Indiana University Health Benefits Guide 2014

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1 Idiaa Uiversity Health Beefits Guide 2014

2 Idiaa Uiversity Health Team Member Beefits 2014 Packig luches ad cartig the kids off to school. Puttig i a full day s work. Whippig up dier, the catchig up with family ad frieds. It s all part of the day-to-day routie. The stuff we do each day to meet our resposibilities ad sped some time with the people we love. But ow ad the, the everyday turs ito somethig out of the ordiary. To help you deal with those little icoveieces or big emergecies, Idiaa Uiversity Health offers a beefits package you ca cout o. It s there for you each day to help pay the doctor bills, provide icome if you become disabled ad protect your family with life isurace if somethig should happe to you. IU Health eve offers beefits that help you save moey o healthcare ad depedet day care expeses those little extras that seem to just chip away at your checkig accout. No matter what the day brigs your way, IU Health ca help you meet it head o. With beefits to help out every day, you ca rest easy. table of cotets Erollmet Iformatio Healthy Results IU Health Team Member Wellbeig Program... 4 Medical Isurace Pharmacy Beefits Detal Isurace...10 Visio Isurace...11 Flexible Spedig/Savigs Accouts Life ad Accidet Isurace Short-Term Disability Isurace Log-Term Disability Isurace Accidet ad Critical Illess Isurace Plas Paid Time Off...18 IU Health 401(k) Savigs Pla A...19 Pla Rates

3 Erollmet Iformatio To have the coverage you eed each day, it s importat to uderstad your beefits choices. Before you eroll, you should read through this beefits guide ad discuss your choices with your family. Be sure you have all the facts before makig your fial decisios. To elect beefits, just follow these simple steps. FIND OUT WHO S ELIGIBLE You are eligible for beefits if you are a full-time or part-time team member scheduled to work at least 48 hours per pay period. Depedets eligible for coverage uder your medical, detal ad/or visio plas iclude the followig: Legally married spouse Registered domestic parter Childre* to the ed of the moth of their 26th birthday Ay age adult child who is permaetly ad totally disabled (A permaetly ad totally disabled child must have bee cotiuously covered as a depedet child prior to erollig i a IU Health pla.) *Childre iclude atural or legally adopted (or placed for adoptio) childre of the team member, the team member s legal spouse or the team member s registered domestic parter; childre for whom the team member, the team member s legal spouse or the team member s registered domestic parter is the court-appoited legal guardia; ad childre who are required by a qualified medical child support order (QMCSO) to be covered by the pla. Cotact Huma Resources Shared Services at or toll-free at if you have questios about the eligibility of ayoe you would like to eroll for coverage. PROOF OF ELIGIBILITY Proof of depedet eligibility will be required for all depedets erolled i medical, detal ad/or visio coverage. If you eroll a depedet (spouse or child) i a IU Health medical, detal or visio pla, you will eed to provide proof of eligibility (as outlied below) via fax to Huma Resources Shared Services ( ) or sca to withi 31 days from your origial hire date. Failure to do so may result i the depedet(s) ot beig eligible for IU Health beefits. If you are erollig your spouse i medical coverage, you must also complete ad submit a Questioaire for Medical Coverage of a Spouse/Domestic Parter so a determiatio ca be made o whether the spouse is eligible for primary or secodary coverage uder a IU Health pla. ACCEPTABLE SUPPORTING DOCUMENTATION (All fiacial iformatio ad Social Security umbers should be marked out.) Legal spouse A copy of the first page of the most recetly filed federal icome tax retur Form 1040 that idicates married filig joitly or married filig separately. Your spouse s ame must appear o the lie provided after the married filig separately status. Child/adult child up to age 26 A copy of ay oe of the followig: birth certificate, legal adoptio papers, official court order, legal guardiaship papers or qualified medical support order. Disabled child over the age of 26 A copy of ay oe of the previous acceptable documets for ay child/adult child, the first page of the most recetly filed Form 1040 ad a statemet from a physicia certifyig that the depedet child caot work to provide self-support due to a permaet ad total disability. If acceptable documetatio is ot provided for ay erolled depedet withi 31 days from your origial hire date or status chage, the coverage for that depedet will ot become effective. WORKING SPOUSE/DOMESTIC PARTNER RULE Workig spouses ad registered domestic parters of erolled team members will, i most situatios, be required to joi their employer s group medical coverage for primary coverage. They still may choose to be covered uder a IU Health medical pla for secodary coverage. (Secodary coverage applies oly to claims ot paid by oe s primary health pla.) However, if the workig spouse/domestic parter s employer s pla does ot provide either credible coverage (prevetive care, major medical ad prescriptio) or pay at least 50 percet of the premium for sigle coverage, the the spouse/domestic parter is eligible to eroll i a IU Health medical pla for primary coverage. If the spouse or registered domestic parter is self-employed, retired, uemployed or works for a compay that does ot provide a credible level of coverage, he or she may eroll i IU Health medical plas for primary coverage. Likewise, the IU Health pla will be primary for you ad your erolled spouse/domestic parter if he or she is employed by a IU Health etity. If you ited to provide coverage for a spouse or domestic parter uder a IU Health medical pla, you must complete ad retur the eclosed Questioaire for Medical Coverage of a Spouse/Domestic Parter. You should complete the first page of the questioaire ad if applicable, have your spouse/domestic parter s employer complete the secod page of the questioaire. If your spouse/domestic parter is employed at a o-iu Health etity, verificatio of the availability of coverage by a represetative from that employer is ecessary i order to determie eligibility for primary coverage uder a IU Health medical pla. The form should be retured to Huma Resources Shared Services via fax ( ) or sca to withi 31 days of your official hire date or status chage. The Workig Spouse/Domestic Parter Rule applies oly to medical coverage ad does ot apply to detal, visio or ay other depedet beefits. This provisio does ot affect eligibility for primary coverage uder ay IU Health medical, detal or visio plas for eligible depedet childre. CHOOSE WHAT YOU WANT You choose the beefits that are importat to you ad your family, ad you get help from IU Health to pay for some of them. IU Health pays a large portio of the cost of your medical coverage, half the cost of detal coverage for the basic optio (IU Health will also pay a portio of the cost for the high optio pla.), the full cost of your basic life isurace ad 50 percet of log-term disability coverage. You ca purchase visio, additioal employee ad depedet life, accidet ad short-term disability coverage at a special group rate. As permitted by law, your cost for medical, detal, visio, flexible spedig accouts ad volutary accidet coverage is deducted from your pay o a pretax basis. This saves you moey because you pay o federal, state or local icome taxes or Social Security taxes o the dollars you sped for these beefits. (Please ote that your portio of the premium coverig your domestic parter ad ay eligible o-tax-depedet childre may be paid o a after-tax basis, due to IRS regulatios.) CHOOSE CAREFULLY MID-YEAR CHANGES AREN T GENERALLY ALLOWED The IRS limits chages durig the year because it allows you to pay for most of your beefits o a tax-free basis. You are allowed to make chages to your medical, detal, visio, volutary accidet ad flexible spedig accout beefits durig the year oly if you have a evet that results i a chage i family status. You ca t switch to a differet pla, but you may be able to add or drop coverage ad add or drop depedets. Chages i family status may apply if: You get married, register a domestic parter, divorce, legally separate or termiate a domestic partership Your child or the child of a domestic parter is bor or adopted, or becomes disqualified or requalifies for depedet coverage Oe of your depedets dies You or your spouse/domestic parter has a chage i employmet status that chages eligibility for beefits Your spouse/domestic parter has a chage i beefits coverage durig his/her employer s erollmet period You are startig or edig a strike or lockout You are takig a upaid leave of absece To chage coverage uder oe of these situatios, you must complete the ecessary forms withi 31 days of the evet (60 days i the evet of a divorce/termiatio of domestic partership) ad submit them to Huma Resources Shared Services. Your chage is effective the first of the moth followig the date of the chage i family status. You may oly apply for a icrease i your life isurace (subject to the isurace compay s approval) durig Ope Erollmet. You may drop or decrease your supplemetal ad depedet life isurace coverage at ay time durig the year by completig a cacellatio form. Your chage is effective the first of the moth followig the date GET ANSWERS TO YOUR QUESTIONS If you wat more iformatio about your beefits, refer to your olie IU Health Employee Hadbook (available o Pulse uder Employee Tools), your erollmet materials or cotact Huma Resources Shared Services ( or toll-free at ). MAKE YOUR ONLINE ELECTIONS BY THE DEADLINE Olie erollmet is due o later tha 31 days from your date of hire. Prit your cofirmatio statemet ad check your beefits deductios o your first pay after your beefits effective date. If they do t match, call Huma Resources Shared Services ( or toll-free at ) or your local Beefits office ad they will make the adjustmets. Depedig upo the timig of whe you eroll i your beefits, you may owe retroactive premiums for the pay periods missed. Your coverage will go ito effect o the first day of the moth followig your official hire date, uless approval is required or the pla has a waitig period. THE IU HEALTH ACCOUNTABLE CARE ORGANIZATION (ACO) Accoutable care orgaizatios (ACOs) are desiged to shift focus away from expesive, hospital-based acute care to a model cetered o prevetive care/welless, coordiated patiet care ad disease maagemet. As teams of physicias ad hospitals workig together to achieve higher-quality patiet outcomes, icreased efficiecies ad lower costs, ACOs are resposible for providig care to patiets while meetig various quality ad efficiecy stadards. IU Health became a ACO i July 2012, iitially icludig IU Health Methodist, Uiversity, North, Saxoy ad West hospitals, IU Health Physicias, IU School of Medicie Faculty Physicias, Methodist Sports Medicie ad HealthNet. The orgaizatio is well-positioed to deliver ew patiet-cetered models of care focused o overall health ad welless, which is cosistet with the core values of IU Health. AFFORDABLE CARE ACT (ACA) AND HEALTH INSURANCE MARKETPLACE EXCHANGE The Affordable Care Act (ACA) is implemetig a ew provisio i which idividuals have access to affordable coverage through a ew competitive private health isurace market the Health Isurace Marketplace Exchage. Available to everyoe, the Marketplace Exchage offers oe-stop shoppig to fid/compare private health isurace optios. Visit healthcare.gov to lear more. Marketplace Exchage iformatio for Idiaa ad states where IU Health team members reside is located o Pulse i the Beefits & Retiremet sectio. IU Health offers eligible team members the optio to eroll i a IU Health medical pla. IU Health is providig iformatio about the Marketplace Exchage to team members to fulfill the requiremets of the law. If you are recetly married ad have ot filed a joit 1040, Note: As of Ja. 1, 2014, all U.S. citizes are required to have please provide a copy of your recet valid/legal certificate/ medical isurace coverage through oe of the followig licese, which must iclude date of marriage. sources: employer s beefit pla; isurace compaies; 2 the request is received. Medicare/Medicaid; or the Marketplace Exchage. 3

