MY CHOICE REWARDS MY CHOICE REWARDS. Enrollment Workbook

Transcription

1 MY CHOICE REWARDS 2015 MY CHOICE REWARDS ment Workbook

2 Inside this Workbook Important Contact Information....2 Introduction/My Choice Rewards....3 Important Terms....4 Dependent Eligibility/Documentation....6 Your My Choice Rewards Benefits Selections Health Care Coverage....8 Medical/Vision Plans....8 Health Savings Account (HSA)....9 Prescription Drug Benefits Sponsored Dependents/Same Sex Domestic Partner/Spouse Surcharge Dental Plans Dental Plan Questions and Answers...25 Delta PPO / Premier Income Replacement and Survivor Benefits Employee Term Life Dependent Term Life (after tax) Accidental Death and Dismemberment (AD&D) Long-Term Disability Health Care Flexible Spending Account (FSA)...28 Day Care Flexible Spending Account (FSA) Web ment Instructions The ment Experience...35 Additional Information About My Choice Rewards Coverage for HFHS Couples Leave of Absence...36 Termination of Benefits Your Rights and Responsibilities...36 Legal Update HIPAA Rights CTO/CTO Sell Back Voluntary Benefits HFHS Rewards Employee Wellness Events Permitting Mid-Year Changes Chart Every effort has been made to ensure the accuracy and completeness of the benefit descriptions contained within this workbook. However, in the event of any interpretation, discrepancy, application and/ or decision in specific circumstances, the official text or terms of the plan document will govern. This workbook is not intended to create or to be construed as a contract between Henry Ford Health System (HFHS) and its employees for any matter, including for the provision of benefits described MY CHOICE REWARDS

3 Important Contact Information Employee Services....(855) Ford Place - 4E, Detroit, Michigan [email protected] Health Alliance Plan / Alliance Health and Life.... (866) (Medical/Vision) W. Grand Boulevard, Detroit, Michigan Blue Cross/Blue Shield of Michigan (Medical/Vision) East Lafayette, Detroit, Michigan Delta Dental Plan of Michigan (Point-of-Service Dental) Stansbury Street, Farmington Hills, Michigan Delta Dental Plan of Michigan (EPO formerly Delta Care) Stansbury Street, Farmington Hills, Michigan Manulife (Medical/Vision) Southdale Road East, Suite 205, London, Ontario, Canada N6E 1A2 (Canadian Residents Only) CIGNA Group Insurance (Life Insurance) West Carson Street, Suite 300, Pittsburgh, Pennsylvania CIGNA Disability Management Solutions (Long-Term Disability Insurance) P.O. Box 22325, Pittsburgh, Pennsylvania CIGNA Group Insurance (AD&D Insurance) P.O. Box 22328, Pittsburgh, Pennsylvania Health Equity (Flexible Spending Accounts/Health Savings Account) 10 W. Scenic Pointe Drive, Suite 100, Draper, UT If you have questions about your enrollment, contact Employee Services or your local Human Resources department MY CHOICE REWARDS 2

4 Introduction Whether it s offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it s all about choice. As a result, Henry Ford Health System is introducing a new approach for its employee benefits program My Choice Rewards beginning with the 2015 Open ment which will take place Monday, Nov Monday, Nov. 24, Benefit selections will be effective Jan. 1, Annually, you have the opportunity to re-examine your benefit needs and make any changes you choose. Once Open ment begins, you can log onto My Choice Rewards HOW MY CHOICE REWARDS WORKS My Choice Rewards offers an array of options under each benefit category. Each option has a different cost, corresponding to the degree of coverage provided. You can select a particular benefit category, depending on your changing needs. My Choice Rewards provides all full time employees with credits to assist in purchasing their benefit selections. Part time employees do not receive credits. Once you ve made all of your selections, simply add up the costs of each option and subtract them from your total credits. If you ve chosen to purchase more benefits than you have credits for, the difference will be subtracted from your pay in equal amounts per pay period. Most benefits can be purchased on a pretax basis, with the exception of Dependent Life Insurance. CONSIDERATIONS The benefits offered under My Choice Rewards have been designed to conform to Section 125 of the Internal Revenue Code, and as such may provide significant tax advantages to you as well as Henry Ford Health System. In order to maintain its tax-qualified status, the My Choice Rewards plan must adhere to the regulations established by the Internal Revenue Service (IRS). These requirements will be summarized in the appropriate sections of this workbook. This workbook is intended to summarize the key features of each benefit offered under My Choice Rewards. You are encouraged to consult with your financial planner or tax advisor before making your benefit selections. Henry Ford Health System reserves the right to modify or discontinue any of its benefits at any time. TAX SAVINGS The Social Security benefit you will be eligible to receive is based in part on the amount of income you have that is subject to Social Security tax. By enrolling in My Choice Rewards, you will have less income subject to Social Security taxes. Consequently, the benefits you or your family may receive from Social Security may be reduced based on the amount of the reduction in your pay as a result of your pretax contributions for My Choice Rewards. USING THE WORKBOOK & PERSONAL ENROLLMENT SUMMARY This workbook contains information you need to know about your benefits, including descriptions of the My Choice Rewards options and enrollment instructions. In addition to this workbook, your Personal ment Summary, which details your current coverage, your options and the associated price tags, will be available online during Open ment beginning Monday, Nov. 10, through Monday, Nov. 24, ALL BENEFITS-ELIGIBLE EMPLOYEES, INCLUDING THOSE WHO HAVE NO CHANGES TO THEIR BENEFITS, ARE ENCOURAGED TO REVIEW THEIR BENEFITS ONLINE. You must go online and enroll if: You want to change your benefit elections You want to update your dependents You have a Flexible Spending Account and want to. continue it in 2015 You provide medical coverage for your spouse who. is eligible for medical coverage elsewhere. You must complete an online verification form every year or you will be assessed a surcharge MY CHOICE REWARDS

5 Important Terms It may be helpful for you to review some of the following terms of the My Choice Rewards program. Change Event An event which permits you to change your election mid-year. The change you wish to make must be on account of and correspond with the event. Please see the chart in the back of this workbook for a detailed listing of when changes can be made for benefit coverages offered as part of My Choice Rewards. If you change from part time to full time, you may elect options previously not available to you or options which were available only at a higher cost. If you change from full time to part time, you must drop options not available to part time employees. Your same medical and dental coverage will be available to you as a part time employee, but at a higher cost. You may change to a different medical or dental option, but may not change to a No Coverage election unless you show you are now covered by another plan. To make benefit changes due to a status change, log on to Employee Self Service within 30 days of the event to make changes. Comparison Chart A chart that allows you to compare the medical/vision or dental plans available to you. Confirmation Statement A statement available online to confirm the selections you made. Consumer-Driven Health Plan (CDHP) A health plan that has higher deductibles and lower employee contributions. The plan requires a member to reach their deductible before any benefits are paid by the plan. A Consumer-Driven Health Plan is sometimes referred to as a Consumer-Directed Health Plan. The terms are interchangeable and refer to the same kind of plan. Copayment The percentage or flat dollar amount of covered expenses you must pay. Credits A pool of dollars full-time employees receive to use toward the purchase of benefits each year. Credits are based on your base annual salary and are adjusted as your salary changes. Deductible The expense you incur before the plan or insurance carrier begins paying your covered expenses. Domestic Partner An individual of the same sex, who currently resides with you in a mutual commitment, similar to marriage, shares financial responsibility, is not legally married to another individual and is not a blood relative. Medical, vision and dental coverage for a same-sex domestic partner is a taxable benefit to the employee. See page 23 for the amount of imputed income that will be added to your check each pay for these benefits. Effective Date All benefits will be effective on January 1. For employees enrolling outside of Open ment, benefits become effective the first of the month following 60 days from your date of hire or first of the month following the qualified life event. Enhanced Plan A benefit level within the HFHS Preferred Medical and Full HAP options that involves lower co-pays, annual deductibles, and out-of-pocket costs. Evidence of Insurability (EOI) - Evidence of Insurability (EOI) is an application process in which you provide information on the condition of your health or your dependent s health in order to be considered for certain types of life or disability insurance coverage if you did not enroll in coverage when first eligible. The insurance company (not the employer) determines your eligibility for coverage. Exclusive Provider Organization A dental benefits plan that provides benefits only if care is rendered by professional providers in a network with whom the dental plan contracts. Flexible Spending Accounts (FSA) There are two types of FSA accounts. The Health Care FSA allows an employee to contribute pre-tax dollars to pay for medical expenses not covered under the plan. The Dependent Care FSA allows an employee to use pre-tax dollars to pay for day care expenses for a child or other dependent. Money not used by a certain date will be forfeited. Full Time Employee Eligibility Employees who are regularly scheduled to work 72 to 80 hours every two weeks may participate in the My Choice Rewards 2015 MY CHOICE REWARDS 4

6 program. Full-time employees receive credits to assist in purchasing medical/vision, dental, long-term disability, and AD&D insurances. Health Engagement A component of the HFHS Preferred Medical and Full HAP options designed to lower costs for employees who make healthy choices. Health Maintenance Organization (HMO) A type of managed care plan that focuses on prevention and wellness. Under an HMO Plan, members are required to seek most routine covered medical care services from their Primary Care Physician (PCP). The PCP coordinates the member s care and refers the member to a specialist when medically necessary. You may select a PCP for yourself and one for each of your covered dependents. With an HMO, you must utilize providers in the HMO network. Health Savings Account (HSA) An account created for individuals who are covered under Consumer-Driven Health Plans (CDHP) to save for medical expenses that CDHPs do not cover. Contributions are made into the account by the individual or the individual s employer and are limited to a maximum amount each year. The contributions are invested over time and can be used to pay for qualified medical expenses, which include most medical care, dental and vision. In-Network A doctor or facility that participates in the PPO Plan or HMO network and has agreed to a reduced fee schedule. Options The choices you have in each benefit area. Out-of-Network A doctor or facility not part of the PPO Plan or HMO network. Generally, services will be covered at a lower percentage than if your doctor were in the network. Out-of-Pocket Maximum The most you would pay in a plan year for eligible medical expenses, excluding the deductibles. Part Time Employee Eligibility Part time employees who are regularly scheduled to work at least 40 hours every two weeks may participate in the My Choice Rewards program. No opt-out credits are available. Part time employees have the same medical/vision and dental options as full time employees, but they may only purchase reduced levels of long-term disability, AD&D and employee life insurance. Personal ment Summary This online form displays your current coverage, the available benefit options, the price tag for each option and available benefit credits. This online summary will assist you in your Benefits Web enrollment. Plan Year The My Choice Rewards Plan Year is January 1 through December 31. Each fall, you will make your selections for the following plan year. Point of Service (POS) Plan A type of managed care plan that gives you the choice to obtain medical services from a network or non-network provider. Unlike a PPO, you must select a Primary Care Physician (PCP) to coordinate your care in-network. You can also self-refer or obtain care from an out-of-network provider at a lower benefit level. Preferred Provider Organization (PPO) A type of managed care plan that gives you the choice to obtain medical services from a network or non-network provider. You make the decision at the time that you need medical care. In a PPO, the doctors and hospitals have agreed to provide medical services at a reduced cost. Generally, you will receive a higher level of coverage if you receive care in-network. Price tag This is the cost to you for a benefit option. The price tag represents the cost of providing you with that benefit option. Primary Care Provider (PCP) The doctor you designate from the HMO participating network to coordinate all of your medical needs, including referral to a specialist or arrangement for hospitalization. Qualification Period The period of time when employees and their covered spouse/same-sex domestic partner can complete the Health Risk Assessment, Member Qualification Form (MQF) and demonstrate a willingness to improve their health status by scoring 85 points or higher on the MQF MY CHOICE REWARDS

7 Spouse Surcharge An additional pre-tax charge assessed to an HFHS employee if they cover their non- HFHS spouse who is also eligible for medical coverage through their non-hfhs employer. Standard Plan A benefit level within the HFHS Preferred Medical and Full HAP options that offers significantly higher out-of-pocket costs and annual deductibles but the same access to quality care and benefits as the Enhanced plan. Tax Savings The Social Security benefit you will be eligible to receive is based in part on the amount of income you have that is subject to Social Security tax. By enrolling in My Choice Rewards, you will have less income subject to Social Security taxes. Consequently, the benefits you or your family may receive from Social Security may be reduced based on the amount of the reduction in your pay as a result of your pretax contributions for benefits. Dependent Eligibility/ Documentation Documentation for newly-added dependents is required. It is your responsibility to ensure that only people who are eligible for dependent coverage are covered by your HFHS benefits. This helps keep benefits costs at reasonable levels for everyone. Use the following guidelines to determine if your enrolled dependents meet Henry Ford Health System s eligibility requirements: Eligible Dependents: Your spouse. Your domestic partner and their children. Young adult children may remain on your benefits plan through the end of the month they turn 26. They do not have to be your IRS dependent, full-time student, or live with you. They can also be married. Any unmarried disabled child regardless of age who depends primarily on you for support, provided the physical or mental disability occurred before age 19. HEALTH PLANS FOR THOSE TURNING 26 HAP Personal Alliance provides coverage for individuals turning 26 and aging off their parents health plan. This is a life event that qualifies the individual to sign up by the end of the month the individual turns 26. During the Special ment Period, you or your dependent can obtain coverage under a separate contract/policy. Visit for more information on the policies designed for young adults. Child is defined as natural children, legally adopted children (including children placed for adoption for whom legal adoption proceedings have started), step-children, children of your domestic partner, alternate recipients under Qualified Medical Child Support Orders (QMCSO), and any other child for whom you have obtained legal guardianship and who is in a regular parent-child relationship. You may also cover certain sponsored dependents. Sponsored dependents are age 20 or older, related to you by blood or marriage and residing in your household, and claimed as dependents on your most recent tax return. Ineligible Dependents Your spouse becomes ineligible when he or she is no longer legally married to you. Your child becomes ineligible at the end of the month he or she reaches age 26. Your sponsored dependent when he or she no longer resides with you or is no longer claimed on your income tax. ACCEPTABLE FORMS OF DOCUMENTATION ARE: Spouse Proof of spousal relationship (any one of the following documents): - Copy of marriage license (must include date of marriage). - Copy of legal, presently valid marriage certificate. - Copy of the first page of the most recently filed 2015 MY CHOICE REWARDS 6

