2015 Employee Benefits Guide

Transcription

1 2015 Employee Benefits Guide

2 I am pleased to present to you Lake Charles Memorial s benefit guide for In this guide you will find valuable information to assist with selecting the plans that are right for you and your family s individual needs. In order to secure your coverage for 2015, you are required to meet with an enrollment counselor during the period of November 11th 21st. Throughout Open Enrollment you have the opportunity to participate in a variety of attractive benefits, including: Medical Insurance Dental Insurance Vision Insurance Basic and Voluntary Term Life Insurance Long and Short Term Disability Wellness Hospital Indemnity Retirement Planning Whole Life Insurance Critical Illness Insurance Accident Insurance Flexible Spending Accounts We are excited to introduce SmartBen this year, a web-based enrollment tool that is a one-stop shop for all of your benefits with Lake Charles Memorial! When you sit with an enrollment counselor this year they will be enrolling you directly onto your SmartBen account. Throughout the year you can view your account, make life event changes to your benefits, see current events posted online, access important documents and much more! Last year we introduced our Get Healthy, Stay Healthy Wellness Program. To incentivize engagement in our wellness program, which promotes healthy lifestyles, our wellness committee structured a points system that would reward your active participation. Your participation has been recorded by WellSteps and those participation points will determine your 2015 medical plan premium as either a Gold, Silver or Bronze participation level. This year we have made minimal changes to your medical benefits, changing only the Out Of Pocket Maximum in accordance with Affordable Care Act guidelines. Beginning January 1, 2015 Lake Charles Memorial will, with a prescription from your physician, cover over-the-counter (OTC) Acid Reflux medications, also referred to as PPI s. Studies and medical experts agree that the OTC and Generic medications for the treatment of Acid reflux work just as well and are just as safe as the brand name prescriptions, but have a much lower retail price. We have made a change in vision insurance carriers for Previously we contracted with AlwaysCare. This year we are changing to VSP, Vision Service Professionals. VSP provides a richer benefit plan than we ve had in recent years while actually lowering your premiums! Lake Charles Memorial Health System takes pride in being able to offer comprehensive and affordable benefits to our employees and values the dedication you all have to the success of our health system. Information about all of the benefits available to you can be found in this Employee Benefits Guide and on the LCMH Intranet. If you have any questions or concerns, please contact your Human Resource Representative. Thank you for being a part of the LCMH family, and we look forward to a successful 2015! Sincerely, Larry M. Graham President 2 We are Memorial. Everything your healthcare should be.

3 2015 employee benefit guide Important Information As You Prepare For Your 2015 Benefit Elections Changing your Benefits During the Year IRS regulations limit when you can make changes to your benefits during the year. Once enrolled, you cannot change your medical, dental or vision coverage, or your FSA elections outside annual Open Enrollment unless you have a permitted change under IRS rules. If you have an eligible change or a question related to an eligible change, contact Human Resources as soon as possible as you only have 30 days from the event to make any changes. Examples of events that may allow you to make benefit changes: Change in Legal Marital Status Change in Number of Dependents Change in Dependent Eligibility Change in Employment Status (including spouse employment status) Paying for Benefits with Pre-Tax Dollars Your share of the cost for medical, dental, vision care and flexible spending accounts are deducted from your pay on a pre-tax basis, as allowed by the IRS. This saves you significant money by reducing your taxable income. Short term disability, voluntary life insurance and all Unum product premiums are paid with after-tax dollars. You have the option of making pre-tax or after-tax contributions to your 403b Retirement account. Who is considered an eligible dependent child? Your legal dependent child is eligible for coverage until the end of the month in which he or she turns age twenty-six (26), regardless of marital or student status. If you have a disabled dependent please speak to our HR Benefits Department as that dependent may be eligible beyond age twenty-six (26). Table of Contents Important Information/SmartBen... 3 Physicians Hospital Organization (PHO) Network... 4 Group Health Plan WellSteps Wellness Program... 6 Prescription Drug Benefits Dental... 9 Voluntary Vision Insurance Flexible Spending Account Employer Paid Basic Life and Accidental Death & Dismemberment (AD&D) Insurance Voluntary Term Life Insurance Voluntary Short Term Disability Employer Paid Long Term Disability Life Assistance Program Retirement Planning Whole Life Insurance Accident Insurance Group Critical Illness Insurance (gci) Group Hospital Indemnity Insurance More Valued Benefits Offered Through Lake Charles Memorial Health System SmartBen Instructions Resources ONLINE 24/7 Introducing SmartBen! A one-stop shop for online self-service benefits enrollment and maintenance! View animated interactive storyboards describing your benefit plan choices. Access your benefit information when you need it, not just during regular HR office hours. This gives you HR and benefit information on demand. Use assumption calculators to perform what if scenarios on your individual benefits and see how your elections affect your paycheck. View innovative decision support calculators through an individualized benefit experience. These and other tools make it easy for you to understand and enroll in the best benefit package for you and your family. Please see page 19 for more information on logging in to SmartBen. Log on today: 3

