CARING FOR YOUR FUTURE

Transcription

1 CARING FOR YOUR FUTURE Make Informed Choices 2016 ENROLLMENT GUIDE - St. James Healthcare

2 TABLE OF CONTENTS Annual Open Enrollment for 2016 Benefits: October 14-30, 2015 SCL Health HR Service Center or Representatives are available Monday through Friday, 7:30 a.m. - 5 p.m. Mountain Time Trouble logging into Lawson Employee Self Service (ESS)? Help Desk or TAC HOW DO I NAVIGATE ENROLLMENT SUCCESSFULLY? Enrollment Checklist...3 KEY UPDATES TO BENEFITS IN BENEFITS AT A GLANCE...4 WHAT HAPPENS DURING ENROLLMENT?...6 Annual Open Enrollment for Current Associates...6 Enrollment for New Associates...6 Enrollment for Rehired or Newly Benefits-Eligible Associates...7 Can I Make Changes or Add Benefit Elections During the Year?...7 BENEFITS ELIGIBILITY...8 Am I Eligible for Coverage?...8 Can I Elect Coverage for my Family?...8 Legally Domiciled Adults and Their Children...9 WHICH ID CARDS WILL I RECEIVE?...10 WELLNESS BENEFITS MEDICAL BENEFITS...13 KNOW HOW YOUR MEDICAL PLAN WORKS...15 Cigna CDHP with HRA (Choice Fund Open Access Plus Plan)...17 Cigna PPO Plan (Cigna Open Access Plus Plan)...19 PHARMACY BENEFITS MEDICAL PREMIUM ASSISTANCE PROGRAM...23 DENTAL BENEFITS...24 VISION BENEFIT...25 FLEXIBLE SPENDING ACCOUNTS (FSAs)...26 LIFE INSURANCE AND AD&D COVERAGE...28 LEGAL BENEFITS EMPLOYEE ASSISTANCE PROGRAM (EAP) BENEFIT PLAN PROVIDERS CONTACT LIST ENROLLMENT GUIDE INDEX BACK NEXT

3 HOW DO I NAVIGATE ENROLLMENT SUCCESSFULLY? Enrollment Checklist When it comes to choosing your benefits, you can choose whatever best meets your needs. Here s a checklist to help you get started. o STEP 1: Review your current benefits and how you and your family have been using them. ostep 2: Consider 2016 medical, dental, vision, and life insurance care needs for you and your family to help choose the 2016 plans that are best for you and to identify how an FSA contribution may benefit you. m Cigna s website ( has tools to help you estimate your healthcare costs. o STEP 3: Read the 2016 Enrollment Guide to learn about SCL Health s benefits and to understand changes in plan designs and costs of premiums, deductibles, copayments and coinsurances in m Review the Key Benefits Updates in 2016, Benefits at a Glance, and What Happens During Enrollment? sections as great starting points. ostep 4: Review dependent eligibility in the Enrollment Guide to be sure your dependents can be enrolled. ostep 5: Determine if your current providers are within the SCL Health Network (Tier 1). Go to the benefits website at to access the network provider directories. ostep 6: Review regulatory notices located in the HR Benefits folder on The Landing and to make sure you are in the know of important benefits changes. Annual Open Enrollment for 2016 Benefits: October 14-30, 2015 SCL Health HR Service Center or Representatives are available Monday through Friday, 7:30 a.m. - 5 p.m. Mountain Time Trouble logging into Lawson Employee Self Service (ESS)? Help Desk or TAC ostep 7: Attend a Benefits Fair and bring questions to discuss with our benefit partners. Fairs are scheduled for October Contact your local HR representative for schedule details. o STEP 8: Contact the HR Service Center if you still have questions after reading the Enrollment Guide or visiting a Benefits Fair. You can reach the HR Service Center at or toll free at o STEP 9: Enroll and/or make changes to your benefits. A. For current or new associates: log in during Annual Open Enrollment (for current associates) between Oct , or within 31 days of your start date (for new hires). m Enroll in benefits or make benefit changes that meet your needs. m Add or update your beneficiaries and dependents. Use this opportunity to drop dependents who are no longer eligible for coverage. NOTE: Social security numbers of your dependent(s) will be required at the time of enrollment. m If you want to take advantage of a tax-free Flexible Savings Account (FSA) for 2016, you must sign up during the Enrollment Period. B. For rehired or newly benefits-eligible associates: Complete an enrollment form and submit it to the HR Service Center. Receive the enrollment form by contacting the HR Service Center. ostep 10: If you need help paying for premiums, find out if you qualify for the Medical Premium Assistance Program. o STEP 11: Review your Confirmation Statement to ensure everything you selected is correct. Open Enrollment closes, a Confirmation Statement (summary of your benefits elections) will be mailed to your home address listed in Lawson. If there are any errors on your confirmation statement, you will have the opportunity to make corrections. Your Confirmation Statement will give details on the correction process you must follow to complete your enrollment. o STEP 12: Complete the Dependent Eligibility Audit through HMS Employer Solutions to keep your newly added dependents covered under your benefit plans. HMS Employer Solutions will reach out to you via mail within days after enrolling your dependent(s). All covered dependents must complete a verification process, so start gathering required documents like marriage certificates and birth certificates. o STEP 13: And finally, improve your own health and wellness in Participate in preventive care, programs and screenings, and make healthier choices for yourself and your family. This is the best way to reduce your own healthcare costs ENROLLMENT GUIDE INDEX BACK NEXT

