Human Resources contact. You can also find them on 6

9 Provider Networks All three of our health plans offer access to quality healthcare providers, hospitals and other healthcare facilities. Depending on the health 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, which means that services are performed within the MaineHealth family or by providers who have a strategic relationship with MaineHealth. Although you may not have a choice as to which physicians provide services, the physicians do have the ability to become strategic partners 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. Preferred Hospitals within the Preferred Network include: Lincoln Health (Miles and St. Andrews campuses) Maine Medical Center MaineGeneral Medical Centers 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 Coastal Women s Health Care Lab NorDx Lab work performed at a Preferred facility or provider will pay at the Preferred benefit level Free Standing Imaging and Surgical Facilities 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 Home Health Providers 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 * 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. 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 above in the Preferred Network) that are part of the Anthem HMO Maine network or Anthem PPO network. In-network (for Healthy Saver and Basic Plans) 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 Out-of-network providers, hospitals and facilities are all those outside of the MaineHealth family and Anthem network. Prescription Drug Benefit All three health plans provide three-tiered coverage for prescription drugs. Tier 1: Generic Tier 2: Formulary Tier 3: Non-formulary 30-day supply $10 $30 $45 >30-day supply $20 $60 $90 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 out-of-pocket maximum. With the Basic Plan, you pay the full cost of all prescriptions until you meet your annual deductible, then you pay copays until you meet the annual out-of-pocket maximum. Once your out-of-pocket maximum is met, there are no copays for the rest of the year. With the Healthy Saver Plan, you pay the full cost of non-preventive 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 a copay even before you meet 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 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. 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. 8 For more information about your prescription drug coverage, the formulary and how to access the mail-order program, contact Anthem at

11 Specialty Pharmacy 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 health plan requires employees to use our specialty pharmacy, Accredo, when purchasing specialty drugs. For more information regarding the use of the specialty pharmacy, please contact Anthem. Paying for Services With the Healthy Saver Plan and the Basic Plan At Your Provider s Office For medical expenses at an in-network provider, show your medical plan ID card but 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. 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 You will pay for prescription drugs at the point of sale. Show your medical plan ID card. 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. 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. 9

12 Deciding Which Plan Is Best for You As you review your health plan options, think about cost, cash flow, and your current and future healthcare needs. 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 and Basic 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 and Basic plans, 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 and Basic Plan cover 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 a plan that offers the HSA. 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 and Basic 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. IN AN EMERGENCY: Call the BHCP at for approval within 48 hours of getting emergency care. 10

13 Compare Plans with the bestfit Plan Advisor Tool As you consider your 2014 health plan options, take advantage of the bestfit Plan Advisor tool on the MaineHealth Employee Benefits Portal. To use the tool: 1. Choose a health status for yourself and covered dependents. 2. Enter the care you will use and your coverage level. 3. 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 2014 out-of-pocket costs under the MaineHealth health 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 be healthy and to keep your family healthy. You can get started right away and participate throughout the year. Below is an overview of a just 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, health education classes, community supported agricultural shares 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 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 WOW! Rewards Participating in the WOW! Rewards program provides benefits-eligible employees the chance each year to choose a better health plan and earn cash rewards for meeting healthy targets for blood pressure, weight (as measured by body mass index), blood glucose and cholesterol. To be eligible, you must complete a fasting health screening and an online health assessment during the eligibility period. Details regarding WOW! Rewards are communicated each year. Tobacco Treatment MaineHealth is committed to creating a tobacco-free community. When you are ready to quit, MaineHealth offers resources to help. MaineHealth employees can see tobacco treatment specialists at on-site facilities, where available, at no cost. Call MaineHealth Central Scheduling at (toll-free) or to find a free tobacco cessation class or treatment group near you, or call the Maine Tobacco HelpLine at , which is free to all Maine residents. Access and click on Tobacco Treatment for more information about resources to help you quit. 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. As a part of the healthcare team at your doctor s office, a Nurse Care Manager can assist you with: Nutrition Physical activity Medications Goal setting and action planning Equipment care and use Preventive health Risk reduction Stress management Care coordination Community resource outreach The Care Manager will provide you education and information specific to your health condition and any other identified needs. The Care Manager can meet with you at the doctor s office, at home or over the phone. The Care Management program is available at no cost to you. If you are interested in the program, ask your primary care physician for a referral or call the MMC PHO Care Management Department at 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, the best-selling book Your Pregnancy Week to Week, 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 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. 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. These network dentists 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. Plan Overview Dental Services Annual Deductible When looking for a Participating Dentist on the Delta website, select Premier Plan or PPO type. Plan Pays Annual Maximum $1,500 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) $50 per person up to a maximum of $100 per family 100% (annual deductible waived) 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 80% 50% 50% (annual deductible waived) 2014 Rates 2014 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 2014 Vision Plan Biweekly Rates Coverage Level Pre-tax After-tax Total Employee Only $2.00 $0.00 $2.00 Employee and Spouse/Family $3.40 $0.00 $3.40 Employee and Child(ren) $3.60 $0.00 $3.60 Family $5.40 $0.00 $5.40 Employee and Domestic Partner $2.00 $1.40 $3.40 Employee, Domestic Partner and Domestic Partner s Child(ren) Employee, Domestic Partner and Employee s Child(ren) $2.00 $3.40 $5.40 $3.60 $1.80 $