4 Lake Charles Memorial s Physician Hospital Organization (PHO) Network Lake Charles Memorial Health System continues to be the healthcare leader in Southwest Louisiana; providing quality healthcare since As a Lake Charles Memorial employee you have access to significantly discounted healthcare benefits if you use a PHO network provider. Our medical plan requires that you first seek approval from the Lake Charles Memorial Medical Committee before accessing an outside provider. Below are some need-to-know facts about Lake Charles Memorial s PHO network. Utilizing Providers Outside of the PHO Network Services rendered outside the Lake Charles Memorial PHO Network will require prior-approval from the Medical Committee of Lake Charles Memorial Health System. Coverage is contingent upon the provider(s) participating in the Aetna network. If the service is available within the PHO network, approval WILL NOT be granted. The Approval Process: If you need treatment that cannot be provided inside of the PHO network, you must first get a referral letter from your doctor to submit to the Lake Charles Memorial Health System Medical Committee. That letter needs to provide background information on your condition, what treatment is needed and to which provider(s) you are being referred. Before submitting your referral to the Medical Committee, you are responsible for making sure the provider you choose is in the Aetna PPO network. Claims will be denied if your provider is not an Aetna provider. Please visit the Aetna provider website referenced at the bottom right corner of this page to locate Aetna providers. You can also contact Meritain Health if you need help finding a provider. *Please Note: Ochsner Medical Center of New Orleans and Childrens Hospital of New Orleans will still require pre-approval for services. However, if approved, claims will be covered at the in-network PHO level of benefits. Lab Services There are three labs within the PHO network: 1. Lake Charles Memorial Hospital Lab 2. Medical Lab of Southwest Louisiana 3. The Pathology Laboratory Labs are covered at 100% if they are performed at the Lake Charles Memorial Hospital Lab or during an office visit. Labs performed at Medical Lab of Southwest LA or The Pathology Lab will be applied to your deductible first then be covered at 80%. If your labs are performed in a physician s office and have to be sent out to a lab for the actual testing, the physician must send off your lab samples to an in-network laboratory in order for the tests to be covered. If your labs are sent to or performed at a lab that is not in the PHO network and you did not receive prior approval from the Medical Committee to utilize the out of network lab, your lab work claims will be denied. It is your responsibility to make sure your physician sends your labs to an in-network provider. Durable Medical Equipment (DME) There are three DME providers within the PHO network: 1. Carmichaels Cashway Pharmacy 2. First Option 3. Medical Technologies 4. In addition, Aetna DME providers are also covered as PHO!! Physician prescribed DME purchased from the above three providers will be covered at the PHO level of benefits. In addition, if you purchase a physician prescribed DME from any Aetna DME provider, the claim will be covered at the PHO level of benefits as well. If you purchase any DME from a provider that is not in the Lake Charles Memorial PHO or Aetna network, the claim will not be covered. Please visit the Aetna provider website referenced at the bottom right corner of this page to locate Aetna providers. Out of PHO Service Area Employees and Dependents If you or your dependent live primarily outside of the Lake Charles Memorial PHO service area, which is a 100 mile radius from the hospital located at 1701 Oak Park Blvd., Lake Charles, LA 70601, we understand that your residence may not be within reach of the PHO network. However there are Aetna providers available to you. If you register yourself or your dependent with Human Resources as out of area, your claims for services rendered by an Aetna provider will be covered at the PHO level of benefits. Services rendered by a provider that is not in the Aetna network will not be covered. Please visit the Aetna provider website referenced below to locate Aetna providers. Locating an Aetna Provider If there is not a Lake Charles Memorial PHO provider that provides the services you are seeking, you can locate an Aetna provider in your area by visiting docfind/custom/mymeritain. Please be sure to choose the Open Choice PPO plan in the search options. You can also contact Meritain Health at if you need help locating an Aetna provider. Please remember, if the service is available within the PHO network, the services will not be covered elsewhere. 4 We are Memorial. Everything your healthcare should be.

5 Group Health Care Plan 2015 employee benefit guide Employees who work on a regular full-time or on a regular part-time basis are eligible to participate in the group health insurance plan. Your health insurance benefits will be effective on the first of the month after your date of hire or the first of the month after the date in which you become benefits eligible. As a participant in the plan, your claims processing is provided by Meritain Health. Please review the following outline of the comprehensive plan. A full Summary Plan Description is available on SmartBen, the LCMH Intranet and in the Human Resources Department. LCMH Physician Network 1 DEDUCTIBLE, PER CALENDAR YEAR (Deductibles do not cross apply) Per Covered Person $750 $2,000 Per Family Unit $2,250 $6,000 Approved Aetna Providers 1 In-network providers are not subject to the Reasonable and Customary charge allowance. 2 Hospital Expense deductible and coinsurance charges, not including copays, will remain eligible under the LCMH Employee Discount Program. The Physician deductible and coinsurance charges relative to Hospital Inpatient and Outpatient expenses are not subject to the LCMH Employee Discount Program. MAXIMUM OUT-OF-POCKET AMOUNT, PER CALENDAR YEAR (Out-Of-Pocket Maximums Cross Apply) Per Covered Person $6,600 $6,600 Per Family Unit $13,200 $13,200 Office Visits Primary Care Physician (Pediatrician, Family Practitioner, Internal Medicine, General Practitioner, OB/GYN) $40 copay, no deductible 60% covered after deductible Specialist Preventative Care Services Services include but are not limited to these services which should be coded as Routine : Exams, Pelvic Exams, Pap Testing, PSA Testing, Immunizations, Colonoscopy Screening and Routine Well Child Care Diagnostic Lab Services During a Physician Office Visit Performed at LCMH Lab Performed at all other approved labs Urgent Care Moss Memorial Urgent Care All other approved urgent care facilities Emergency Room In-patient Ambulatory Surgery Schedule of Medical Benefits $55 copay, no deductible 60% covered after deductible 100% 60% covered after deductible 100% covered, no deductible 100% covered, no deductible 80% covered after deductible $50 copay, no deductible $100 copay, no deductible $250 copay per visit, no deductible Hospital Services 2 $500 copay per admission; no deductible $500 copay per admission; no deductible 60% covered after deductible 60% covered after deductible 60% covered after deductible N/A 60% covered after deductible $250 copay per visit, no deductible; R&C charges may be applied 60% covered after deductible 60% covered after deductible Out-patient: includes X-Ray, Pre-Admission Testing, Radiation Therapy, Chemotherapy, Hemodialysis Physician Services 80% covered after deductible 60% covered after deductible In-patient 80% covered after deductible 60% covered after deductible Out-patient 80% covered after deductible 60% covered after deductible NOTE: Charges made by any provider other than a LCMH PHO network provider will not be eligible under this plan unless preapproved in writing by the Lake Charles Memorial Medical Committee. Coverage through an Approved Aetna Provider as referenced above will still require written pre-approval. Emergency care is an exception. 5