8 federal income tax return that indicates married filing jointly (financial amounts may be blocked out). - Copy of the first page of the most recently filed federal income tax return that indicates married filing separately, your spouse s name must appear on the tax form on the line provided after the married filing separately status (financial amounts may be blocked out). - Canadian employees who do not claim dependents on their U.S. federal income tax must submit their Canadian income tax form listing eligible dependents. If an Identification Number is used in place of a dependent name, documentation (such as the Social Insurance Number card) must be submitted that links the dependent s name to the Identification Number. Domestic Partner (same sex) Proof of spousal relationship (any one of the following documents): - Copy of the first page of the most recently filed federal income tax return that indicates your domestic partner is your IRC Section 152 dependent. - Copy of a Domestic Partnership Registration Certificate from any city, county, or state offering the ability to register a domestic partnership. - Copy of Affidavit of Domestic Partnership (available on HR Connect). - Marriage certificate Unmarried, Natural, & Legally Adopted Child, Step-Children, and Children of your Domestic Partner; until the end of the month they reach age 26 Proof of Parent/Child relationship (any one of the following documents): - Copy of legal birth certificate (employee must be listed as a parent), Canadian employees must provide the long form birth certificate. - Copy of hospital certificate (employee must be listed as parent and must include date of birth). - Affidavit of Parentage (must be certified and filed with the state). - Copy of the first page of the most recently filed federal income tax return showing the child listed as a dependent and indicating that child lived with you (financial amounts may be blocked out). OR - Canadian employees who do not claim dependents on their U.S. federal income tax must submit their Canadian income tax form listing eligible dependents. If an Identification Number is used in place of a dependent name, documentation (such as the Social Insurance Number card) must be submitted that links the dependent s name to the Identification Number. - Copy of Qualified Medical Child Support Order (QMSCO). Documentation from Social Security or physician certification of total and permanent disability incurred before age 19 Sponsored Dependent Copy of the first page of the most recently filed federal income tax return showing the individual listed as a dependent and indication that they lived with you (financial amounts may be blocked out). If your sponsored dependent is Medicare eligible, provide a copy of their Medicare Card Parts A and B AND a copy of the first page of the most recently filed federal income tax return as noted above. Your My Choice Rewards Selections The My Choice Rewards program provides eligible employees with the opportunity to purchase benefits from the following categories: Medical/Vision Dental Standalone Vision Employee Term Life Insurance Dependent Term Life Insurance Accidental Death and Dismemberment (AD&D) Long-Term Disability Health Savings Account (HSA) Health Care Flexible Spending Account (FSA) Dependent Care Flexible Spending Account (FSA) MY CHOICE REWARDS

9 Health Care Coverage For most of us, health care coverage is the first thing that comes to mind when we hear the word benefits. Satisfying our family s health care needs is a significant concern for many of us. Henry Ford Health System understands this and continues to offer medical/vision and dental options to meet these needs. You can enhance your health care coverage by carefully reviewing every option and considering how each will work with the other plans in the My Choice Rewards program or other coverage you may have. For example, if you choose a medical/vision plan option with co-pays, you may want to put pretax dollars in a Health Care FSA to cover the total co-pays you expect to incur during the year. MEDICAL/VISION PLANS My Choice Rewards offers a number of different options for combined medical and vision coverage. Please keep in mind your choice of plans may be limited due to your primary place of residence or employment group. You will be able to choose from among the following medical/vision plans: HAP Consumer-Driven Health Plan (CDHP) Henry Ford Health System (HFHS) Preferred Medical (HMO) Full HAP (HMO) HAP Point of Service (POS) HAP Standalone Vision Community Blue PPO (BCBSM) Manulife 1 1 Available only to Canadian residents. While online, be sure to sign up for Henry Ford MyChart, a secure online tool that offers Henry Ford patients a simple and convenient way to manage their health care needs online. If you are a Henry Ford patient, you can: Use your personal MyChart to view outpatient lab or test results, communicate with your doctor, view upcoming appointments and much more. It s simple to use and easy to get started. Sign up now for access to your medical information electronically by going to OPTIMIZING YOUR BENEFITS OPTIMIZING YOUR BENEFITS CHOOSE HENRY FORD FOR PEDIATRIC CARE Did you know that Henry Ford has over 50 board-certified pediatricians at more than 25 locations throughout southeastern Michigan to provide your child with the highest level of medical care? The pediatricians at Henry Ford are devoted to the healthy development and medical care of infants, children and teens. Henry Ford offers specialty pediatric services for advanced medical and surgical care of children, including pediatric orthopedics and sports medicine, pediatric neurology, pediatric ophthalmology, and many other areas. Henry Ford pediatricians provide care at many Michigan hospitals including Henry Ford Hospital, Henry Ford Macomb Hospital, Henry Ford West Bloomfield Hospital and Children s Hospital of Michigan. To find a Henry Ford pediatrician, call1-800-henry- FORD or log on to HAP Consumer-Driven Health Plan (CDHP) Another lower cost option is the HAP Consumer-Driven Health Plan, with Health Savings Account*. New for 2015, this plan has higher deductibles and lower employee contributions. Contributions are nearly $16 to $53 less per pay than the HFHS Preferred Medical option, depending on the level of coverage (single, two-person or family). Employees choosing this option are required to use HFHS Preferred Network providers. Deductibles are $1,300 single/$2,600 family, and must be met before most services are covered. For example, if you get sick, see your doctor and fill prescription medications on Jan. 1, you must pay the cost of those services. That amount goes toward meeting your deductible. Once the deductible is met, most services are covered or covered with a $20-$40 co-pay; *A Consumer-Driven Health Plan is sometimes referred to as a Consumer- Directed Health Plan. The terms are interchangeable and refer to the same kind of plan MY CHOICE REWARDS 8

10 prescription medication coverage lowers the cost to $4, $27 or $45, depending on the medication s tier classification. Preventive services are covered 100 percent before the deductible is met. Health Savings Account (HSA) the HFHS contribution. You do not have to contribute to the HSA if you select the HAP CDHP. Please note: If you participate in the HAP CDHP with an HSA, you cannot enroll in the Health Care Flexible Spending Account (see page 28 for details about the FSA). The HAP CDHP is paired with a Henry Ford-funded Health Savings Account (HSA). For 2015, HFHS will automatically contribute to the HSA for you on Jan. 1, 2015: $500 (single), $750 (two person), or $1,000 (family). (This will help reduce your contribution for meeting the deductible to $800 single/$1,600 family.) The idea behind the HSA is that some of the money you would have spent on health plan contributions can be contributed to your HSA, with pre-tax dollars. If you don t use the money, it will roll over from year to year and is portable between employers and even into retirement. You save on taxes and have greater control and flexibility of your health care dollars. HSA contributions can be used toward your deductible, qualified health care expenses that are not covered by the HAP CDHP, and co-payments and coinsurance. Some eligibility requirements may apply to HSAs. For example, if you have Medicare, you cannot contribute to a HSA. For these and other HSA details, visit healthequity.com/ed/hfhs and review the FSA/HSA comparison chart on page 30. For new hires, benefit status changes and mid-year life events that occur after Jan. 1, the HFHS contribution to the HSA will be prorated. In 2016, employees will be required to meet certain wellness criteria to receive HEALTHY CHOICES Health Risk Assessment (HRA) and Member Qualification Form (MQF) data from the past five years shows many healthy trends among Henry Ford employees. Measures for preventive tests, alcohol use, cholesterol, blood sugar, blood pressure and tobacco use are all trending in a positive direction. The challenge for Henry Ford employees is weight management. If weight is a health challenge for you, consult the Employee Wellness Resource Guide at www. henryfordconnect.com/wellness for weight loss programs, exercise opportunities and resources that could help you trend lower when it comes to your personal weight. OPTIMIZING YOUR BENEFITS If you plan to contribute to an HSA in 2015 and you currently are enrolled in the health care FSA for 2014, be sure that the balance of your health care FSA is $0 on Dec. 31, 2014.* Otherwise, you will not be permitted to make any HSA contributions (including pre-tax or the HFHS-funded portion) to your account until April 1, The IRS limits the use of your health care FSA and prohibits you from making contributions to your new HSA or receiving contributions from Henry Ford if you have a balance in your health care FSA on Dec. 31, * Based on your health care FSA balance on Dec. 31, 2014 without taking into account expenses that have been incurred but not reimbursed as of this date, pending claims, claims submitted, claims received or claims under review that have not been paid as of Dec. 31, These will not be taken into account MY CHOICE REWARDS

11 HFHS Preferred Medical Option The HFPN is the physician network within the HFHS Preferred Medical option. A physician-led subsidiary of Henry Ford Health System, it is comprised of Henry Ford Medical Group (HFMG) physicians, hospital-employed and private practice physicians. The HFPN is a growing and connected community of physicians focused on delivering an even higher level of service and clinical excellence to patients and the community. The HFHS Preferred Medical option was designed specifically for System employees and remains one of the the lowest cost options. As an HFPN patient, you will experience well-coordinated, consistent care and improved safety. Physician members are committed to raising quality and have agreed to adopt and adhere to quality and efficiency standards defined by the physicians. They are working collaboratively to improve their performance and offer exceptional care delivery and patient satisfaction. By selecting the HFHS Preferred Medical option and an HFPN doctor, employees and their dependents can receive services at any Henry Ford facility and can be referred to any specialist within the HFPN. ees will continue to have access to all of the pediatric and OB/GYN providers who participate in HFHS Preferred and Full HAP options. Today, almost 1,700 physicians have joined the HFPN and are located in Wayne, Oakland and Macomb counties, and the Downriver area. Of those: 1,074 are Henry Ford Medical Group (HFMG) physicians 95 are employed by HFHS hospitals 530 are private practice physicians To find out if your physician is part of the HFPN, log on to and select the Find a Doctor/Facility tab. Full HAP Option The Full HAP option allows employees to choose from a broader network of providers at a higher employee contribution level than the HFHS Preferred Medical option. The Full HAP option allows members to access any network with which HAP is affiliated. However, if you select the Henry Ford Physician Network, you must utilize the physicians within that Network. Additional Information To find out if your physician is in the Henry Ford Preferred Medical or HAP CDHP options, you can obtain a directory online at If you are enrolled in the Full Hap or HAP Point of Service (POS) options, you can view an online directory at For a Community Blue PPO directory go to HEALTHY CHOICES Quitting tobacco can save your health, your looks, and your money. A pack of cigarettes costs $6.95 in Michigan at a pack a day, that s over $2,500 a year. Quit today and start planning your new wardrobe, dream vacation, or earlier (and healthier) retirement. To get started, consult the Employee Wellness Resource Guide at wellness and click on Smoking Cessation to find a program that s right for you. HAP is committed to helping you achieve your best health. If you are not able to achieve the points required to qualify for the Enhanced Plan, you might qualify for an opportunity to earn the same points by different means. HAP Client Services Specialists are available to help you. They will also work with your doctor, if you wish to find a wellness program option with the same points that is right for you, such as a smoking cessation or weight loss program. Please call Client Services toll-free at (888) to find out what s available for you MY CHOICE REWARDS 10

12 You and your dependents can change your PCP and remain part of the HFHS Preferred Medical option, as long as the new PCP is part of the HFHS Preferred Network. Changing your PCP will not affect your contribution for medical coverage. Changing your network assignment will affect your medical contribution. If you need to change from the Henry Ford Preferred Medical option to the Full HAP option, you will continue to have a pretax deduction up to the cost of the Henry Ford Preferred Medical option. The added contribution will be an after-tax deduction. OPTIMIZING YOUR BENEFITS The co-pay for an OB/GYN visit will be reduced to the same cost as a primary care physician office visit. The Standard plan of benefits offers the same access to quality care and benefits but with higher out-of-pocket costs. The out-of-pocket costs under the Standard plan include higher co-pays and annual deductibles. Standalone Vision Coverage A new HAP standalone vision option will be available for employees who opt out of medical coverage. (For employees who enroll in a System medical plan, vision coverage is included.) For more information, see page 20. For example, if you have single coverage under the Henry Ford Preferred option at $47.06 per pay pre-tax, and you change your network selection to the Full HAP Network option, which is $69.21 per pay pre-tax, your pre-tax contribution will be $47.06 and your after-tax contribution will be $22.15 per pay for the remainder of the year. Healthcare Plan Changes Employees who choose the HFHS Preferred Medical or Full HAP options for their medical coverage have an opportunity to save on out-of-pocket health care costs and improve their health status in HAP s Health Engagement program, which rewards employees who take responsibility for their own health with lower outof-pocket costs. The medical chart on the following pages outlines the level of benefits associated with each medical option available through the My Choice Rewards program. The Enhanced plan waives co-pays for recommended preventive care and screenings as well as pre-natal services, offers lower co-pays for other services, and has annual deductibles. Preventive services include: Cancer screenings (breast, cervical, prostate, and colon) Recommended physical, eye and hearing exams Recommended lab tests Smoking cessation counseling Well baby/child exam visits HEALTHY CHOICES Immunizations are important throughout your life span to protect your health and the health of family, friends, colleagues and patients. Review your immunization needs with your PCP at your MQF visit or your next appointment. Because immunizations are considered preventive, the cost of the immunizations and the PCP visit to get them is covered by HAP. For your convenience, the HFHS Employee Health Clinic also offers vaccines at no cost to employees. Employees may stop by one of Employee Health Services four hospitalbased clinics for Chicken Pox, Whooping Cough, Hepatitis B, Pneumonia (65 and older), Shingles (50 and older), Tetanus and Flu immunizations. These diseases have complications that, for many, can be life threatening. For your own good health and to protect those around you, be sure to keep your vaccinations up to date MY MY CHOICE CHOICE REWARDS REWARDS