4 MAKING SMART CHOICES FOR YOU AND YOUR FAMILY Life is filled with important decisions like choosing which benefit plan is best for you and your family. We have introduced changes for 2016, so it is important that you carefully review this enrollment guide and make informed decisions about your benefits coverage for Key Benefits Changes for 2016 Medical Increase in plan deductibles and out-of-pocket maximums (Details on Page 15) Medical and Pharmacy Cigna PPO Plan: Out-of-pocket maximums will now include medical and pharmacy costs (Details on Page 15) Pharmacy Cigna PPO Plan Pharmacy to be administered through Cigna starting January 1, 2016 (Details on Page 21) Vision Benefit enhancement allowance for frames available every 12 months (Details on Page 25) Dental Benefit enhancement Increase in annual maximum plan coverage for basic and major care services (Details on Page 24) Do I Have to Make Changes to my Current Benefits? Your current benefits elections, except for FSAs, will remain the same as they are in 2015 at the new 2016 premium rates if you do not make any changes during the annual Open Enrollment period. (Details on Page 6.) Although this is a passive enrollment, we strongly encourage you to actively review this material, weigh your benefit options and make choices that meet the needs of you and your family. BENEFITS AT A GLANCE SCL Health offers many different benefits to help you stay healthy and to protect you and your loved ones. Here s a quick glance of benefits offered to you with more details available on the pages listed in the right-hand column. Benefits/Choices Plan Options Choices at a Glance Page Wellness* Automatically enrolled; voluntary participation o SCL Health Wellness Portal o EAP o Cigna Personal Health Team o Cigna Healthy Pregnancy o Cigna Treatment Decision Support o Quitline Tobacco Cessation These wellness plans are paid by SCL Health and are available all year long. Participation is voluntary. Cigna programs are available to all Cigna Medical Plan members. Incentives are also available throughout the year to encourage you to participate in certain wellness initiatives such as an annual health risk questionnaire or biometric screening. 11 Medical Enroll in one of two plan options or waive medical coverage o Cigna CDHP Plan o Cigna PPO Plan o Waive Medical Coverage The medical plan you choose will determine your Pharmacy Plan. Choose from the following levels of coverage: o Associate o Associate + Spouse o Associate + Child(ren) o Associate + Family 13 Medical Premium Assistance Program** Apply for assistance if you are eligible, through HR Service Center Dental Enroll in one of three plan options or waive coverage o Medical Premium Assistance Program (if eligible) Available to associates with the following 2015 annual household gross incomes: o Associate-Only Coverage = $37,000 or less o Associate + Dependents Coverage = $43,000 or less 23 o Delta Dental Core Plan o Delta Dental Choice Plan o Delta Dental EPO Plan o Waive Dental Coverage Choose from the following levels of coverage: o Associate o Associate + Spouse o Associate + Child(ren) o Associate + Family ENROLLMENT GUIDE INDEX BACK NEXT

5 BENEFITS AT A GLANCE, continued Benefits/Choices Plan Options Choices at a Glance Page Vision Enroll in or waive coverage o EyeMed Vision Plan o Waive Vision Coverage Choose from the following levels of coverage: o Associate o Associate + Spouse o Associate + Child(ren) o Associate + Family 25 Flexible Spending Accounts Enroll in one account, both accounts or waive coverage o Health Care and/or o Dependent Care o Waive FSA Plans Two account options: health care (general healthcare expenses) and/or dependent care (childcare and eldercare expenses, etc.). 26 Basic Life and Accidental Death & Dismemberment* Automatically enrolled o Basic coverage (equal to 1X salary) Basic Life and AD&D Insurance is a company-paid benefit, which you are automatically enrolled in. 29 Supplemental Life and Accidental Death & Dismemberment Enroll in or waive additional coverage for yourself Spouse Life and Accidental Death & Dismemberment Enroll in or waive coverage for your spouse o 1X Salary o 2X Salary o 3X Salary o 4X Salary o 5X Salary o Waive Supplemental Coverage o $25,000 o $50,000 o $100,000 o $150,000 o $200,000 o Waive Spouse Coverage Additional Life and AD&D Insurance coverage is available for you to purchase. Life and AD&D Insurance coverage is available for you to purchase for your spouse Child Life and Accidental Death & Dismemberment Enroll in or waive coverage for your dependent child(ren) o $5,000 o $10,000 o $25,000 o Waive Child Coverage Life and AD&D Insurance coverage is available for you to purchase for your dependent child(ren). 29 Legal Enroll in or waive legal coverage o Hyatt Legal Plan o Waive Legal Coverage Legal coverage is available for you to purchase for you and your covered dependents. 30 * You are automatically enrolled in wellness plans like EAP. ** You can elect to participate in the Medical Premium Assistance Program outside of your enrollment period ENROLLMENT GUIDE INDEX BACK NEXT