6 Health Insurance Pay Period Rates Coverage Level Full-Time Employees Bronze Silver Gold Employee Only $43.99 $20.84 $15.84 Employee + Spouse $ $ $ Employee + Child(ren) $ $ $ Family $ $ $ Wellness Points Earned in points or less Points 500+ Points Coverage Level Part-Time Employees Bronze Silver Gold Employee Only $86.70 $53.69 $48.69 Employee + Spouse $ $ $ Employee + Child(ren) $ $ $ Family $ $ $ Wellness Points Earned in points or less Points 500+ Points Please Note: 2015 Medical Premiums are based on points earned participating in the wellness program during Bronze level also includes employees that did not participate in the wellness program. WellSteps Wellness Program At Lake Charles Memorial Health System we call our wellness program the Get Healthy Stay Healthy Wellness Program. We are dedicated to supporting you and your participating family members throughout your journey to improved health and wellness. How Does It Work? By electing to participate in the wellness program provided through WellSteps you can earn a discount on your medical insurance as illustrated above in this year s medical insurance rates. Each year we will provide a list of healthy lifestyle annual activities and behavior change campaigns that will help you live a healthier lifestyle by making small changes one-step at a time while earning points that can result in significant discounts in your medical premiums for the next calendar year! In 2014 employees worked to achieve the highest Gold level, 500 accumulated points for the maximum 2015 premium discount. Imagine the possibilities for next year!! Annual activities include but are not limited to: Having an annual qualified wellness exam Completing WellSteps campaigns Being smoke free OR have been smoke free for at least 90 days If you are a smoker, enrolling in AND completing a smoking cessation program Receiving a flu shot. These are available for free to all LCMH employees Completing the WellSteps Personal Health Assessment online survey Participating in the Lake Charles Memorial s wellness screening And more. New Hires, hired after September 1st, 2014, will receive the Silver level premium discount by registering for their WellSteps account and completing the online Personal Health Assessment within 30 days of their medical insurance effective date. For more information on our wellness program, please visit 6 We are Memorial. Everything your healthcare should be.

7 2015 employee benefit guide Schedule of Pharmacy Benefits Generic (30 day supply) Generic (90 day supply) Preferred Brand (30 day supply) Preferred Brand (90 day supply) Non Preferred Brand (30 day supply) Non Preferred Brand (90 day supply) Therapeutic Alternative* (30 day supply) Therapeutic Alternative* (90 day supply) 30 day supply 90 day supply MEDICAL PLAZA PHARMACY (No deductible to meet) $15 co-pay $30 co-pay $60 co-pay $120 co-pay $100 co-pay $200 co-pay $100 co-pay $200 co-pay Specialty Drugs Greater of $200 or 20%, $500 max per script Greater of $400 or 20%, $1,000 max per script ALL OTHER SCRIPTCARE PHARMACIES ($200 Individual & $500 Family deductibles apply) $30 co-pay Not available $120 co-pay Not available $200 co-pay Not available $200 co-pay Not available Greater of $400 or 20%; $1,000 max per script Not Available * Therapeutic Alternative drugs are single source, highly utilized drugs where there is a therapeutic alternative that is generic. Diabetic Program The Diabetic Program is offered as part of your prescription drug program and can be a big savings on your diabetic medications and supplies. Supplies covered include test strips, insulin syringes, glucose chews, lancets, lancet devices, blood glucose calibration solution, alcohol swabs and insulin infusion pump supplies. The program also offers a free glucose monitor. There is no pharmacy deductible to meet with this program and products are shipped right to your door! A representative will even call you when it is time to reorder. Please call for more information and to learn how to get started today! Diabetic Supplies $5 (no deductible) Insulin Pump Supplies 45% discount (no deductible) Dispense As Written (DAW) Process The Dispense as Written DAW process, in effect at LCMH since January 1st, 2014, facilitates the utilization of the most cost effective prescription type, Brand Name Vs. Generic Drug, while adhering to physician written orders for the needs of the patient. Please consult with your physicians concerning what form of prescription is appropriate for your individual needs. ScriptCare Compounding Program through Pharmacy Innovations Millions of patients have unique health needs that require a compounded prescription with several ingredients. For these patients, personalized medication solutions are the way to better health. How the Program Works: Compounded prescriptions exceeding $100 will reject at a retail pharmacy The rejection message will instruct the pharmacist to call Script Care s customer service department Customer Service will assist the pharmacy in transferring the prescription to Pharmacy Innovations for compounding Pharmacy Innovations will compound the prescription and ship overnight to the member s home 1 Medications and immunizations recommended by the U.S. Preventive Services Task Force and mandated under PPACA will be covered at 100% in their most cost-effective form when purchased at Medical Plaza. This includes Women s Preventive Care Drugs such as generic contraceptives. 7