13 Health Engagement Achieve The Health Engagement Program will again be available to all employees and their covered spouses/same-sex domestic partners who selected the HFHS Preferred Medical or the Full HAP options in 2014 and who plan to remain in 2015, or new enrollees in either plan. If you have questions about Health Engagement, log on to Or, contact HAP directly by calling Client Services toll free at Hearing or speech-impaired members may call HAP s Telecommunications Device for the Deaf at HAP personnel are available Monday through Friday from 7 a.m. to 7 p.m. and Saturdays from 8 a.m. to noon. Remember: Employees and their covered family members will continue to remain in the Enhanced or Standard Plan through March 31, Employees and their covered spouses/same-sex domestic partners must qualify for the Enhanced Plan every year. Employees and their spouses/same-sex domestic partners who were hired after Jan. 1, 2014 and automatically placed in the Enhanced Plan will have to meet the qualifications for A spouse/same-sex domestic partner who was added to your medical coverage due to a midyear life event in 2014 will be required to qualify for the Enhanced Plan in Qualification for the Enhanced Plan requires completion of the SUCCEED Health Risk Assessment (HRA) and completion of the Member Qualification Form (MQF). HAP s qualification period for Health Engagement is Jan. 1 through March 31, the first three months of 2015; however, employees may begin qualifying now and are encouraged to do so. Employees hired after Jan. 1, 2015 will be placed in the Enhanced plan of benefits for 2015 and will need to qualify in 2016 to remain in the Enhanced Plan of benefits. Employees who would like to get a jump start on completing the HRA and MQF can take action now: The MQF is currently available at Print your personalized MQF to take with you to meet with your PCP. Otherwise, you ll receive your MQF in your HAP enrollment packet in January. The SUCCEED HRA is available at Did you get all A s on your 2014 MQF? Employees and their spouses/same-sex domestic partners who received all A s on their MQFs when qualifying for 2014 have earned a free pass for this year only and are not required to complete an MQF. If you qualify for the free pass, it will be indicated on your MQF. If you or your spouse/same-sex domestic partner received the free pass last year, you are required to see your PCP to complete your MQF during the Health Engagement Achieve qualification period to qualify for the Enhanced plan. For covered couples, if one spouse/same-sex domestic partner did not receive all A s in 2014, that individual is required to complete the MQF during the qualification period. The spouse/same-sex domestic partner who received all A s has earned a free pass for this year only and is not required complete the MQF. All who want to qualify for the Enhanced plan must also complete the online HRA. Everyone is encouraged to make an appointment with their PCP during the year to keep up their commitment to a healthy lifestyle. OPTIMIZING YOUR BENEFITS Co-Pays for MQF Visits If you or your spouse were not required to complete an MQF last year, you must complete an MQF during the qualification period to qualify for the Enhanced plan for A visit to complete your MQF is preventive, and you will not be charged a co-pay. However, if you receive nonpreventive care during the visit or additional lab work that is not required for completing the MQF, there will be a charge for those services. For example, if you decide to have vitamin D testing during your visit, you will be billed for that test. Any fees not considered preventive may be applied toward meeting your deductible. In addition, if your doctor recommends a follow-up visit based on your MQF visit, you may be charged a copay for that visit. Services required as part of the MQF process can be found on the back of your MQF form MY MY CHOICE REWARDS 12

14 Changes to Health Engagement for 2015 Employees and spouses who want to qualify for the Enhanced Plan (and did not receive all A s on their 2014 MQF) must complete both the MQF and the HRA. When you visit your primary care provider (PCP) during this year s qualification period (Jan. 1 through March 31, 2015) to complete the MQF, you ll need to accumulate 85 points out of a possible 100 to qualify. Point values for 2015 are: Tobacco Use: 20 Points. If you were a smoker, you must be able to demonstrate through a screening test that you have quit when you meet with your PCP to complete your MQF by March 31, Preventive screenings: 20 points. All age/gender specific preventive tests must be current or scheduled when you visit your PCP. Weight Management: 15 points. At your PCP visit, your BMI must be <30. If it was 30 or more at your visit last year, you must have lost at least 5 percent of your body weight by the time of your visit this year. Blood Pressure: 15 points. You must have a blood pressure of <140/90; if diabetic, <140/85. Cholesterol: 15 points. Within normal ranges or agree to a treatment plan. Blood Sugar Control: 10 points. Within normal ranges or agree to a treatment plan. Alcohol Use: 5 points. Within normal ranges or agree to a treatment plan. There is still time to make lifestyle changes that will allow you to qualify for the Enhanced Plan in Consult the Employee Wellness Resource Guide at for free and reduced-cost programs that can help. For information on HAP s smoking cessation benefits, visit and look for information by the topic smoking cessation. Co-pays for smoking cessation products and medications will be waived at HFHS pharmacies for employees who have HAP. As part of the Health Care Reform Wellness Regulations. HAP members may be offered reasonable alternatives for obtaining the points for those that cannot meet the established wellness target. In Levels 2 and 3 of Achieve, members can qualify for the Lifestyle Behavior targets on the Member Qualification Form (MQF) by either meeting the wellness target or discussing a reasonable altermative plan with their physicians. Contact HAP Customer Service at (888) for details. A Real-Life Cost Comparison: Health Engagement Enhanced Plan vs. Standard Plan Pam Smith is an employee enrolled in the HFHS Preferred Medical option with individual coverage and is in the Enhanced plan of Health Engagement Achieve. The plan offered to Pam has a $250 deductible in the Enhanced plan with lower co-pays and a $1,000 deductible with higher co-pays in the Standard plan. Pam takes care of herself and is in pretty good shape. Recently Pam hurt her knee when she ran her first half marathon. After seeing her PCP, she is referred to a specialist to help get her back on the running track. The specialist recommends an outpatient procedure to help her recover. The chart to the right is a breakdown in the cost savings. Service Enhanced Plan Standard Plan PCP Visit $20 $40 Specialist Visit $40 $60 Outpatient Co-pay $100 $150 Annual Deductible $250 $1,000 Total Out of Pocket costs: Use an FSA for Increased Savings Pam could save more money by planning for health care services she may need and put aside money in a health care Flexible Spending Account (FSA). In this case, if Pam could contribute $410 or $15.77 per pay pre-tax, on an annual basis, she would save more than $100 in taxes. Plus, she could use her FSA card and swipe it at the point of service and pay for the expense without having contributed the full $410. She would continue to have payroll deductions until she reached the $410 in contributions to her health care FSA. For details on FSAs, turn to page 28. $410 $1, MY CHOICE REWARDS

15 OPTIMIZING YOUR BENEFITS If you plan to contribute to an HSA in 2015 and you currently are enrolled in the health care FSA for 2014, be sure that the balance of your health care FSA is $0 on Dec. 31, 2014.* Otherwise, you will not be permitted to make any HSA contributions (including pre-tax or the HFHS-funded portion) to your account until April 1, The IRS limits the use of your health care FSA and prohibits you from making contributions to your new HSA or receiving contributions from Henry Ford if you have a balance in your health care FSA on Dec. 31, * Based on your health care FSA balance on Dec. 31, 2014 without taking into account expenses that have been incurred but not reimbursed as of this date, pending claims, claims submitted, claims received or claims under review that have not been paid as of Dec. 31, These will not be taken into account. No Increase in Co-Pays and Annual Deductibles for Health Engagement A co-pay is a fee you pay when you visit your physician or an emergency room for care. For example, a visit to your primary care physician for an illness may result in a $20 co-pay, which you pay at the point of service. A deductible is an amount you must pay out of pocket before your medical insurance will begin to cover any of your medical costs. For example, if your deductible is $250, you will need to pay the first $250 of your medical costs before your insurance starts to pay benefits. If you re healthy and do not require medical care during the year, you may never pay a deductible. Annual Deductibles HEALTHY CHOICES The hardest health behaviors to change are often those that impact body weight. If maintaining a healthy weight is a challenge for you, take advantage of one of the many weight-loss resources available through HFHS. Your PCP may be able to provide one-on-one assistance, or consult the Employee Wellness Resource Guide at wellness and click on Weight Management to find a program that s right for you. Programs include medical weight loss, Weight Watchers at Work, and programs to help you change your eating habits. A comprehensive list of services, co-pays and annual deductibles is available on the following pages. Enhanced plan: Annual deductibles are $250 for individuals and $500 for families. Standard plan: Annual deductibles are $1,000 for individual and $2,000 for family coverage MY CHOICE REWARDS 14

16 HAP Medical Plan Options Listed below are the various medical plan options available in the My Choice Rewards Plan. Health Care Services Coverage Enhanced Plan Coverage Standard Plan Coverage In Network Out of Network Benefit Period January - December January - December January - December Jan. - Dec. Jan. - Dec. Annual Deductibles $1,300 individual; $2,600 Family $250 individual; $500 Family $1,000 Individual; $2,000 Family None $150 ind.; $300 Fam. Co-Insurance (amount member pays) None None None None 20% Out-of-Pocket Maximums $6,450 Individual; $12,900 Family $6,600 Individual; $13,200 Family $6,600 Individual; $13,200 Family $6,600 Individual; None $13,200 Family Preventive Services Preventive Office Visit/Physical Exam Covered Covered Covered Covered Not Covered Deductible does not apply Deductible does not apply Deductible does not apply Well Baby/Child Office Visit Covered up to 24 months Covered up to 24 months Covered up to 24 months Covered Not Covered Deductible does not apply Deductible does not apply Deductible does not apply up to 24 months Immunization Covered Covered Covered Covered Not Covered Deductible does not apply Deductible does not apply Deductible does not apply Related Laboratory and Radiology Services Covered Covered Covered Covered Not Covered Deductible does not apply Decutible does not apply Deductible does not apply Pap Smears and Mammograms Covered Covered Covered Covered Not Covered Deductible does not apply Deductible does not apply Deductible does not apply Outpatient and Physician Services Primary Care Office Visit $20 Co-pay $20 Co-pay $40 Co-pay $20 Co-pay Plan pays 80% After deductible Deductible does not apply Deductible does not apply Specialty Physician Office Visit $40 Co-pay $40 Co-pay $60 Co-pay $40 Co-pay Plan pays 80% After deductible Deductible does not apply Deductible does not apply Gynecology $20 Co-pay $20 Co-pay $40 Co-pay $40 Co-pay Plan pays 80% After deductible Deductible does not apply Deductible does not apply Audiology Examinations $40 Co-pay $40 Co-pay $60 Co-pay $40 Co-pay Plan pays 80% After deductible Deductible does not apply Deductible does not apply Eye Examinations $40 Co-pay $40 Co-pay $60 Co-pay $40 Co-pay Plan pays 80% After deductible Deductible does not apply Deductible does not apply Allergy Treatment and Injections Covered after deductible Covered after deductible Covered after deductible Covered Plan pays 80% Laboratory and Radiology Services Covered after deductible Covered after deductible Covered after deductible Covered Plan pays 80% Dialysis Covered after deductible Covered after deductible Covered after deductible Covered Plan pays 80% Chemotherapy Covered after deductible Covered after deductible Covered after deductible Covered Plan pays 80% Radiation Therapy Covered after deductible Covered after deductible Covered after deductible Covered Plan pays 80% Outpatient/Office Surgery & Related Svcs. $100 Co-pay after deductible $100 Co-pay after deductible $150 Co-pay after deductible $100 Co-pay Plan pays 80% Chiropractic Not Covered Not Covered Not Covered Not Covered Not Covered Emergency/Urgent Care Emergency Room Services $150 Co-pay Non-System Facility $150 Co-pay Non-System Facility $250 Co-pay Non-System Facility $150 Co-pay Non- $150 Co-pay Non- $100 Co-pay at HFHS Facility $100 Co-pay at HFHS Facility $200 Co-pay at HFHS Facility System Facility System Facility After Deductible Deductible does not apply Deductible does not apply $100 Co-pay at $100 Co-pay at Co-pay waived if admitted Co-pay waived if admitted Co-pay waived if admitted HFHS Facility HFHS Facility Co- pay waived Co-pay waived if admitted if admitted Urgent Care Facility Services $50 Co-pay Non-HFHS Facility $50 Co-pay Non-HFHS Facility $50 Co-pay Non-HFHS Facility $50 Co-pay Non- $50 Co-pay Non- $40 Co-pay at HFHS Facility $40 Co-pay at HFHS Facility $40 Co-pay at HFHS Facility HFHS Facility HFHS Facility After deductible Deductible does not apply Deductible does not apply $40 Co-pay at $40 Co-pay at HFHS Facility HFHS Facility Emergency Ambulance Service Covered after deductible Covered after deductible Covered after deductible Covered Plan pays 80% Inpatient Hospital Services HAP Consumer-Driven HFHS Preferred Medical HAP Point Of Service (POS) Health Plan (CDHP) and Full HAP (HMO) Hospital Inpatient stay in semi -private room, $100 Co-pay per Admission $100 Co-pay per Admission $500 Co-pay per Admission $100 Co-pay Plan pays 80% specialty units as medically necessary, after deductible after deductible after deductible per Admission No out of network physician services, surgery, therapy, coverage for laboratory, radiology, hospital services and Organ Transplant supplies and Related Services Bariatric Surgery and Related Services $1,000 Co-pay after deductible $1,000 Co-pay after deductible $1,000 Co-pay after deductible $1,000 Co-pay after Plan pays 80% One procedure per lifetime One procedure per lifetime One procedure per lifetime deductible; One procedure One procedure per lifetime per lifetime MY CHOICE REWARDS