6 WHAT HAPPENS DURING ENROLLMENT? Open Enrollment Reminder Don t forget you must re-enroll in the Flexible Spending Accounts (FSAs) if you want to continue participation in All of your other 2015 benefit elections will automatically roll over to 2016 if you choose not to make changes during annual Open Enrollment. Annual Open Enrollment for Current Associates Open Enrollment is your once-a-year opportunity to make changes to your benefits elections and covered dependents. Your new benefits elections will be effective January 1, You can only make changes mid-year if you have a qualifying event*. During annual Open Enrollment, you may: Change, add or drop benefit coverage for you and your eligible dependents. Action required by you: SCL Health utilizes the services of HMS Employer Solutions to verify dependent eligibility. When you add new dependents to SCL Health Medical, Dental, Vision or Life Insurance coverage, you will receive a letter days after enrollment detailing the verification process. Unverified dependents are removed from coverage. Information on eligible dependents is on Page 8. Enroll in Health Care and/or Dependent Care Flexible Spending Accounts (FSAs) to save money on eligible out-of-pocket expenses. If You Don t Want to Make Changes to Your Current Coverage During Open Enrollment You do not need to log on to Lawson Employee Self-Service (ESS) unless you are electing Flexible Spending Accounts for If you do not make any changes during annual Open Enrollment, your benefits coverage will remain the same as it was in 2015, at the new 2016 premium rates. However, FSAs will not automatically roll over to Even if you are not planning to make any changes to your current elections, review your benefits Enrollment Guide to ensure that you and your family are getting the most out of your SCL Health benefits program. Enrollment for New Associates If you are benefits-eligible, you must enroll within 31 days from your date of hire by logging on to Lawson Employee Self-Service (ESS). Coverage will begin for you and any covered eligible dependents on the first day of the month following your date of hire month. If You do not Enroll Within 31 Days From Your Start Date You will only be automatically enrolled into the following company-paid benefits: Basic Life Insurance and AD&D Coverage How to Make Benefit Changes During Annual Open Enrollment or Enroll as a New Hire Please Follow These Steps to use the Lawson Employee Self- Service (ESS) Enrollment System. 1.From a worksite computer, navigate to the Lawson Portal login page by visiting The Landing. 2. Enter your Lawson Employee Self-Service (ESS) user name, also referred to as your S-number or S-ID. There will be a link for associates to look up their S-ID. 3. Enter your network password (case sensitive) to log in. This is the same as your network/computer login password. Click Login. Call the Help Desk if you have difficulty with logging in: Click on Benefits on the left side of your screen, then: Annual Open Enrollment: Click on Benefits Enrollment New Hire Enrollment: Click on New Hire Enrollment. Read the information on the Welcome page and follow the on-screen prompts. When You Enroll, Keep in Mind: The 2016 annual Open Enrollment period is October 14-30, The online benefits enrollment system will close at midnight (CST) on October 30, You can log in to the system to elect 2016 benefits only from a work computer. You cannot enroll from your home computer. Do NOT use your browser s back button. Use Previous and Next buttons on the enrollment site. If you exit the enrollment site before you submit your final elections, your elections to that point will NOT be saved. you submit your final elections, you can still return to the enrollment portal in Lawson during the Open Enrollment period or within 31 days of your start date to make more changes. However, you must submit all new changes and selections or your updated elections will NOT be saved. You ll also miss out on tax savings because you won t be enrolled in the Health Care or Dependent Care Flexible Spending Accounts (FSAs). * If you experience a qualifying work or family status event during 2016, please contact the HR Service Center at ENROLLMENT GUIDE INDEX BACK NEXT

7 Enrollment for Rehired or Newly Benefits-Eligible Associates How to Enroll as a Rehire or Newly Benefits-Eligible Associate Rehired and Newly Benefits-Eligible Associates must enroll in benefits by submitting a paper enrollment form to the HR Service Center. You can access the enrollment form by contacting the HR Service Center at If You do not Enroll Within 31 Days From Your Start Date or Transfer Date You will only be automatically enrolled into the following company-paid benefits: Basic Life Insurance and AD&D Coverage Can I Make Changes or Add Benefit Elections During the Year? Outside of an Enrollment Period, you can enroll or make changes to your coverage only if you are experiencing a qualifying work or family status change event, such as a birth, marriage, divorce, becoming newly benefits-eligible, or a gain or loss of independent coverage. Otherwise, you will not be able to enroll or make changes until the next annual Open Enrollment period. You will have 31 days from the qualifying work or family status event date to enroll or make changes to your elections. If you experience a qualifying life event during 2016, please contact the HR Service Center at to receive the Benefits Change Request Form. You ll also miss out on tax savings because you won t be enrolled in the Health Care or Dependent Care Flexible Spending Accounts (FSAs) ENROLLMENT GUIDE INDEX BACK NEXT

8 BENEFITS ELIGIBILITY Am I Eligible for Coverage? To be eligible for benefits with the following rates: Full-time associate rates Part-time associate rates You must be regularly scheduled for: At least 36 hours per week Between hours per week And considered the following full-time equivalent ( FTE ): At least a 0.9 FTE Between FTE Can I Elect Coverage for My Family? If you are eligible to elect coverage for yourself, you may also elect coverage for your eligible dependents. Eligibility includes: Your legal spouse. Your common-law spouse if you live in a state that recognizes such marriages (an affidavit is required). Legally domiciled adults and their children (see Page 9). Your children and stepchildren from birth to age 26. Your adult child who depends solely on you for support because of a mental or physical handicap (documentation is required). For Medical, Dental, Vision and Supplemental Life Benefits, You Can Choose From the Following Coverage Levels: Yourself only ( Associate ). You and your spouse or common-law spouse ( Associate + Spouse ). You and your legally domiciled adult ( Associate + LDA ). You and your children ( Associate + Children ). You and your family ( Associate + Family ). You and your legally domiciled adult and family ( Associate + LDA Family ) You Do Not Need to Choose the Same Coverage Level for Medical, Dental, Vision or Supplemental Life Insurance. For example, you can elect to cover you and your family for Medical and Dental, you and your spouse for Vision and just yourself for Supplemental Life Coverage. Dependent Verification of Eligibility Once you have enrolled in your benefits, you will be mailed a letter to your home mailing address within days from the date you enrolled. The letter from HMS Employer Solutions will ask you to provide documentation supporting eligibility for only new dependents you add to the 2016 plans. Examples of acceptable documentation include a marriage certificate, birth certificate, recent tax filings, etc. Reminder: Unverified dependents are removed from coverage and can only be added back during the 2016 annual Open Enrollment period. To check on the status of your dependent audit: Call Visit Upload required documents Check status of your dependent audit ENROLLMENT GUIDE INDEX BACK NEXT