8 Lowering Prescription Cost with Therapeutic Alternatives Listed below are brand name medications included in the Therapeutic Alternative tier. These brand medications do not have an exact generic equivalent, but do have a generic therapeutic alternative. If you are taking any of the Therapeutic Alternative medications in the left-hand column, please consult with your doctor about lowering your out-of-pocket expense with a generic therapeutic alternative. These generic alternatives are less expensive and therapeutically equivalent to the brand name. $100 Copay Single Source Brand (30 day supply) Benicar Benicar HCT $15 Copay Generic Therapeutic Alternatives (30 day supply) losartan K, irbesartan, candesartan, telmisartan, losartan K/HCTZ, irbesar/hctz, valsartan/ HCTZ, candesartan/hctz, telmisartan/hctz THERAPEUTIC CATEGORY ANTIHYPERTENSIVES - ARBs Beconase AQ flunisolide, fluticasone, triamcinolone Intranasal Steroids Crestor simvastatin, pravastatin, lovastatin, atorvastatin ANTIHYPERLIPIDEMICS - HMG CoA Reductase Edarbi losartan K, irbesartan, candesartan, telmisartan, losartan K/HCTZ, irbesar/hctz, valsartan/ ANTIHYPERTENSIVES - ARBs HCTZ, candesartan/hctz, telmisartan/hctz Livalo simvastatin, pravastatin, lovastatin, atorvastatin ANTIHYPERLIPIDEMICS - HMG CoA Reductase Omnaris flunisolide, fluticasone, triamcinolone Intranasal Steroids Pristiq venlafaxine ER HCL, duloxetine ANTIDEPRESSANTS - SNRIs Rhinocort Aqua flunisolide, fluticasone, triamcinolone Intranasal Steroids Simcor Teveten Teveten HCT simvastatin, pravastatin, lovastatin, atorvastatin losartan K, irbesartan, candesartan, telmisartan, losartan K/HCTZ, irbesar/hctz, valsartan/ HCTZ, candesartan/hctz, telmisartan/hctz ANTIHYPERLIPIDEMICS - HMG CoA Reductase ANTIHYPERTENSIVES - ARBs Travatan Z latanoprost Prostoglandin Agonist-Glaucoma Veramyst flunisolide, fluticasone, triamcinolone Intranasal Steroids Vytorin simvastatin, pravastatin, lovastatin, atorvastatin ANTIHYPERLIPIDEMICS - HMG CoA Reductase Important News for Acid Reflux Medications (PPIs): Starting January 1, 2015, Lake Charles Memorial Health System will cover physician prescribed over-the-counter (OTC) PPIs at your standard Generic copay. Examples include: Nexium OTC, Prilosec OTC, Prevacid 24HR and their store brand/off label over-the-counter omeprazole equivalents. These prescriptions will be covered with just your standard Generic copayment! Although Lake Charles Memorial will continue to cover Generic PPIs and add coverage of Over the Counter PPIs, they will remove coverage of all Brand PPI medications. Brand medications that are to be removed from coverage will include, but are not limited to, the following medications: Aciphex, Prevacid, Prilosec, Protonix, Nexium, and Dexilant. Why is LCMH making this change? Lake Charles Memorial is making this change to offer our members a cost savings by covering over-the-counter PPI medications with a standard generic copayment. There are many products now available over the counter, and studies and medical experts agree that they work just as well and are just as safe, but have a much lower retail price than prescription versions. 8 We are Memorial. Everything your healthcare should be.

9 2015 employee benefit guide To aide in proper oral hygiene, the Lake Charles Memorial Health System Dental Plan allows for bi-annual exams, cleaning, and x-rays, performed by any dentist of your choice, covered at 100%. There is no network of providers to adhere to. Your dental benefit election is separate from your medical plan election, therefore, you may elect coverage based on your needs and that of your family. All regular full-time and regular part-time employees are eligible to participate in the plan. Your dental insurance benefits will be effective on the first of the month after your date of hire or the first of the month after the date in which you become benefits eligible. Plan Features Dental Insurance Calendar Year Deductible $50 per individual $150 per family Calendar Year Maximum (Per Individual) $1,200 Orthodontic Lifetime Maximum (Per Individual) $1,200 Amount Covered Dental Benefits Under Plan Preventive and Diagnostic Routine Examinations and Cleanings (once every six months) Fluoride for Children (under age 19, once every six months) 100%, deductible waived Space Maintainers (under age 19, once every five months) X-Rays (Full mouth, limited to children under age 19, once every five years) Bitewings (once every six months) Restorative Services Extractions Periodontic Treatment Oral Surgery Endodontic Treatment 80% Fillings Crown Repair General Anesthesia Denture Repair Antibiotic Drugs, which are injected by a Dentist or Physician Major Services Crowns 50% Restorative Inlays, Crowns Prosthodontics Removable Dentures, Partials 50% Orthodontic Expenses (limited to dependent children up to age 19) 50%, deductible waived Pay Period Rates Coverage Level Full-Time & Part-Time Employees Employee Only $6.38 Employee + Spouse $12.19 Employee + Child(ren) $13.94 Family Coverage $

10 Voluntary Vision Insurance Lake Charles Memorial Health System provides vision insurance through Vision Service Professionals (VSP). The comprehensive benefits package is designed to promote overall good eye health. All regular full-time and regular part-time employees are invited to participate in the plan. Your vision insurance benefits will be effective on the first of the month after your date of hire or the first of the month after the date in which you become benefits eligible. SERVICE NETWORK OUT-OF-NETWORK ALLOWANCES Exam (1 per 12 months): $10 co-pay Up to $45 Materials (1 per 12 months): $25 co-pay Allowance as described below Standard Plastic Lenses (1 per 12 months): Single Vision Bifocal Trifocal Lenticular Progressive Frames (1 per 24 months, 1 per 12 months for children age 18 and under): Member may select any frame available Contact Lenses (1 per 12 months): Fit, follow-up and materials In lieu of eyeglasses and lenses Elective Medically Necessary Covered Covered Covered Covered $55 allowance $150 allowance; 20% discount off the overage $150 allowance; 15% discount off the overage Covered in full Up to $30 Up to $50 Up to $65 Up to $100 Up to $50 Up to $70 retail allowance Up to $105 allowance Up to $210 allowance Per Pay Period Rates Employee Only $2.73 Employee and Child(ren) $5.89 Employee and Spouse $5.49 Family $9.39 A directory of vision care providers may be located online: 10 We are Memorial. Everything your healthcare should be.