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. If you enroll in the Healthy Saver Plan or the Basic Plan, you can set up a Health Savings Account through HealthEquity. 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 2014, the total combined limit for your and MaineHealth s contributions is $3,300 for Employee Only coverage or $6,550 for Employee + Dependent(s) coverage. And if you will be age 55+ by Dec. 31, 2014, you can contribute $1,000 more in 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. 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 health 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). 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! 2014 Flexible Spending Accounts Annual Pre-tax Deferral Maximums Healthcare Flexible Spending Account... $2,500 Dependent Care Flexible Spending Account... $5,000* Transit Flexible Spending Account... $1,560 If you enroll in the Healthy Saver Plan or Basic Plan, you may elect an HSA if eligible, but you may not elect a Healthcare FSA. 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 to be eligible dependents for purposes of the Healthcare FSA. Eligible Healthcare Expenses You can be reimbursed for any health, 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 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 contribute a maximum of $2,500 to your Healthcare FSA on a pre-tax basis in 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 * Highly compensated individuals (with an annual base salary over $115,000) are limited to a maximum contribution of $2,000 in

21 The following limitations may apply to some married participants: If your spouse contributes to a Dependent Care FSA with his or her employer, the combined maximum for both of you is $5,000 for any calendar year. Your contribution to your Dependent Care FSA cannot be more than your spouse s earned income. If you and your spouse file separate income tax returns, the maximum you may contribute is $2,500 for the calendar year. Eligible Dependent Care Expenses Dependent care provided in your home, as long as the caretaker cannot be claimed as a dependent on your federal income tax return and is not one of your children under age 19 Dependent care provided outside of your home, including: Licensed nursery schools Summer day camps Legally-approved day care centers for children and disabled adults After school programs Who is Eligible? Dependents who: Live with you Rely on you for financial support Are claimed as a dependent on your federal income tax return Are either a child under the age of 13, or a spouse or other dependent adult who is physically or mentally unable to care for himself or herself Dependent Care Tax Credit The federal dependent care tax credit can be applied up to $3,000 in expenses for one child and $6,000 in expenses for two or more children. The non-refundable amount is determined by multiplying your child care expenses (up to the allowable limit) by a certain percentage, based on adjusted gross income. For example, those making $15,000 can receive a credit equal to 35% of expenses for a maximum tax break of $1,050 for a single child or $2,100 for two or more kids. The credit percentage falls to 20% for families earning $43,000 or more. If you plan to take the tax credit, you cannot use the Dependent Care FSA for that portion of your expenses. You may want to speak with a financial planner or tax adviser to help you decide whether you should enroll in the Dependent Care FSA or take the federal dependent care tax credit, based on your needs. For more information, go to or Transit FSA You may contribute up to $130 per month to this account to use for the cost of mass transit to get to and from work. This includes traveling by: Bus Rail Ferry Van pools You can be reimbursed for fares and tickets. You can also use your Benefits Debit Card to pay for fares if the provider will accept it. Unlike the Healthcare and Dependent Care FSAs, you can carry over unused balances from one year to the next. And, you can enroll, change, or suspend contribution amounts at any time. If you leave employment with MaineHealth, you will forfeit any unused balance in your Transit FSA. 19