4 Healthy Results IU Health Team Member Wellbeig Program Idiaa Uiversity Health is committed to providig team members with a healthy eviromet, ad is pleased to provide the followig programs ad services desiged to help you live a healthy life. HEALTHY RESULTS WELLNESS SERVICES ARE AVAILABLE TO ALL TEAM MEMBERS All IU Health team members are eligible for all of the programs ad services offered by Healthy Results, regardless of participatio i a IU Health beefits pla. Healthy Results offers persoal health coachig, tobacco cessatio programs, Weight Watchers at Work ad much more. Participatio i the welless program is completely volutary, ad your iformatio is kept private ad cofidetial. For more iformatio o the IU Health Healthy Results program: Call WELL or toll-free at ; Visit the Healthy Results Welless Portal at Pulse > Resources > Healthy Results; or Sed a to WELLNESS INCENTIVES Ay IU Health team member who erolls i a IU Health medical pla is eligible to ear welless icetive dollars i the form of premium reductios. If you do ot participate i a IU Health medical pla, you are welcome to complete the Health Assessmet to help you kow your umbers ad care for your health. Newly hired team members may complete a Health Assessmet, which cosists of a Health Screeig ad Health Survey, to ear icetive dollars i the form of premium reductios. O-site Health Assessmets are available, ad team members ca sig up olie at Pulse > Resources > Healthy Results or call WELL (toll-free at ) for a appoitmet. A Physicia Optio is also available. If you choose the Physicia Optio, your physicia ca complete the form ad fax it to Healthy Results o your behalf. This form ca be foud at Pulse > Forms > Welless Forms or at Pulse > Resources > Healthy Results. Participatio at ay time i 2014 will also qualify you for icetives i Whe usig the Physicia Optio, team members must also complete the olie health survey i order to be eligible for the welless icetive. The Health Assessmet is your first step to participatig i the Welless Track. IU Health rewards both participatio ad achievig health metrics. To lear more about how to participate ad ear your maximum icetive, please visit the Healthy Results Welless Portal at Pulse > Resources > Healthy Results or call WELL (toll-free at ). Team members who are erolled i a IU Health medical pla ad choose to participate i the Welless Track ca ear up to a maximum premium reductio of $28/pay ($728/year). The icetive structure optios i the form of a premium reductio are as follows: $10/pay ($260/year) by achievig the Broze level* OR $24/pay ($624/year) by achievig the Silver level* OR $28/pay ($728/year) by achievig the Gold level* *Cotact Healthy Results at WELL to fid out how you ca qualify for this icetive level. Frequetly Asked Questios What if I caot atted a screeig? You ca visit your persoal physicia ad have him or her submit the Physicia Optio form to Healthy Results if you are uable to atted a screeig. (Healthy Results will be able to cofirm the icetive amout you will receive.) How ca I ear the maximum icetive? There are may ways to ear the full icetive amout. Visit the Healthy Results Welless Portal at Pulse > Resources > Healthy Results to lear how to ear your full icetive or call WELL for more iformatio. What if I caot meet the health metric? If you take measures to improve your health, you may take advatage of the re-qualificatio opportuities. Healthy Results offers reasoable alteratives to team members who are uable to meet the health metric. Please visit the Healthy Results Welless Portal (Pulse > Resources > Healthy Results) to lear more about your optios. Visit the Healthy Results Welless Portal For iformatio o programs ad services, visit the Healthy Results Welless Portal at Pulse > Resources > Healthy Results. To access other team member wellbeig iitiatives ad resources, go to Pulse > Employee Tools > Wellbeig. Cotact the call ceter for help Call Ceter represetatives are available if you eed assistace. Call WELL (toll-free at ) Moday through Friday from 8 am to 5 pm. Voice mails ca be left after hours or sed a to Medical Isurace IU Health offers eligible team members three differet medical plas. Two Health Savigs Accout (HSA)-based medical plas HSA Medical Pla ad HSA Medical Saver Pla ad a traditioal preferred provider orgaizatio (PPO) pla are available. Team members ca choose their providers ad facilities, with the percetage of care covered by the pla based o where care is received (IU Health, Ecore/PHCS or Out of Network). For all three plas, the highest level of coverage is offered whe IU Health providers ad facilities are used. HSA (Health Savigs Accout) Medical Pla & HSA (Health Savigs Accout) Medical Saver Pla Two HSA-based medical pla optios Plas provide lower premiums for team members willig to accept potetially higher out-of-pocket costs for care Plas offer a tax-advataged savigs opportuity HSA balace carries over year to year Medical care ad prescriptios cout toward out-ofpocket maximum Deductible, coisurace ad out-of-pocket maximums based o where services are received Team member is resposible for full cost of services (icludig prescriptios) prior to meetig the deductible (except for prevetive care services ad prevetive prescriptios) Vice presidets ad above are eligible oly for oe of the HSA plas Fudig Your IU Health HSA IU Health will pre-fud its cotributio to team member HSAs the first pay of the moth i which coverage is effective, i the amouts of: $600* Employee Oly coverage $1,200* Family coverage *Amout will be prorated o a quarterly basis depedig upo whe coverage begis. Q1: Full Amout Q2: $450 Employee Oly/$900 Family Q3: $300 Employee Oly/$600 Family Q4: $150 Employee Oly/$300 Family Team members erollig i oe of the HSA-based medical plas will automatically be erolled i a Accidet ad Critical Illess isurace pla this plus the HSA cotributio made by IU Health may offset the higher deductible. Additioal iformatio about the Accidet ad Critical Illess isurace pla ca be foud o pages Traditioal PPO Medical Pla Deductible, coisurace ad out-of-pocket maximums based o where services are received Copays for medical care ad prescriptios cout toward out-of-pocket maximum The covered perso is resposible for PCP ad specialist office visit copays, ad for 50 percet of out-of-etwork office visits Provider listigs for all the medical pla offerigs are available o the IU Health Plas website at myiuhealthplas.com. This site also icludes summaries about each pla, pharmacy iformatio ad FAQs. The IU Health Plas Customer Service phoe umber is or toll-free at Medical Pla Cost Estimator Tool Team members ca access a olie modelig tool to compare all three medical plas to help determie which medical pla ad coverage optio provides the best value for their idividual situatio. The tool factors i medical premium deductios ad the cost of aticipated healthcare eeds for It also estimates the potetial tax savigs of usig a HSA pla. The Medical Pla Cost Estimator Tool is located at PLAN DESIGN HIGHLIGHTS IU Health recogizes the importace of ecouragig team members to seek ipatiet ad outpatiet care, as well as to purchase prescriptio medicatios withi the orgaizatio. By doig this, IU Health miimizes dollars paid to other healthcare orgaizatios for care that ca be provided withi IU Health facilities. Castlight persoal healthcare tool Team members ad their adult family members (18 years or older) erolled i a IU Health medical pla are eligible to access the Castlight healthcare tool. With Castlight, you ca: Search for earby doctors, medical facilities ad healthcare services based o the price you ll pay ad quality of care. See persoalized cost estimates based o your locatio, your medical pla beefits ad whether you ve already met your deductible. Review step-by-step explaatios of past medical spedig so you kow how much you paid ad why. Read recommedatios about ways to save moey ad fid high-quality care. Become a more savvy healthcare cosumer today go to mycastlight.com/iuhealth to register ow. You also ca call a Castlight Guide at with ay questios. 4 5