11 2015 employee benefit guide Whether you are married with children, single with no children, a single parent or any other lifestyle status, a Flexible Spending Account (FSA) can save you money. An FSA allows you to set aside pre-tax dollars to cover qualified expenses that you would normally pay out of your pocket with after-tax dollars. You pay no federal income or state income taxes on the money you place in your FSA. The FSA is actually comprised of two accounts: a health care spending account and a dependent care account. Employees who work on a regular full-time basis or on a regular part-time basis are eligible to participate. Your FSA contributions will not roll over into the next year. You must re-enroll in the FSA program each year. Health Care Spending Account The Health Care Spending Account may be used for any medical, prescription drugs, dental or vision care expenses not reimbursed by Lake Charles Memorial Health System s health plan. These expenses may include the deductible, coinsurance, or costs not covered by the plan. The maximum yearly contribution is $2,500. With your Health Care Spending Account you will receive a benefits debit card, Benny Card. This card works like any Visa or Mastercard but can only be used to pay for eligible expenses such as prescription drugs, medical copays, as well as vision and dental expenses. For a complete list of eligible expenses, visit Lost or stolen cards will require a $5 replacement fee. Cards are issued once when you initially enroll; they are not reissued annually. Dependent Care Account The Dependent Care Account may be used to pay for dependent care expenses that enable you or your spouse to work. You may claim dependent care expenses for your children under age 13, or for a dependent adult or child over 13 who requires day care. Expenses that qualify for the Dependent Care Account include the cost of care in licensed day care centers, pre-school tuition and care provided in or outside of your home, such as an adult day care facility. The maximum yearly contribution is $5,000. End Of The Year Run-Out Healthcare FSA: Lake Charles Memorial has opted for the grace period extension offered by the IRS, which allows an additional 2 1/2 months (3/15/15) to incur expenses toward your healthcare FSA after the plan year has ended. These expenses incurred between January 1st and March 15th cannot be paid for using your Benefit Debit Card (Benny Card). Charges to your Benny Card are credited to current year contributions. Expenses incurred in the grace period must be submitted by paper claim for reimbursement. Claim forms can be found on the LCMH Intranet and on SmartBen. Dependent Care FSA: You may incur dependent care claims until the end of the plan year (12/31/14) Healthcare and dependent care FSA claims can be submitted with proper documentation until 4/15/2015. Be sure to save your receipts! Some expenses will require additional information, including receipts to verify eligibility of the expense to comply with IRS rules. That is why it is important to save all receipts for expenses which you use your Benny Card to pay. If you fail to submit receipts promptly when they are requested, the expenses will be declared ineligible and you will have to reimburse your account. If there is continued non-compliance, you could jeopardize the tax-exempt status of your account and lose access to your benefit debit card. **Tip: If you are asked to provide a receipt from a physician or dentist s office and can t find the receipt, contact their office and ask if they can provide you with an additional copy. Don t pass up the opportunity to use your pre-tax dollars! WITHOUT THE FSA Flexible Spending Account WITH THE FSA Employee Gross Salary $30,000 Employee Gross Salary $30,000 FSA Contribution $0 FSA Contribution $2,000 Taxable Wages $30,000 Taxable Wages $28,000 Estimated federal, state & social security taxes $9,195 Estimated federal, state & social security taxes - $8,582 Out-of-Pocket Medical / Daycare Expenses - $2,000 Out-of-Pocket Medical / Daycare Expenses $0 Employee's Take Home Pay $18,805 Employee's Take Home Pay $19,418 Employee Annual Savings $613 You can monitor your flex accounts online by going to and creating an account. There you can view your account balances, see activity details and more... 11

12 Employer Paid Basic Life and Accidental Death and Dismemberment (AD&D) Lake Charles Memorial Health System provides at no cost to full time active employees, a Basic Life and AD&D benefit through Cigna. The amount of the AD&D insurance benefit is equal to the amount of your life insurance benefit. This benefit will be effective on the first day of the month following 90 days of employment. Employer Paid Life and AD&D Benefit 1.5 Your Annual Salary Maximum Benefit $50,000 Voluntary Term Life Insurance Self Spouse Guaranteed Issue $500,000 (Not greater than 5x annual earnings) Max Benefit $500,000 (Not greater than 5x annual earnings) Purchase Increments $10,000 $5,000 $25,000 (Not to exceed 50% of the employee benefit) $100,000 (Not to exceed 50% of the employee benefit) Eligible full time and eligible part time employees have the opportunity to purchase Voluntary Term Life insurance through Cigna. You may purchase up to $500,000 of benefit in $10,000 increments, not to exceed 5 times your annual earnings on a Guarantee Issue basis. Cigna is allowing an open enrollment this year for you and your spouse. All elections up to the Guarantee Issue amount will not require evidence of insurability. If you are enrolled in the voluntary life program, you have the opportunity to purchase life insurance for your spouse and child(ren). You can enroll your spouse in $5,000 increments up to a maximum of $100,000 (not to exceed 50% of your benefit amount) with a Guarantee Issue of $25,000. Amounts over the Guarnatee Issue will require evidence of insurability. The monthly premium per $1,000 of coverage for employee and spouse are shown below. An insured s premium will increase at the start of a calendar year when they advance to the next age band. The spouse rate is based on the employee s age and will also increase in accordance with the same schedule. You may also elect to cover your unmarried dependent children age 26 or younger. Child coverage can be purchased at $2,000 or $5,000. Children do not require medical underwriting. The rate is not per child; the monthly rate applies to all children you elect to cover. Voluntary Term Life insurance is effective on the first day of the month following 90 days of employment. MONTHLY EMPLOYEE AND SPOUSE RATES (Based on Employee s Age) TO DETERMINE YOUR MONTHLY PREMIUM: Amount of Insurance X Rate = Monthly Premium $1,000 Example: Employee, Age 35, Purchasing a $50,000 Life Benefit $50,000 X $0.125 = $6.25 per month $1, We are Memorial. Everything your healthcare should be. Age Rate/$1,000 of Benefit Under 25 $ $ $ $ $ $ $ $ $ $2.17 Monthly Child Rates $2,000 Benefit $0.18 $5,000 Benefit $0.44