22 How You Save Money with Tax-Advantaged Accounts Here is an example of how you can save on taxes by participating in a tax-advantaged savings account such as the FSA or the Health Savings Account described on page 16. This example assumes you earn $36,000 per year and contribute $2,500 to the Healthcare FSA and $5,000 to the Dependent Care FSA. Description With Spending Accounts Without Spending Accounts Annual salary $36,000 $36,000 Pre-tax contribution to Dependent Care FSA $5,000 $0 Pre-tax contribution to Healthcare FSA $2,500 $0 Taxable income $28,500 $36,000 Federal tax withholding* $4,275 $5,400 Social Security (FICA) withholding* $2,180 $2,754 Healthcare and dependent care costs $0 $7,500 Take-home pay $22,045 $20,346 Annual tax savings $1,699 N/A *Assumes a federal tax rate of 15% and a FICA tax rate of 7.65%. This is only an estimate. Please consult your tax advisor. What You Should Know About FSAs Because of the tax advantage offered by these accounts, the IRS imposes strict rules and limitations on how you may use them. The account(s) can be used only for expenses billed during the current plan year of January 1 through December 31. You have until March 31 of the following year to submit claims for expenses you incurred during the previous calendar year. For the Healthcare and Dependent Care FSAs, once you make your elections for a calendar year, you cannot change them until the next annual enrollment. You cannot increase, decrease, or cancel your contributions during the year, unless you have a qualified life event or status change (as described on page 3). You can change your contribution to the Transit FSA at any time during the year. If you have any unused money in your Healthcare FSA or Dependent Care FSA at the end of the year, it is forfeited. This is referred to as the use it or lose it rule, so plan carefully! This use it or lose it rule does not apply to the Transit FSA. If you enroll in the Healthy Saver Plan or the Basic Plan, you may not participate in the Healthcare FSA. You can open a Health Savings Account to pay for health expenses with tax-free dollars. 20

23 Life and Accidental Death & Dismemberment (AD&D) Insurance Basic Life and AD&D Insurance MaineHealth s life insurance program is provided to help you ensure that your family is financially secure in the event of your death. As an eligible employee, you will be enrolled in employer-paid basic life and accidental death and dismemberment insurance equal to one times or two times your annual salary (see certificates of coverage). In the event of an accidental death or dismemberment, you or your beneficiaries may receive an additional amount equal to the total of your life insurance coverage. Voluntary Life Insurance You can elect a greater level of financial protection by purchasing voluntary life insurance. If you elect voluntary life insurance coverage for yourself, you may also purchase coverage for your spouse or domestic partner and dependent children. Salary is defined as your base salary plus dedicated shift differential. For You You may purchase voluntary life insurance for yourself in amounts of $10,000 up to five times your annual salary to a maximum of $500,000. You are guaranteed a coverage amount of $200,000 if you enroll when you are first eligible and have not waived coverage before. Employee Voluntary Life Insurance 2014 Biweekly Rates Your Age as of 12/31/2014 Biweekly Cost per $10,000 of Coverage Non-tobacco Tobacco 0-29 $0.172 $ $0.207 $ $0.282 $ $0.466 $ $0.748 $ $1.280 $ $2.010 $ $2.322 $ $3.893 $ $7.007 $ $ $

24 For Your Spouse or Domestic Partner You can purchase coverage in increments of $5,000. Coverage must be equal or less than the coverage you get for yourself. The maximum coverage amount is $500,000. Spouse/Domestic Partner Voluntary Life Insurance 2014 Biweekly Rates Your Spouse/Domestic Partner s Age as of 12/31/2014 Biweekly Cost per $5,000 of Coverage 0-29 $ $ $ $ $ $ $ $ $ $ $ For Your Dependent Children You can purchase coverage in increments of $2,000. You can purchase coverage up to $10,000 per child, no matter how many children you cover. Child Voluntary Life Insurance 2014 Biweekly Rates Coverage Amount Biweekly Rate $2,000 $0.090 $4,000 $0.180 $6,000 $0.270 $8,000 $0.360 $10,000 $0.450 If you have a salary reduction due to a change in rate of pay or scheduled hours, your voluntary life insurance election will be adjusted so that it does not exceed five times your new annual salary. Any spouse or domestic partner voluntary life insurance amounts will be adjusted as well. 22