17 HAP Medical Plan Options (cont d) Listed below are the various medical plan options available in the My Choice Rewards Plan. HAP Consumer-Driven HFHS Preferred Medical HAP Point Of Service (POS) Health Plan (CDHP) and Full HAP (HMO) Health Care Services Coverage Enhanced Plan Coverage Standard Plan Coverage In Network Out of Network Maternity Services Initial Office Visit to Confirm Pregnancy Covered Covered $40 Co-pay $25 Co-pay Plan pays 80% Deductible does not apply Deductible does not apply Deductible does not apply Subsequent Prenatal and Postnatal Covered Covered $40 Co-pay $25 Co-pay Plan pays 80% Office Visits Deductible does not apply Deductible does not apply Deductible does not apply Labor, Delivery and Newborn Care $100 Co-pay per Admission $100 Co-pay per Admission $500 Co-pay per Admission $100 Co-pay Plan pays 80% after deductible after deductible after deductible per Admission Mental Health Inpatient Services $100 Co-pay per Admission $100 Co-pay per Admission $500 Co-pay per Admission $100 Co-pay Plan pays 80% after deductible after deductible after deductible per Admission Outpatient Services $20 Co-pay $20 Co-pay $40 Co-pay $15 Co-pay Plan pays 80% after deductible Deductible does not apply Deductible does not apply Chemical Dependency: Inpatient Services $100 Co-pay per Admission $100 Co-pay per Admission $500 Co-pay per Admission $100 Co-pay Plan pays 80% after deductible after deductible after deductible per Admission Outpatient Services $20 Co-pay $20 Co-pay $40 Co-pay $15 Co-pay Plan pays 80% after deductible Deductible does not apply Deductible does not apply Other Services Home Health Care Covered after deductible Covered after deductible Covered after deductible Covered Plan pays 80% Up to 60 visits Up to 60 visits per benefit period per benefit period (combined in and (combined in and out of network) out of network) Hospice Care Covered after deductibile; Covered after deductible; Covered after deductible; Covered; 210 days Plan pays 80%; 210 days lifetime 210 days lifetime 210 days lifetime lifetime (combined 210 days lifetime in and out of (combined in and network) out of network) Skilled Nursing Care Covered after deductible; Covered after deductible; Covered after deductible; Covered; up to 730 Plan pays 80%; for authorized services - up to for authorized services - up to for authorized services - up to days, renewable renewable after days, renewable after 60 days 730 days, renewable after 60 days 730 days, renewable after 60 days after 60 days days (combined in (combined in and and out of network) of network) Durable Medical Equipment; Prosthetics Covered after deductible; Covered after deductible; Covered after deductible; Covered; Coverage Plan pays 80%; Coverage provided for Coverage provided for Coverage provided for provided for Coverage provided approved equipment approved equipment approved equipment approved equipment for approved equipment Hearing Aid (Hardware) Covered after deductible; Covered after deductible; Covered after deductible; Covered; for Plan pays 80%; for authorized equipment for authorized equipment for authorized equipment authorized for authorized conventional conventional hearing aids hearing aids Physical, Speech and Occupational Covered after deductible; Covered after deductible; Covered after deductible; Covered; up to 60 Plan pays 80%; up to up to 60 combined visits per up to 60 combined visits per up to 60 combined visits per combined visits per 60 combined visits benefit period benefit period benefit period benefit period per benefit period Combined in and out Combined in and out of network of network Voluntary Sterilizations $100 Co-pay after deductible $100 Co-pay after deductible $100 Co-pay after deductible $100 Co-pay Plan pays 80% Infertility Services Covered after deductible; Covered after deductible; Covered after deductible; Covered; Services Plan pays 80% Services for diagnosis, Services for diagnosis, Services for diagnosis, Services for Services for counseling, and treatment of counseling and treatment of counseling and treatment of diagnosis, diagnosis, anatomical disorders anatomical disorders causing anatomical disorders causing counseling and counseling and causing infertility in infertility in accordance with infertility in accordance with treatment of treatment of accordance with HAP s benefit, HAP s benefit, referral and HAP s benefit, referral and infertility in infertility in and practice policies practice policies practice policies accordance with accordance with HAP s benefit, HAP s benefit, referral and referral and practice policies practice policies Assisted Reproductive Technologies Covered after deductible; Covered after deductible; Covered after deductible; Covered; Plan pays 80%; One attempt of One attempt of artificial One attempt of artificial One attempt of One attempt of insemination per lifetime insemination per lifetime insemination per lifetime artificial artificial insemination per insemination per lifetime lifetime 2015 MY CHOICE REWARDS 16

18 HAP Medical Plan Options (cont d) Listed below are the various medical plan options available in the My Choice Rewards Plan. HAP Consumer-Driven HFHS Preferred Medical HAP Point Of Service (POS) Health Plan (CDHP) and Full HAP (HMO) Health Care Services Coverage Enhanced Plan Coverage Standard Plan Coverage In Network Out of Network Pharmacy Generic / Preferred Brand / Non-Preferred 30 day supply: 30 day supply: 30 day supply: 30 day supply: $4 / $27 / $45 Co-pay $4 / $27 / $45 Co-pay $9 / $27 / $65 Co-pay $4 / $27 / $45 Co-pay at SystemPharmacy at SystemPharmacy at System Pharmacy at System Pharmacy $15 / $40 / $60 Co-pay at $15 / $40 / $60 Co-pay at $20 / $40 / $80 Co-pay at $15 / $40 / $60 Not covered Non-System Pharmacy. Non-System Pharmacy. Non-System Pharmacy Co-pay at Non-System Pharmacy 90 day supply: 90 day supply: 90 day supply: 90 day supply: $12 / $67 / $105 Co-pay $12 / $67 / $105 Co-pay $27 / $67 / $145 Co-pay $12 / $67 / $105 at System Pharmacy at System Pharmacy at SystemPharmacy at System Pharmacy $30 / $80 / $120 Co-pay at $30 / $80 / $120 Co-pay at $40 / $80 / $160 Co-pay at $30 / $80 / $120 Not covered Non-System Pharmacy Non-System Pharmacy Non-System Pharmacy Co-pay at Non-System Pharmacy In case of discrepancies betweenthe summary and the medical plan contract, the terms of the summary plan description, plan document and contract govern. OPTIMIZING YOUR BENEFITS For 2015, a new interactive decision-making tool calleld Alex will allow you to compare benefit choices and help you decide on the best choices for you and your family. Athough Alex will provide recommendations, you will make the decision about what s best for you and your family. Alex is available on Employee Self Service MY CHOICE REWARDS

19 BCBSM Medical Plan Options Listed below are the various medical plan options available in the Flexible Benefits Plan. BCBSM Community Blue PPO Health Care Services In Network Out of Network Benefit Period January - December January - December Annual Deductibles $250 Individual; $500 Family (Waived if services is performed in a $250 Individual; $500 Family; Out of network deductible amounts physician s office and for covered inpatient and outpatient facility also apply toward the in network deductible services provided at HFHS facilities) Co-Insurance (amount member pays) None None Out-of-Pocket Maximums $500 Individual/$1,000 Family $1,000 Individual/$2,000 Family Preventive Services: Preventive Office Visit/Physical Exam Covered; One per member per calendard year Not Covered Well Baby Office Visit Covered; One per member per calendar year Not Covered Immunization Covered Not Covered Related Laboratory and Radiology Services Covered Not Covered Pap Smears and Mammograms Pap Smear Covered; Mammogram Covered; One per member per year Pap Smear Not covered; Mammogram 60% after deductible; One per member per year Outpatient and Physician Services: Primary Care Office Visit $15 Co-pay Covered 60% after deductible; Must be medically necessary Specialty Physician Office Visit $15 Co-pay Covered 60% after deductible Gynecology Covered; One per member per calendard year Not covered Audiology Examinations Covered; One every 36 months Not covered Eye Examinations Covered; one eye exam in any period of 12 consecutive months Up to a maximum payment of $25 per exam (member responsible for difference) Allergy Treatment and Injections Covered Covered 60% after deductible Laboratory and Radiology Services Covered 80% after deductible Covered 60% after deductible Dialysis Covered 80% after deductible Covered 60% after deductible Chemotherapy Covered 80% after deductible Covered 60% after deductible Radiation Therapy Covered 80% after deductible Covered 60% after deductible Outpatient Surgery/Office Surgery Covered 80% after deductible Covered 60% after deductible & Related Services Chiropractic $15 Co-pay per visit; Limited to a combined maximum Covered 60% after deductible; Limited to a combined maximum of 24 visits per member per calendar year of 24 visits per memer per callendar year Emergency/Urgent Care: Emergency Room Services $125 Co-pay Non-System Facility $125 Co-pay Non-System Facility $75 Co-pay at HFHS Facility $75 Co-pay at HFHS Facility Co-pay waived if admitted or for an accidental injury Co-pay waived if admitted or for an accidental injury Urgent Care Facility Services $50 Co-pay at Non-System Facility Covered at 60% after deductible; Must be medically necessary $40 Co-pay at HFHS Facility Emergency Ambulance Services Covered 80% after deductible Covered 80% after deductible Inpatient Hospital Services: Hospital Inpatient stay in semi-private Covered 80% after deductible Covered 60% after deductible room, specialty units as medically necessary; physician services, surgery, therapy, laboratory, radiology, hospital services and supplies. Bariatric Surgery & Related Services Covered 80% after deductible, must meet specific criteria Covered 60% after deductible, must meet specific criteria Maternity Services: Initial Office Visit to Confirm Pregnancy Covered Covered 60% after deductible Subsequent Prenatal and Postnatal Covered Covered 60% after deductible Office Visits Labor, Delivery and Newborn Care Covered 80% after deductible Covered 60% after deductible; Includes delivery provided by a includes delivery by a certified nurse midwife certified nurse midwife Mental Health: Inpatient Services Covered 80% after deductible Covered 60% after deductible Outpatient Services Coverd 80% after deductible Covered 80% after deductible in particpating facilities only. Covered 60% after deductible in physician s office 2015 MY CHOICE REWARDS 18

20 BCBSM Medical Plan Options (cont d) Listed below are the various medical plan options available in the Flexible Benefits Plan. BCBSM Community Blue PPO Health Care Services In Network Out of Network Chemical Dependency: Inpatient Services Covered 80% after deductible Covered 60% after deductible Outpatient Services Covered 80% after deductible, in approved facilities only Covered 80% after deductible, in approved facilities only Other Services: Home Health Care Covered 80% after deductible Covered 80% after deductible Hospice Care Covered; Provided through a participating hospice program only; Covered; Provided through a participating hospice program only; limited to dollar maximum that is reviewed and adjusted periodically limited to a dollar maximum that is reviewed and adjusted periodically Skilled Nursing Care Covered 80% after deductible; up to 120 days per member Covered 80% after deductible; upt to 120 days per member per calendar year per calendar year Durable Medical Equipment; Covered 80% after deductible Covered 80% after deductible Prosthetics & Orthotics Hearing Aid (Hardware) Covered Not Covered Physical, Speech and Occupational Covered 80% after deductible; Limited to a combined maximum of Covered 60% after deductible; Limited to a combined maximum of Therapy 60 visits per member per calendar year 60 visits per member per calendar year; Services at non-participating outpatient physical therapy facilities are not covered Voluntary Sterilizations Covered 80% after deductible Covered 60% after deductible Infertility Services Not Covered Not Covered Assisted Reproductive Technologies Not Covered Not Covered Pharmacy: Generic / Preferred Brand / Non-Preferred 30 day supply: 30 day supply: $4 / $17 / $35 Co-pay at System Pharmacy $4 / $17 / $35 Co-pay at System Pharmacy $15 / $30 / $50 Co-pay Non-System Pharmacy $15 / $30 / $50 Co-pay plus 25% of BCBSM approved amount for the drug at Non-System Pharmacy 90 day supply: 90 day supply: $12 / $51 / $105 Co-pay at System Pharmacy $12 / $51 / $105 Co-pay at System Pharmacy $15 / $30 / $50 Co-pay at Non-System Pharmacy $15 / $30 / $50 Co-pay plus 25% of BCBSM approved amount for the drug at Non-System Pharmacy In case of discrepancies between the summary and the medical plan contract, the terms of the summary plan description, plan document and contract govern. HEALTHY CHOICES Keeping your weight in check can be challenging, especially as we lose muscle and our metabolism slows with age. Exercise can help. It boosts metabolism and increases the number of muscle cells in your body, which use up energy in the form of calories. For exercise ideas, log on to Try something new or get reacquainted with an activity you ve enjoyed in the past. You could take advantage of discounts at FitnessWorks ( spend some me time doing yoga, Zumba and dance classes, or get involved in the next Wellness Challenge MY CHOICE REWARDS

21 Medical/Vision Plan Options Vision Care (The vision coverage available is based on the medical option selected.) HAP Consumer-Driven HFHS Preferred Medical HAP Point of Service (POS) BCBSM Community Blue PPO Health Plan and Full HAP (HMO) Options Services Coverage Enhanced Plan Standard Plan In Network Out of Network In Network Out of Network Eye Exam $40 Co-pay; After deductible $40 Co-pay; unlimited $60 Co-pay; deductible does $25 Co-pay; Plan pays 80% Annual Exam covered in full up to unlimited exams (Waived for exams (Waived for not apply; unlimited eye unlimited eye unlimited eye approved charges preventive care) preventive care) exams; $40 Co-pay for exams; exams preventive care $15 Co-pay for preventive care Frames Covered up to $40; One Covered up to $40; One Covered up to $40; One Covered up to plan Not Covered Covered up to $40; one pair every 24 pair every 12 months with pair every 12 months with pair every 12 months with maximum, subject months prescription change; prescription change; prescription change; to planlimitations; otherwise one pair every otherwise one pair every otherwise one pair every Covered up to $40; 24 months 24 months 24 months one pair every 24 months Lenses Covered in full up to the Covered in full up to the Covered in full up to the Covered up to plan Not Covered Covered in full up to the approved approved charges; one approved charges; one approved charges; one maximum, subject charges; one pair every 12 months pair every 12 months with pair every 12 months with pair every 12 months with to plan limitations; prescription change; prescription change; prescription change; Covered in full up otherwise, one pair every otherwise, one pair every otherwise, one pair every to the approved 24 months 24 months 24 months charges; one pair every 12 months with prescription change; otherwise, one pair every 24 months Contact Lenses Covered in full up to $80 Covered in full up to $80 Covered after deductible Covered up to plan Not Covered Covered in full up to the approved in lieu of eyeglasses; in lieu of eyeglasses; in full up to $80 in lieu of maximums; charges in lieu of eyeglasses Contact lens fitting exams contact lens fitting exams eyeglasses; contact lens subject to plan are not covered are not covered fitting exams are not limitations; covered covered in full up to $80 in lieu of eyeglasses; contact lens fitting exams are not covered In addition to the vision plan you choose, additional savings on out-of-pocket expenses are available to you as an employee of Henry Ford Health System through Henry Ford OptimEyes. After applying insurance benefits, the following discounts will apply to your balance: An additional 10% on frame (after current frame promotion) 10% on all lenses and upgrades 10% on all contacts (based on regular retail pricing) 10% on accessories 25% on all ready made sunglasses May not be combined with coupons or other promotions Henry Ford identification badge and indicate that you are a System employee at the time the eligible service is provided. For a Henry Ford OptimEyes location near you, go online to henryfordoptimeyes.com or call (800) EYE-CARE ( ). HAP Standalone VIsion Plan Employees who opt out of medical/vision coverage now have an opportunity to purchase vision coverage only. Services and benefits are available through Henry Ford OptimEyes and HAP. Discounts are not available on: Professional fees Co-pays Warranty replacements Industrial safety glasses Exams Eye glass and contact lens savings program Discounts may not be combined with other discounts, coupons or promotions. Sale price merchandise is not included in the discount program. These benefits are available to you and your immediate family members (spouse and dependents.) To take advantage of these discounts, simply present your Services Eye Exam Frames Lenses Contact Lenses Coverage Covered one per benefit period when performed by a Henry Ford OptimEyes Optometrist Covered up to $40; One pair every 12 months with prescription change; otherwise one pair every 24 months Covered in full up to the approved charges; one pair every 12 months with prescription change; otherwise one pair every 24 months Covered up to $80 in lieu of eyeglasses; Contact lens fitting exams are not included MY CHOICE REWARDS 20