5 Medical Isurace cotiued The chart below highlights the deductibles, coisurace differeces ad maximums for the IU Health medical isurace optios. Idividual/Family (Employee & Child; Employee & Spouse; Employee & Family) Aual deductible IU Health = $600/$1,200* Ecore/PHCS = $1,200/$2,400 Out of Network = $1,200/$2,400 Idividual/Family (Employee & Child; Employee & Spouse; Employee & Family) IU Health = $1,500/$3,000 Ecore/PHCS = $2,000/$4,000 Out of Network = $2,500/$5,000 IU Health HSA cotributio N/A $600/$1,200 $600/$1,200 Employee HSA cotributio limits Coisurace for ipatiet or outpatiet treatmet after satisfactio of deductible*** (chart shows the employee s resposibility; pla pays balace of covered charges) Out-of-pocket maximum (OOPM) Office visit copaymet/visit Urget care copaymet/visit Traditioal PPO Medical Pla Idividual/Family (Employee & Child; Employee & Spouse; Employee & Family) IU Health = $2,000/$4,000 Ecore/PHCS = $2,500/$5,000 Out of Network = $3,000/$6,000 N/A $2,700/$5,350** $2,700/$5,350** IU Health = 10% & $250 copay Ecore/PHCS = 30% & $250 copay Out of Network = 50% & $250 copay IU Health = $3,750/$7,500 Ecore/PHCS = $5,500/$11,000 Out of Network = $6,500/$13,000 Deductible, copays ad coisurace apply toward the above out-of-pocket maximum amouts IU Health = $20 copay primary care/$35 copay specialist Ecore/PHCS = $20 copay primary care/$35 copay specialist Out of Network = 50% HSA Medical Pla IU Health = 10% Ecore/PHCS = 30% Out of Network = 50% IU Health = $3,750/$7,500 Ecore/PHCS = $5,500/$11,000 Out of Network = $6,500/$13,000 Deductible, copays ad coisurace apply toward the above out-of-pocket maximum amouts IU Health = 10% Ecore/PHCS = 30% Out of Network = 50% $20 copay IU Health = 10% Ecore/PHCS = 10% Out of Network = 10% HSA Medical Saver Pla IU Health = 20% Ecore/PHCS = 40% Out of Network = 60% IU Health = $4,250/$8,500 Ecore/PHCS = $6,250/$12,500 Out of Network = $7,500/$15,000 Deductible, copays ad coisurace apply toward the above out-of-pocket maximum amouts IU Health = 20% Ecore/PHCS = 40% Out of Network = 60% IU Health = 20% Ecore/PHCS = 20% Out of Network = 20% HSA-based medical plas, Health Savigs Accouts (HSA) ad Limited-Purpose Flexible Spedig Accouts (LPFSA) A HSA-based medical pla is a medical pla that provides lower premiums for team members willig to accept potetially higher out-of-pocket costs for their care. The pla member is resposible for payig the full cost of services for themselves ad their erolled depedets, icludig prescriptios with the exceptio of prevetive care services ad prevetive prescriptios util the aual deductible is met. Oce the deductible is met, the pla begis to pay coisurace based o where care is received. (Coisurace is a cost-sharig feature i which the employee ad the health pla each pay a certai percetage of the cost of care util the employee s out-of-pocket maximum is reached.) HSA plas allow team members to cotribute fuds to a persoal Health Savigs Accout (HSA) o a pretax basis, which ca be used to pay for eligible medical, detal ad visio expeses. Employers are also allowed to make cotributios to employees HSA accouts. IU Health will make a pre-fuded employer cotributio to participatig team members HSA accouts the first pay of the moth i which coverage is effective. The cotributio amout will deped o whether a team member selects the Employee Oly coverage optio or the Family (Employee & Spouse, Employee & Childre or Family) pla, ad will be prorated o a quarterly basis depedig upo whe coverage begis. IU Health will make this cotributio eve if a team member decides ot to cotribute to his or her ow HSA. A team member erolled i a HSA medical pla is resposible for payig the full cost of services for themselves ad their erolled depedets, icludig prescriptios with the exceptio of specific qualified prevetive care services ad prevetive prescriptios util the aual HSA pla deductible is met. Oce the deductible is met, the pla begis to pay coisurace based o where the services are received. If erolled at the family coverage level (Employee & Spouse, Employee & Childre or Family), the full family deductible must be met. The HSA-based medical plas are coupled with a taxadvataged Health Savigs Accout (HSA) to help pay for eligible expeses prior to the deductible beig met. Uused HSA fuds roll over from year to year ad stay with you through retiremet or if you should leave IU Health or o loger participate i the pla. Ulike with a traditioal Health Care Flexible Spedig Accout (FSA), uused HSA balaces are ot lost at the ed of the year. This provides idividuals the opportuity to accumulate fuds for future qualifyig expeses. Oce erolled i the HSA, you will receive a welcome package from JP Morga Chase (the pla admiistrator) with additioal iformatio about your HSA. More iformatio about HSAs ca be foud i the Overview of Flexible Spedig/Savigs Accouts chart o pages Similar to a 401(k) or a 403(b) pla, members ca choose to ivest their HSA fuds (oce their HSA balace reaches $2,000). A itegrated ivestmet platform provided by JP Morga Chase provides members with a seamless ad affordable way to ivest ad grow their HSA dollars. Team members who eroll i oe of the HSA-based medical plas should be aware that oly those reimbursable charges icurred after the HSA effective date are eligible for reimbursemet from the accout. A limited-purpose FSA is available to pay for eligible, o-reimbursed detal ad visio costs. (See page 12 for iformatio o limited-purpose FSAs.) Per federal regulatios, HSA pla members are ot eligible for erollmet i Medicare (Parts A, B, C ad/or D), Medicaid, TriCare or aother pla (i.e. through spouse/ domestic parter s employer) ad may ot participate i a traditioal Health Care Flexible Spedig Accout (FSA). A HSA pla member is ot eligible for erollmet if his or her spouse is erolled i a FSA. I additio, a pla member is ot eligible for a HSA if his or her spouse is erolled i a Health Reimbursemet Accout (HRA) or a Health Icetive Accout (HIA) through his or her employer that may be used to pay the pla member s eligible expeses. ER copaymet/visit for emergecy treatmet (if ot admitted) o-emergecy care at ER is ot covered $200 copay (waived if admitted) IU Health = 10% Ecore/PHCS = 10% Out of Network = 10% IU Health = 20% Ecore/PHCS = 20% Out of Network = 20% For geeral iformatio about the HSA (icludig a complete listig of HSA-qualified expeses), please visit the JP Morga Chase website at chase.com/hsa ad click o the HSA Iformatio ad FAQs lik uder Resources. Physicia etwork IU Health Busiess Solutios Ecore/PHCS Out of Network IU Health Busiess Solutios Ecore/PHCS Out of Network IU Health Busiess Solutios Ecore/PHCS Out of Network Facilities etwork IU Health Busiess Solutios Ecore/PHCS Out of Network IU Health Busiess Solutios Ecore/PHCS Out of Network IU Health Busiess Solutios Ecore/PHCS Out of Network *Deductible waived for full-time team members with base pay less tha $33, i 2014 (IU Health physicia/facility oly). This also pertais to their covered depedets. **Team members age 55 or older may cotribute a additioal $1,000 aually. ***Pre-certificatio is required for most ipatiet ad outpatiet treatmets. 6 7