25 Evidence of Insurability Evidence of insurability is medical information you may need to provide about the condition of your health before you can be approved for certain levels of life insurance coverage. You will need to complete an evidence of insurability form if: You want to be covered for more than $200,000 for yourself You want your spouse or domestic partner to have coverage greater than $100,000 You did not purchase Voluntary Life insurance for yourself, spouse or child when you were initially eligible and want to enroll during annual Open Enrollment. What You Should Know About Your MaineHealth Life Insurance If you are an employee whose spouse is also employed under the MaineHealth family: You may not elect voluntary life insurance for your spouse. Your spouse must elect this coverage as the employee. Only one of the parents may carry the coverage for your dependent children. If you enroll a totally disabled dependent, coverage will be delayed until the dependent is no longer totally disabled. The effective date of coverage will be delayed if you are not in active employment on the original effective date. You may drop or decrease coverage for yourself or dependents at any time during the plan year. You can only add or increase coverage during annual Open Enrollment or if you have a qualified life event or status change (see page 3). Life Planning Financial & Legal Resources Support When You Need It Most Dealing with the death of a family member is difficult enough even before worrying about the personal, legal and financial decisions that need to be made. That s why MaineHealth s group life insurance through Unum includes Life Planning Financial & Legal Resources. This service provides financial and legal guidance and emotional support for beneficiaries as well as employees and spouses who are terminally ill. Counselors offer customized, objective, personal advice to each covered person. Regardless of their recommendations, the consultants don t receive any commission. For more information, please call the HR Solutions Center at

26 Disability Coverage If you cannot work due to a non-work related injury or illness, MaineHealth provides short-term disability (STD) and long-term disability (LTD) coverage at no cost to you. Coverage is effective as of the first day of the month on or after six months of continuous active employment. Short-term Disability Our short-term disability program replaces up to 60% of your lost income based on your lost hours if you are unable to work, or can only work on a partial basis, because of a disability that is not work-related. This includes the birth of a child. The STD benefit begins after 14 days of non-work-related disability. Days 1 through 3 will be paid at 100% of your pre-disability wages with Paid Time Off (PTO) or Earned Time, if available. Days 4 through 14 will be paid at up to 100% of your pre-disability wages using your Frozen Sick Time or PTO/Earned Time, if available. The STD benefit is paid to you in your regular biweekly paycheck. You may be able to receive 100% of your pre-disability earnings by using your accumulated Frozen Sick Time (if applicable) or PTO/Earned Time along with your STD benefit. The benefit is payable for up to 24 weeks. At that point, Unum will review your claim to determine whether you are eligible to receive long-term disability benefits. Long-term Disability Salary is defined as your base salary plus dedicated shift differential. Our long-term disability program replaces up to 60% of your lost income if you are unable to work, or can only work on a partial basis. The maximum amount you can receive each month is $10,000. LTD benefits begin after either 180 days or the end of STD benefits whichever is later. You will get the LTD benefit in a monthly check from Unum. If you are disabled before age 60, you may be able to receive payment until you turn 65. If you are disabled after age 60, please see the Summary Plan Description for details. Your LTD benefit may be reduced by payments from Workers Compensation, Social Security Disability and other sources of disability income. If you are disabled by a pre-existing condition in the first year you are covered under the LTD program, no benefit will be payable. If you need to open an STD claim, please call , Monday through Friday, 8 a.m. to 8 p.m. 24

27 Employee Discount Program As an employee of the MaineHealth family, you can take advantage of great discounts by showing your employment badge to local vendors and using a Perkscard. Discounts are available for: Auto care Florists Beauty Gyms and fitness centers Cellular services Hearing aid discounts through HearPO For more information, visit Lodging Pet insurance through VPI Restaurants Uniforms Worldwide Emergency Travel Assistance Services Worldwide Emergency Travel Assistance Services protects you in the event of a medical emergency when you are traveling. This program is administered by Unum, and can help you whether you are traveling for business or pleasure, in a foreign land or just 100 miles from home. The benefits include: Guaranteed hospital admission (upon validation of your medical insurance) Emergency medical evacuation Return travel to your home when medically authorized Multilingual services Legal referrals Return of remains if death occurs during travel. For more information, visit College Savings Plans A 529 plan is an educational savings plan meant to help families set aside money for future college costs. NexGen College Investing Plan: Call for more information. College America offered by Virginia 529: Contact any broker or financial advisor authorized to sell American Funds, or call for more details. MaineHealth does not offer payroll deductions for 529 contributions. Benefits Plan Documents and Forms To access the MaineHealth benefits plan documents and benefits forms, go to and go to the Library tab. For information about other benefits such as Paid Time Off, Tuition Assistance and Retirement Plans, please contact your MaineHealth member organization s HR department. 25