9 Legally Domiciled Adults and Their Children SCL Health recognizes Legally Domiciled Adults (LDA) and their Children as eligible dependents for benefits coverage. If you are eligible to enroll for benefits at SCL Health, you have the option of enrolling an LDA and/or the dependent children of your LDA. In order to enroll, you will be required to complete an affidavit, which is an official declaration confirming your relationship. Who Qualifies for Coverage as a Legally Domiciled Adult? A Legally Domiciled Adult (LDA) is an individual who: Type A: OR Type B: Is at least eighteen (18) years of age. Is at least eighteen (18) years of age. Has a close personal relationship with the associate or civil union partnership with the associate (not a casual roommate or tenant). Has for at least six (6) months lived in the same principal residence as the associate and remains a member of the associate s household throughout the coverage period. Shares basic living expenses and is financially interdependent with the associate. Has not been in a civil union, legally married to or legally separated from anyone else in the past six months. Is not legally related to the associate by blood Is the associate s child or parent by birth, by marriage (step/in-law), by legal adoption or by legal guardianship. Has for at least six (6) months lived in the same principal residence as the associate and remains a member of the associate s household throughout the coverage period. Meets the definition of his or her tax dependent as defined by Section 152 of the Internal Revenue Code during the coverage period. Is neither receiving benefits from an employer nor eligible for any group coverage. in any way that would prohibit marriage. Is neither receiving benefits from an employer nor eligible for any group coverage. Are there tax implications for enrolling an LDA? Due to the regulations under the Internal Revenue Code, only associates with qualified tax dependents (includes those who are legally married and LDA Type B) can pay benefits premiums with pre-tax dollars. Associates with LDA Type A partners will have to pay the LDA portion of the premium using post-tax dollars. Also, the tax code requires SCL Health to report the value of the benefit to the LDA as imputed income on the associate s W-2 form, and applicable taxes must be paid on those dollars. For assistance with enrolling your LDA, contact the HR Service Center at or How Do I Add My LDA to My Benefits? You will need to submit a Legally Domiciled Adult Affidavit to the HR Service Center and three (3) forms of proof that your LDA meets the SCL Health criteria for coverage. To receive the affidavit contact the HR Service Center at or Annual Open Enrollment: For those adding an LDA during open enrollment, the completed LDA affidavit must be submitted by the end of the open enrollment period October 30, Supporting documents must be submitted within 31 days of the coverage effective date, which is January 31, If supporting documentation is not received by this date, your LDA will be removed from coverage as of January 1, New hires / rehires / newly eligible: The LDA affidavit and supporting documents must be submitted to the HR Service Center within 31 days from your start date or transfer date. Your LDA will not be enrolled in coverage until the supporting documentation is received. What Types of Documentation / Proof are Needed to Add My LDA to My Benefits? Following are examples of acceptable proof: Power of attorney (medical or financial) Civil union certificate Joint documents dated a minimum of six (6) months prior to enrollment showing current relationship status, such as a recurring household bill or statement of account. The documents must list the associate and LDA partner s name, the date and shared mailing address. Examples of joint documents: Car loan or lease Mortgage or lease Utilities bill Bank statements Joint credit cards Shared legal guardianship documents Primary beneficiary or executor designation Copy of driver s license showing proof of shared residency. A copy of the front page of the associate s prior year federal tax return (Form 1040) confirming the LDA is a qualified tax dependent as defined in Section 152 of the Internal Revenue Code ENROLLMENT GUIDE INDEX BACK NEXT

10 WHICH ID CARDS WILL I RECEIVE? Medical Cigna PPO will distribute new ID cards to all members for the new plan year. Cigna CDHP Cigna will distribute new ID cards only if you elected coverage for Associate + Spouse or Associate + Child(ren), if you or your dependents enroll for coverage for the first time, or if you change coverage for If you need a replacement or additional ID cards, you can log in to the secure member area, to access your personalized information and print a temporary card. If you have not already done so, you will need to set up a user name and password under the Members Sign On feature. Pharmacy Pharmacy plan information will be included on your medical ID card. Dental Delta Dental of Colorado, our dental provider, will distribute new ID cards only if you or your dependents enroll for coverage for the first time or change coverage for If you need replacement or additional ID cards, log in to the secure member area of their site, click Subscribers and log in under Subscriber Login to access your personalized information and print a temporary card. If you have not already done so, you will need to set up a user name and password under the Members Sign On feature. Vision EyeMed, our vision care provider, will distribute new ID cards only to newly enrolled participants. If you need a replacement or additional ID cards, you can log in to the secure member area of their website and order a new one by going to clicking Members and then entering your user name and password. If you have not already done so, you will need to set up a user name and password under the Members Sign On feature. You do not need your ID card in order to use your EyeMed plan. If you have your card, we recommend you take it with you, as it helps the provider correctly apply your discount or benefit. Flexible Spending Account Debit Card 24HourFlex will distribute new debit cards only if you enroll for the first time. If you are currently enrolled in the Health Care and/or Dependent Care FSA and make a new election for 2016, you will use the most recently issued card from 24HourFlex. If you need to replace a debit card for 2016, please contact 24HourFlex at after January 1, Reminder If you need to obtain healthcare services prior to receiving your ID card, visit the websites listed above and follow their registration instructions to login and print temporary cards or contact the HR Service Center. Many of our plan administrators offer members the opportunity to register and: print temporary ID cards view eligibility view claims status track deductibles view your Health Reimbursement Account (HRA) and more. You may enroll as a member on the website once the carrier has received your eligibility and updated its system ENROLLMENT GUIDE INDEX BACK NEXT