6 Pharmacy Beefits For several years, team members erolled i a IU Health medical pla have bee able to take advatage of the coveiece ad lower copaymet amouts offered at IU Health retail ad mail-order pharmacies. Expaded weekday ad Saturday hours exist at some locatios, ad you may choose to have 90-day supplies filled (except for Tier 4 drugs) at the coveiet IU Health retail pharmacy sites or make arragemets for mail order. It s easy to trasfer a prescriptio from aother pharmacy. Just call the most coveiet IU Health Pharmacy locatio. If available, please have your Rx umber, ad the IU Health pharmacy will be able to call the out-of-etwork pharmacy ad trasfer the prescriptio for you to fill at the lowest copay available. IU Health has expaded pharmacy optios for employees by addig Kroger pharmacy as a preferred out-of-etwork provider. Team members ca take advatage of additioal pharmacy locatios ad exteded hours of service. IU Health pharmacies offer $4 geerics Ayoe erolled i a IU Health medical pla ca fill a 30-day supply of eligible geeric drugs for $4 ad a 90-day supply for $10 at IU Health ad Kroger pharmacies. The list of eligible geerics ad quatities is available o the IU Health Plas website: myiuhealthplas.com. The table o the ext page shows the cost differeces of covered prescriptios for employees isured uder a IU Health medical pla depedig o whether the employee chooses to have prescriptios filled at a IU Health pharmacy, a preferred out-of-etwork Kroger retail pharmacy or at a o-preferred out-of-etwork retail pharmacy. The copay amouts will apply to the aual out-of-pocket maximum for employees erolled i the traditioal PPO medical pla. For team members erolled i oe of the HSA-based offerigs, the coisurace amouts will apply to both the aual deductible ad the aual out-of-pocket maximum. Team members erolled i oe of the HSA-based medical plas will pay the full cost of their prescriptios for themselves ad their erolled depedets with the exceptio of prevetive prescriptios util the aual HSA pla deductible is met. Oce the deductible is met, the pla begis to pay a percetage based o the pharmacy where the prescriptio is filled. If the prescriptio is a emergecy medicatio, you ca fill your prescriptio at ay local pharmacy, ad i most cases at the lower copay amout. Emergecy medicatios iclude prescriptios writte outside of ormal busiess hours such as at a urget care facility or emergecy room. Emergecy medicatios do ot iclude maiteace medicatios such as for blood pressure or cholesterol. Examples of emergecy medicatios iclude atibiotics for severe ifectios, medicatios to maage severe pai or medicatios for coditios that caot wait util the ext busiess day. Ask the pharmacist at the o-iu Health pharmacy to call whe fillig the prescriptio to get a override for the emergecy medicatio to be filled at the lower IU Health copay. The other optio for i-etwork copays o emergecy prescriptios whe IU Health pharmacies are ot available is to submit a reimbursemet form, which is available at myiuhealthplas.com. For more iformatio about the prescriptio drug beefits, visit the IU Health Plas website at myiuhealthplas.com. O the site, you will fid iformatio about prevetive medicatios, $4 geerics, mail-order or emergecy medicatios, IU Health retail pharmacy ad Kroger pharmacy locatios, alog with other details about this beefit. You will also fid the Pharmacy Call Ceter phoe umber ( ) for ay additioal questios you may have about pharmacy beefits. Here is the copaymet iformatio for covered prescriptios filled at a IU Health retail pharmacy, a Kroger pharmacy or at aother retail pharmacy. HSA Medical Pla/ Traditioal PPO Medical Pla* HSA Medical Saver Pla** Tier 1 Preferred Geeric Tier 2 Preferred Brads ad Selected Geerics Tier 3 No-preferred Brads ad Selected Geerics Tier 4 Specialty/Biotech Copaymets for a 30-day supply ad 90-day supply (if available) Preferred I-Network IU Health Pharmacy: $10 for 30-day supply; $25 for 90-day supply $15 for 30-day supply; 90-day supply ot available No-preferred Out-of-Network or Other Retail: $25 for 30-day supply; 90-day supply ot available Preferred I-Network IU Health Pharmacy: $30 for 30-day supply; $75 for 90-day supply $35 for 30-day supply; 90-day supply ot available No-preferred Out-of-Network or Other Retail: $50 for 30-day supply; 90-day supply ot available Preferred I-Network IU Health Pharmacy: 30% of cost for 30-day supply ($50 miimum ad $100 maximum); 30% of cost for 90-day supply ($150 miimum ad $300 maximum) 33% of cost for 30-day supply ($60 miimum ad $120 maximum); 90-day supply ot available No-preferred Out-of-Network or Other Retail: 50% of cost for 30-day supply; ($150 miimum ad $300 maximum); 90-day supply ot available Preferred I-Network IU Health Pharmacy: 25% of cost for 30-day supply ($75 miimum ad $170 maximum); 90-day supply ot available 30% of cost for 30-day supply ($75 miimum ad $210 maximum); 90-day supply ot available No-preferred Out-of-Network or Other Retail: Not available Preferred I-Network IU Health Pharmacy: 20% of cost 25% of cost No-preferred Out-of-Network or Other Retail: 30% of cost Preferred I-Network IU Health Pharmacy: 20% of cost 25% of cost No-preferred Out-of-Network or Other Retail: 30% of cost Preferred I-Network IU Health Pharmacy: 20% of cost for 30-day supply (after deductible satisfied) 25% of cost No-preferred Out-of-Network or Other Retail: 30% of cost Preferred I-Network IU Health Pharmacy: 20% of cost 25% of cost No-preferred Out-of-Network or Other Retail: Not available * The amouts will apply to both the aual deductible ad out-of-pocket maximum for team members erolled i the traditioal PPO medical pla. **For team members erolled i oe of the HSA-based medical pla offerigs, the amouts will apply to both the aual deductible ad the aual out-of-pocket maximum. Team members erolled i oe of the HSA-based medical plas will pay the full cost of their prescriptios for themselves ad their erolled depedets with the exceptio of prevetive prescriptios util the aual HSA pla deductible is met. Oce the deductible is met, the pla begis to pay a percetage based o the pharmacy where the prescriptio is filled util the out-of-pocket maximum is met. 8 9

7 Detal Isurace Visio Isurace Most of your detal care takes place at home, but regular detal checkups ad cleaigs are also importat. That s why IU Health offers two detal plas to help you avoid problems with your teeth ad help pay for repairs if you eed them. HOW THE PLANS WORK You ca select either the basic pla or the high optio pla. IU Health cotributes the same premium amout toward either selectio. The UitedHealthcare Visio pla provides a cotact les beefit, a frame beefit that offers choice, a provider etwork that icludes private practice ad retail chai locatios, ad discouts o refractive eye surgery. The beefits of the pla are greatest whe you use i-etwork providers, which iclude optometrists, ophthalmologists ad retail chai locatios. You ca also go to o-etwork providers ad receive reimbursemet at specific rates. The Delta Detal plas combie the affordable cost of a detal poit-of-service program with the flexibility of a traditioal pla. Delta Detal offers beefits through a etwork of detal care providers to help you save time ad moey. The basic optio pla provides differet levels of coverage based upo whether the detist is a member of the Delta Detal PPO etwork. The high optio pla provides the same level of reimbursemet regardless of whether or ot the detist is i-etwork. The pla offers exams oce a year, ew eyeglass leses or cotact leses oce every 12 moths ad ew frames every 24 moths. There is a $10 copay for the exam ad a $10 copay o materials. Visio I-Network ad No-Network Compariso The followig chart shows the differece betwee the two detal isurace optios. I-Network Beefit No-Network Reimbursemet Basic Optio High Optio Examiatio 100% Up to $40 Delta Detal PPO Detist Premier & No-participatig Detist* Ay Detist* Deductible $50 per perso $75 per perso $50 per perso Maximum pla paymet/ caledar year $1,200 $750 $1,500 Class I Beefits: Prevetive services, sealats, x-rays Class II Beefits: Filligs, crow repairs Periodotic services, root caals, extractios Class III Beefits: Crows, bridges, implats, detures Class IV Beefits: Orthodotic services icludig braces (depedet age limit: to ed of moth of age 19) 100% (deductible does ot apply) 75% 50% 90% 100% (deductible does ot apply) For more iformatio about the Delta Detal pla optios, refer to your olie IU Health Employee Hadbook, cotact Delta Detal s Customer Service departmet by callig or visit deltadetali.com. 50% 50% 80% 80% 50% 50% 50% 50% to lifetime maximum of $1,500 50% to lifetime maximum of $500 50% to lifetime maximum of $1,500 *Whe you receive services from a o-participatig detist, the above percetages idicate the portio of usual ad customary charges that Delta Detal will reimburse. If the charges exceed these amouts, you will be resposible for the differece. Sigle Visio Leses 100% Up to $40 Bifocal Leses (stadard ad progressive/o-lie) 100% Up to $60 Stadard Trifocal/Leticular Les 100% Up to $80 Progressive/No-Lie Bifocals Frame* Basic Progressive Leses covered i full; High-Ed Progressives $40 copay $130 retail allowace with 30% off balace over $130 at participatig providers Up to $60 Up to $45 Elective Cotacts** 100% (12 pairs disposable) Up to $130 allowace less ay fittig ad evaluatio fee Necessary Cotacts** 100% Up to $210 * A frame from a selectio of quality covered frames o display. A predetermied allowace will be provided for frames that are ot covered. ** Participats choose from covered-i-full selectio of more tha 50 differet types of cotact leses from 15 leadig maufacturers. A predetermied allowace will be provided for cotact leses that are ot covered. For more iformatio about the UitedHealthcare Visio pla, refer to your olie IU Health Employee Hadbook, cotact UitedHealthcare s Customer Service departmet by callig or visit myuhcvisio.com. The provider locator feature o the website allows you to idetify providers ear your home. ID cards are ot issued. Team members erollig i this coverage ca visit providers after their effective date ad idetify themselves as members. Like medical ad detal coverage, premiums for the visio pla are withheld o a pretax basis. ID cards are ot issued. Team members erollig i this coverage ca visit providers after their effective date ad idetify themselves as members