13 2015 employee benefit guide Voluntary Short Term Disability Short Term Disability Insurance from Cigna can replace a portion of your weekly income if you get sick or injured off-the-job and are unable to work. It is designed to provide a specified weekly benefit income paid to the employee to be used as needed. Voluntary Short Term Disability coverage is available to all newly eligible regular full-time and regular part-time employees a 3/12 pre-existing condition limitation will apply. 1 Active full time and part time employees that are not currently enrolled in the Short Term Disability plan may elect coverage during open enrollment as a late entrant without medical underwriting, however, a pre-existing condition limitation of 12/12 will apply. 2 WEEKLY BENEFIT 60% OF WEEKLY EARNINGS Maximum Weekly Benefit $1,250 Elimination Period Maximum Benefit Period Premium Calculations 30 Days for Injury 30 Days for Sickness 9 Weeks $0.425/ $10 of benefit Please refer to the Leave of Absence Policy, which can be found on the LCMH intranet, for your rights under FMLA. TO DETERMINE YOUR MONTHLY PREMIUM: Weekly Earnings 60% = Weekly Benefit Weekly Benefit Rate = Monthly Premium $10 Example: $800 Weekly Earnings 60% = $480 Weekly Benefit $480 $0.425 = $20.40 per month $10 1 Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) or for which a reasonable person would have consulted a physician during the 3 months prior to the most recent effective date of insurance. Such conditions are pre-existing and will not be eligible for coverage until you have been insured under this plan for 12 consecutive months after your most recent effective date of insurance. 2 Late entrants will deviate from footnote #1 above in that the look-back period will be 12 months prior to the most recent effective date rather than 3. The limitation will remain in force for the 12 months after the most recent effective date of insurance. Employer Paid Long Term Disability Lake Charles Memorial Health System provides all full-time active employees with Long Term Disability Insurance through Cigna. Disability Insurance provides the security of knowing your paycheck will not stop if you have an extended disability due to illness or accident. Upon approval of a disability claim, you will receive 50% of your monthly salary to a maximum monthly benefit of $6,000 once you have been out of work for 90 days. If your disability is permanent, this benefit may continue until you reach retirement age. MONTHLY BENEFIT 50% OF MONTHLY EARNINGS Maximum Monthly Benefit $6,000 Elimination Period 90 Days Life Assistance Program Cigna provides a Life Assistance Program to help you and your family find a solution and restore your peace of mind. Some of the services that are available to you and your family: Basic clinical and work/life support by phone or web Up to 3 face to face sessions with licensed behavioral clinicians.* 24/7 phone consultation with CIGNA licensed clinicians Monthly phone seminars on relevant topics Unlimited access to online research and other key resources Life events research and qualified referrals (i.e., child care providers) *The LAP is a value added service provided by Cigna and is not related to any benefits of the LCMH Group Medical plan. If you foresee needing more than the 3 free visits, you need to make sure that the provider you are seeing is in the PHO network or the Aetna network as any claims submitted to Meritain are subject to the terms of the medical plan. 13

14 Retirement Planning 403(b) Tax-Deferred Contribution Account All employees are eligible to participate in the LCMH 403(b) Tax-Deferred Contribution Account upon date of hire. Lake Charles Memorial Health System has made a conscientious decision to assist employees in saving for their future by enforcing an automatic enrollment in the 403(b) retirement plan at a 3% contribution level. What this means is that if a new employee does not personally enroll or decline participation, he or she will be automatically enrolled in the plan and automatically have 3% of his or her base compensation for hours worked deferred into their individual account. Employees are immediately 100% vested in these contributions. Newly eligible employees will have 90 days to opt out of participation in the plan and request reimbursement of their contributions. Since inception, our enrollment in the retirement plan has increased significantly which is our goal. We feel that as an employer, we have a responsibility to ensure that our employees take advantage of the benefits provided. In 2015, we are implementing another phase in retirement savings for employees who do not take initiative to manage their plan. If the employees who were automatically enrolled did not touch their plan by allocating funds or increasing/decreasing their contribution level, they will see an automatic increase of 1% to their contribution. Meaning, if you were automatically enrolled in 2014 at 3% and made zero changes to your account, your contribution in 2015 will be 4%. 401(a) Account Employees who participate in the LCMH 403(b) Tax-Deferred Contribution Account may participate in the LCMH 401(a) Retirement Planning Account beginning January 1 or July 1, coinciding with or immediately following the date on which all eligibility requirements are met: 1. Completion of one (1) year of eligibility service, to include 1,000 working hours by the anniversary of your hire date. 2. Attain age Employed in a job classification covered by the Plan as an eligible class. You are in an eligible class if you are employed by LCMH in any capacity, and you are not a leased employee. As a Defined Contribution Plan, LCMH will make a matching contribution to your 401(a) Account equal to 100% of the first 3% of your contribution to the 403(b) Tax-Deferred Contribution Plan, based on your hours worked and subject to the Federal Matching Contribution limits. The graded vesting schedule, as illustrated below, applies to the 401(a) Account: Years of Vesting Service Vested Interest Less than 2 0% 2, but less than 3 20% 3, but less than 4 40% 4, but less than 5 60% 5, but less than 6 80% 6 or more 100% Please contact Human Resources or refer to the LCMH Retirement Plan Summary Plan Description for further plan details. Plan Ahead for Your Retirement How much income do you think you'll need during retirement? According to financial planners, you'll probably need about 70% to 80% of your pre-retirement income after you retire. Have you thought about where that income will come from? Reaching your retirement goal is easier with pre-tax contributions from both you and your employer into a retirement plan. The bottom line is, the more you put away monthly, and/or the higher the rate of return on your investments, the more likely you'll reach your retirement goal. Need Advice? For help with retirement planning needs such as funds allocation, projecting your retirement income requirements, etc., you can contact Investment Advisor, Jeff Wylie at to schedule an appointment. 14 We are Memorial. Everything your healthcare should be.