11 WELLNESS Take responsibility for your own health and wellness to help manage your medical costs. SCL Health offers many health and wellness programs take advantage of them! See below for an overview of a few of the wellness programs offered. Check out our website to view all wellness and incentive programs. Wellness Portal SCL Health has partnered with Preventure to provide you online support, tools and resources through the online Wellness Portal to help you make health and wellness a part of your everyday life. You can use this SCL Health portal to support your wellness goals by doing things like: finding healthy recipes, taking self-paced online workshops, and utilizing helpful food and activity trackers, to name a few. It s also a great place to learn more about your health. For example, when you complete the confidential Health Risk Questionnaire (HRQ), you receive a wellness score, a customized report, and personal recommendations to help you succeed in your journey to live well, all based on your responses. Please know that all your responses remain confidential. Absolutely no individual data will be shared with SCL Health or its health insurance partners. The results from the questionnaire will only be shared with SCL Health in aggregate form, meaning only total population reports will be provided. For assistance with the SCL Health Wellness Portal, please contact Preventure, Monday-Friday, 8 a.m. 8 p.m. ET at or supportteam@preventure.com. Wise & Well Incentive Program (Limited Time Only) All benefits-eligible associates of SCL Health can earn $150 by participating in our new Wise & Well incentive plan. But don t wait to the last minute, because some steps can t be done overnight. Deadlines: Complete a biometric screening by Friday, Oct. 30, 2015, to earn $50 in your Dec. 11 paycheck. Earn an additional $100 by completing five easy steps before Monday, Nov. 30, This reward will be paid out in January 22, 2016, paychecks. Here s How it Works: Visit to complete the following five activities, worth 1 point each. You must complete all five activities by the deadlines provided to earn the incentive. Complete an Online Class (Register by SEPTEMBER 30, 2015) Sign up for one of two classes, Ready, Set, Goal (4-week program) or Kitchen Makeover (6-week program). Register by Sept. 30 to ensure you complete the course and earn your point by the November 30 deadline. Complete Your Biometric Screening (by OCTOBER 30, 2015) Onsite events will be available in larger SCL Health locations in September. Visit our website for a list of dates and times, other screening options and important details. Participants who get screened after Oct. 30 will not be disqualified, but will forfeit $50 in total incentives. Take our Online Health Questionnaire (by NOVEMBER 30, 2015) Log on and click on Know Your Health Status. The minute survey is completely confidential. Associates who completed the survey earlier this year will see a point already credited to their profile ENROLLMENT GUIDE INDEX BACK NEXT

12 Pick a Healthy Activity (by NOVEMBER 30, 2015) Sign up for Preventure s Exercise Challenge or tell us about a healthy activity you re already involved in such as an organized run, tobacco cessation program, or working with a personal health coach. Details and instructions are online. Designate a Doctor (by NOVEMBER 30, 2015) Go online and designate who your primary care physician (PCP) is, and if you don t have one, take time to find one. The information you provide is confidential and will not be shared with anyone at SCL Health. Having a relationship with a PCP is an important step in taking care of your health and well-being. The deadline to earn your five points is November 30, Please contact Preventure at or supportteam@preventure.com if you have any questions. Cigna: Personal Health Team SCL Health and Cigna partnered to bring all Cigna Plan members and their dependents a Personal Health Team. This program is designed to help you meet your personalized health and well-being needs. The program consists of a dedicated team of registered nurses, behavioral specialists, health coaches, exercise specialists or nutritionists all supported by doctors and pharmacists who are there to support you in achieving your personal health goals. How Does the Personal Health Team Help Me Improve My Health? The Personal Health Team can support you whether you need help in learning more about a chronic condition, understanding your doctor s treatment plan, making a treatment decision or you just want to make a few lifestyle changes like losing a little extra weight. Programs across the country similar to this have shown tremendous results in improving the health status of associates. This includes things like improvements in cholesterol and blood sugar levels, overall reductions in cardiac risks, and improvements in preventive care. Most importantly, similar programs have had high ratings of satisfaction from the participants. How Does the Program Work? The Personal Health Team will be reaching out by telephone to Cigna members. If you receive a call from the Personal Health Team, it s because your medical claims history may suggest that the team can provide you additional support or resources. Some examples of when Cigna might call you are: You have a chronic condition and your records indicate you may be missing care that is known to be evidence-based and the team s support can help you. You have recently been hospitalized or seen in the Emergency Department. You have a complex healthcare need that requires support from a Case Manager. You can also reach out to the Personal Health Team directly. The program is available to anyone under the Cigna medical plan who would like some support in meeting their personalized health goals. The team can help with things like tobacco cessation, weight management and stress management. How Can I Access the Program? You can access the program in three ways: Call , enter your subscriber ID and say Personal Health Team Call , and provide your subscriber ID when asked Go online at The team is available for coaching and non-emergent care support from 9 a.m. to 9 p.m., Monday through Friday, and 9 a.m. to 2:30 p.m. on Saturday. You may also access the team 24/7 if you need immediate treatment guidance ENROLLMENT GUIDE INDEX BACK NEXT