8 Flexible Spedig/Savigs Accouts Lookig to save some extra moey? Cosider a Depedet Care, Health Care or a Limited-Purpose Flexible Spedig Accout or a Health Savigs Accout Overview of Flexible Spedig Accouts Depedet Care Flexible Spedig Accout (DCFSA) Go to the IU Health Plas Flex website (ezflexpla.com/iuhealth) to lear about eligible expeses, the reimbursemet process ad to check your accout balace/activity. There are several types of flexible spedig ad savigs accouts available to help you save moey o o-reimbursed medical, detal ad visio expeses. With the exceptio of Depedet Care Flexible Spedig Accouts, the type of accout(s) i which you are eligible to participate is determied by the type of medical coverage i which you are erolled. Accout Eligibility Iformatio Aual Cotributios Ayoe with day care expeses for the followig depedets while you work (ad, if married, while your spouse is at work, is a full-time studet or is disabled): Your childre uder 13 Your depedet who is physically or metally disabled ad icapable of self-care, icludig your spouse or child of ay age Your depedet paret or other depedet who speds at least eight hours a day i your home Eligible depedet care expeses iclude those for care i your home, i a babysitter s home, at a licesed day care ceter or by a relative who is ot your depedet. Use It or Lose It Applies You must use all of the moey i your accout each year or you will forfeit the amout ot used. Maximum: $5,000 Overview of Health Savigs Accouts Accout Eligibility Iformatio Aual Cotributios Health Savigs Accout (HSA) (Oly available for team members erolled i a HDHP, icludig a IU Health HSA-based medical pla) Idividuals (ad their tax depedets) erolled uder aother medical pla that pays first dollar or who are erolled i Medicare, Medicaid, TriCare or aother pla (i.e., through spouse/domestic parter s employer) are ot eligible for the HSA. Go to the JP Morga Chase website (chasehsa.com) to verify your accout effective date, lear about eligible expeses, the reimbursemet process, check accout balace/activity ad to ivestigate ivestmet optios. The same eligible IRS-deductible medical, detal ad visio expeses ot covered uder your isurace plas as listed uder Health Care Flexible Spedig Accout above apply. Fuds i this accout which are cotributed by IU Health ad you (if you choose to do so) ca be used to reimburse expeses icurred i your HSA-based medical pla ad for your portio of the coisurace. Ulike with the Health Care ad Depedet Care Flexible Spedig Accouts, ay uused fuds will roll over util the ext caledar year. I additio, you ca ivest ad grow your HSA. A HSA pla member is ot eligible for erollmet if his or her spouse is erolled i a FSA. I additio, a pla member is ot eligible for a HSA if his or her spouse is erolled i a Health Reimbursemet Accout (HRA) or a Health Icetive Accout (HIA) through his or her employer that may be used to pay the pla member s eligible expeses. Maximums: Sigle coverage $2,700*/team member plus $600** IU Health cotributio Family coverage $5,350*/team member plus $1,200** IU Health cotributio Age 55+ may cotribute additioal $1,000 aually *Team members erollig i oe of the HSA-based medical plas will automatically be erolled i a Accidet ad Critical Illess pla this plus the HSA cotributio made by IU Health may offset the higher deductible. Additioal iformatio about the Accidet ad Critical Illess pla ca be foud o pages **Amout will be prorated o a quarterly basis depedig upo whe coverage begis. Health Care Flexible Spedig Accout (HCFSA) (Not available for team members erolled i a High Deductible Health Pla (HDHP), icludig a IU Health HSA-based medical pla) Go to the IU Health Plas Flex website (ezflexpla.com/iuhealth) to lear about eligible expeses, the reimbursemet process ad to check your accout balace/activity. Eligible expeses iclude ay IRS-deductible medical, detal, visio ad hearig expeses ot covered uder your isurace plas, such as: Medical ad detal deductibles, copaymets ad other out-of-pocket expeses ot paid by your pla Routie eye exams, glasses or cotacts Prescriptio drug copaymets Hearig exams ad hearig aids Adult orthodotia ad TMJ expeses Smokig-cessatio programs Prescriptio icotie withdrawal products Weight loss programs if idividual is diagosed as obese (30+ Body Mass Idex) Over-the-couter medicies ad drugs used to treat curret illess (if your doctor writes a prescriptio) Maximum: $2,500 Reimbursemet Optios for Depedet Care, Health Care ad Limited-Purpose Flexible Spedig Accouts Check IU Health Plas Flex will process check reimbursemets twice a week. Claims received by Tuesday at 5 pm (Easter Time) will be paid that Friday. Claims received by Thursday at 5 pm (Easter Time) will be paid the followig Tuesday. Checks for claim reimbursemet will be mailed to you from the IU Health Plas Columbus, Id., office o the paymet date. Reimbursemet Optios for the Health Savigs Accout You will be issued a debit card ad may order a checkbook to pay for or reimburse yourself for eligible expeses. JP Morga Chase may be cotacted at: T For geeral iformatio about the HSA (icludig a listig of HSA-qualified expeses), please log o to the JP Morga Chase website at chasehsa.com. The miimum check amout is $5 uless the remaiig balace i your accout is less. Use It or Lose It Applies Team members may carry over up to $500 of their FSA balace ito the ext pla year. Balaces above $500 will be forfeited at the ed of the curret pla year. The check stub with your reimbursemet check will show you how much has bee deposited ito your accout ad how much you have used to date. Limited-Purpose Flexible Spedig Accout (LPFSA) (Oly available for team members erolled i a HDHP, icludig a IU Health HSA-based medical pla) Go to the IU Health Plas Flex website (ezflexpla.com/iuhealth) to lear about eligible expeses, the reimbursemet process ad to check your accout balace/activity. Oly eligible IRS-deductible detal or visio expeses ot covered uder these plas ca be reimbursed from this accout. Fuds i a LPFSA caot be used for medical expeses. Use It or Lose It Applies Team members may carry over up to $500 of their FSA balace ito the ext pla year. Balaces above $500 will be forfeited at the ed of the curret pla year. Maximum: $2,500 Direct Deposit Paymets for reimbursemet by direct deposit (ito a checkig or savigs accout) will be processed o a daily basis. There is o miimum amout for claims reimbursed by direct deposit. You ca check your Explaatio of Beefits olie via the IU Health customized IU Health Plas Flex webpage. IU Health Plas Flex may be cotacted at: T or toll-free at Website: ezflexpla.com/iuhealth 12 13