15 2015 employee benefit guide Whole Life Insurance Unum s whole life insurance is designed to pay a death benefit to your beneficiaries but it can also build cash value you can use while you are living. The policy accumulates cash value at a guaranteed rate of 4.5%.* Once your cash value builds to a certain level, you can borrow from the cash value or use it to buy a smaller paid-up policy with no more premiums due. If you are diagnosed with a medical condition that limits life expectancy to 12 months or less, you can request up to 100% of the benefit amount, to a maximum of $150,000. Your spouse and dependents have this option as well. *The policy accumulates cash value based on a non-forfeiture interest rate of 4.5% and the 2001 CSO mortality table. The cash value is guaranteed and will be equal to the values shown in the policy. Employees must be a U.S. citizen or legally authorized to work in the U.S. to receive overage. Spouses and dependents must live in the U.S. to receive coverage. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to policy form L or contact your Unum representative. Underwritten by: Provident Life and Accident Insurance Company, Chattanooga, Tennessee Unum complies with state civil union and domestic partner laws when applicable. unum.com 2014 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Unum s accident insurance can pay benefits based on the injury you receive and the treatment you need, including emergency-room care and related surgery. The benefit can help offset the out-of-pocket expenses that medical insurance does not pay, including deductibles and co-pays. Family coverage is available. Employees must be a U.S. citizen or legally authorized to work in the U.S. to receive overage. Spouses and dependents must live in the U.S. to receive coverage. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to policy form GA-1 or contact your Unum representative. See schedule of benefits for a full list of covered injury and treatments. THIS IS A LIMITED POLICY Group Accident Insurance Underwritten by: Unum Life Insurance Company of America, Portland, Maine Unum complies with state civil union and domestic partner laws when applicable. unum.com 2014 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. 15

16 16 We are Memorial. Everything your healthcare should be. Group Critical Illness Unum s group critical illness insurance can help protect your finances from the expense of a serious health problem, such as a stroke or heart attack. Cancer coverage is also available. You choose a lump-sum benefit up to $50,000 that s paid directly to you at the first diagnosis of a covered condition. You can use the benefit any way you choose. You can use this coverage more than once. If you receive a full benefit payout for a covered illness, your coverage can be continued for the remaining covered conditions. The diagnosis of a new covered illness must occur at least 90 days after the most recent diagnosis. Each condition is payable once per lifetime. Employees must be a U.S. citizen or legally authorized to work in the U.S. to receive overage. Spouses and dependents must live in the U.S. to receive coverage. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to policy form CI-1, or contact your Unum representative. THIS IS A LIMITED POLICY Underwritten by: Unum Life Insurance Company of America, Portland, Maine Unum complies with state civil union and domestic partner laws when applicable. unum.com 2014 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Group Hospital Indemnity Insurance Unum s group hospital indemnity insurance can complement your health insurance to help you pay for the costs associated with a hospital stay. It can also provide funds for the out-of-pocket expenses your medical plan may not cover, such as co-insurance, co-pays and deductibles. You may also purchase coverage for your spouse and dependent children. A wellness option can pay an annual benefit for preventive care. Employees must be a U.S. citizen or legally authorized to work in the U.S. to receive overage. Spouses and dependents must live in the U.S. to receive coverage. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy form GHI-1, or contact your Unum representative. THIS IS A LIMITED POLICY This coverage is a supplement to health insurance. It is not a substitute for comprehensive health insurance and does not qualify as minimum essential health coverage. Underwritten by: Unum Life Insurance Company of America, Portland, Maine Unum complies with state civil union and domestic partner laws when applicable. unum.com 2014 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. CU-9733