22 OUR COMMITMENT TO AFFORDABILITY Did you know there are additional benefits available to you that can reduce your out-of-pocket expenses and make your health care more affordable? Read further to see how the Special Medical Credit, Flexible Spending Account and Health Savings Account may help you save money. Special Medical Credit The Special Medical Credit is available for singleperson, two-person and family households in 2015: For employee only coverage, the credit is $32.30 per pay ($70 per month). For two-person coverage, the credit is per pay ($140 per month). For family coverage, the credit is $85.85 per pay ($186 per month). The credit is available for full-time employees who enroll in the HFHS Preferred Medical or Full HAP options. Eligibility for the credit is based on the total family income as indicated on the most recently filed 1040 tax return and the number of dependents indicated on that tax return(s). A new application must be completed each year. Please refer to chart. SPECIAL MEDICAL CREDIT INCOME GUIDELINES Family Size* 1040 Earnings** 1 $23,340 2 $31,460 3 $39,580 4 $47,700 5 $55,820 6 $63,940 7 $72, $80,180 Employees may also apply for the Special Medical Credit on a quarterly basis due to life events, status changes and new hire eligibility. Application Date Credit appears on Check Dated March 9, 2015 March 27, 2015 June 1, 2015 June 19, 2015 September 7, 2015 September 25, 2015 Open ment for 2016 First full pay of January 2016 Applications can be obtained from HR Connect. After review of the application and tax return information, Employee Services will notify you of the determination. Cancellation of the Special Medical Credit will occur if you are no longer a full-time employee enrolled in the HFHS Preferred Medical or Full HAP options or you are no longer eligible for benefits. Prescription Drug Benefits Employees and their family members enrolled in any of the medical plans provided by HFHS will continue to pay reduced co-pays for their prescriptions filled at a System Pharmacy. HFHS employees enrolled in the HAP Consumer-Driven Health Plan, HFHS Preferred Medical, Full HAP and HAP Point-of-Service options will be required to use a HFHS pharmacy versus a retail pharmacy. Over 90 percent of employees and their dependents use HFHS pharmacies. This change supports the System s growth strategy, which is directly linked to jobs and financial stability. * Based on the number of exemptions (you, spouse, dependents) reported on your most recent federal tax return under family size. ** Based on the total family income amount indicated your federal income tax Form 1040 or form 1040EZ) MY CHOICE REWARDS

23 There are some exceptions for using HFHS pharmacies: Employees may use a non-hfhs Pharmacy in an emergency or urgent situation when a prescription of 14 days or less duration is prescribed; and Any prescription for a specific medication, including maintenance drugs, may be filled up to three times per member, per plan (HAP Consumer-Driven Health Plan, HFHS Preferred, Full HAP and HAP Point-of- Service) within the existing HAP pharmacy network. Drugs listed on the Maintenance Drug List may be filled for up to a 90-day supply. Active employees and retirees enrolled in BCBSM and Manulife medical options may continue to use either HFHS Pharmacies or the existing HAP Pharmacy Network. The number of pills/doses given are 30 for a 30-day supply and 90 for a 90-day supply. All medical options have a three-tier prescription drug benefit to include: Generic drugs (First Tier) These drugs are the most affordable way for you to obtain quality medications at your lowest copayment. A generic drug is labeled with the medication s basic chemical name and usually has a brand-name equivalent. The U.S. Food and Drug Administration (FDA) requires that generic drugs have the same active chemical composition, same potency and be offered in the same form as their brand-name equivalents. Generic drugs must meet the same FDA standards as brand-name drugs and are tested and certified by the FDA to be as effective as their brand-name counterparts. Preferred brand name drugs (Second Tier) These are preferred brand-name drugs that have no generic equivalent. You re covered for these medications at a slightly higher co-payment. Non-preferred brand name drugs (Third Tier) These are brand-name drugs that either have equally effective and less costly generic alternative(s) or one or more preferredbrand (second tier) options. You or your doctor may decide that a medication in this category is best for you. If you choose a Third Tier drug, you re covered at the highest co-payment or coinsurance level which still represents a significant savings compared to its full retail cost. In cases where brand name drugs are dispensed when an equivalent generic drug is available, the employee s prescription charge will reflect the appropriate brand name drug co-pay or the net difference in cost between the brand name drug and equivalent generic drug plus the generic drug co-pay whichever is greater. Contact HAP ( or Community Blue PPO ( to obtain their current three tier prescription drug information. Employees and their dependents enrolled in a System medical plan, pay reduced co-pays on each prescription filled at an HFHS System outpatient pharmacy. Review the medical comparison chart on page 15 for more information. FREE PRESCRIPTION HOME DELIVERY Have your medications shipped right to your door. Henry Ford Pharmacy offers free home delivery of your medications, whether you need a simple refill or even a new prescription. To find out how, call or ask a Henry Ford pharmacist. Or go to for more information. Sponsored Dependents You may also cover certain sponsored dependents, but no credits are given for this coverage. For related information, see pages 6-7. (Sponsored dependents are not eligible for dental coverage or HAP Standalone Vision.) The rates per pay period for sponsored dependent medical coverage are: Medical Option Sponsored Dependent with Medicare Sponsored Dependent without Medicare HAP CDHP $ per pay $ per pay HFHS Preferred Medical $ per pay $ per pay Full HAP $ per pay $ per pay HAP Point of Service Not eligible $ per pay Community Blue PPO Not eligible $ per pay 2015 MY CHOICE REWARDS 22

24 Same-Sex Domestic Partners You may cover a same sex domestic partner for medical/vision and/or dental coverage. For related information, see pages 6-7. Your pre-tax deduction is based on the level of coverage you select (i.e., employee plus one or family coverage). The premiums for this coverage are a taxable benefit to you. Each pay, additional income will be added to your paycheck and taxes will be applied. A full-or part-time benefits eligible employee will have an additional $228 added to his/her check every pay for medical and $4 per pay for dental regardless of the options selected. Spouse Surcharge Employees who elect to cover a spouse on an HFHS medical plan who is eligible for health insurance with their own non-hfhs employer will be assessed a surcharge of $46.15 pre-tax per pay. This surcharge is in addition to the employee s per pay contribution for medical coverage and is designed to shift the responsibility of coverage to a broader spectrum of employers. Other dependents covered on an employee s medical plan are not affected by this surcharge. Employees who cover a same-sex domestic partner are excluded from the surcharge, as the cost to cover a same-sex domestic partner is taxable to the employee. Employees may cover their spouses on their medical plans even if they are eligible for coverage through their employer, but will be assessed the per pay surcharge. Employees who cover their spouses will be required to complete an online verification form stating the spouse does not have the opportunity to be covered by their non-hfhs employer. If your spouse is covered on your medical plan and you do not complete the online verification form, you will be defaulted to receive coverage for your spouse and the surcharge will apply. Random audits will be conducted and ineligible spouses will be removed. Falsification may result in disciplinary action, which could include termination. Dental Plans Henry Ford Health System offers you and your eligible dependents the opportunity to seek quality dental care on a regular, preventive basis. Changes to your dental option may be made every year. Employees enrolled in the Delta Basic or Comprehensive options have two networks from which to choose a Delta Dental participating provider. You will receive the highest level of coverage if you go to a Delta Dental PPO dentist. Although your coverage levels will be lower for some services when you go to a non-ppo dentist, you may still save money if that dentist participates in the Delta Dental Premier Network. Delta Dental EPO (Exclusive Provider Organization) allows employees the freedom to visit any Delta Dental EPO dentist within the EPO Network. There are no requirements to choose a primary dental office. You and your family members are no longer required to see the same dentist. You can see any Delta Dental EPO dentist any time without requiring approval. The following chart indicates the services covered by Delta Dental Plan of Michigan. It shows your copayment, if any, for the services listed. OPTIMIZING YOUR BENEFITS Review your first paycheck of the New Year Friday, Jan. 2, 2015, to verify elections and contributions. As a new hire, or newly benefitseligible employee, you should also review your paycheck to verify elections and contributions are correct. If you have questions, contact Employee Services at [email protected] or (855) MY CHOICE REWARDS

25 Dental Plan Comparison Chart Service Delta Basic Delta Comprehensive Delta EPO Diagnostic & Preventive - Class I PPO Premier PPO Premier Deductible $25 Single; $50 Family None $25 Single; $50 Family Diagnostic and Preventive Services - Used to diagnose and/or prevent dental abnormalities or disease (includes exams, cleanings and fluoride treatment) Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Emergency Palliative Treatment - Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Used to temporarily relieve pain Sealants - To prevent decay of permanent teeth (up to age 14) Plan pays 100% Plan pays 100% Plan pays 1000% Plan pays 100% Plan pays 100% Brush Biopsy - To detect oral cancer Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% (Excludes lab fees) Radiographs - X-rays Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Basic Services - Class II Oral Surgery Services - Extractions and dental surgery, including preoperative and postoperative care Relines and Repairs - Relines and repairs to bridges and dentures Minor Restorative Services - Used to repair teeth damaged by disease or injury (for example, amalgam [silver] or resin [white] fillings Major Restorative Services - Used when teeth can t be restored with another filling material (for example, crowns) Peridontic Services - Used to treat diseases of the gums and supporting structures of the teeth Endodontic Services - Used to treat teeth with diseased or damaged nerves (for example, root canals) Major Services - Class III Posthodontic Services - Used to replace missing natural teeth (for example, root canals) Orthodontic Services - Class IV Orthodontic Services - Used to correct malposed teethand/or facial bones (for example, braces) Maximum Payment - Per person per year Plan pays 60% Plan pays 40% Fixed co-pay schedule Plan pays 85% Plan pays 65% Plan pays 60% Plan pays 40% Fixed co-pay schedule Plan pays 85% Plan pays 65% Plan pays 60% Plan pays 40% Fixed co-pay schedule Plan pays 85% Plan pays 65% Plan pays 60% Plan pays 40% Fixed co-pay schedule Plan pays 85% Plan pays 65% Plan pays 60% Plan pays 40% Fixed co-pay schedule Plan pays 85% Plan pays 65% Plan pays 60% Plan pays 40% Fixed co-pay schedule Plan pays 85% Plan pays 65% Plan pays 60% Plan pays 40% Fixed co-pay schedule Plan pays 60% Plan pays 40% No coverage No coverage You pay $2,000 Plan pays 60% Plan pays 50% $750 No limit $1,500 Ortho Age Limit No Coverage To age 19 No age limit Ortho LIfetime Maximum No coverage None $1,500 per person In case of discrepancies between the summary and the dental plan contract, the terms of the summary plan description, plan document and contract govern MY CHOICE REWARDS 24

26 Dental Plan Questions and Answers Delta Dental PPO (Point-of-Service) Delta Dental EPO (replacing the DeltaCare option) What are Delta Dental PPO SM, Delta Dental Premier and Delta Dental EPO? Delta Dental PPO (Point-of-Service) is Delta Dental s national preferred provider organization program that gives you access to two of the nation s largest networks of participating dentists: Delta Dental PPO and Delta Dental Premier. Although you can go to any licensed dentist anywhere, your out-ofpocket costs are likely to be lower if you go to a dentist who participates in one of these networks. Delta Dental EPO is an exclusive provider organization program administered by Delta Dental of Michigan. You must receive dental care from a Delta Dental EPO Dentist in order to receive Benefits. You do not need to select a primary care dentist, nor receive all dental care from a specific EPO Dentist. You may receive dental care from any EPO Dentist at any time. How do I find a participating dentist? To find out whether your dentist participates in Delta Dental PPO or Delta Dental Premier, you can call his or her office, check our website at or call our Customer Service department at (800) To find out whether a particular dentist participates in Delta Dental EPO, you can call his or her office, check our website at or call our Customer Service department at (800) Do I have to go to a participating dentist? No. You can go to any licensed dentist anywhere, regardless of whether he or she participates in Delta Dental PPO or Delta Dental Premier. However, your out-of-pocket costs may be higher if you go to a nonparticipating dentist. Yes. You must seek care from a Delta Dental EPO dentist. Can I change dentists whenever I d like? Yes. You can change dentists at any time. Yes. You may choose any Delta Dental EPO dentist at any time. Can each member of my family choose a different dentist? Am I covered if I go to a nonparticipating dentist? Am I covered for Emergency Services? Will I receive dental cards? Yes. Each member of your family may see a different dentist. Yes. However, when you seek care from a nonparticipating dentist, you are responsible for all fees charged. We will reimburse you up to our nonparticipating dentist fee, which is generally lower than our fee for participating dentists. Yes. No. Your dentist can verify your eligibility through the Customer Service department or our online Dental Office Toolkit. Yes. Each member of your family may see a different dentist as long as that dentist participates in Delta Dental EPO. No. If you go to a non-epo dentist, you will be responsible for all charges for the services rendered, and you may need to pay the dentist at the time of your appointment. Yes. If you require emergency dental treatment, you may obtain treatment from any dentist. You will be responsible for paying for the emergency dental treatment, but Delta Dental will reimburse you up to the designated maximum for emergency dental treatment. No. Your dentist can verify your eligibility through our Customer Service department or our online Dental Office Toolkit. Who do I call if I have questions? If you have questions, please call the Customer Service department at (800) If you have questions, please call our Customer Service department at (800) MY CHOICE REWARDS