9 Life ad Accidet Isurace A death or serious ijury ca mea some tough times for a family. That s why it s best to be prepared for the uexpected. IU Health helps out by offerig the followig life isurace coverage to give your family some fiacial security ad peace of mid if somethig should happe to you or a covered depedet. Note: You must be actively at work o the date your coverage is scheduled to be effective, or your coverage will ot become effective util you retur to active employmet. BASIC LIFE INSURANCE Team members are automatically erolled i basic life isurace. Coverage is provided to beefits-eligible team members after six moths of service. The etire cost is covered by IU Health. Eligible team members will be isured for 1½ times their base pay, up to a maximum of $150,000. However, you do eed to complete a beeficiary desigatio form. If you do t ame a beeficiary, the isurace compay will pay beefits to your estate, which ca mea a delay of beefits ad extra taxes. You ca obtai a form from the Forms page o Pulse, uder the Beefits & Retiremet sectio. The IRS requires that compay-provided life isurace i excess of $50,000 be cosidered a taxable beefit to employees. If you wat to waive coverage over $50,000 ad avoid the additioal tax, please cotact Huma Resources Shared Services ( or toll-free at ) or your local Beefits office to obtai the proper form. SUPPLEMENTAL LIFE INSURANCE New team members who eroll withi 31 days of their official hire date may elect up to $150,000 of coverage without a statemet of good health. To add supplemetal life isurace, eroll olie ad submit a statemet of good health if you wat more tha $150,000 i coverage. You may chage your beeficiary desigatio at ay time by completig a beeficiary chage form, located o Pulse > Forms > Beefits & Retiremet > Beeficiary Chage for Life Plas. DEPENDENT LIFE INSURANCE You must eroll withi 31 days of your official hire date. There are two levels of depedet coverage (childre ages 21 to 25 must be full-time studets to be covered by this policy): Optio 1 Spouse/domestic parter isured to 50 percet of your IU Health life isurace coverage up to $10,000; each eligible child isured at $3,000 Optio 2 Spouse/domestic parter isured to 50 percet of your IU Health life isurace coverage up to $25,000; each eligible child isured at $7,500 VOLUNTARY ACCIDENT INSURANCE The coverage pays a beefit i the evet of a covered accidetal death or i the evet of certai accidets that result i serious ijury such as the loss of a had or foot, or of oe s sight, speech or hearig as examples. You ca choose amog three coverage optios: employee, spouse or child. (If elected, the child optio covers all eligible depedet childre up to age 21 or up to age 25 if the depedet is a full-time studet.) A reduced beefit of $1,000 would be payable i the evet of the accidetal death of a ewbor child less tha six moths old. Team member coverage is available i $10,000 icremets up to $500,000. Spouse/domestic parter coverage is available i $5,000 icremets also up to $500,000, although team member coverage must also be elected ad the spouse/domestic parter s coverage caot exceed the team member s coverage level. Coverage for childre is available i $2,000 icremets up to $50,000, although team member coverage must also be elected ad the amout of coverage selected caot exceed 50 percet of the team member s elected coverage levels. After your first 31 days of eligible employmet, volutary accidet isurace may oly be chaged or cacelled durig Ope Erollmet. Premiums are pretax deductios. See your olie IU Health Employee Hadbook for additioal details. Geerally, the effective date for your life isurace electios is the first of the moth followig your official date of hire as log as you eroll olie withi 31 days of your official hire date. However, the effective date will be later if the team member or depedet to be covered is disabled, as defied by the isurace compay, o the date coverage would otherwise be effective. Eligible Employees Full-time ad part-time employees scheduled to work at least 48 hours per pay period Short-Term Disability Isurace Eve just a few weeks without a paycheck ca really set you back fiacially. So IU Health offers a volutary short-term disability (STD) isurace pla that replaces a portio of your icome if you get sick or hurt ad caot work. The IU Health short-term disability pla, isured by Uum, allows you to select either 50 percet or 60 percet of your weekly icome. HOW YOU QUALIFY FOR BENEFITS You ca receive a weekly beefit from the pla if you eroll for coverage ad: You are totally disabled due to a o-work-related illess or ijury (as well as pregacy) for 14 days or 30 days depedig o the optio you choose, ad You file a claim for beefits with the isurace compay. To obtai claim filig iformatio, cotact Disability Maagemet withi three days of the start of your disability. Full-time ad part-time employees scheduled to work at least 48 hours per pay period Full-time ad part-time employees scheduled to work at least 48 hours per pay period Who is Covered You Oly You Oly Your spouse/domestic parter ad childre (childre ages 21 to 25 must be full-time studets to be covered by this policy) Cost of Coverage Paid by orgaizatio Paid by you if you elect coverage Beefit Amout Basic Life Supplemetal Life Depedet Life Volutary Accidet ad Dismembermet 1½ times base pay up to $150,000* From $5,000 to $500,000, depedig upo how much coverage you elect Paid by you if you elect coverage Optio 1 Spouse/domestic parter: 50 percet of your IU Health life coverage up to $10,000 Child: $3,000 Optio 2 Spouse/domestic parter: 50 percet of your IU Health life coverage up to $25,000 Child: $7,500 *Physicias ad certai executives receive basic life isurace equal to two times base pay, up to $500,000. You may also qualify for a partial disability beefit if you ve bee totally disabled for four weeks uder this pla (plus your 14-day or 30-day waitig period) ad ca oly retur to work part time because of medical limitatios. WHEN BENEFITS BEGIN AND END Whe you eroll i the pla, you choose either a 14-day or 30-day waitig period optio. If you choose the 14-day optio, beefits will start o the 15th day of your total disability. With the 30-day optio, beefits start o the 31st day of disability. Beefits for illesses ad ijuries cotiue for up to either 22 weeks or 24 weeks, depedig o the waitig period you select. (Disability date for pregacy may vary.) Beefits may ed sooer if: Full-time ad part-time employees scheduled to work at least 48 hours per pay period Your spouse/domestic parter ad childre (childre ages 21 to 25 must be full-time studets to be covered by this policy) Paid by you if you elect coverage $10,000 to $500,000 (you) ad $5,000 to $500,000 (spouse/ domestic parter) ad $2,000 to $50,000 (childre) Beefits are paid oly if you die or are dismembered i a accidet. You ca retur to work part time but choose ot to You fail to submit proof of disability whe asked to Your earigs exceed the amout allowed You must be actively at work o the day your coverage becomes effective ad before the disability occurs. You die 14 15

10 Short-Term Disability Isurace cotiued BENEFIT AMOUNT The STD pla replaces up to either 50 percet or 60 percet of your base pay. With Uum, beefits will be paid weekly (for the previous week) to better help you meet your fiacial resposibilities. The miimum weekly STD beefit is $46.15, the maximum weekly beefit is $1,500. Remember, you ca select a beefit amout of either 50 percet or 60 percet of your weekly base pay. Your beefit amout will automatically chage (icrease or decrease) wheever you receive a chage to your base pay. Your pay is based upo a average of your earigs just prior to your date of disability. COORDINATING STD WITH PAID TIME OFF If you have available Paid Time Off you must use it durig your 14-day or 30-day waitig period. You may receive Paid Time Off alog with your STD beefits (if you have available time) for the first 30 days that you receive your disability paymets. After that, your STD beefits will be reduced by the amout you receive from Paid Time Off or other sources such as Social Security. See your olie IU Health Employee Hadbook for a summary descriptio of the Paid Time Off program or ask your maager. NO TAXES ON YOUR BENEFITS Sice you pay for STD coverage with after-tax dollars from your pay, your STD beefits are ot subject to icome or Social Security taxes. PRE-EXISTING CONDITION LIMITATION If your disability is due to a illess, ijury or pregacy that occurred before your elected STD coverage becomes effective (a pre-existig coditio), o beefits for that coditio are payable for the first 12 moths you are covered uder the pla. These limitatios will o loger apply oce you ve bee treatmet-free for oe year or covered by the pla for oe year, whichever happes first. A pre-existig coditio limitatio also applies to a icrease i your coverage amouts from the 50 percet beefit level to the 60 percet beefit level at a subsequet Ope Erollmet period. COVERAGE IS GUARANTEED Proof of good health is ot required for erollmet or icrease i coverage. You caot be tured dow for coverage. However, remember that pre-existig coditio limitatios apply to your coverage. Beefits cotiue util you become eligible for Medicare or util you are o loger totally disabled, whichever happes first. See your olie IU Health Employee Hadbook for details about maximum beefit periods if you become disabled after age 60. TAXES ON YOUR BENEFITS Sice IU Health pays for your basic LTD coverage, beefit paymets will be subject to federal/state icome taxes ad Social Security taxes. However, sice the buy-up LTD coverage (if purchased) is paid by you as a after-tax beefit, this amout will ot be subject to those taxes. PRE-EXISTING CONDITION LIMITATION You will ot receive beefits for a disability that is caused by or results from a pre-existig coditio if the disability occurs durig the first 12 moths after your coverage begis. A pre-existig coditio is a illess or ijury for which you received medical treatmet, cosultatio, care or services Your Mothly Pay $2,000 x 60 percet Total Disability Beefit Due $1,200 Social Security Beefit - $400 LTD Pla Beefit $800* icludig diagostic measures, or took prescribed drugs or medicies i the 12 moths prior to your effective date of coverage ad the disability begis i the first 12 moths after your effective date of coverage. Pre-existig coditio limitatios apply to both the basic LTD pla ad the optioal buy-up pla. HOW BENEFITS ARE COORDINATED WITH OTHER DISABILITY PAYMENTS Uum coordiates your beefit paymets from this pla with other disability icome you receive so your total paymet is ot more tha 60 percet of your base mothly pay. Here is how it works: Let s say you ear $2,000 per moth ad have bee totally disabled for 180 days. You have basic LTD coverage oly. Let s also assume you receive $400 per moth i Social Security beefits because of your disability. The chart below shows how your beefit would be determied. Sice you receive $400 from Social Security, Uum deducts that amout from the total beefit due to you. Log-Term Disability Isurace *Taxes are applicable to the group beefit but are ot applicable to ay buy-up portio you may receive. You may thik there s ot much chace of ever eedig logterm disability (LTD) beefits, but statistics show that before retiremet, you are much more likely to become disabled tha you are to die. IU Health wats to help you maitai a icome if you ever suffer from a log-term illess or ijury that keeps you out of work. IU Health provides basic LTD coverage (for beefits-eligible employees) at o cost to you. Ad if you wat a higher level of icome protectio, you may purchase buy-up coverage at a later Ope Erollmet period. You become eligible for LTD coverage after oe year i a beefits-eligible positio. However, you may ot eroll for buy-up coverage util the Ope Erollmet period followig the date your basic LTD coverage begis. BASIC LTD Basic LTD replaces up to 50 percet of your base mothly pay, which icludes disability beefits you may receive from Social Security, retiremet plas or workers compesatio. The maximum mothly beefit is $8,333. Your pay is based upo a average of your earigs just prior to your date of disability. BUY-UP LTD You may purchase a additioal buy-up of 10 percet of your base mothly pay oly durig Ope Erollmet followig your first 12 moths as a full-time or part-time beefits-eligible team member. The buy-up replaces up to 60 percet of your base mothly pay (icludig group disability paymets), up to a combied maximum of $10,000 per moth. WHEN BENEFITS BEGIN AND END Beefits uder both plas begi after 180 days of disability. To begi receivig beefits, you ll eed to cotact Disability Maagemet to obtai claim filig iformatio. However, if you re erolled i the short-term disability pla ad you re already receivig STD beefits, you do t eed to file a secod claim for LTD. Uum will cotiue sedig disability beefit paymets to you provided you cotiue to meet the criteria for disability beefits. You are also expected to participate i the retur to work program ad case maagemet should you fid yourself off work due to illess or ijury. Accidet ad Critical Illess Isurace Plas To offset medical pla deductibles ad out-of-pocket expeses, IU Health is providig team members erollig i oe of the HSA-based medical plas for 2014 a Accidet ad Critical Illess pla paid by IU Health. Your erollmet is guarateed,* ad there are o medical questios to aswer you will be automatically erolled. Team members ot erollig i a IU Health HSA-based medical pla may also eroll i the Accidet ad Critical Illess isurace plas; however, the team member will be resposible for premiums. *Team members must be actively at work o the date the coverage is scheduled to become effective, or coverage will ot become effective util they retur to work. Accidet ad Critical Illess isurace may help you be better prepared to take care of out-of-pocket expeses related to a uforesee accidet or critical illess ad to help lesse the fiacial burde of expeses like: Isurace deductibles ad prescriptio copays Out-of-etwork doctor visits Physical or occupatioal therapy Critical Illess isurace is ot iteded to replace your curret medical isurace. Offerig Critical Illess isurace as part of the beefit pla ca help team members protect themselves ad their families if they should face serious illess. It provides a lump-sum paymet of up to $3,000 if you experiece certai covered coditios, such as heart attack, stroke ad various other health coditios. This beefit ca ease the fiacial impact of certai critical illesses by helpig you pay for some of the out-of-pocket expeses, such as meetig your HSA-based medical isurace deductible associated with a covered coditio. Similar to Critical Illess coverage, Accidet isurace complemets your medical isurace coverage by helpig to ease the fiacial impact of a accidet. It provides you with a paymet whe you suffer ijuries resultig from a accidet ragig from fractures, burs ad dislocatios to more severe ijuries ad treatmets. You may use this paymet as you see fit. It is iteded to help you with ay of the out-of-pocket expeses you may icur because of a accidet, such as meetig your HSA-based medical isurace deductible. Alterative therapy 16 17

