Regularly scheduled full- or part-time colleague with 48 or more budgeted hours per pay period

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1 Welcome to Open Enrollment Saint Francis Healthcare! Trinity Health and Saint Francis Healthcare are pleased to provide you with the information you will need to enroll in benefits for next year. Throughout the rest of this communication, you will see Trinity Health and Saint Francis Healthcare referred to as simply Trinity Health. If you have more questions after reviewing this guide, refer to the For More Information section to learn where you can get answers. What s Inside What s New for Other Information About 3 Enrolling Health Care Reform Update 4 Medical Coverage 5 Medical Plan Highlights 6 More About the Health 8 Savings PPO Live Your Whole Life 9 Dental Coverage 11 Vision Care Coverage 12 Flexible Spending 13 Accounts Life Insurance 14 Time Away from Work 15 Voluntary Benefits 16 How to Enroll 17 For More Information 18 Important Reminders 19 Who Is Eligible Benefit Hours Requirement Dependents Other Medical, dental and vision coverage Regularly scheduled full- or part-time colleague with 48 or more budgeted hours per pay period Eligible adult: You may cover your spouse or Eligible Adult. An Eligible Adult is an adult who resides and has financial interdependence with the colleague, and is not a tax-qualified dependent or related by blood, adoption or marriage to the colleague. Flexible spending accounts Life insurance Short-term disability* Long-term disability Regularly scheduled full- or part-time colleague with 48 or more budgeted hours per pay Dependent children are eligible for coverage through the end of the Plan Year in which they turn age 26, regardless of marital status, student status, residency, financial dependency or other requirements provided they meet both of the following criteria: They are: Your or your eligible adult s natural children; Your or your eligible adult s legally adopted children or children placed with you or your eligible adult for adoption; or Children for whom you or your eligible adult are the court-appointed legal guardian. They are not otherwise covered under the Plan or any other group health plan offered by the Employer. Can submit claims for eligible dependents period Regularly scheduled full- or Can elect coverage for your spouse, part-time colleague with 48 or eligible adult or eligible children more budgeted hours per pay period Regularly scheduled, full- or Not applicable part-time colleague with 48 or more budgeted hours per pay period Regularly scheduled full-time colleague with 70 or more budgeted hours per pay period Not applicable New hires must satisfy the required waiting period New hires must satisfy the required waiting period New hires must satisfy the required waiting period You become eligible the first day of the month following 30 days of employment. You become eligible the first day of the month following 1 year of employment. *Pre-existing conditions apply. Verifying your dependents If you add a new dependent, you must show the appropriate documents to your Human Resources department by Nov. 18, To obtain a full list of documentation requirements and resources available to obtain this documentation, visit Saint Francis - Wilmington 1

2 What s New for 2016 While most of the medical plan benefits will not change for 2016, urgent care visits under the Essential PPO Plan will now be covered at 80% coinsurance after you meet the deductible. You will have the opportunity to contribute $100 more per year to your HSA, up to a maximum of $5,450 in 2016, if you participate in the Health Savings PPO Plan with any coverage level above colleague only. We are pleased to introduce the Trinity Health MyBenefits internet site for You can log on at to find information about the 2016 Open Enrollment process and to learn more about your Trinity Health benefits. To enroll in benefits, click on My Self Service and follow the instructions. If you participate in the Health Care Spending Account (HCSA), you will now be able to contribute up to $2,550 for You may not participate in the HCSA if you elect the Health Savings PPO Plan. Beginning in 2016, we will be offering a revised well-being program to help you earn a premium discount on your medical coverage throughout the year. See the Live Your Whole Life page in this guide and the Live Your Whole Life website (mybenefits.trinity-health.org/lywl) for more information. We are continuing to harmonize who is covered under Trinity Health benefits and programs. For 2016, the definition of Eligible Adult is changing. See the Who Is Eligible section for more information. Starting Jan. 1, 2016, Cancer Treatment Centers of America (CTCA) and affiliated hospitals will no longer be a covered provider. For anyone who is currently receiving treatment through CTCA, more information will be provided on a transition process. See for more details. Beginning Jan. 1, 2016, supplemental life insurance can be purchased for eligible adults and their dependents. Starting Jan. 1, 2016, The Hartford will be our new life insurance provider. Any increase or new election to colleague supplemental life coverage or spouse/eligible adult life coverage will require you to submit a Personal Health Application. The Personal Health Application must be sent to The Hartford by Jan. 8, Starting in 2016, your beneficiary designation for life and supplemental life insurance coverage will need to be the same. Beginning Jan, 1, 2016, The Hartford will be providing our disability insurance. Your 2015 elections will carryover. 2 Saint Francis - Wilmington