28 Benefit Plan Contacts HR Solutions Center Health Insurance Anthem Blue Cross Blue Shield for questions about the Healthy Saver or Basic plans for questions about the Healthy HMO Hospital Admission Preauthorization required Mental Health/ Substance Abuse (All MaineHealth health plans) Preauthorization required For Urgent Care Outside of Maine BLUE Prescription Drug Benefit Anthem for questions about the Healthy Saver or Basic plans for questions about the Healthy HMO Mail Order Prescriptions Prior Authorization Specialty Drugs (CuraScript)

29 Dependent Verification Center Aon Hewitt Employee Health Improvement Works on Wellness WOW! WOW! Rewards Program WOW! Healthy Paybacks Tobacco Treatment Health Information & Resources (WOW Health Coach, Care Management & More) KidsHealth WebMD Health Manager LifeBalance Healthy Pregnancy & Newborns 866-WOW Employee Assistance Program EAP Program LifeBalance ID: mainehealth Password: lifebalance Dental Insurance Northeast Delta Dental Vision Insurance Anthem Blue View Vision

30 Flexible Spending Accounts EBPA Health Savings Account HealthEquity Tobacco Treatment MaineHealth Central Scheduling Maine Tobacco Helpline Health Information MaineHealth Learning Resource Center Other Benefits Employee Discount Program

31 Enrolling Online: The MaineHealth Benefits Portal All benefits-eligible MaineHealth employees will enroll in 2014 benefits online using the MaineHealth Benefits Portal ( the Portal ). The Portal provides easy and convenient access to a variety of resources during your new hire enrollment and on an ongoing basis all year long. Access the Portal to: Enroll in your benefits Get documents and forms such as Summary Plan Descriptions, benefits summaries, rates and vendor information Access helpful tools Link directly to benefits plan websites and resources Make any benefits changes for life events during the year, such as a marriage or birth of a baby Your new hire enrollment must be completed within 31 days of your date of hire using the MaineHealth Benefits Portal at The Portal supports the following browsers: Microsoft Internet Explorer, version 8.0, 9.0 and 10; Mozilla Firefox, Google Chrome and Safari, including Mac, ipad and iphone. We encourage you to keep your browser updated. Important Notice Regarding Dependent Eligibility If you want to cover dependents on your health plan, you will have to demonstrate 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. 29

32 Step-by-Step Enrollment Instructions Follow the steps below to enroll in your 2014 MaineHealth benefits through the MaineHealth Benefits Portal. Step 1: Log In to You ll need to enter your username and password to access the Portal. All usernames and passwords have been set to the following: Username: Enter the first two letters of your first name + the first four letters of your last name + the last four numbers of your Social Security number on the Portal landing page (as shown below). Password: Enter the last four digits of your Social Security number. Your Username will remain the same as long as you work for MaineHealth, even if you transfer among organizations. Enter your username and password and click Log In. Do NOT use the Back button in your Internet browser. This will log you out of the site. To navigate through the site, use the navigation bar located on the left-hand side of the screen. Please note: Your enrollment process is not complete unless you Review and Agree to your elections and receive an on-screen confirmation statement. Step 2: Review the Home Page From the Home Page, click on ENROLL NOW. Enrollment is broken down into the following three steps or tabs. You will follow each step through each tab to make changes or confirm your information on file and choose your benefits for the new plan year. 1. Enter Your Information 2. Select Your Benefits 3. Confirm Step 3: Verify Your Personal Information Please check that all your personal information including your tobacco user status is correct. If you need to make any changes, you can do so directly on the site. However, if you need to make a change to your first name, last name, DOB, gender, home address or work , please contact the HR Solutions Center. Verify that all information is accurate. When done, check I agree at the bottom of the page and click Continue. Please Note: Any field that has an asterisk next to it is required. 30