13 MEDICAL What Factors Should I Consider When Deciding on a Medical Plan? Choosing a medical plan option is one of the most important decisions for you and your family. When selecting a medical plan, you should ask yourself several questions and carefully consider each answer: How will my medical plan selection affect my pharmacy plan? When you enroll in a medical plan you will also have pharmacy benefits through the medical plan s vendor. See the bottom of the medical plan costs comparison chart for pharmacy costs. You may also look at Pages for additional pharmacy benefit information. How much healthcare will you and your family need next year? What will it cost you? Cigna s website ( has tools to help you estimate your healthcare costs. How do I find a doctor or find out if my current doctor is in the SCL Health Network? Cigna has a custom provider directory created specifically for SCL Health. The directory can be accessed through Search for your current provider by name or by specialty, or locate a new doctor within your area under the Tier 1 Network. Designate Your Primary Care Physician (PCP) in 2016 The objective of a PCP is for you to have a specific care center to help you make the most of the healthcare system. Simply visit your plan s website ( and choose your provider. Typically you ll want to pick your PCP or the place you go for routine care. Keep in mind that if you go to and use the Cigna Open Access Plus (OAP) network provider search, you must be currently enrolled with Cigna to see the SCL Health Network (Tier 1) on mycigna.com. Please note: Specialist referrals are still not required under our medical plans. Are you more concerned about the cost of your monthly contribution or your out-ofpocket costs? How will you save for future healthcare costs? Know Your 2016 Medical Plan Options by Name In 2016, SCL Health offers three medical plan options. During your Enrollment period, it is up to you to enroll in the plan that best fits your needs and budget. Your options (including their official names) are: 1. Cigna CDHP with HRA (the Choice Fund Open Access Plus Network Plan). 2. Cigna PPO Plan (the Cigna Open Access Plus Network Plan) ENROLLMENT GUIDE INDEX BACK NEXT

14 Understand the Network (Tiers) in Your Plan The SCL Health medical plans are Point of Service plans. Each provider network tier has a different arrangement for sharing costs. You and your covered family members choose which tier to use each time you seek care. One of the best ways to make your healthcare dollars go further is to use the SCL Health Network (Tier 1) whenever possible to take advantage of its: Lower copays for physician/specialist office visits, where applicable. Lower deductibles. Lower coinsurance. To enjoy all these cost savings, you first need to know which hospitals and doctors are in the SCL Health Network and which ones are not, as shown in the chart below. Why SCL Health Network (Tier 1) is Your Best Choice At SCL Health, we are in the healthcare business. That allows us to offer our associates both exceptional care and the opportunity to control costs. All three medical plan options offer the highest level of benefits when you use SCL Health Network (Tier 1) providers and facilities. Remember, you can access a custom provider directory created specifically for SCL Health. Just follow the steps on Page 13 to locate SCL Health Network (Tier 1) providers and facilities. Lower out-of-pocket maximums. Network Tiers SCL Health Network (Tier 1) Cigna Network (Tier 2) Out-of-Network (Tier 3) Hospitals SCL Health facilities Children s Hospital Colorado (facility charges only) Hospital facilities that are part of the Cigna Open Access Plus (OAP) network All other hospital facilities Doctors Select primary care physicians and specialists with privileges at an SCL Health facility All SCL Health employed primary care physicians and specialists Physician Network (SCLP) primary care physicians and specialists All Cigna Open Access Plus (OAP) network physicians and specialists All other doctors who are not part of the Cigna Open Access Plus (OAP) or SCL Health Networks *The SCL Health Network (Tier 1) pays the highest level of benefit for both doctors and facilities ENROLLMENT GUIDE INDEX BACK NEXT

15 KNOW HOW YOUR MEDICAL PLAN WORKS Pre-certification is required for all hospital admissions. SCL Health Medical Plan Options 1. Cigna CDHP with HRA (Choice Fund Open Access Plus Plan) 2. Cigna PPO Plan (Cigna Open Access Plus Plan) SCL Health Medical Plan Options at a Glance: Preventive Care All SCL Health medical plan options cover in-network preventive care at 100% (this includes annual physical checkups, recommended screenings for your age, and immunizations). Prescription Drug Benefits Once you enroll in a medical plan, you will then have pharmacy coverage as well through the medical plan s vendor. Deductible All of the SCL Health medical plans have a deductible that you must meet before the plan begins to pay coinsurance. The deductible is lower at the SCL Heath Network (Tier 1) level. Out-of-Pocket Maximum The out-of-pocket maximum is the most you will pay out-of-pocket for medical and pharmacy costs during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year. Quick Glance Medical Benefit Options Cigna CDHP with HRA Cigna PPO 1st - HRA Employer Contribution 2nd - Deductible Associate Associate + Spouse Associate + Children Associate + Family 3rd - Coinsurance (for most services) 4th - Annual Out-of-Pocket Maximum (Includes Medical and Pharmacy costs) Associate Associate + Spouse Associate + Children Associate + Family Primary Care Physician Office Visit Specialist s Office Visit Preventive Care Hospitalization SCL Health Network (Tier 1) Cigna Network (Tier 2) Associate Associate + Spouse Associate + Children Associate + Family $1,250/ person $2,500/ family 85%; you pay 15% $2,500/ person $5,000/ family 85%; you pay 15% 85%; you pay 15% 100% 85%; you pay 15% $2,500/ person $5,000/ family 70%; you pay 30% $5,000/ person $10,000/ family 70%; you pay 30% 70%; you pay 30% 100% 70%; you pay 30% Out of Network (Tier 3) $500 $1,000 $1,000 $1,000 $5,000/ person $10,000/ family 50%; you pay 50% $10,000/ person $20,000/ family 50%; you pay 50% 50%; you pay 50% 50%; you pay 50% 50%; you pay 50% SCL Health Network (Tier 1) Cigna Network (Tier 2) Out of Network (Tier 3) Not applicable. The CDHP is the only medical plan option that offers HRA with annual funding from SCL Health. $1,250/ person $2,500/ family 85%; you pay 15% $2,500/ person $5,000/ family $2,500/ person $5,000/ family 70%; you pay 30% $5,000/ person $10,000/ family $25 copay $50 copay $40 copay $75 copay 100% 85%; you pay 15% 100% 70%; you pay 30% $5,000/ person $10,000/ family 50%; you pay 50% $10,000/ person $20,000/ family 50%; you pay 50% 50%; you pay 50% 50%; you pay 50% 50%; you pay 50% Continued on next page ENROLLMENT GUIDE INDEX BACK NEXT