3 Other Information About Enrolling Your enrollment requirements If you don t make benefit elections on or before Nov. 11, 2015, you will automatically receive a default package of benefits, which includes the same elections you had last year for medical, dental, vision, life insurance, AD&D and disability. Keep in mind: If you want to contribute to the Health Savings Account or the health care or dependent care flexible spending accounts you must make an election. Last year s election will not carry forward. If you want to participate in the Essential PPO Assist Plan for 2016, you must apply each year and meet specific income and eligibility guidelines. For more information on the Essential PPO Assist Plan, refer to page 7. If you wish to participate in these programs next year you must complete your enrollment by Nov. 11, 2015 at 11:59 p.m. EST. Benefit elections are effective for the entire year Remember, the benefits you elect during open enrollment will be in effect from Jan. 1 through Dec. 31, Open enrollment is your only opportunity during the year to make elections for your 2016 benefits unless you experience a qualified family status change. If you experience a qualified family status change or certain employment status changes and provide any required documentation to your Human Resources within 30 days of the event, you will be allowed to make certain benefit changes as long as they are consistent with the status change. For example, if you get married during the plan year, you ll be able to add your spouse/eligible adult to your coverage within 30 days of the marriage. For more information on qualified family status changes, visit Adding family members If you re adding family members to your benefit plan during this year s open enrollment, you re required to provide written documentation (for example, marriage certificate or birth certificate) verifying their dependent status to your Human Resources no later than Nov. 18, If you don t submit the required documentation by the deadline, your dependents will not be enrolled for coverage for 2016, and you ll be required to wait until next year s open enrollment period to add them to the plan provided they remain eligible, and you provide written documentation verifying their dependent status at that time. You are required to provide a Social Security number for each of your dependents over the age of one in order for them to be covered. Please provide any missing dependent Social Security numbers to your Human Resources. Please note, you have the option to purchase coverage for your spouse/eligible adult and dependents. If you and your spouse/eligible adult or dependent(s) both work for Trinity Health, and are benefits eligible, you cannot elect dual coverage (enrolled as a colleague and a dependent). In addition, only one of you will be able to elect coverage for your child(ren). To view the complete eligibility rules and documentation requirements for you and your family members, visit Choose your Primary Care Physician (PCP) Maintaining a relationship with your PCP is important because they are trained to recognize any health problems you may have. A PCP is the doctor you see for most services, including annual check-ups. Your PCP can also help you identify and meet your health goals and help you prevent serious, long-term health conditions. And, by following their preventive recommendations, they can help keep your health care costs low. Trinity Health encourages you to select a PCP and develop a relationship with them. To find an in-network physician or provider, visit website. Saint Francis - Wilmington 3

4 The Affordable Care Act The Affordable Care Act (ACA) was put in place to make sure citizens have access to health insurance they can afford. Since Jan. 1, 2014, the law has required that most U.S. citizens and legal resident aliens have health insurance whether they get it from an employer, a private insurance company or from the government. If they do not have health insurance, they may have to pay a tax penalty. As a colleague at Trinity Health, here is how the law may affect you: Trinity Health will continue to offer health insurance for U.S. colleagues who are benefits eligible. During open enrollment, you can choose the Trinity Health medical plan that works best for you and your family. The law requires employers to offer medical and prescription coverage to employees who work more than 30 hours a week or more than 130 hours per month. Colleagues who work an average of 30 hours a week over a rolling 12-month period are eligible for medical coverage through Trinity Health. A Trinity Health medical plan may be your best option for coverage. You will probably continue to hear a lot about the health insurance marketplace that has been set up in each state to help people find health insurance. To evaluate the most appropriate coverage for you and your family, please visit Trinity Health will continue communicating with you about your benefits coverage as weremaincommittedtoprovidingyouwith the latest information. In the meantime, if you have questions, please contact your your Human Resources representative. Women s Preventive Care under the Affordable Care Act Part of the Affordable Care Act (ACA) (also known as health care reform) requires employers to cover certain women s preventive care services, including contraception, under health insurance benefits at no charge. As a health ministry of the Catholic Church, we have engaged in extensive advocacy with the support of the Catholic Health Association, to find an acceptable resolution to this issue. The final rules from the U.S. Health and Human Services, Treasury and the Department of Labor give an accommodation to certain religious and religiously-affiliated organizations, like Trinity Health, to provide an exemption from the requirement to provide contraceptive coverage to employees as preventive health services. The intent of the rules is to accommodate the moral perspectives of certain religiously-affiliated employers while also providing for the preventive health care needs of their employees who may not share the employers religious beliefs. In 2016, your medical/pharmacy benefit provider will continue to provide these benefits as mandated by the ACA. Trinity Health colleagues will be provided with access to these benefits, but they will not be paid for by Trinity Health or its health plans. Contact your medical/pharmacy benefit provider for further details. More about the Clinically-Integrated Network A Clinically-Integrated Network (CIN) joins local physicians and health care providers that have made a decision to partner with a Regional Health Ministry (RHM) to deliver services focused on high quality and cost-efficient care designed to improve the health of those we serve. Seeking care within the CIN can help you and your physician make health care decisions that ensure that you are accessing the right care, at the right time, in the right setting. In addition, by utilizing our CIN you will pay less out of pocket for the care you receive, because all of the CIN providers are in our Tier 1 network. The Affordable Care Act is changing the way we provide care. As a result, there have been many changes designed to help increase health care quality and reduce the cost in order to make it more affordable. Our health care organization is changing in order to deliver better care at a reduced cost and with an improved, people-centered care experience. There are a lot of changes happening on the health care landscape. We believe putting them in place will better position our organization to keep our colleagues and their families healthier, fulfill our Mission, meet our nation s needs and improve the health of the millions of people and the hundreds of communities we serve. If you have questions about these changes, please contact your Human Resources. 4 Saint Francis - Wilmington