33 Step 4: Add Your Family Information Please be sure to add all dependents in the Family Information section before proceeding to the next section. To do this, click on the Add dependents >> link. When all your family information is accurate, check I agree and click Continue. Step 5: Answer Key Questions Answer questions about whether you are receiving Social Security benefits or whether your spouse is employed by and eligible for benefits from MaineHealth. Click Continue. Step 6: Make Your Medical, HSA, Dental and Vision Plan Elections You will see a box confirming that if you elect medical coverage through MaineHealth for 2014 but you do not test negative for tobacco use, you will pay a tobacco fee in addition to your payroll deductions for coverage. Click Continue. To start your enrollment, on the Select Your Benefits tab click on the Get Started button. 31

34 From here, you can compare costs across all available plans by choosing your desired tier in the Compare Costs drop-down menu, compare plan details side by side by clicking on Help Me Decide and review details of a specific plan by clicking on the plan name link. Upon making your plan selection, you will be able to waive or cover eligible dependents by checking the box next to each dependent s name. If you wish to add a new dependent at this time, click on the Add Dependent button to be directed to the Family tab to add the dependent. If you are satisfied with your selection, click Save & Continue. Please Note: During the enrollment process, plans that are incomplete, or with no selection, are blue and show no cost. Complete plans are green with checkmarks indicating that you have elected or waived the plan and will show your bi-weekly cost. If you have elected to enroll in the Healthy Saver Plan and are eligible for an HSA, you will be automatically enrolled with a zero contribution election. This is so MaineHealth can deposit your startup contribution. If you wish, you may enter an additional contribution of your own to your HSA up to your annual limit. 32

35 Step 7: Elect Voluntary Life Insurance Coverage These enrollments differ from the medical, dental and vision plans. When choosing these benefits, you will not need to select dependents to be covered, but you will need to choose whether you would like to enroll in the plan and enter a coverage amount. When you are satisfied with your election, click Next. Step 8: Elect Contributions to FSAs Healthcare and Dependent Care To elect the FSA plans and make a contribution, select the radio button next to the plan name and enter your contribution amount in the box provided. When you are satisfied with your election, click Next. When you are satisfied with all your benefits plan elections, click on the Continue button at the bottom of the page. If you have exceeded the guaranteed issue for any of your selected life plans, you will receive a pop-up reminder at this point. 33

36 Step 9: Select a Primary Care Physician Following the plan selection, you may see the Primary Care Information page, depending on the medical plan you choose.you will have to enter the required information and can search for your PCP s ID by clicking on Provider Website. Step 10: Update Beneficiary Information Enter your life insurance beneficiary assignments to total 100%. When done, click Continue. If you would like to add another beneficiary, click on Add Beneficiary to be directed to the Beneficiary Maintenance page. 34

37 Step 11: Review and Agree to Your Elections You will now be on the final review page. Review all your benefit elections and covered dependents. Once you ve completed your enrollment, check the I agree to the changes I ve made and I m done with my enrollment box at the bottom of the page and then click the Save My Enrollment! button at the bottom of this page. Please Note: If you are enrolling in the Unum Life Insurance plans and are subject to evidence of insurability (EOI), once you click on Save My Enrollment, you will be automatically linked to Unum s website to complete an online EOI form and submit it directly to Unum. Dependent Eligibility Verification MaineHealth routinely conducts an eligibility audit on all employees with dependents enrolled in the health plan. The audit requires employees to provide documentation verifying their dependents status. If you are enrolling new dependents under the health plan, you will be required to provide proof of your dependents eligibility. Our Dependent Verification Center will mail a packet to your home shortly after enrollment with specific details on the documents needed from you. 35

38 Step 12: Receive Your Confirmation You will be able to change your elections as many times as you like until the enrollment period ends. If you would like to make a change after receiving your confirmation, you will need to start the enrollment process from the beginning. Your changed elections will not be saved until you receive a new confirmation. After you agree to your elections, you will receive an on-screen confirmation. We highly recommend that you send yourself an confirmation of your elections. To do so, click on the icon on the New Elections page after making your election. If you don t have an address in the system, please print out the confirmation page before you leave the site by clicking on the Printer icon. Questions If you have any benefits-related questions that cannot be answered on this website or if you are having trouble signing on to the Portal, please call the HR Solutions Center at If you forget your password, click on Forgot Password on the Log In page of the Portal. Please Note: Although the online benefits enrollment site is a secure site, and your information is encrypted during transit, it is important that you log off when you have completed your session. Click the Log Out icon in the upper right-hand corner of the enrollment site to log off. For security purposes, the system will automatically log you out if you are idle for more than 30 minutes. 36