16 Quick Glance Medical Benefit Options, Continued Urgent Care SCL Health Network (Tier 1) Cigna CDHP with HRA Cigna Network (Tier 2) Out of Network (Tier 3) 85%; you pay 15% SCL Health Network (Tier 1) Cigna PPO Cigna Network (Tier 2) Out of Network (Tier 3) $50 copay, then the plan pays 85% and you pay 15% of balance Hospital ER 85%; you pay 15% $150 copay (waived if patient is admitted), then the plan pays 85% and you pay 15% of balance Diagnostic Lab and X-ray 85%; you pay 15% 70%; you pay 30% 50%; you pay 50% Physician's office: office visit copay, Plan pays 100%; Outpatient: Plan pays, 85%; you pay 15% Physician's office: office visit copay, Plan pays 100%; Outpatient: Plan pays, 70%; you pay 30% Physician's office: office visit copay, 50% you pay 50%; Outpatient: Plan pays, 50%; you pay 50% Quick Glance Pharmacy Benefit Options SCL Health Pharmacy (30-Day) Generic Insulins Formulary Non- Formulary Retail* (30-Day) Cigna CDHP with HRA Cigna PPO Kaiser Permanente EPO (Denver) Generic Prescription costs first apply to your HRA fund. Once your HRA fund is exhausted, $17 copay $17 copay Formulary you pay 100% of the cost until you 25% of full price meet the deductible. ($75 maximum copay) $35 copay Non- Formulary 80% after deductible until you meet the out-of- pocket maximum. $10 copay $30 copay $45 copay 50% of full price ($125 maximum) 50% of full price (no maximum) N/A Prescriptions must be filled at a Kaiser Permanente Pharmacy. (Except for outpatient prescriptions) Not covered Mail Order (90-Day) Once out-of-pocket maximum is Generic $20 copay $34 copay met, plan pays 100%. Insulins $30 copay Generic and Formulary copays apply Formulary $90 copay $70 copay Non- Formulary Specialty Generic Formulary Non- Formulary 50% of full price ($250 maximum copay) 25% of full price ($250 maximum per prescription) *Cigna Plan Members: An $8 surcharge applies to all high-cost retail pharmacies (Walgreens, CVS, Rite Aid). Not covered 25% of full price ($250 maximum per prescription) ENROLLMENT GUIDE INDEX BACK NEXT

17 CIGNA CDHP WITH HRA (CHOICE FUND OPEN ACCESS PLUS PLAN) STEP BY STEP SCL Health funds a Health Reimbursement Account (HRA) for you to use to cover initial out-of-pocket expenses. If you use all the funds in your HRA, you will then pay the full cost of your medical expenses, including prescriptions, until you meet your annual deductible. The HRA amount and annual deductible increase when you cover your children, spouse, LDA or full family. What Are the Advantages of the Consumer Driven Health Plan? The CDHP option is designed to encourage you to be more aware of your healthcare expenditures. It also offers a number of special features, for example: It has the lowest per-paycheck cost. You have access to a Health Reimbursement Account (HRA) that is funded by SCL Health. Your out-of-pocket expenses are paid from the HRA. Once the money in your HRA is exhausted, you pay the full medical and pharmacy expenses until you reach the annual deductible. Once you meet your annual deductible, the plan begins to pay a portion of your medical and pharmacy costs (known as coinsurance) until you meet your annual out-of-pocket maximum. If you meet your annual out-of-pocket maximum, the plan then pays 100 percent of your eligible medical and pharmacy expenses for the remainder of the plan year. If you have money left in your HRA at the end of the year, it rolls over to the next year (if you enroll in the CDHP option for the next year). Online tools on that enable you to check your claims, explanation of benefits (EOBs) and tracking of your deductible and your Health Reimbursement Account (HRA) funds ENROLLMENT GUIDE INDEX BACK NEXT