5 Watch the Video to Learn More Scan the tag with your smartphone to download and view a video about your 2016 medical plan choices. Get the free mobile application at If you don t have a smartphone, visit your benefits website to view the video. Medical Coverage Trinity Health is offering you three medical plan choices for 2016 which support our efforts to provide a common experience for all colleagues and provide meaningful choices. All three plans are administered by Aetna and support our clinically-integrated network structure. The three medical plan options are the Traditional PPO, the Health Savings PPO, and the Essential PPO. Each plan offers these three tiers so you can pay less by receiving care from network providers. Tier 1, or the Trinity Health Preferred network providers, are facilities or physicians aligned with our organization that provide you with the most cost-effective care. For services unavailable through Trinity Health Preferred network providers, select Aetna providers will be available at the Tier 2 benefit level. Tier 2 includes select Aetna Providers (facilities and physicians) not listed under Tier 1. Tier 2 providers can save you money, but not as much as using our Tier 1 network. Tier 3 providers are out-of-network providers and this Tier provides the lowest level of coverage. You can use these facilities and physicians for care, but you will pay the most out of your pocket when you do. How the medical plan works Traditional PPO If you elect coverage under the Traditional PPO, you pay for a portion of the medical services you receive until you meet the annual deductible. Then, coinsurance begins up to the annual out-of-pocket maximum. Health Savings PPO With the Health Savings PPO, you pay less per pay period for coverage leaving more money in your paycheck and you have access to a Health Savings Account (HSA) to help pay for current and future medical expenses. Here s how it works: First Second Third You pay the full cost of medical and prescription expenses until you reach the annual deductible (Note: preventive care services and certain preventive 90-day generic prescriptions do not require you to pay the deductible). Once you meet the deductible, you pay coinsurance until you reach the out-of-pocket maximum. Once you reach the out-of-pocket maximum, Trinity Health pays 100% of all remaining eligible expenses during the year. To learn more about the Health Savings PPO, see page 8 of this enrollment guide. If you enroll in the Health Savings PPO, you will automatically have an HSA. Trinity Health and Saint Francis Healthcare contribute to your HSA to help you pay for expenses toward your annual deductible and out-of-pocket maximum. You can also contribute to this account to build savings for current and future medical expenses. We encourage you to consult with a tax advisor for IRS rules and tax implications related to HSAs. Essential PPO The Essential PPO works the same as the Traditional PPO where you pay a portion of the medical services you receive until you meet the annual deductible. Then, coinsurance begins. If you elect the Essential PPO, you pay less in premium contributions than in the Traditional PPO, however, your out-of-pocket costs are higher. Saint Francis - Wilmington 5

6 Medical Plan Highlights For more information about your medical plan options or to find a provider, visit Medical Plan Highlights Traditional PPO Health Savings PPO Essential PPO Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 Trinity Health- N/A Health Savings Account (HSA) Health Reimbursement Account (HRA), funded account if you qualify Single $650 $750 Family $1,300 $1,500 Annual deductible Individual $250 $750 $1,500 $1,300 1 $2,500 1 $3,500 1 $1,000 $2,500 $4,000 Family $500 $1,500 $3,000 $2,600 1 $5,000 1 $7,000 1 $2,000 $5,000 $8,000 Coinsurance 10%* 20%* 40% R&C* 10%* 20%* 40% R&C* 20%* 30%* 40% R&C* Preventive care 0% no 0% no 40% 0% no 0% no 40% 0% no 0% no 40% deductible deductible R&C* deductible deductible R&C* deductible deductible R&C* Office visit PCP: $20 PCP: $30 40% 10%* 20%* 40% 20%* 30%* 40% Specialist: Specialist: R&C* R&C* R&C* $30 $40 Urgent care visit 0% after $35 copay 10%* 20%* Emergency room 0% after $100 copay 10%* 0% after $100 copay Inpatient None** $500** $1,000** None** $500** $1,000** None** $750** $1,000** admission Outpatient $50** $100** $200** None** $100** $200** $50** $100** $200** admission Out-of-pocket maximum (includes deductible, copayments, and coinsurance) Individual $2,500 $4,750 $9,500 $2,600 $5,000 $7,000 $3,500 $5,500 $9,000 Family $5,000 $9,500 $19,000 $5,200 $10,000 $14,000 $7,000 $11,000 $18,000 Prescription drug Trinity-Health Retail Pharmacy Trinity-Health Retail Pharmacy Trinity-Health Retail Pharmacy 34 day supply Owned Pharmacy Owned Pharmacy Owned Pharmacy Generic $8 $10 $8 $10 Brand formulary 16% ($24 min, 20% ($30 min, 16% after 20% after 20% ($24 min, 25% ($30 min, $64 max) $80 max) deductible,0% deductible,0% $64 max) $80 max) Brand non-formulary 32% ($48 min, 40% ($60 min, after out-of-pocket after out-of-pocket 40% ($48 min, 50% ($60 min, $80 max) $100 max) max max $96 max) $120 max) Trinity-Health CVS Caremark Trinity-Health CVS Caremark Trinity-Health CVS Caremark 90 day supply Owned Pharmacy Owned Pharmacy Owned Pharmacy Generic $24 $25 $24 $25 Brand formulary 16% ($72 min, 20% ($75 min, 16% after 20% after 20% ($72 min, 25% ($75 min, $192 max) $200 max) deductible,0% deductible,0% $192 max) $200 max) Brand non-formulary 32% ($144 min, 40% ($150 min, after out-of-pocket after out-of-pocket 40% ($144 min, 50% ($150 min, $240 max) $250 max) max max $288 max) $300 max) Out-of-pocket maximum based on Deductible and out-of-pocket maximum Out-of-pocket maximum based on Tier 2 based on Tier 1 Tier 2 1 The full family deductible must be met even if only one person in the family is receiving care. * Subject to deductible. ** Subject to deductible and coinsurance. Select, generic preventive drugs are covered at 100% and are not subject to the annual deductible. See My Benefits for the complete list of eligible drugs. 6 Saint Francis - Wilmington