27 Delta Dental PPO/Delta Premier DELTA DENTAL PPO DENTIST You will receive the highest level of coverage if you go to a Delta Dental PPO (PPO) dentist. Delta Dental will pay PPO dentists directly based on their submitted fee or the amount in their local Delta Dental s PPO dentist schedule, whichever is less. If the PPO dentist schedule amount for a covered service is lower than the dentist s submitted fee, the dentist cannot charge you the difference. For example: If a PPO dentist charges $100 for a service covered at 100 percent, and if the PPO dentist schedule amount for that service is $80, we will pay the dentist $80 and you will owe nothing. The dentist cannot charge you the $20 difference between his or her submitted fee and the PPO dentist schedule amount. Submitted fee:.... $ PPO dentist schedule amount:.... $ Delta Dental pays 100% of $80:.... $ You pay:.... $ 0.00 The PPO dentist accepts the PPO dentist schedule amount. The $20 difference cannot be charged to you. DELTA DENTAL PREMIER DENTIST Although your coverage levels will be lower for some services when you go to a non-ppo dentist, you may still save money if that dentist participates in another Delta Dental program called Delta Dental Premier (Premier). We pay Premier dentists directly based on their submitted fee or their local Delta Dental s Maximum Approved Fee, whichever is less. If the Maximum Approved Fee for a covered service is lower than the dentist s submitted fee, the dentist cannot charge you the difference. For example: If a non-ppo dentist who participates in Delta Dental Premier charges $100 for a service that is covered at 80 percent, and if the Maximum Approved Fee for that service is $95, we will pay the dentist $76 (80 percent of $95). You will owe the dentist the remaining $19. The dentist cannot charge you the $5 difference between his or her submitted fee and the Maximum Approved Fee. Submitted fee:.... $ Maximum Approved Fee:.... $ Delta Dental pays 80% of $95:.... $ You pay:.... $ Delta Dental pays 80 percent of the Maximum Approved Fee and you pay 20 percent. The $5 difference between the Maximum Approved Fee and the submitted fee cannot be charged to you. Because your coverage level is lower when you go to a Premier dentist, you pay $19. NON-PARTICIPATING DENTIST If you go to a non-participating dentist (a dentist who does not participate in Delta Dental PPO or Delta Dental Premier), you will probably have to pay more. Our payment for covered services will be based on the dentist s submitted fee or the local Delta Dental s nonparticipating dentist fee, whichever is less. Delta Dental will usually send payment directly to you, and you will be responsible for paying the dentist whatever he or she charges. In addition, you might have to pay the dentist at the time of your appointment. For example: If a non-participating dentist charges $100 for a service that is covered at 80 percent, and if the non-participating dentist fee for that service is $82, we will pay you $65.60 (80 percent of $82). You will owe the dentist the remaining $ You will be responsible for paying him or her the full $100. Submitted fee:.... $ Non-participating dentist fee:.... $ Delta Dental pays 80% of $82:....$ You pay:.... $ Delta Dental pays 80% of the non-participating dentist fee and you pay 20%. In addition, you are responsible for the difference between the non-participating dentist fee and the submitted fee MY CHOICE REWARDS 26

28 Income Replacement and Survivor Benefits Protecting our family s income in the event of a serious injury or death is a concern that many of us have. Financial security can be achieved through personal financial planning, including employer-sponsored voluntary life and disability insurance. EMPLOYEE TERM LIFE INSURANCE While there is no one way to determine the amount of life insurance you should purchase, careful consideration should be given to all of your financial obligations, including mortgage payments, children s schooling and lifestyle maintenance for your family. My Choice Rewards provides you with an array of life insurance options. You may choose either more or less coverage, in the increments shown below, based on your projected needs. Coverage can be purchased with pretax dollars. The maximum protection you can receive from this benefit is $1,000,000. Coverage Maximum Benefit 1 x Your Base Pay... $250,000 2 x Your Base Pay.... $500,000 3 x Your Base Pay... $750,000 4 x Your Base Pay.... $1,000,000 $10,000* $25,000* $50,000* Opt out* *Options available to part time employees. Note: If you move up more than one coverage level, or you are electing coverage when you previously waived coverage, you must furnish evidence of insurability (EOI). COVERAGE AFTER AGE 65 If you continue to work after age 65, the amount of your life insurance will reduce on January 1 following your 65th birthday as follows: Age % of elected option Age % of elected option Age % of elected option IMPUTED INCOME When you purchase insurance in excess of $50,000, you are subject to the IRS Imputed Income rules. Imputed Income is the value of your life insurance more than $50,000. You are required to pay federal and state income taxes as well as Social Security tax on this excess amount. The amount of tax you pay is based on your age. The value of the life insurance in excess of $50,000 will be reported on your W-2. TERMINAL ILLNESS BENEFIT ees who are diagnosed with a terminal illness (life expectancy of 12 months or less) may apply to have up to 50 percent of their Employee Life Insurance paid out to them in advance. Information is available from Employee Services. DEPENDENT TERM LIFE INSURANCE My Choice Rewards also provides Dependent Term Life Insurance options on an after-tax basis. Because of IRS regulations, no pretax dollars or credits may be used for this coverage. Your Dependent Term Life Insurance options are: Spouse Coverage Child(ren) Coverage $50,000 spouse $15,000 each child $25,000 spouse $10,000 each child $10,000 spouse $5,000 each child If you choose to enroll, you must designate who will be covered by the Dependent Term Life Insurance. You may choose spouse-only coverage or, child(ren)-only coverage. For dependent eligibility requirements, see pages 6-7 of this workbook. Employees who have a same-sex domestic partner may enroll their partner in dependent term life insurance by selecting the coverage level for spouse. (You are the beneficiary for your spouse or dependent s life insurance.) Note: If you are electing dependent coverage when you have previously waived coverage, you must furnish evidence of insurability (EOI) for your spouse; children do not require EOI. Dependent Term Life Insurance coverage does not reduce if you continue working past age MY CHOICE REWARDS

29 Accidental Death and Dismemberment Coverage level and maximum benefits. 5 x base annual salary for employee ($1,250,000) 2.5 x employee s base annual salary for spouse ($625,000) 0.1 x employee s base annual salary for each child ($50,000) 4 x base annual salary for employee ($1,000,000) 2 x employee s base annual salary for spouse ($500,000) 0.1 x employee s base annual salary for each child ($50,000) 3 x base annual salary for employee ($750,000) 1.5 x employee s base annual salary for spouse ($375,000) 0.1 x employee s base annual salary for each child ($50,000) $100,000 employee $50,000 spouse $10,000 each child $50,000 employee* $25,000 spouse $5,000 each child $20,000 employee* $10,000 spouse $5,000 each child *Options available to part time employees. AD&D insurance provides protection against financial hardship when you or a covered dependent suffer an accidental death, loss of limb, paralysis or loss of sight. Your AD&D coverage options are indicated in the above chart. If you choose to enroll in AD&D coverage, you must designate who will be covered. You may choose either employee-only coverage or employee and dependents coverage. For dependent eligibility requirements, see pages 6-7 of this workbook. Employees who have a same sex domestic partner may enroll their partner in Accidental Death and Dismemberment Insurance by selecting the coverage level for family. COVERAGE AT AGE 75 AND OLDER When you or your spouse reach age 75, the coverage amount is reduced on the January 1 following the 75th birthday as follows : LONG-TERM DISABILITY (LTD) Long-Term Disability Insurance or LTD provides a source of income for you, if you are unable to work due to a serious illness or injury. If you have previously waived LTD and would now like to elect coverage, or you are increasing more than one level of coverage, you will have to furnish evidence of insurability (EOI). If you are initially enrolling in or increasing your LTD coverage during open enrollment, you will not be eligible for the higher coverage amount for any disability resulting from a pre-existing condition that begins 3 months before the coverage effective date and in the first 12 months after the effective date of coverage. Since your LTD benefit is paid for on a pretax basis or by the company, any long term disability benefit you receive will be subject to income taxes. Your LTD options are as follows: 50% of base annual salary: maximum monthly benefit of $10,700* 60% of base annual salary: maximum monthly benefit of $12,850 70% of base annual salary: maximum monthly benefit of $15,000 *Option available to part time employees. Health Care Flexible Flexible Spending Account The Health Care FSA is designed to cover specific out-ofpocket expenses you may anticipate during the course of the plan year. The Health Care FSA allows you to use pretax dollars to pay for health expenses not covered by insurance. Expenses payable through the Health Care FSA may include charges for contact lenses, eyeglasses, dental expenses, plus deductibles and copayments. In fact, any medical, dental, hearing or vision expenses that would otherwise qualify as a deduction on your income tax return will qualify for reimbursement, as long as the expense is not paid by another benefit plan. You must re-enroll each year. Age % of the elected coverage amounts Age % of the elected coverage amounts Age % of the elected coverage amounts This reduction also applies to any dependents you have chosen to cover MY CHOICE REWARDS 28

30 PLAN YEAR After the date you are no longer enrolled in the plan, or the end of the plan year, whichever comes first, you will have 90 days to submit eligible expenses. Note: Claims received beyond 90 days after your termination date or the date you are no longer enrolled, will be denied. The plan year ends December 31. If you have not terminated employment, you have through April 30 to submit eligible expenses. You may deposit, pretax, from $30 to $2,500 annually to your account. Deposits to your account will be made each pay period throughout the plan year. The following table shows the approximate dollar amount you may save by using the Health Care FSA, depending on your combined tax bracket. Account Tax Savings by Combined Tax Bracket* Deposit 27% 37% 40% $100 $27 $37 $40 $200 $54 $74 $80 $500 $135 $185 $200 $1,000 $270 $370 $400 *Combined Tax Bracket Information (rounded): 27 percent combined tax bracket (15 percent federal, 4.35 percent state and 7.65 percent FICA [rounded]). 37 percent combined tax bracket (25 percent federal, 4.35 percent state and 7.65 percent FICA [rounded]). 40 percent combined tax bracket (28 percent federal, 4.35 percent state and 7.65 percent FICA [rounded]). HOW TO ENROLL ing in the Health Care FSA is a simple procedure and consists of the following steps: 1. Select the option to participate. Decide how much you want to deposit in your account from January 1 through December 31, Enter this annual amount in the space provided. Remember you may elect to deposit between $30 per year and $2,550 per year into the Health Care FSA. 2. Equal deposits will be made over 26 pay periods, starting with the first pay period in January. 3. If you enroll in the Health Care FSA mid-year, your annual amount will be divided by the number of pay periods remaining in the year. 4. You may only submit expenses incurred on or after your participation date. HOW TO RECEIVE REIMBURSEMENT 1. Once you pay an expense for health care services, you may request reimbursement. 2. Submit a completed Request for Reimbursement Form and original receipts to the plan administrator. 3. Reimbursement checks are generally processed every week but are guaranteed within two pay periods. 4. Each participant is responsible for keeping records to support these expenses. HEALTH CARE FSA CARD Employees who enroll in the Health Care FSA automatically receive an FSA Card. You can use your Health Care FSA Card at most medical providers (including doctors offices, pharmacies, dental providers, vision care providers and hospitals) that accept the card. It is linked to your Health Care FSA account balance. When you incur an eligible health care expense, you simply swipe your Health Care FSA Card at the point of purchase. Additional detailed information will be mailed home to employees who enroll in the Health Care FSA. ESTIMATING HEALTH CARE EXPENSES To estimate how much money the Health Care FSA may help you save, make a list of medical, dental, vision or hearing expenses not covered by any insurance program that you expect to incur during the plan year (January 1, 2015 through December 31, 2015). The reimbursable expense listing on the following pages may help you to determine which expenses to include. Estimate the dollar value of these expenses and multiply the total by your combined tax rate for federal, state and Social Security taxes to estimate your savings. FSA Administrator Change for 2015 The third party administrator for health care and dependent care Flexible Spending Accounts will change from Benefit Express to HealthEquity (visit If you currently have an FSA, you will receive a letter mailed to your home in November about this change and how to submit claims during the first quarter of MY CHOICE REWARDS

31 The following examples illustrate possible savings incurred by participating in the Health Care FSA. EXAMPLE ONE: (SINGLE PARTICIPANT) Pat Smart is single, earning $27,000 and has approximately a 27 percent tax rate (15 percent federal, 4.35 percent state, and 7.65 percent FICA [rounded]). She has the following expenses: Eligible Expenses Amount Medical Plan Deductible.... $150 Medical Copayment Routine Physical Eyeglass/Contact Lens Expense Dental Expenses Total Out-Of-Pocket Expenses...$697 By paying for expenses through the Health Care FSA, Pat Smart could save approximately $188 per year ($697 x 27 percent). EXAMPLE TWO: (MARRIED PARTICIPANT) Mr. and Mrs. Smith, a working couple with a combined income of $124,000, pay approximately 40 percent in taxes (28 percent federal, 4.35 percent state, and 7.65 percent FICA [rounded]). They have the following expenses: Eligible Expenses Amount Medical Plan Deductible....$300 Medical Copayment Routine Physical Eyeglass/Contact Lens Expense Dental Expenses Total Out-Of-Pocket Expenses...$925 By paying for expenses through the Health Care FSA, Mr. and Mrs. Smith could save approximately $370 per year ($925 x 40 percent). PLANNING CAREFULLY The following IRS regulations apply to Health Care FSAs: Once you decide to participate in the Health Care FSA, your decision must remain in effect until the end of the plan year. Each year you will have an opportunity to enroll again. You may change your payroll deduction amount for your Health Care FSA during the plan year, only if you have a change in status. IRS-approved changes include a change in marital status, death of spouse or child, birth or adoption of a child and termination of employee s or spouse s employment. It will be your obligation to go online to Employee Self Service within 30 days of the event, if there is a change in status. Health Care FSA (Flexible Savings Account) and HSA (Health Savings Account) A side-by-side comparison Description Use it to pay for medical expenses before you meet the deductible for your HAP Consumer-Driven Health Plan (CDHP). Use it to pay for a variety of eligible health and medical expenses. You must use it by the end of the year or first quarter of the new year or forfeit the remaining funds. Rolls over from year to year. You can take it with you if you change employers or retire. Make contributions with pre-tax dollars. Employees can contribute a maximum of $2,500 annually. Employee and employer together may contribute $3,350 to $6,650 depending on family status (single/married). Catch-up contributions up to an additional $1,000 for employees age 55+. All funds available beginning Jan. 1, 2015 (applies to health care FSA only). Only funds that have already been deposited into the account are available. HFHS contributes funds to the account at the beginning of the benefit year for Designed to be used with the HAP CDHP. Can be used with any health plan except CDHP. FSA HSA Any balance in the Health Care FSA that is not used for eligible expenses within the plan year must be forfeited. You will have 90 days after the end of the plan year or the date you are no longer enrolled in the plan (whichever comes first), to submit eligible expenses for reimbursement. For 2015, expenses incurred between January 1, 2015 and March 15, 2016 are eligible for reimbursement; however you have until April 30, 2016 to submit for reimbursement. Please note that some of the Change Events described on the chart at the back of this workbook are not available for Health Care FSA MY CHOICE REWARDS 30