39 Health Care Reform in 2014 Two key provisions of the Health Care Reform law are effective on January 1, 2014: the Individual Mandate and the introduction of the Health Insurance Marketplace. Individual Mandate Under the Individual Mandate provision, you must have health insurance as of January 1, 2014 or pay a federal tax penalty. You can get your insurance through MaineHealth if you are eligible, a spouse s or domestic partner s plan, a parent s plan (if you are under age 26), the government, or through a new state Health Insurance Marketplace. If you are eligible for and enroll in a MaineHealth health plan, you will meet the Individual Mandate requirement. Health Insurance Marketplace Want to Know More? To learn more about the new Health Insurance Marketplace and Health Care Reform, access or call You can also access or call for more information. The Health Insurance Marketplace, or public exchange, is a place that people can buy health insurance. A Marketplace is available in each state. All Americans can purchase health insurance through a Marketplace, but if you are a benefits-eligible employee, the MaineHealth health plans are likely to be the more cost-effective option. The legally required Marketplace Notice on pages offers more information about the Marketplace and the availability of tax credits. 37

40 Legal Notices New Health Insurance Marketplace Coverage Options and Your Health Coverage PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers one-stop shopping to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn t meet certain standards. The savings on your premium that you re eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the minimum value standard set by the Affordable Care Act, you may be eligible for a tax credit. 1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution as well as your employee contribution to employer-offered coverage is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact The MaineHealth HR Solutions Center at 229 Vaughan Street, Portland, Maine or The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. 1 An employer-sponsored health plan meets the minimum value standard if the plan s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. 38

41 PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. 3. Employer name: MaineHealth 5. Employer address: 110 Free Street 4. Employer Identification Number (EIN): Employer phone number: City: Portland 8. State Maine 9. ZIP code: Who can we contact about employee health coverage at this job? The MaineHealth HR Solution Center 11. Phone number (if different from above): address: Here is some basic information about health coverage offered by this employer: As your employer, we offer a health plan to: All employees. Some employees. Eligible employees are: Employees in an approved benefits-eligible position and regularly scheduled to work 20 or more hours per week. With respect to dependents: We do offer coverage. Eligible dependents are: Legal spouse; Domestic partner; Children under age 26 this includes your biological children, stepchildren, domestic partners children and legally adopted children. Also includes legal wards and legally placed foster children- up to age 26, who live with you; Children of any age, who are unmarried, principally dependent on you for support, and incapable of self-sustaining employment because of physical or mental disability; Children who are unmarried and become eligible for medical coverage under the terms of a Qualified Medical Child Support Order (QMCSO). We do not offer coverage. If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount. If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Employer information you ll need when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums can be requested by contacting the MaineHealth HR Solutions Center at

42 Premium Assistance under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. 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 for either of these programs, you can contact your State Medicaid or CHIP office or dial 877-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, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at or by calling toll-free EBSA (3272). If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, You should contact your State for further information on eligibility ALABAMA Medicaid Website... Phone ALASKA Medicaid Website... Phone (Outside of Anchorage) Phone (Anchorage) ARIZONA CHIP Website... Phone (Outside of Maricopa County) Phone (Maricopa County) IDAHO Medicaid and CHIP Medicaid Website... Medicaid Phone CHIP Website... CHIP Phone COLORADO Medicaid Medicaid Website... Medicaid Phone (In state) Medicaid Phone (Out of state) FLORIDA Medicaid Website... Phone GEORGIA Medicaid Website... Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone MONTANA Medicaid Website... clientindex.shtml Phone INDIANA Medicaid Website... Phone IOWA Medicaid Website... Phone KANSAS Medicaid Website... Phone KENTUCKY Medicaid Website... Phone LOUISIANA Medicaid Website... Phone MAINE Medicaid Website... public-assistance/index.html Phone TTY MASSACHUSETTS Medicaid and CHIP Website... Phone MINNESOTA Medicaid Website... Click on Health Care, then Medical Assistance Phone MISSOURI Medicaid Website... hipp.htm Phone OKLAHOMA Medicaid and CHIP Website... Phone NEBRASKA Medicaid Website... Phone NEVADA Medicaid Medicaid Website... Medicaid Phone