7 Paying for medical coverage Contribution levels for the medical plans are based on the Social Security taxable wage base ($118,500 for 2015, indexed annually) to ensure our benefit plan cost-sharing model is appropriately aligned with our colleagues income levels. The amount you pay for medical coverage is based on your annual base salary (your base rate of pay times your budgeted hours) and your participation in the Well-Being programs. If at any time during the 2016 plan year, you earn $118,500 or more, you will pay a higher premium contribution per pay period for your medical insurance. Traditional PPO Health Savings PPO Essential PPO Full-time Part-time Full-time Part-time Full-time Part-time Your per pay Reward No Reward No Reward No Reward No Reward No Reward No period cost Reward Reward Reward Reward Reward Reward Colleague only Colleague plus spouse/eligible bug adult Please contact your Human Resources for medical plan rates. Colleague plus child(ren) Colleague plus family Need help with your health care costs? You may be eligible for the Essential PPO Assist plan if you meet certain income requirements. It is the same as the Essential PPO, but includes a Trinity Health-funded Health Reimbursement Account (HRA), to help you pay for your health care costs at the time of service. You do not make contributions to the HRA under the Essential PPO Assist plan. To participate in the Essential PPO Assist, you must apply for and meet specific income and eligibility guidelines. To learn more about the qualifications, please see the application form on My Benefits or You can apply for the Essential PPO Assist by completing an application form and submitting it with a copy of your most recent Federal Income Tax Form 1040 or 1040EZ to your Human Resources by Nov. 18, NOTE: Even if you think you qualify for the Essential PPO Assist, you should elect the medical plan you think will be best for you and your family which could be the Traditional PPO, the Health Savings PPO, or the Essential PPO. If you qualify for the Essential PPO Assist plan, you will be moved to the Essential PPO Assist plan. Otherwise, you will remain in the plan you elected during open enrollment. Saint Francis - Wilmington 7

8 More about the Health Savings PPO TheHealthSavingsPPO is a consumer-driven health plan which gives you the opportunity to participate in a plan where your health care costs are more closely determined by your decisions. Here are some reasons to consider choosing the Health Savings PPO in 2016: IlikedthatIsaved money in premium contributions spending money only when I used medical care. I can really save for my health care expenses when I use the HSA. It s great that Trinity Health makes its full contribution to my HSA in January. For certain generic preventive drugs and diabetes and asthma drug classes, I didn t have to pay my deductible before the plan started paying those expenses. How the deductible works TheHealthSavings PPO Plan includes a combined deductible. A combined deductible means the full family deductible must be met even if only one person in the family is receiving care. Coinsurance begins once the combined deductible has been met. How the Health Savings Account (HSA) works When you enroll in the Health Savings PPO plan, you automatically have a Health Savings Account (HSA) through Health Equity to help you pay for current or future health care costs. Trinity Health will make a full contribution to your account in January based on the coverage level you elect. In addition, you can also contribute to this account up to IRS limits: Coverage Level Trinity Health Your Voluntary Total IRS Allowed Contributions Contributions* HSA Contributions Colleague only $650 $2,700 $3,350 All other coverage levels $1,300 $5,450 $6,750 *If you are 55 or older, you can contribute an additional $1,000 in catch-up contributions to your HSA. May be subject to state taxation. Questions about the HSA How do I get an HSA? To be eligible for the HSA, you must enroll in the Health Savings PPO. In addition, you cannot have coverage under any other medical plan, such as Medicare, TRICARE, or coverage through a spouse s health plan. Who can use funds in my HSA? You and your dependents can pay for medical, dental and vision expenses with funds in your HSA. Dependents must be claimed on your tax return. Why would I contribute to my HSA? Contributions to the HSA are a great way to save on taxes. With the HSA, you do not pay taxes on the amount you contribute through payroll deductions, the amount you withdraw for medical expenses, and the interest you earn in the account (up to amounts set by federal law). Keep in mind that you can change the amount you contribute to your HSA at any time during the plan year. How can I use the money in my HSA? You may use the HSA to pay for qualified medical expenses now and during retirement for you and your qualified dependents. How do I pay for medical expenses with my HSA? When you receive eligible health care services, you can pay for those services with your HSA debit card, or through several online and smartphone app options. You ll receive more information about your payment options if you enroll in the Health Savings PPO with the HSA. What happens if I don t use all the money in my HSA each year? Any money you do not use during the year is carried over, without any limits. Remember, you own the money in your HSA and it is yours to keep even when you change jobs or retire. Can I enroll in the Health Care Spending Account (HCSA) if I have an HSA? When you enroll in the Health Savings PPO which includes the HSA, you will not have access to the health care spending account (HCSA). However, the HSA may be seen as having more advantages over the HCSA including: The opportunity to carry over savings from year to year you do not forfeit any amount in your HSA at the end of the plan year (if you are currently enrolled in the HCSA, you must utilize your account funds by Dec. 31, 2015); Contributions of up to $6,750 in tax-free HSA dollars each year (the HCSA maximum is $2,550); Your HSA dollars are saved in a bank account that may earn interest. How do I know if the Health Savings PPO, including an HSA, is right for me? Your medical plan choice depends on your personal situation. If you answer yes to some of these questions, the Health Savings PPO plan is right for you: Would you like to have lower per pay period contributions deducted from your paycheck? Do you want to save on taxes by contributing to the HSA for your health care costs? Do you need a way to pay for future health care costs? Can you see your HSA balance growing as you keep making contributions each year? We encourage you to consult with a tax advisor for IRS rules and tax implications related to an HSA.! For more information about the Health Savings PPO, including the Health Savings Account (HSA), visit or 8 Saint Francis - Wilmington