32 FLEXIBLE SPENDING ACCOUNT SAVINGS HOW MUCH CAN YOU SAVE? Income without FSA Annual Salary $35,000 Federal Income Tax -5,250 State Income Tax -1,050 Social Security Tax -2,678 Net Income $26,022 Medical Expenses -2,500 Spendable Income $23,522 Income with FSA Annual Salary $35,000 Health Care FSA -2,500 Taxable Income $32,500 Federal Income Tax -4,875 State Income Tax -975 Social Security Tax -2,503 Spendable income $24,147 Annual Savings with FSA = $625 You are required to keep copies of your Health Care FSA receipts in the event you are audited by the IRS. Health Care Reimbursement Expenses The general rule is that allowable expenses are those medical, dental and vision expenses eligible under Treasury Regulation 213 and not compensated by insurance plans. The following items are examples of eligible expenses and are in addition to the deductible and co-pay amounts from the medical and dental plans. ALL MEDICAL, DENTAL and VISION CLAIMS (including all prescriptions) must be incurred during the plan year and processed by your insurance carriers (primary and secondary) FIRST, before submitting them to your Health Care FSA for reimbursement. GENERAL ELIGIBLE REIMBURSABLE EXPENSES Medical plan copayment and deductible Dental plan copayment and deductible Vision plan copayment and deductible Prescription co-pays Laboratory and X-ray co-pays and deductible Examples of Eligible Reimbursable Expenses Acupuncture (with medical diagnosis) Alcoholism Treatment Ambulance Service Artificial Limbs Aspirin Birth Control Pills Braille Books and Magazines Car Controls for the Handicapped Chiropractic Care Condoms Contact Lenses and Solutions Crutches Dental Fees (excludes bleaching or whitening) Dental Implants Dermatologist Fees Diagnostic Tests Doctor Fees Durable Medical Equipment (with prescription and letter of medical necessity) Equipment for the Disabled Flu Shots Hearing Aids and Batteries Hearing Exams Hearing Treatment Hospital Services (excluding phone & TV) Immunizations Injections Insulin In Vitro Fertilization Lab Fees Lamaze Classes (mother s cost only) Lasik Surgery Legal Abortion Long-Term Storage of Sperm or Embryo Medical Nursing Home Services Midwife Mileage to and from Medical Services Nursing Services Optometrist Fees Ophthalmologist Fees Organ Transplants Orthodontia Treatment Orthotics Osteopath Fees Oxygen Periodontal Fees Physical Exams Physical Therapy Prenatal Care Prescription Drugs (dispensed by a pharmacist) Prescription: Eyeglasses, Sunglasses and Reading Glasses (excluding sunglass clips) Psychiatric Fees Psychologist Fees Psychotherapy (by an approved provider) Radial Keratotomy, PRK Services for Diagnosed Severe Learning Disabilities Smoking Cessation Drugs & Programs (prescribed by doctor and dispensed by a pharmacist) Special Schools for the Disabled Sterilization Substance Abuse Treatment Surgery (medically necessary) Telephone for the Deaf Therapy for Mental/Nervous Disorders Transportation for Medical Care Vaccinations Vitamins (requiring a prescription) Weight-Loss Programs (must be prescribed by a physician to treat a specific medical condition) Wheelchairs X-ray Fees MY CHOICE REWARDS

33 Examples of Non-Eligible Reimbursable Expenses Baldness Treatments Breast Pump Rental or Purchase COBRA Premiums Cosmetic Surgery, Procedures, Services and Products (non-medically necessary) Childcare Classes (in any other form than Lamaze) Dancing Lessons Dental Veneers or Bonding (non-medically necessary) Diaper Service Doula Expenses Electrolysis Electronic Toothbrushes Exercise Equipment Expenses for a Vacation (even if recommended by a doctor) Family/Marriage Counseling Funeral Services Hair Transplants Health Club Dues and Memberships Herbal & Holistic Drugs or Remedies Insurance Premiums Marijuana or other controlled substances (even for medical purposes) Maternity Clothes Pregnancy Test (over the counter) Special Diet Foods and Supplements Swimming Lessons Teeth Bleaching or Whitening Temporomandibular Joint Disorder (TMJ) Varicose Vein Treatment This list summarizes regulations that are frequently amended or updated by the IRS and should be used as a guide. Actual expense eligibility will be determined at the time of utilization and submission. This list may be amended or changed during the plan year without notice. Day Care FSA The Day Care FSA allows you to use pretax dollars to pay for day care expenses for a child or other dependent. By planning for such expenses, you can reduce your tax bill. You must re-enroll each year. This account will reimburse you for day care expenses to enable you and your spouse to work outside the home. This includes the cost of a childcare center, a babysitter or other caregiver for a disabled dependent spouse or parent. Eligible caregivers may include relatives. However, you cannot pay a dependent (a teenage daughter, for example) to take care of another dependent. Under current IRS regulations, day care expenses will qualify for reimbursement under the plan if they meet the following requirements: The services provided must enable you and, if married, your spouse to be employed. If married, your spouse must be employed, a full-time student or permanently disabled. The dependent must be under 13 years of age or physically or mentally incapable of caring for himself or herself, and you must be able to claim this dependent on your income taxes. If the services are provided outside your household, they must be provided for a dependent who spends at least eight hours each day in your household. If the services are provided by a day care facility that cares for six or more children at the same time, it must be a qualified day care center. The amount to be reimbursed must not be greater than your income or that of your spouse, whichever is lower. If you decide to utilize the Day Care FSA, you cannot use the Federal Tax Credit for the same expenses. PLAN YEAR After the date you are no longer enrolled in the plan, or the end of the plan year, whichever comes first, you will have 30 days after the end of your plan year to submit eligible expenses. Note: Claims received beyond 30 days after your termination date or the date you are no longer enrolled will be denied. The plan year ends December 31. If you have not terminated employment, you have through January 31 to submit eligible expenses. HOW THE DAY CARE FLEXIBLE SPENDING ACCOUNT WORKS The Day Care FSA operates much like a bank account. You may deposit to your account, pretax, as little as $50 per plan year and up to $5,000 per plan year per household ($2,500 for married couples filing separately). Deposits to your account will be made each pay period throughout the plan year MY CHOICE REWARDS 32

34 TAX ADVANTAGES The following table shows the approximate dollar amount you may save by using the Day Care FSA, depending on your combined tax bracket. Account Tax Savings by Combined Tax Bracket* Deposit 27% 37% 40% $100 $27 $37 $40 $200 $54 $74 $80 $500 $135 $185 $200 $1,000 $270 $370 $400 *Combined Tax Bracket Information (rounded): 27 percent combined tax bracket (15 percent federal, 4.35 percent state and 7.65 percent FICA [rounded]). 37 percent combined tax bracket (25 percent federal, 4.35 percent state and 7.65 percent FICA [rounded]). 40 percent combined tax bracket (28 percent federal, 4.35 percent state and 7.65 percent FICA [rounded]). IMPORTANT NOTICE 2015 DAY CARE REIMBURSEMENT LIMITATIONS The Internal Revenue Code (IRC) requires that a test be performed on an annual basis to measure the amount of Day Care Reimbursement Accounts for highly compensated employees (those making $115,000 or more per year), versus those who are not highly compensated. Based on the results of the test, HFHS is required to limit your maximum day care reimbursement. You will be notified during the first quarter of 2015 if your contribution is limited. If so, you will be informed of the options available to you at that time. HOW TO ENROLL ing in the Day Care FSA is a simple procedure and consists of the following steps: 1. Select the option to participate. Decide how much you want to deposit in your account from January 1 through December 31, Enter this annual amount in the space provided. Remember you may elect to deposit between $50 per year and $5,000 per year into the Day Care FSA. 2. Equal deposits will be made over 26 pay periods starting with the first pay period in January. 3. If you enroll in the Day Care FSA mid-year, your annual amount will be divided by the number of pay periods remaining in the year. 4. You will be required to provide information about your dependents and your day care provider such as receipts, Social Security numbers or Federal Tax Identification numbers. 5. You may only submit expenses incurred on or after your participation date. HOW TO RECEIVE REIMBURSEMENT 1. Submit a completed Request for Reimbursement Form along with original receipts to the plan administrator. 2. Reimbursement checks are generally processed every week but are guaranteed within two pay periods. 3. Each participant is responsible for keeping records to support these expenses. ESTIMATING DAY CARE EXPENSES If you are or will be incurring day care expenses, the following example may help to show you how the Dependent Care FSA can save you tax dollars. Example: Pat Smart is a single parent earning $27,000 and has approximately a 27 percent tax rate (15 percent federal, 4.35 percent state, and 7.65 percent FICA [rounded]). Each year, Pat Smart pays $3,600 for day care expenses. When Pat Smart has paid the day-care expenses and has the funds in the account, a receipt may be submitted to be reimbursed for that expense. By paying for expenses through the Day Care FSA, Pat Smart could save approximately $972 per year ($3,600 x 27 percent) MY CHOICE REWARDS

35 Remember to reduce the number of weeks you use day care by the number of holidays and vacation days you have allotted. PLANNING CAREFULLY The following IRS regulations apply to Day Care FSAs: Once you decide to participate in the Day Care FSA, your decision must remain in effect until the end of the plan year. Each year you will have an opportunity to enroll again. You may change your payroll deduction amount for the Day Care FSA during the plan year, only if you have a change in status. The IRS defines a change in status for the Day Care FSA as the death of a dependent parent, the change in your spouse s student status, death of child or loss of child custody. It will be your obligation to go online to Employee Self Service within 30 days of the event, if there is a status change. Any balance in the Day Care FSA that is not used for eligible expenses within the plan year must be forfeited. You will have 30 days after the end of the plan year or the date you are no longer enrolled in the plan (whichever comes first), to submit eligible expenses for reimbursement. For 2015, only expenses incurred between January 1, 2015, and December 31, 2015, are eligible for reimbursement; however, you have until January 31, 2016, to submit for reimbursement. My Choice Rewards Web ment Instructions During Open ment, all benefits-eligible employees must log on to if they are making changes to their benefits. Computer kiosks are located throughout the System. If you need help enrolling or have questions about benefits choices after reading this newsletter, call Employee Services at (855) STEP 2 STEP 3 Enter your six-digit employee identification number. Then enter your Employee Self Service password, which is also your password for Open ment. If you don t remember your password, click on Forgot your Password. If you need to reset your password, click on Contact IT Help Desk or call (248) or tie line Access your Personal ment Summary and 2015 Flex Benefits ment Workbook. STEP 4 Make your benefits selections for STEP 5 STEP 6 STEP 7 STEP 8 Update your dependent information. If you add new dependents, submit birth certificates and/or marriage certificates to Employee Services. Submissions must be postmarked by Wednesday, Nov. 26, You may also scan and documents to [email protected] or fax to (313) Include your Employee ID on all documents. After completing your benefit selections, if you are satisfied with your choices, proceed to receive your confirmation number. Record this number. You must obtain a confirmation number, as this completes your enrollment and confirms your benefit selections have been recorded and submitted. This does not mean your elections are correct. It only means the information you entered was recorded. Print your temporary confirmation statement. Confirmation statements will not be mailed home. Review the confirmation statement for accuracy and keep it as proof of your enrollment for HOW TO ENROLL STEP 1 Go to from any computer which has access to the web starting Monday, Nov. 10. STEP 9 A final confirmation statement will be available for you to print beginning the week of Dec. 8, Go to Employee Self Service/Benefits Home and print the final confirmation statement MY CHOICE REWARDS 34

36 DEFAULT PLAN Flexible Spending Accounts default to nonparticipation unless you enroll each year. For new hires and rehires as of January 1, 2015, the default package for full and part time employees is no coverage. If you are enrolled in the default package, you will have no coverage for the rest of the plan year. Also, if you experience a life event, you may not be able to make a change to your benefits until the next Open ment period. Receiving a confirmation number does not mean your benefit elections are correct. It only means the information you entered was recorded. You must thoroughly review the confirmation statement provided to you at the end of the enrollment process to ensure you made the right choices and that your dependents have coverage. Your covered dependents must have a Y in the medical and or dental columns if they are to have coverage in Making Choices... the ment Experience This year Henry Ford has added new features to provide information about your benefits: Web Page. Visit MyChoiceRewards. This is the hub for My Choice Rewards information during Open ment. Materials are organized and housed together on an easy-to-navigate web page. Alex. A new, interactive decision-making tool called Alex will allow you to compare benefits choices and help you decide on the best choices for you and your family. Although Alex will provide recommendations, you will make the decisions about what s best for you and your family. You ll be able to use Alex as you prepare to enroll for benefits. Read Morning Post and Monitor for more details about Alex. NAVIGATION IMPROVEMENTS When you go online to enroll for benefits, you ll notice several new features that make enrolling easier: Tabs at the top of each page have been added, similar to the Employee Self-Service pages on HR Connect. These tabs will make the enrollment process more intuitive and help you complete the enrollment process faster. At-A-Glance summaries are presented in a streamlined and consolidated manner to help you select and verify the benefits you have chosen and ensure that you have not overlooked any options or dependents. Summaries include charts that combine and consolidate all your health benefits choices; show what benefits have been/have not been selected; and a list of dependents and what benefits have been selected for your dependents. More detailed information about the actual cost of the employee Rewards package, both to Henry Ford Health System and to you. Electronic submission of documentation for required materials such as Dependent Proof for medical and dental plans. You can now upload required documentation for dependents online during the enrollment process. If you provide HFHS medical coverage for your spouse, you will continue to answer a few online questions regarding the Spouse Medical Surcharge. This must be done every year. PHONE OR As always, after reading the key messages, newsletter and enrollment workbook, if you still have questions, call Employee Services at (855) or [email protected], or use the Chat Line which is available between 8 a.m, and 5 p.m. weekdays. During Open ment a link to Chat can be found on MY CHOICE REWARDS

37 Additional Information about My Choice Rewards COVERAGE FOR HFHS COUPLES If both a husband and wife are Henry Ford Health System employees, they cannot be double covered under My Choice Rewards. A person covered as an employee cannot be an eligible dependent. However, one spouse could opt out of health care coverage and be covered as a dependent by the other spouse under two-person or family coverage. Eligible dependents of a couple employed by HFHS can be double covered under My Choice Rewards. Keep in mind that coordination of benefits rules apply for health care coverage, so that not more than 100 percent of eligible expenses can be paid. Similarly, an employee cannot be covered as a dependent on a spouse s life insurance contract. However, an eligible dependent may be covered under both spouse s dependent life insurance contracts. If that dependent dies, both spouses could collect on the dependent life coverage in which they were enrolled. An eligible expense may only be reimbursed once, even if both spouses participate in flexible spending accounts. LEAVE OF ABSENCE If you are on a leave of absence during Open ment, changes made to your employee or dependent life, long term disability or accidental death and dismemberment insurance will not be in effect until you return to work in If you make changes to your medical and/or dental coverage those changes will be effective January 1, TERMINATION OF BENEFITS Benefit coverage for you and your family will terminate on the last day of the month in which you terminate your employment or are in an ineligible benefit status. Long-term disability coverage ends on the date of termination. If you become ineligible for coverage, you and your eligible dependents may have continuation rights for medical/vision, dental and Health Care Flexible Spending Account benefits under the federal law known as COBRA. If you terminate your employment or are in an ineligible benefit status, you will be notified about your continuation rights. HAP Personal Alliance Coverage for Gaps New HFHS employees have an eligibility waiting period before their HFHS benefits begin. Most benefits are not effective until the first of the month following 60 days of employment. Employees who are leaving the System or are longer eligible for coverage because of a life event will also experience a discontinuation of coverage. For these gaps in coverage, HAP Personal Alliance offers health plans for individuals and families that may be a lower-cost alternative to COBRA. If your loss of coverage is due to a qualifying life event, you can sign up during a Special ment Period (SEP). The loss of previous coverage is considered a qualifying event. Call HAP Personal Alliance at (855) WITH-HAP, or visit for information about Special ment Period qualifying events. Health Plans for Those Turning 26 HAP Personal Alliance provides coverage for individuals turning 26 and aging off their parents health plan. This is a life event that qualifies the individual to sign up by the end of the month the individual turns 26. During the SEP, you or your dependent can obtain coverage under a separate contract/policy. Visit for more information on the policies designed for young adults. YOUR RIGHTS AND RESPONSIBILITIES You are responsible for notifying Employee Services at the time a covered dependent no longer remains eligible for benefit coverage by going online to Employee Self Service within 30 days of the event to remove your dependent. LEGAL UPDATE The Women s Health & Cancer Rights Act requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. This law also requires that written notice of the availability of the coverage be delivered to all plan participants upon enrollment and annually thereafter. This language serves to fulfill that requirement for These services include: 2015 MY CHOICE REWARDS 36