43 NEW HAMPSHIRE Medicaid Website... Phone NEW JERSEY Medicaid and CHIP Medicaid Website... humanservices/dmahs/clients/ medicaid/ Medicaid Phone CHIP Website... CHIP Phone NEW YORK Medicaid Website... Phone NORTH CAROLINA Medicaid Website... Phone NORTH DAKOTA Medicaid Website... Phone UTAH Medicaid and CHIP Website... Phone VERMONT Medicaid Website... Phone OREGON Medicaid and CHIP Website Phone PENNSYLVANIA Medicaid Website... Phone RHODE ISLAND Medicaid Website... Phone SOUTH CAROLINA Medicaid Website... Phone SOUTH DAKOTA Medicaid Website... Phone TEXAS Medicaid Website... Phone VIRGINIA Medicaid and CHIP Medicaid Website... Medicaid Phone CHIP Website... CHIP Phone WASHINGTON Medicaid Website... premiumpymt/apply.shtm Phone ext WASHINGTON Medicaid Website... Phone ext WEST VIRGINIA Medicaid Website... Phone , HMS Third Party Liabilit WISCONSIN Medicaid Website... Phone WYOMING Medicaid Website... equalitycare Phone To see if any more States have added a premium assistance program since July 31, 2013, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services , Menu Option 4, Ext Women s Health and Cancer Rights Act of 1998 Requires Coverage for Reconstructive Surgery After Mastectomies The Women s Health and Cancer Rights Act of 1998 requires health plans that provide medical and surgical benefits for mastectomies to also provide benefits for the following, as requested by the patient in consultation with her physician: 1. Reconstruction of the breast on which the mastectomy has been performed 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance 3. Prostheses 4. Treatment of physical complications of all stages of the mastectomy, including lymphedemas. You and your covered dependents will receive these benefits if needed. Benefits are subject to the same deductibles, copayments, coinsurance or limitations that may apply to other covered services under your plan. Please contact your healthcare contract administrator if you have any questions or concerns. The telephone number is located on the back of your health plan ID card. 41

44 2014 Employee Benefits Guide

45 Pen Bay Healthcare 2014 Health Plan Biweekly Payroll Deduction Rates Rates are based on 26 payroll deductions per year. FULL TIME (35-40 hours) Employee Biweekly Payroll Deduction Under $30,000 - $100,000 - $150,000 - $200, Healthy Saver CDHP Nonsmoker* $30,000 $99,999 $149,999 $199,999 and Over Employee Only $30.21 $36.09 $50.50 $64.92 $79.33 Employee + Child(ren) $71.36 $80.17 $99.05 $ $ Employee + Spouse $ $ $ $ $ Employee + Family $ $ $ $ $ Under $30,000 - $100,000 - $150,000 - $200, Healthy HMO Nonsmoker* $30,000 $99,999 $149,999 $199,999 and Over Employee Only $50.21 $56.09 $70.50 $84.92 $99.33 Employee + Child(ren) $96.36 $ $ $ $ Employee + Spouse $ $ $ $ $ Employee + Family $ $ $ $ $ Under $30,000 - $100,000 - $150,000 - $200, Basic Plan Nonsmoker* $30,000 $99,999 $149,999 $199,999 and Over Employee Only $60.21 $66.09 $80.50 $94.92 $ Employee + Child(ren) $ $ $ $ $ Employee + Spouse $ $ $ $ $ Employee + Family $ $ $ $ $ PART TIME ( hours) Employee Biweekly Payroll Deduction All 2014 Healthy Saver CDHP Nonsmoker* Employees Employee Only $91.00 Employee + Child(ren) $ Employee + Spouse $ Employee + Family $ All 2014 Healthy HMO Nonsmoker* Employees Employee Only $ Employee + Child(ren) $ Employee + Spouse $ Employee + Family $ All 2014 Basic Plan Nonsmoker* Employees Employee Only $ Employee + Child(ren) $ Employee + Spouse $ Employee + Family $ * biweekly will be added as a Tobacco Fee for employees enrolled in a health plan who do not test negative for tobacco.