9 Live Your Whole Life Staying healthy all the way around - in body, mind, and spirit - makes us happier and more productive at home and on the job. At Trinity Health, we believe that an annual Health Assessment and taking part in healthy activities are essential steps in understanding your Well-Being. It s so important that we reward you with a lower premium contribution for medical coverage each pay period when you and your covered spouse or eligible adult complete these steps. Period 1 Getting Started Activities Complete your Health Assessment The Health Assessment is an online questionnaire about your health habits. Your answers are kept secure and confidential; summary data is used to identify areas for future well-being and prevention programs. Note: To maintain your reward of a lower premium contribution on your medical benefits each pay period, the health assessment must be completed by you and your covered spouse or eligible adult in Period 1 (Oct. 1, Feb. 1, 2016.) Log in to your Live Your Whole Life account at mybenefits.trinity-health.org/lywl to review your options or call for help. Periods 2 and 3 Completing Meaningful Choice Activities To continue receiving the reward throughout the year, you and your covered spouse or eligible adult need to complete one meaningful choice activity in Periods 2 and 3. You can choose from a variety of Meaningful Choice Activities that fit your lifestyle. Some examples include talking with a health coach, completing an online journey, tracking physical activity, or participating in a well-being challenge. Period 2 between Feb. 1 and April 30, 2016 You and your covered spouse or eligible adult must complete one Meaningful Choice Activity between Feb. 1 and April 30, Completing this activity will ensure you continue the reward of a lower premium contribution on the cost of your medical benefits each pay period. Period 3 between May 1 and July 31, 2016 You and your covered spouse or eligible adult must complete one Meaningful Choice Activity between May 1 and July 31, Completing this activity will ensure you continue the reward of a lower premium contribution on the cost of your medical benefits each pay period. Check out the Live Your Whole Life website at mybenefits.trinity-health.org/lywl to learn more about all qualifying Meaningful Choice Activities. Want to learn more? Learn more about the Live Your Whole Life Rewards and Meaningful Choice Activities requirements on the Live Your Whole Life website. If you feel that you need an exception to one of the requirements in the Live Your Whole Life program, you must complete the Exception Request Form (found on the website). The form must be filed prior to the end of each Period.! For more information on dates and activities, please visit the Live Your Whole Life website at mybenefits.trinity-health.org/lywl. Saint Francis - Wilmington 9

10 Be a smart health care consumer As you know, the cost of high-quality health care continues to increase each year. Being a smart consumer means getting the best price on something you need, whether it s a new car or health care. Being a smart health care consumer doesn t mean you should avoid trips to the doctor it means making the best decisions about when to go to the doctor. Regular checkups can improve your health and extend your life. By getting the recommended exams and tests, you increase your chances of discovering problems before an illness significantly affects your health. Plus, preventive care is beneficial not only to your physical well-being, it also makes sense for your financial health because generally, it s covered by your medical plan. For more information on preventive care benefits, visit An easy way to be a smart health care consumer is to choose a Trinity Health Tier 1 provider when you or a family member needs medical care. Besides receiving excellent care at our own facilities, you receive the highest level of benefits while paying the lowest available copayment and coinsurance amounts. Maintenance Choice program for your maintenance medications Our prescription drug plan requires that you receive your maintenance medications* in 90-day supplies through the CVS Caremark Mail Service Pharmacy, a local CVS pharmacy or through a nearby Trinity Health onsite pharmacy. Once you reach your plan limit (initial fill and 2 refills) for filling 30-day supplies at a retail pharmacy, you will pay the full cost of your medications if you do not move your prescription to one of the long-term options listed here. *A maintenance medication is a long-term medication taken regularly for chronic conditions or long-term therapy. 10 Saint Francis - Wilmington

11 Dental Coverage You have a choice between two Delta Dental of Michigan plan options: the High plan and the Standard plan. Visit for providers in your area. Dental Plan Highlights High Plan Standard Plan Participating Dentist Nonparticipating Dentist Participating Dentist Nonparticipating Dentist Annual deductible Individual $25 $50 $50 $100 Family $50 $100 $100 $150 Class I - Preventive services 100% covered 100% covered 100% covered 100% covered ($0 colleague cost) (Usual and Customary ($0 colleague cost) (Usual and Customary rates apply) rates apply) Class II - Basic services 20% after deductible 20% after deductible 40% after deductible 40% after deductible Class III - Major restorative services 40% after deductible 40% after deductible 50% after deductible 50% after deductible Class IV - Orthodontics 50% after deductible 50% after deductible Not covered Maximums Per person annual (non-orthodontics) $1,750 $1,250 $1,500 $1,000 Per person lifetime (orthodontics) $1,500 $1,500 Not applicable Not applicable Your per pay period cost Full-time Part-time Full-time Part-time Colleague only Colleague plus spouse/eligible adult Colleague plus child(ren) Colleague plus family Please contact your Human Resources for dental plan rates. NOTES: When you receive services from a non-participating dentist, you will be responsible for the difference between what your dentist charges and the Delta Dental non-participating dentist fee. Fluoride treatments are covered once every 12 months to age 14. Bitewing x-rays are covered once every 12 months.! For more information about your dental plan options or about Delta Dental, visit Saint Francis - Wilmington 11