17 2015 employee benefit guide More Valued Benefits Offered Through Lake Charles Memorial Health System Tuition Reimbursement Lake Charles Memorial Health System provides eligible employees with the opportunity to participate in courses of study through accredited colleges or universities and be reimbursed in accordance with policy. Tuition reimbursement is available to regular full time and part time employees after successful completion of the ninety (90) day introductory period. Courses must be directly job related or hospital career goal directed and the application must be submitted in advance of the start of any course(s). Child Care Assistance It is important to know that your child is well cared for while you are at work. One of the most important decisions you will ever make as a parent or guardian is choosing quality, affordable child care. Lake Charles Memorial Health System understands this and provides an assistance program to full-time and part-time employees. The program pays child care costs for one child per employee ages 6 weeks to 5 years or until they enter a Pre-K program. Lake Charles Memorial pays $20.00 a week for one child for full-time employees and $10.00 a week for one child for part-time employees. Afterschool Care or Academy schools do not qualify for child care assistance with Lake Charles Memorial Health System. Please contact the Human Resources Department to find out which licensed facilities are participating in the program and for details on method of payment. Sick Child Day Care Sick Child Day Care, located at nd Ave., Suite C, provides peace of mind to the working parent knowing that your child is being taken care of while they are sick allowing you to come to work. Sick Child Day Care is available to all employees, Monday Friday 6:00 a.m. - 6:00 p.m. for children ages 6 weeks to 13 years. The cost is $5.00 a day. Full and Part-Time employees can charge the fee on their badge or pay at time of service. To utilize this service, contact Nurse Staffing and speak with the House Supervisor at least 2 hours prior to your shift. The Nurse Staffing contact number is Do not leave a message; make sure you speak to the House Supervisor. The House Supervisor will need to know the employee s name, department name, child s name, type of sickness, child s age and what time you need an attendant to be there. Paid Time Off (PTO) and Extended Leave Bank (ELB) It is the policy of Lake Charles Memorial Health System to provide compensated leave time to all eligible employees based on employment status and length of service. All full-time and part-time employees excluding those classified as temporary, contract or PRN are eligible for paid leave benefits. Hours accrue beginning at the time of hire, but are not eligible to use until the pay period following satisfactory completion of the ninety (90) day introductory period. This time can be used in increments of two (2) hours or more for planned and unplanned time off in accordance with departmental policy. The accrual schedule for full-time employee PTO is as follows: Years of Service Hours Accrued Per Pay Period PTO Hours Per Year 1 to Hours 5 to Hours 15 + years Hours *PTO hours will carry over to the next year. The maximum accrual for each level is the equivalent of two years of an annual accrual. The Extended Leave Bank is available to full-time and part-time employees. ELB hours cannot be utilized until 24 hours of PTO have been used, unless you are hospitalized or have a procedure requiring moderate (conscious) sedation. Full-time employees accrue 9 days/72 hours per year or 2.77 hours per pay period with a maximum accrual of 320 hours. Part-time employees accrue PTO and ELB based on hours paid in the pay period. 17

18 More Valued Benefits Offered Through Lake Charles Memorial Health System Bereavement Leave It is the policy of Lake Charles Memorial Health System to grant up to 24 hours of bereavement leave to eligible employees in the event the employee suffers a loss of an immediate family member or grandparent. For the purposes of this policy, immediate family members are defined as spouse, mother, father, sister, brother, son, daughter, mother-in-law, father-in-law and legal guardian. Please refer to the policy which can be found on the intranet. Payroll Deduction Charge System Full-Time and part-time employees of Lake Charles Memorial Health System can use their employee identification badge to purchase items in the gift shop, pharmacy and cafeteria through payroll deduction. You must sign up for this benefit through Human Resources and remain an employee in good standing as it is defined in the policy in order to use this benefit. Direct Deposit This benefit provides a safe, confidential and convenient way for all employees to receive wage and compensation payments via direct deposit. Employees must complete a Direct Deposit Authorization Form as part of the enrollment process as a new hire. The form requires the name and address of the Financial Institution; designation as to whether the account is a checking or savings account; account number, routing/transit number, date and signature of employee. Checking accounts require a voided check and other accounts require a letter from the financial institution providing the type of account, account # and routing/transit number. Failure to complete the appropriate Direct Deposit paperwork prior to the first day of work will result in a delayed start date. Continued failure to do so could result in disciplinary action. Cellular Phone Plan Discounts As an employee of Lake Charles Memorial Health System you are eligible to receive discounts through various cellular phone service providers such as AT&T, Sprint and Verizon. Please contact your Human Resources Department for more information on how you could start saving today! Wishing Well Gift Shop Birthday Discount All employees receive a 25% discount off of any one item in the Wishing Well gift shop to be used any time during the 30 days prior to or 30 days after your birthday. Happy birthday from Lake Charles Memorial Health System! Discounted Gym Memberships Gym Discount Location Phone Number Project Fit $150 Boot Camp Classes (Regularly $225) 528 7th Street LC Fitness $32.20 Individual $47.96 Family 4324 Lake Street GiGi s Fitness $ I n d i v i d u a l $59.27 Family 709 Ryan Street CHRISTUS Atletic Club Lake Charles Dynamic Dimensions Our Lady Queen of Heaven Family Life Center Keyon s Fitness $ I n d i v i d u a l $59.27 Family $38 Individual $53 Family (12 month contract) $40 Individual $50 Family 15% discount to memberships on auto draft *Please refer to the policies which can be found on the Lake Charles Memorial Intranet for more detailed information on these benefits. 18 We are Memorial. Everything your healthcare should be Nelson Road Moss Bluff & Sulphur locations Msgr Deblanc Place N. Martin Luther King

19 2015 employee benefit guide 19

20 Resources PRODUCT CARRIER PHONE NUMBER WEBSITE Human Resources Department Health/Dental Plan and Claims Administrator Meritain Health Health and Dental Claims: P.O. Box / Lubbock, TX Hospital website: Employee Intranet: lcmhweb/sitepages/home.aspx (Group Number: GR1445) Pharmacy Benefits Manager ScriptCare Diabetic Program ScriptCare In-Network Pharmacy Medical Plaza Pharmacy Vision VSP Flexible Spending Account Meritain Health Employer Paid Life Insurance Voluntary Term Life AD&D Employer Paid Long Term Disability Cigna Voluntary Short Term Disability FMLA Cigna Life Assistance Program Cigna Group Accident Insurance Group Critical Illness Insurance Whole Life Insurance Unum Hospital Indemnity Insurance Retirement American United Life Insurance Company One America Financial (Group Number: G62261) Partner Investment Advice Jeff Wylie Sick Child Day Care Cambridge Investment Research Lake Charles Memorial Health System Nurse Staffing The information in this guide should in no way be construed as a promise or guarantee of employment or benefit coverage. Pricing, underwriting, plan specifics and all other product features are solely that of the Insurance Company and not Complete Benefit Alliance. If there is a conflict between the information in this guide and the actual plan document or policies, the documents or policies will always govern. Complete details about the benefits can be obtained by reviewing current plan descriptions, contracts, certificates, policies and plan documents available from the Benefits Department.