11 Accidet ad Critical Illess Isurace Plas cotiued IU Health 401(k) Savigs Pla A Paymets are made directly to you, ot your healthcare provider. These two products ca help provide you with a icreased level of fiacial cofidece so you ca focus more o your recovery ad less o your fiaces. Followig is a example showig potetial beefits of Accidet coverage: Kathy s daughter suffers a cocussio durig the soccer game agaist her high school s biggest rival. Care Received After Ijury Beefit Paid Ambulace (groud) $200 Emergecy Care $50 Physicia Follow Up ($50 x 2) $100 Medical Testig $100 Cocussio $200 Broke Tooth (repaired by crow) $200 Total Beefit Accidet Isurace $850 To lear more about the Accidet ad Critical Illess isurace plas, their premiums ad erollmet (Note: Erollmet is automatic if selectig 2014 coverage i oe of the HSA-based medical plas.), cotact MetLife at 800.GET.MET8 ( ) Moday through Friday from 8 am to 11 pm EST or go to aiciisurace.com/iuhealth. Team members ot erollig i a IU Health HSA-based medical pla may also eroll i the Accidet ad Critical Illess isurace plas; however, the team member will be resposible for premiums. Premiums will be paid through coveiet payroll deductios. Team members have the optio to select a Low or High pla for Accidet isurace ad $15,000 of Critical Illess isurace for themselves ad eligible family members. To eroll i or review the Accidet ad Critical Illess isurace plas, go to aiciisurace.com/iuhealth. Your erollmet is guarateed,* ad there are o medical questios to aswer as log as you eroll withi 31 days of your official hire date. *Team members must be actively at work o the date the coverage is scheduled to become effective, or coverage will ot become effective util they retur to work. Idiaa Uiversity Health uderstads the importace of helpig you prepare for your retiremet. Your success i savig for retiremet is a critical part of esurig a more secure fiacial future. The IU Health 401(k) Savigs Pla A: (1) is iteded to help you achieve fiacial security i your retiremet, (2) is structured to give you cotrol over how the moey i your retiremet accout is ivested, (3) offers you a variety of ivestmet optios ad (4) provides tax advatages. Eligibility All eligible* full-time, part-time ad supplemetal team members who are age 21 ad older are immediately eligible to participate i the pla. O your eligibility date, you may start makig cotributios by either goig olie to retireolie.com or callig JP Morga at If you do ot actively eroll i the pla, you will be automatically erolled after 30 days of employmet at a pretax cotributio rate of 4 percet of your eligible compesatio. You may choose to opt out of the pla, chage your cotributio type from pretax to after-tax Roth, or elect to cotribute at a cotributio percetage other tha the automatic 4 percet. Simply go olie or call JP Morga to make these chages. You may make chages at ay time durig the pla year. The 1 percet employer cotributio will be made after the ed of the pla year. Ivestmet Choices The pla offers a variety of ivestmet choices. Detailed iformatio about the pla ad its ivestmet choices will be set to you oce you have bee erolled i the pla. Accout Access You may access your accout by callig JP Morga s toll-free accout iformatio lie at Represetatives are available weekdays betwee 8 am ad 9 pm EST. The TDD umber for employees with a hearig impairmet is You may also log o to the JP Morga website retireolie.com. Password Istructios: Whe accessig the website for the first time, eter your Social Security umber as your userame. Whe you first log o, your temporary password is the last four digits of your Social Security umber ad the two-digit moth ad two-digit date (MMDD) of your birthdate. Example: For someoe with a Social Security umber of ad a birth date of Nov. 1, 1975, the userame would be ad the temporary password would be If you do ot log o to the JP Morga website withi 45 days of hire, you will be required to request a activatio code from JP Morga. *Excludes studets, residets, iters ad fellows. Oce you are logged o, you ca: Paid Time Off IU Health provides a flexible Paid Time Off program for fulltime ad part-time, exempt ad o-exempt team members scheduled to work 48 or more hours per pay period. The Paid Time Off beefit allows you to receive your curret base rate of pay for days off work used for the followig: Six fixed holidays (New Year s Day, Memorial Day, Idepedece Day, Labor Day, Thaksgivig ad Christmas) that use the accrued Paid Time Off balace ad are ot paid separately Persoal busiess Persoal ad family illess Vacatio Additioal iformatio about the IU Health Paid Time Off policy ca be foud i the olie IU Health Employee Hadbook that ca be accessed through Pulse uder Huma Resources. Employee Cotributios You ca cotribute to the pla o a pretax ad/or after-tax basis, up to 75 percet of your eligible compesatio or the Iteral Reveue Service (IRS) limit. The IRS limit for 2014 is $17,500. Pretax cotributios are deducted before you pay curret icome taxes. Earigs o your etire accout, alog with your pretax cotributios, are taxed oly whe you take a distributio from the pla. Roth 401(k) cotributios are after-tax cotributios ad are deducted after you pay curret icome taxes. You ca receive the earigs i your Roth accout tax-free if you have a qualified distributio. Catch-up cotributios may be made if you are age 50 or older. The IRS limit for catch-up cotributios is $5,500 for Employer Cotributios IU Health will make a matchig cotributio equal to 100 percet of the first 4 percet of your cotributios. Matchig cotributios will be made each pay period. Review your accout balace ad ivestmet optios Make or chage your cotributio electios Make or chage your ivestmet electios Update your beeficiary(ies) Vestig You are always 100 percet vested i your pretax ad after-tax Roth cotributios. You are immediately 100 percet vested i the matchig cotributios. You are 100 percet vested i your employer cotributios after three years of vestig service. A year of vestig service equals 1,000 or more paid hours i the computatio year (the period used for determiig W-2 earigs). You are automatically vested if you retire at age 65 or older, if you become totally ad permaetly disabled, or if you die. For more iformatio, or to review a copy of the Summary Pla Descriptio, please refer to the olie IU Health Employee Hadbook o Pulse. IU Health will also make a aual 1 percet employer cotributio if you: work at least 1,000 hours durig the pla year are employed o Dec. 31 of the pla year are a o-physicia team member 18 19