12 Vision Care Coverage You have a choice between two United Health Care vision plan options: the High plan and the Standard plan. Visit for providers in your area. UHC Vision Plan Highlights High Plan Standard Plan In-network Out-of-network In-network Out-of-network (reimbursement schedule) (reimbursement schedule) Benefit frequency Calendar year Calendar year Calendar year Calendar year Vision exam Covered in full Up to $40 $10 copayment Up to $40 Pair of lenses Single vision Up to $40 Up to $40 Bifocal $0 copayment Up to $60 $0 copayment Up to $60 Trifocal Up to $80 Up to $80 Lenticular Up to $80 Up to $80 Frames The preferred price is a The preferred price is a Covered frame $50 wholesale allowance $50 wholesale allowance Non-covered frame at independent locations Up to $45 at independent locations Up to $45 Contact lenses (in lieu of eyeglasses) Elective Necessary or a maximum of $150 or a maximum of $150 of retail allowance at retail locations of retail allowance at retail locations Contact lens coverage is provided under the plan and may vary dependent on the type of contact lenses prescribed. Please see the benefit summary on My Benefits for additional information. Additional pair of eyeglasses 20% discount 20% discount 20% discount 20% discount or contact lenses Additional lense options Your per pay period cost Colleague only Colleague plus spouse/eligible adult Colleague plus child(ren) Colleague plus family The following lens options are covered in full: standard scratchresistant coating, standard basic and high-end progressive lenses, standard polycarbonate lenses, standard antireflective coating, UV, tints, photochromic, Transitions, edge coating The following lens options are covered in full: standard scratch-resistant coating, standard polycarbonate lenses. Please contact your Human Resources for vision plan rates.! For more information about your vision care plan options, visit 12 Saint Francis - Wilmington

13 Health Care and Dependent Care Flexible Spending Accounts You have the opportunity to set aside before-tax money to offset eligible health care or dependent care expenses. There are two different types of Flexible Spending Accounts a Health Care Spending Account and a Dependent Care Spending Account. How much can I contribute? What expenses will it cover? When do I have to spend the money? How do I access my FSA savings? Health Care Spending Account (HCSA) Before-tax dollars in any amount between $130 and $2,550 Eligible health care products and services used by you and/or your eligible dependents. Examples include: Vision care, including eyeglasses, contact lenses and saline solution Dental care, both preventive and restorative Orthodontia Physical therapy, counseling, or psychological services Chiropractic care and acupuncture Copayments, coinsurance and deductibles Prescribed Over-the-Counter (OTC) medications For a list of expenses that are eligible for HCSA reimbursement, visit Contributions made to the HCSA during the 2016 calendar year can be used for claims with dates of service between Jan. 1, 2016 and Mar. 15, You can use a variety of payment options to access your FSA savings. These include the WageWorks Health Card, Pay my Provider, Pay me Back, or the Mobile application. Dependent Care Spending Account (DCSA) Before-tax dollars in any amount between $130 and $5,000 Expenses for the care of your eligible dependents (child under age 13 or qualifying adult incapable of self-care) while you work: Babysitting or au pair services Before and after-school programs Day care and nursery school Pre-school programs Elder care services Contributions made to the DCSA during the 2016 calendar year can be used for claims with dates of services between Jan. 1 and Dec. 31, You can use a variety of payment options to access your FSA savings. These include Pay my Provider, Pay me Back; or the Mobile application. Reminders: If you choose to enroll in the Health Savings PPO medical plan option, you cannot enroll in the HCSA. The Health Savings Account works just like the HCSA but offers additional benefits, such as the opportunity to carry over unused funds, contribute up to $2,700/individual ($5,450/family), plus an additional $1,000 in catch-up contributions if you are age 55 or over, and earn interest on your savings. You must make health care and/or dependent care spending account elections for 2016 during open enrollment. Your prior year elections will NOT carry forward. Health Care Spending Account and Dependent Care Spending Account claims for the 2016 plan year must be postmarked on or before Mar. 31, If you choose to contribute to the Health Care Flexible Spending Account for the first time in 2016, a new WageWorks Health Card will be mailed to your home. Otherwise, you will only receive a new WageWorks Health Card when your current card expires.! For more information about your FSA benefits and to obtain a list of eligible expenses, visit Take advantage of WageWorks mobile site As the nation s largest independent provider of consumer-directed benefit solutions, WageWorks offers FSA participants the latest technology to make it easier to manage your savings. Their mobile site and new EZ Receipts app offer the following features: Check your current HCSA and DCSA account balances Submit HCSA and DCSA claims Submit WageWorks Health Care card receipts Learn more at or contact your Human Resources. Saint Francis - Wilmington 13