38 Reconstruction of the breast upon which the mastectomy has been performed, Surgery/reconstruction of the other breast to produce a symmetrical appearance, Prostheses, and Treatment for physical complications during all stages of mastectomy, including lymphedema. In addition, the plan may not: Interfere with a woman s rights under the plan to avoid these requirements, or Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the requirements of the law. However, the plan may apply deductibles and co-pays consistent with other coverage provided by the plan. HIPAA RIGHTS Henry Ford Health System sponsors a group health plan. As such, the System has access to the individually identifiable health information of Plan participants (1) on behalf of the Plan itself; or (2) on behalf of the System, for administrative functions of the Plan. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its regulations restrict the System s ability to use and disclose Protected Health Information (PHI). Protected Health Information means any information relating to the past, present or future physical or mental condition of an individual (or payment therefore) that identifies the individual or can be used to identify the individual. It is the Henry Ford Health System s policy to comply fully with HIPAA requirements. Consequently, if you become a covered participant under the group health plan, you have a right under HIPAA to receive a Notice of Privacy Practices for Protected Health Information. To request a copy, call (855) or [email protected]. Combined Time Off (CTO)/ Paid Time Off (PTO) Some changes to CTO/PTO will go into effect Jan. 1, CTO CTO Sellback will be eliminated. There will be no changes to CTO accrual rates or maximum bank balances for current employees. For new hires, the CTO accrual rate will be reduced effective Jan. 1, 2015, allowing for a 3, 4, and 5-week accrual annually based on years of service: 0 to 4 years = 3 weeks; 5 to 9 years = 4 weeks; and 10+ years = 5 weeks. Also effective Jan. 1, 2015, new hires will be able to maintain a maximum balance equal to their annual accrual rate. PTO PTO will remain the same for current Leadership, Advance Practice Providers (APP) and Physicians. Effective Jan. 1, 2015, all newly hired Leadership and APPs will follow a new tiered approach for PTO based on the following years of service: 0 to 4 years = 4 weeks; 5 to 9 years = 5 weeks; and 10+ years = 6 weeks. Voluntary Employee Benefits Henry Ford offers voluntary employee benefits to all full-time and part-time benefits eligible employees. The benefits include: Premier Purchase Program Auto Insurance Home Owners Insurance Group Legal Pet Insurance To find out more, log on to GROUP LEGAL BENEFITS Henry Ford Health System and ARAG legal solutions are always looking for ways to enrich the benefits available to you as an HFHS employee. During Open ment, there are two different group legal plans to choose from: UltimateAdvisor and UltimateAdvisor Plus. These plans provide benefits to assist you with everyday legal issues. UltimateAdvisor is $9.11 per pay. UltimateAdvisor Plus is $11.08 per pay. Both plans cover you and your eligible dependents. The website to enroll, cancel or change your legal coverage is Or, call Coverage may only be changed, elected or cancelled during Open ment, Monday, Nov. 10, through Monday, Nov MY CHOICE REWARDS

39 HFHS Rewards As a Henry Ford employee, your benefits extend beyond compensation and health insurance coverage. Rewards are benefits employees receive at no cost as valued members of the Health System, such as those noted below. To find out more about Rewards, log on to and follow the links described below. For information about: Employee Assistance Program (EAP) Helping Hands Henry Ford Kids Child Care Employee Health and Wellness Log on to HR Connect, click on the Work Life icon, and use the right-hand navigation column. For information about: Employee Discounts negotiated by the System such as: Banking and Credit Union Services Wireless Services Dining and Entertainment Lodging and Travel, and more Log on to HR Connect, click on the Benefits icon, and select Employee Discounts from the list of benefits. For information about: Tuition Reimbursement of up to $3,000 per year Log on to HR Connect and click on the Benefits icon. For information about: Combined Time Off and Paid Time Off Special Medical Credit Log on to HR Connect and click on the Benefits icon. For information about: Direct Deposit Log on to HR Connect and click on Your Paycheck. For information about: Employee Health Clinic services Seasonal flu shots and other health screenings through Employee Health Fitness Works Log on to HR Connect and click on Work Life, and click on Employee Health and Wellness in the right-hand navigation column. Employee Wellness Henry Ford LiveWell Wellness is at the core of Henry Ford Health System s vision statement, Transforming lives and communities through health and wellness one person at a time. As a part of the System s commitment to wellness a virtual center of excellence, Henry Ford LiveWell, has been established. Henry Ford LiveWell works to coordinate System wellness efforts, create collaborative partnerships, and promote innovative approaches. It recognizes that wellness is unique to each person and aims to meet individuals where they are on their wellness journey. For more information about the wellness programs available to you, visit and check out the wellness resource guide for employees. HFHS Wellness Ambassadors Between our hospitals, medical centers, dialysis centers and nursing homes, there are a lot of places HFHS employees work. HFHS wellness ambassadors help us learn what the wellness needs are at their site. Are you interested in a session on healthy eating? How about a yoga class? Stress management techniques? All this and more can be available through your wellness ambassador. Discover your wellness ambassador by visiting wellness and click on wellness at your site. Look for your location and click on it to find your contact. If you are interested in becoming a wellness ambassador (and we welcome more than one per site), please fill out the form and send it to employeewellness@hfhs. org. Join the team that is making a difference! WELLNESS PROGRAMS BY THE NUMBERS 15,608 employees have participated in or been touched by a HFHS-offered wellness program. 7,899 apples were handed out to employees on Employee Health and Fitness Day in May. 291 employees have participated in 9 recess events. 2,004 employees took part in the Team Up for Wellness challenges. 362 employees attended 19 Lunch and Learns. 10 locations offered Weight Watchers at Work MY CHOICE REWARDS 38

40 Events Permitting Mid-Year Election Changes Consistent with Event IRS Qualifying Event Explanation of Event Medical/Vision and Dental Health Care/Day Care Life, Accidental Death & Dependent Life Flexible Spending Dismemberment, Long Accounts Term Disability Marriage This event allows you to add your new spouse within 30 days of your marriage. Stepchildren may be added. Proof is required. Add spouse Change Option Increase Coverage Decrease Coverage Increase coverage Decrease coverage Increase coverage Decrease coverage Divorce, legal separation/annulment or death of spouse This event allows you to remove your spouse within 30 days of the event. Proof is required. Remove Spouse and dependents Change Option Opt out Increase coverage Decrease coverage Opt out Increase coverage Decrease coverage Opt out Increase coverage Decrease coverage Birth, Adoption, Placement for Adoption of a child or gain stepchild(ren) This event allows you to add your newborn child or newly adopted child within 30 days of the event. Proof is required. Add dependent Change Option Remove dependents Opt out Increase coverage Decrease coverage Opt out Increase coverage Decrease coverage Opt out You may not Increase coverage Decrease coverage Death of Dependent This event allows you to remove your dependent within 30 days of the event. Proof is required. Remove dependent Change Option Add dependents Decrease coverage Opt out Increase coverage Increase coverage Decrease coverage Opt out Decrease coverage Increase coverage Other eligible dependents (Aged Parents) This event allows you to add a sponsored dependent to your existing medical coverage only within 30 days of the event. Proof is required. A sponsored dependent must be an IRS dependent such as a parent or adult child who lives with you and is claimed on your Federal Income Tax. Add your sponsor dependent Add other dependents Remove other dependents Make any changes to dental coverage Increase limit Decrease limit No changes are allowed No changes are allowed Employee changes status Part time to full time This event allows you to enroll in medical/vision or dental if your status changes from part time to full time. You are now eligible to receive flex credits. You have 30 days to make your elections. Part to Full time: Opt out No changes are allowed Increase coverage Decrease coverage Increase coverage Decrease coverage Full time to part time For status changes from full time to part time, please see event for Significant Cost Changes Please see event for Significant Cost Changes Please see event for Significant Cost Changes Please see event for Significant Cost Changes Please see event for Significant Cost Changes Employee now ineligible for benefits You are no longer eligible for active benefits. All benefits will be canceled and COBRA or conversion rights will be provided. Elect COBRA continuation Active coverage will be cancelled in active benefits Elect COBRA continuation Active coverage will be cancelled in active benefits Continue COBRA coverage for dependent care FSA Conversion rights are available Active coverage will be cancelled in active benefits Conversion rights are available Active coverage will be cancelled in active benefits MY CHOICE REWARDS

41 Events Permitting Mid-Year Election Changes Consistent with Event (continued) IRS Qualifying Event Explanation of Event Medical/Vision and Dental Health Care/Day Care Life, Accidental Death & Dependent Life Flexible Spending Dismemberment, Long Accounts Term Disability Employee rehires within 30 days This event allows you to be reinstated in your prior elections within 30 days of your rehire. Have your prior elections reinstated Make changes to prior elections Have your prior elections reinstated Make changes to prior elections Have your prior elections reinstated Make changes to prior elections Have your prior elections reinstated Make changes to prior elections Employee rehires after 30 days This event allows you to enroll in all of your benefits as a new hire within 30 days of your rehire. Spouse/Dependent now eligible for their employer s plan This event allows you to change some of your options within 30 days of being covered under your spouse/ dependent employer s plan. Proof is required. Remove dependents who now have other coverage Opt out if covered by spouse/ dependent s plan Add dependents Decrease coverage Increase limit Increase coverage Decrease coverage Opt out No changes are allowed Spouse/Dependent or HFHS employee* lose eligibility for their employer s plan This event allows you to change some of your options within 30 days, due to your spouse/dependent losing coverage through their employer s plan. Losing coverage does not mean voluntarily opting out of coverage. Proof is required. Add dependents who lost coverage Remove dependents Increase limit Decrease limit Increase coverage Decrease coverage Opt out Increase coverage Decrease coverage Opt out In rare situations, an HFHS employee may waive coverage because they are employed and have full time benefits elsewhere. If the employee loses their eligibility through that employer, they would be entitled to enroll in all of the HFHS benefits listed in this chart. Proof is required Change in Residence or Worksite of employee, spouse or dependent that causes eligibility or loss of eligibility This event allows you to change your medical/vision or dental coverage, within 30 days, because you or a dependent moved out of the service area (as defined by the insurance contract.) Change option Add dependents Remove Dependents No changes are allowed No changes are allowed No changes are allowed Significant cost changes For HFHS Employee This event allows you to change certain benefits, within 30 days, due to your status change from full time to part time. The loss of flex credits results in a cost change to you. Switch to less costly option Remove dependents Add dependents No changes are allowed Decrease coverage Increase coverage Decrease coverage Increase coverage Employee begins FMLA Leave This event allows you to change certain benefits within 30 days as a result of your FMLA leave. Change Option Add dependents Remove dependents Increase limit Decrease limit Increase coverage Decrease coverage Increase coverage Decrease coverage 2015 MY CHOICE REWARDS 40

42 Events Permitting Mid-Year Election Changes Consistent with Event (continued) IRS Qualifying Event Explanation of Event Medical/Vision and Dental Health Care/Day Care Life, Accidental Death & Dependent Life Flexible Spending Dismemberment, Long Accounts Term Disability Employee returns from FMLA Leave Special ment Rights Under HIPAA Loss of other coverage or acquisition of new dependent This event allows you to change certain benefits within 30 days that were terminated as a result of your FMLA leave. This event allows you to enroll in medical coverage, within 30 days, even though you previously opted out. Eligibility to enroll is contingent on adding a newborn or adding a dependent that recently lost coverage. Losing coverage does not mean voluntarily opting out of coverage. Proof is required. if coverage was terminated while on FMLA Change option if coverage was not terminated while on FMLA Add dependents Remove dependents in medical/vision only Add dependent(s) in dental Opt out of dental if coverage was terminated while on FMLA if coverage was not terminated while on FMLA No changes are allowed if coverage was terminated while on FMLA if coverage was not terminated while on FMLA No changes are allowed if coverage was terminated while on FMLA if coverage was not terminated while on FMLA No changes are allowed Judgment, Divorce or Medical Child Support Order Require coverage for child(ren) under employee s plan This event allows you to enroll your dependent, within 30 days, as a result of a Judgment, Divorce or Medical Child Support Order. Proof is required. Add dependent as a result of the Order Add dependents not part of the Order Remove dependents Change option Opt out Elect if Order requires Increase limit if Order requires Decrease limit No changes are allowed No changes are allowed Coverage required under spouse s plan This event allows you to remove your dependent within 30 days because your dependent is now enrolled under your spouse s plan. Proof is required. Remove dependent Add dependent Change option Opt out Decrease limit Opt out Increase limit No changes are allowed No changes are allowed Entitlement to Medicare/Medicaid This event allows you to remove you or your dependent that is now eligible for Medicare or Medicaid within 30 days of becoming eligible. Proof is required Remove dependent Opt out Add dependent Change option Decrease limit Opt out Increase limit No changes are allowed No changes are allowed Loss of Medicare/ Medicaid eligibility This event allows you to enroll your dependent that is no longer eligible for Medicare or Medicaid within 30 days of losing eligibility. Proof is required in medical/vision only Add dependent to medical/ vision only Change option Remove dependents Increase limit Decrease limit No changes are allowed No changes are allowed MY CHOICE REWARDS