12 Pla Rates Medical Isurace Rates* (Per pay period, 26 of 26 pays) Traditioal PPO Pla HSA Medical Pla HSA Medical Saver Pla Detal Isurace Rates (Per pay period, 26 of 26 pays) Basic Optio High Optio Employee Oly Full-time (.9 to 1.0 FTE): IU Health Pays IU Health Pays IU Health Pays less tha $33, $53.78 $ $40.51 $ $32.52 $ $33, $84, $93.95 $ $77.80 $ $62.46 $ $84, $135, $ $ $80.33 $ $63.93 $ $135,699 $167, (ad part-time.6 to.89 FTE) $ $ $90.68 $ $72.17 $ $167,010 + $ $ $ $ $80.41 $ Employee & Childre Full-time (.9 to 1.0 FTE): less tha $33, $92.44 $ $69.63 $ $55.91 $ $33, $84, $ $ $ $ $ $ $84, $135, $ $ $ $ $ $ Employee Oly FT (.9 to 1.0 FTE) < $33, FT (.9 to 1.0 FTE) > $33, & Part-time (.6 to.89 FTE) Employee & Childre FT (.9 to 1.0 FTE) < $33, FT (.9 to 1.0 FTE) > $33, & Part-time (.6 to.89 FTE) Employee & Spouse/ Domestic Parter FT (.9 to 1.0 FTE) < $33, FT (.9 to 1.0 FTE) > $33, & Part-time (.6 to.89 FTE) Family FT (.9 to 1.0 FTE) < $33, FT (.9 to 1.0 FTE) > $33, & Part-time (.6 to.89 FTE) IU Health Pays IU Health Pays $2.19 $4.57 $6.10 $12.70 $4.86 $10.12 $9.18 $19.12 $6.95 $4.57 $19.31 $12.70 $15.38 $10.12 $29.06 $19.12 $7.15 $9.52 $16.17 $22.77 $15.85 $21.12 $25.18 $35.12 $6.95 $4.57 $19.31 $12.70 $15.38 $10.12 $29.06 $19.12 $135,699 $167, (ad part-time.6 to.89 FTE) $ $ $ $ $ $ $167,010 + $ $ $ $ $ $ Employee & Spouse/ Domestic Parter Full-time (.9 to 1.0 FTE): less tha $33, $ $ $80.28 $ $64.46 $ $33, $84, $ $ $ $ $ $ $84, $135, $ $ $ $ $ $ $135,699 $167, (ad part-time.6 to.89 FTE) $ $ $ $ $ $ Visio Isurace Rates (Per pay period, 26 of 26 pays) Per Pay Employee $3.00 Employee & Childre $5.52 Employee & Spouse/Domestic Parter $5.09 Family $8.01 $167,010 + $ $ $ $ $ $ Family Full-time (.9 to 1.0 FTE): less tha $33, $ $ $ $ $82.13 $ $33, $84, $ $ $ $ $ $ $84, $135, $ $ $ $ $ $ $135,699 $167, (ad part-time.6 to.89 FTE) $ $ $ $ $ $ $167,010 + $ $ $ $ $ $ *Note: Rates may be reduced by the welless icetives eared for those who are participatig i the volutary Welless Track

13 Pla Rates cotiued Supplemetal Life Isurace Rates (Per pay period, 26 of 26 pays after tax) Amout of Age Age Age Age Age Age Age Age Age Age Additioal Coverage $5,000 $.18 $.25 $.28 $.46 $.72 $1.15 $2.01 $2.40 $4.25 $9.46 Log-Term Disability Isurace Rates (Rates per $100 of covered payroll per pay period, 26 of 26 pays after tax) The cost is $0.13 per moth per $100 of covered payroll. For example, if you make $24,000 per year, (which is $2,000 per moth) the optio costs you $2.60 a moth. $10,000 $.37 $.51 $.55 $.92 $1.43 $2.31 $4.02 $4.80 $8.49 $18.92 $25,000 $.92 $1.27 $1.38 $2.31 $3.58 $5.77 $10.04 $12.00 $21.23 $47.31 $50,000 $1.85 $2.54 $2.77 $4.62 $7.15 $11.54 $20.08 $24.00 $42.46 $94.62 $100,000 $3.69 $5.08 $5.54 $9.23 $14.31 $23.08 $40.15 $48.00 $84.92 $ $150,000 $5.54 $7.62 $8.31 $13.85 $21.46 $34.62 $60.23 $72.00 $ $ $200,000 $7.38 $10.15 $11.08 $18.46 $28.62 $46.15 $80.31 $96.00 $ $ $250,000 $9.23 $12.69 $13.85 $23.08 $35.77 $57.69 $ $ $ $ $300,000 $11.08 $15.23 $16.62 $27.69 $42.92 $69.23 $ $ $ $ $350,000 $12.92 $17.77 $19.38 $32.31 $50.08 $80.77 $ $ $ $ $400,000 $14.77 $20.31 $22.15 $36.92 $57.23 $92.31 $ $ $ $ $450,000 $16.62 $22.85 $24.92 $41.54 $64.38 $ $ $ $ $ $500,000 $18.46 $25.38 $27.69 $46.15 $71.54 $ $ $ $ $ Note: Deductios may chage if your age chages or if you select a differet amout. Volutary Accidet Isurace Rates Employee or Spouse/Domestic Parter (Per pay period, 26 of 26 pays pretax) Coverage Level employee or coverage Level employee or spouse/domestic spouse/domestic Parter Pla Parter Pla $10,000 $.10 $260,000 $2.40 $20,000 $.19 $270,000 $2.50 $30,000 $.28 $280,000 $2.59 $40,000 $.37 $290,000 $2.68 $50,000 $.47 $300,000 $2.77 $60,000 $.56 $310,000 $2.87 $70,000 $.65 $320,000 $2.96 $80,000 $.74 $330,000 $3.05 $90,000 $.84 $340,000 $3.14 Depedet Life Isurace Rates (Per pay period, 26 of 26 pays after tax) coverage Choice Optio 1: coverage Choice Optio 2: Spouse/Domestic Parter $10,000; Child $3,000 Spouse/Domestic Parter $25,000; Child $7,500 $.98 $2.44 $100,000 $.93 $350,000 $3.24 $110,000 $1.02 $360,000 $3.33 $120,000 $1.11 $370,000 $3.42 $130,000 $1.20 $380,000 $3.51 $140,000 $1.30 $390,000 $3.60 Short-Term Disability Isurace Rates (Rates per $100 of covered payroll per pay period, 26 of 26 pays after tax) Age optio a optio b optio c optio D 14-day waitig period 14-day waitig period 30-day waitig period 30-day waitig period 50% beefit 60% beefit 50% beefit 60% beefit Uder 55 $.69 $.90 $.51 $ $.87 $1.14 $.64 $ ad over $1.31 $1.71 $.96 $1.24 $150,000 $1.39 $400,000 $3.70 $160,000 $1.48 $410,000 $3.79 $170,000 $1.57 $420,000 $3.88 $180,000 $1.67 $430,000 $3.97 $190,000 $1.76 $440,000 $4.07 $200,000 $1.85 $450,000 $4.16 $210,000 $1.94 $460,000 $4.25 $220,000 $2.04 $470,000 $4.34 $230,000 $2.13 $480,000 $4.44 $240,000 $2.22 $490,000 $4.53 $250,000 $2.31 $500,000 $

14 Pla Rates cotiued Volutary Accidet Isurace Rates Childre (Per pay period, 26 of 26 pays pretax) Coverage Level child Pla coverage Level child Pla $2,000 $.02 $28,000 $.26 $4,000 $.04 $30,000 $.28 $6,000 $.06 $32,000 $.30 $8,000 $.08 $34,000 $.32 $10,000 $.10 $36,000 $.34 $12,000 $.12 $38,000 $.36 $14,000 $.13 $40,000 $.37 $16,000 $.15 $42,000 $.39 $18,000 $.17 $44,000 $.41 $20,000 $.19 $46,000 $.43 $22,000 $.21 $48,000 $.45 $24,000 $.23 $50,000 $.47 $26,000 $.24 PTO Accrual: No-Exempt Team Members FTE Scheduled Hours 0 5 Years of Service 5 10 Years of Service 10 or More Years of Service Hours Days Maximum Hours Days Maximum Hours Days Maximum per pay per year hours/days per pay per year hours/days per pay per year hours/days / / / / / / / / / / / / / / /45 PTO Accrual: Exempt Team Members FTE Scheduled Hours 0 5 Years of Service 5 or More Years of Service Hours Days Maximum Hours Days Maximum per pay per year hours/days per pay per year hours/days / / / / / / / / / /45 24

15 2013 IUHealth 11/13 IUH#15816

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