14 Life Insurance Colleague life insurance options If eligible, you receive employer-provided basic life/ad&d insurance at one times your annual base salary. In addition, you have the option to purchase supplemental coverage for yourself in the increments shown in the table below. If you purchase colleague supplemental life insurance and you re approved, the premium contributions will be deducted from your paycheck on an after-tax basis. You will be eligible for will preparation services through The Hartford s EstateGuidance Will Services at no charge. To get started, access The Hartford s EstateGuidance Will Services online at and enter the Trinity Health Web ID WILLHLF in the Promotional Code box. Basic life/ad&d (employer-paid) Supplemental life Supplemental AD&D Maximum amounts Personal Health Applications Colleague Life Insurance Plan Highlights (full- and part-time) One times annual base salary One to eight times annual base salary One to eight times annual base salary Basic life: $1.5 million Supplemental life: $1.5 million (Combined: $3 million) Any increase in colleague Supplemental life coverage will require you to complete a Personal Health Application form. For more information about your life insurance benefits or to obtain a Personal Health Application form, visit NOTE: Personal Health Application forms should be sent to The Hartford by Jan. 8, Costs for colleague supplemental life insurance coverage are based on your age as of Jan. 1, 2016, and will be available when you enroll online. Are your beneficiaries up-to-date? You may want to take a moment to review the beneficiary(ies) you have on file for your life coverage. If you haven t yet designated beneficiaries, your life insurance benefits will be paid according to the plan provisions as outlined in the Summary Plan Description. You ll have an opportunity to review (and change, if you wish) your life insurance beneficiary(ies) during the open enrollment process. Dependent life insurance options You have the option to purchase coverage for your dependents (including your spouse, eligible adult or eligible children). You may elect coverage for your dependents without electing coverage for yourself. If you and your spouse or eligible adult both work for Trinity Health and are benefit eligible, you cannot elect Spouse/Eligible Adult coverage for that individual. Also, only one of you will be able to elect coverage for your child(ren). If your dependent child also works at Trinity Health and is benefit eligible, you cannot elect child life coverage for that individual. Personal Health Application Dependent Life Insurance Plan Highlights (full- and part-time) Spouse/Eligible Adult life 1 Child(ren) life 2 Coverage amount Coverage amount $10,000 $20,000 $50,000 $80,000 $100,000 $5,000 $10,000 $20,000 Any increase in spouse/eligible adult supplemental life coverage will require you to complete a Personal Health Application form. NOTE: Personal Health Application forms should be sent to The Hartford by Jan. 8, Costs for spouse/eligible adult life insurance coverage are based on your age as of Jan. 1, 2016, and will be available when you enroll online. 2 Child(ren) life insurance costs cover all of your eligible children, and will be available when you enroll online.! For more information about your life insurance benefits or to obtain a Personal Health Application form, visit 14 Saint Francis - Wilmington

15 Time Away From Work At Trinity Health, we are working to harmonize time off benefits across the enterprise. Our goal is to help strengthen and enhance the enterprise and provide our colleagues with meaningful benefits that are competitive and sustainable. Here are some of the benefits you receive as you need time away from work. Short-term disability Short-term disability (STD) pays a benefit if you are unable to work because of a qualified injury or illness. NOTE: this is not an employer-paid for benefit. You pay the full cost of coverage on a post-tax basis. Rates are based on your pay and age. Amount of benefit When benefits begin How long benefits continue Use of PTO time 60% of base pay Option A: up to $500 maximum per week Option B: up to $2,000 maximum per week After a 14 calendar day elimination period following an injury or illness Up to 11 weeks or until you no longer qualify for benefits, whichever comes first Full- or part-time colleagues are required to use PTO until only 40 hours remain. Long-term disability Long-term disability (LTD) pays a benefit if you are unable to work for a long period of time because of a qualified injury or illness. Amount of 60% of base pay employer-provided Up to a maximum of $10,000 benefit When benefits After 90 days of disability may begin How long benefits Benefits continue until you are able to return continue to work, are deemed no longer disabled, or until normal retirement age. For more information about your disability, visit For more information about your disability benefits, visit Saint Francis - Wilmington 15

16 Voluntary Benefits In addition to your group benefits, Trinity Health has partnered with Trinity Health Plus Benefits to provide eligible colleagues the opportunity to elect personal insurance plans. Open enrollment for these benefits will be held in the Spring of Individual policy options include: LifeTime benefit term insurance with long- term care Critical illness coverage Individual short-term disability insurance Legal coverage Group accident insurance Additional voluntary benefits available for enrollment all year long include: Auto and home insurance Pet insurance Discount marketplace Long-term care Employee financial solutions ID theft protection For more information, call Be sure to tell the representative that you are a member of Trinity Health and Saint Francis Healthcare. 16 Saint Francis - Wilmington