18 Take a look at how the Cigna CDHP with HRA (Choice Fund Open Access Plus Plan) works. STEP 1 Each year, SCL Health funds your Health Reimbursement Account (HRA). The amount depends on the coverage level you choose, as shown below. Associate $500 Associate + Spouse $1,000 Associate + Children $1,000 Associate + Family $1,000 The CDHP is the only medical plan option that offers an HRA with annual funding from SCL Health. STEP 2 Funds from your HRA are first applied to your deductible. Once your HRA balance is zero ($0), you pay 100% of your expenses until you meet the annual deductible. Annual Deductible Included in Your HRA Dollar Amount HRA Dollar Amount Maximum Annual Deductible You Pay Annual Deductible (1) Included in (3) = (1)-(2) Tier 1 Tier 2 Tier 3 Deductible* (2) Tier 1 Tier 2 Tier 3 Associate $1,250 $2,500 $5,000 $500 $750 $2,000 $4,500 Associate + Spouse $1,250/person; Associate + Children $2,500/family Associate + Family $2,500/person; $5,000/family $5,000/person; $10,000/family $1,000 $250/person; $1,500/family $1,500/person; $4,000/family * If you have money in your HRA at the end of 2016, it will roll over into the 2017 HRA if you remain in the Cigna CDHP plan in STEP 3 $4,000/person; $9,000/family you meet the annual deductible, you and the plan each pay a portion of your medical costs until you reach the annual out-of-pocket maximum. (The annual maximum includes the deductible.) SCL Health Network (Tier 1) Cigna Network (Tier 2) Out of Network (Tier 3) Primary care office visit The plan pays 85% of the cost; you pay 15% Specialist office visit The plan pays 85% of the cost; you pay 15% The plan pays 70% of the cost; you pay 30% The plan pays 70% of the cost; you pay 30% Hospital ER The plan pays 85% of the cost; you pay 15% Urgent care facility The plan pays 85% of the cost; you pay 15% The plan pays 50% of the cost; you pay 50% The plan pays 50% of the cost; you pay 50% Coinsurance for most services The plan pays 85% of the cost; you pay 15% The plan pays 70%; you pay 30% The plan pays 50%; you pay 50% STEP 4 Once you reach the out-of-pocket maximum, the plan pays 100 percent of the cost for covered services and prescriptions through December 31. The deductible is included in the out-of-pocket maximum. Annual Out-of-Pocket Maximum* Associate Associate + Spouse Associate + Children Associate + Family SCL Health Network (Tier 1) Cigna Network (Tier 2) Out of Network (Tier 3) $2,500/person; $5,000/family $5,000/person; $10,000/family $10,000/person; $20,000/family * Out-of-pocket costs including pharmacy will cross-accumulate for SCL Health Network (Tier 1) and Cigna Network (Tier 2). Out of Network (Tier 3) expenses do not accumulate to any other Tiers, meaning that any out-of-pocket expenses incurred from Tier 3 (out of network), will not count toward your Tier 1 or Tier 2 annual out-of-pocket maximum amounts. NOTE: If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-ofpocket expenses, such as annual deductible and coinsurance responsibility. See page 26 for more details for more FSA details. Learn More: To reach Cigna representatives who are experts on our three tier plans, request the Hospital Vertical Team when calling Cigna at 800-CIGNA24 ( ). The Hospital Vertical Team is available business hours Monday Friday ENROLLMENT GUIDE INDEX BACK NEXT

19 CIGNA PPO PLAN (CIGNA OPEN ACCESS PLUS PLAN) STEP BY STEP Under the Cigna Choice PPO, you may choose the providers that fit your needs and receive different levels of coverage based on the network tier. You and the plan each pay a portion of your medical costs until you reach the annual out-of-pocket maximum. You are not required to select a primary care physician (PCP) or obtain a referral to see a specialist. However, you are able to select a PCP to provide ongoing healthcare to you and your family. Designating a PCP assists in your healthcare being coordinated through a key provider, to ensure you receive any necessary treatment, when and where you need it, in a manner you can understand. The objective of designating a PCP is for you to have a specific care center to help you make the most of the healthcare system (Page 13). Take a look at how the Cigna PPO Plan (Cigna Open Access Plus Plan) works. STEP 1 You pay 100% of your expenses until you meet the annual deductible. If you seek care at an SCL Health facility or with an SCL Health Network provider, you pay a lower deductible. Annual Deductible SCL Health Network (Tier 1) Cigna Network (Tier 2) Out of Network (Tier 3) Associate Associate + Spouse Associate + Children Associate + Family $1,250/person; $2,500/family $2,500/person; $5,000/family $5,000/person; $10,000/family STEP 2 you meet the annual deductible, you and the plan each pay a portion of your medical costs until you reach the annual out-of-pocket maximum. (The annual maximum includes the deductible.) SCL Health Network (Tier 1) Cigna Network (Tier 2) Out of Network (Tier 3) Primary care office visit Specialist office visit Hospital ER Urgent care facility $25 copay $50 copay $40 copay $75 copay The plan pays 50% of the cost; you pay 50% The plan pays 50% of the cost; you pay 50% You pay a $150 copay (waived if patient is admitted), then the plan pays 85% of the balance and you pay 15% You pay a $50 copay, then the plan pays 85% of the balance and you pay 15% Coinsurance for most services The plan pays 85%; you pay 15% The plan pays 70%; you pay 30% The plan pays 50%; you pay 50% STEP 3 Once you reach the out-of-pocket maximum, the plan pays 100 percent of the cost for covered services and prescriptions through December 31. The deductible is included in the out-of-pocket maximum. Annual Out-of-Pocket Maximum* SCL Health Network (Tier 1) Cigna Network (Tier 2) Out of Network (Tier 3) Associate Associate + Spouse Associate + Child Associate + Family $2,500/person; $5,000/family $5,000/person; $10,000/family $10,000/person; $20,000/family * Deductibles and out-of-pocket costs including pharmacy will cross-accumulate for SCL Health Network (Tier 1) and Cigna Network (Tier 2). Out of Network (Tier 3) expenses do not accumulate to any other Tiers, meaning that any out-of-pocket expenses incurred from Tier 3 (out of network) will not count toward your Tier 1 or Tier 2 annual deductible or out-of-pocket maximum amounts. NOTE: If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-ofpocket expenses, such as annual deductible and coinsurance responsibility. See page 26 for more details for more FSA details. Learn More: To reach Cigna representatives who are experts on our three tier plans, request the Hospital Vertical Team when calling Cigna at 800-CIGNA24 ( ). The Hospital Vertical Team is available business hours Monday Friday ENROLLMENT GUIDE INDEX BACK NEXT