17 How to Enroll Annual enrollment is conducted using our web-based tool which you access through your benefits website. It takes only about 10 minutes to make your benefit elections online, and you may not need to fill out any forms. If you don t have a computer with Internet access in your workplace or your home, you can enroll at computer stations provided by your Human Resources department or at your local public library. You can enroll any time that s convenient to you during the open enrollment period 24 hours a day, seven days a week. During the two-week open enrollment period, you can make as many changes to your benefit elections as you wish. The last day to modify your choices is Nov. 11, Be sure that your personal information is secure on the enrollment website. Trinity Health has taken extra precautions to ensure the integrity of all confidential records. Step-by-step instructions 1. Log on to or My Benefits. Use your Lawson User ID and password to log in. 2. Click on Benefits, then Benefits Enrollment Carefully read the Benefits Enrollment Welcome page and continue 3. Verify that your dependent data is up-to-date and accurate. You must actively enroll or decline each benefit offering. You can update dependent information by clicking on Add/Change Dependents. Next you will see the 2016 benefits for which you are eligible and can enroll for. Lawson will then display your current 2015 elections. 4. Review each list of benefits and make changes to your current election You will have the option to keep, add, or change your election While enrolling in benefits, please do not use the back button or you will encounter election processing problems. To view a previous screen, click the Previous button. 5. Review your confirmation and click PRINT, otherwise choose make changes and complete the process over. Important: Print the confirmation page for your records after you enroll. The confirmation statement you print from Lawson will be the only printed record of your 2016 elections. If you can t remember your password, contact IT Help Desk (to reset password) and ask them to reset your password and security questions. Saint Francis - Wilmington 17

18 For More Information We hope this enrollment guide has provided you and your family with all of the information you need to make your benefit elections for In addition to Open Enrollment, please remember to review and update your personal information, such as your address, phone number, and emergency contacts as necessary. You may update your personal information at any time throughout the year. If you still have questions about your options or the open enrollment process, you can: Attend a benefits meeting or fair, where you ll receive additional information and have an opportunity to ask questions regarding your benefit options. More details regarding location will be posted and announced online. Day Time(s) Meeting Type Location Tuesday, Oct. 13 8:00 a.m. 4:30 p.m. Benefit Fair VIP Hallway Wednesday, Oct. 21 1:00 p.m. Colleague Meeting DuPont Room 136 3:30 p.m. Benefits Contact Information: Plan Type Contact Phone Website Saint Francis Healthcare Portal 2015 Open Enrollment Folder Benefits/Eligibility and Human Resources General Questions Enrollment Lawson Work computer Non-work Computer Trinity Health IT Help Desk (to reset password) Medical Aetna Prescriptions Caremark Dental Delta Dental of Michigan Vision United Health Care Flexible Spending Accounts WageWorks and Computer Benefits Life Insurance The Hartford Credit Union Franklin Mint Credit Union Delaware Alliance Disability The Hartford Employee Assistance Program Carebridge access code: BKKR5 Voluntary Benefits Trinity Healh Plus Voluntary Benefits Employment Verification The Work Number company code: Saint Francis - Wilmington

19 Important Reminders Benefit elections are final for 2016 Remember, the benefits you elect during open enrollment will be in effect from Jan. 1 through Dec. 31, The choices you make now are final for 2016, because open enrollment is your only opportunity during the year to switch medical, dental or vision plan coverage. If you experience a qualified family status change or certain employment status changes and provide any required documentation to! For more information on qualified family status changes, visit your Human Resources within 30 days of the event, you will be allowed to make certain benefit changes that are consistent with the status change. For example, getting married is considered a family status change. If you get married during the plan year, you ll be able to add your spouse/eligible adult to your coverage within 30 days of the marriage. HIPAA privacy notice is available online Trinity Health takes the security of its colleagues and family members Personal Health Information (PHI) very seriously. To access a copy of the Health Information Portability and Accountability Act (HIPAA) Privacy Notification, visit If you are unable to access the HIPAA notice online, contact your Human Resources to request a paper copy by mail. Medical plan election notification When you enroll in a Trinity Health medical plan, the medical plan coverage provides benefits through a clinically integrated network (CIN) of hospitals, physicians, and other health care providers and professionals, including care coordinators and case managers that monitor and coordinate all aspects of your medical care. Trinity Health and Saint Francis Healthcare participate in the CIN. When you and your covered dependents receive health care services at facilities or by the colleagues of your employer or a health care provider or professional affiliated with your employer, colleagues of your employer or a health care provider or professional affiliated with your employer will have access to and may use and disclose your and your covered dependents personal health information to manage and coordinate your care. Any access to and use and disclosure of protected health information will comply with the privacy and security regulations under HIPAA and any applicable state privacy and security laws. Plan documents and Summary of Benefits and Coverage (SBC) are available online Health Care Reform legislation requires all employers to provide an easy-to-read summary of their medical plan options called the Summary of Benefits and Coverage (SBC). The SBC provides basic information about your medical plan options, comparison examples, and a glossary of terms. To access a copy of the SBC, visit your benefits website. If you are unable to access the SBC online, contact your Human Resources to request a paper copy by mail. Notice: Women s Health and Cancer Rights Act of 1998 The Women s Health and Cancer Rights Act of 1998 requires all employers who provide a medical benefit plantoits employees to communicate the coverage provisions established under the Act. Trinity Health s medical benefit plan provisions are as follows: The Trinity Health medical benefit plan will not restrict benefits if you or your eligible dependent receives benefits for a mastectomy and elects breast reconstruction in connection with the mastectomy. Benefits will not be restricted provided that the breast reconstruction is performed in a manner determined in consultation with your (or your eligible dependent s) physician, and may include: Reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; and Prostheses and treatment of physical complications of all stages of mastectomy, including lymphedemas. Benefits for breast reconstruction may be subject to appropriate plan coverage provisions and limitations, including annual deductible, copayment and coinsurance provisions that are consistent with those established for other benefits under the plan. If you have any questions about your medical plan provisions relating to the Women s Health and Cancer Rights Act of 1998, contact your Human Resources. Saint Francis - Wilmington 19

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