How To Get A Good Health Care Plan At Rochester General

Transcription

1 Welcome to Rochester Regional Health! This online presentation on the Rochester General Health Benefits Program is designed to provide you an overview of the comprehensive benefits package Rochester Regional Health makes available to our eligible employees. Should you have any questions pertaining to any of the content, please contact the Benefits team at or

2 It is important that you have all the tools and information you need to make informed benefit decisions that are best for you. We encourage you to read your benefits materials thoroughly before making your benefit decisions. Keep in mind, the choices you make regarding most of your benefits are binding until the next annual enrollment unless you have a qualifying event. You will need to understand the benefits-related decisions that need to be made, understand how to get help if you have questions about enrollment, and understand when your enrollment deadline is. 2

3 Rochester General offers several benefits to our eligible Employees Medical, Dental, Vision, Flexible Spending Accounts, Life Insurance, Supplement Life Insurance, Dependent Life Insurance, Accidental Death and Dismemberment Insurance, Short- Term Disability, Long-Term Disability, a 403(b) Plan, a Pension Plan, Paid Time Off (otherwise referred to as PTO), and Vacation. 3

4 Short Term Disability, the Pension Plan, PTO, and Vacation are benefits that you do not need to make an active decision regarding. That is, you will be provided the benefit automatically at no cost to you if you are eligible. You will have 30 days from your date of hire, which is your enrollment period, to make a decision on the other benefits listed. All employees, including per diems, are eligible for the 403(b) plan and will be automatically enrolled in the plan after 60 days of employment. 4

5 Enrolling in your benefits is one of your most important tasks as a new hire. To enroll, make your elections via Workday, our online benefit enrollment system. You can access Workday at the link provided here or from the link on the main Rochester Regional Health Portal page. Again, you will have up to 30 days from your hire date to complete your enrollment. Failure to enroll in benefits within 30 days may result in no coverage for certain benefits. Now let s take a closer look at the benefits Rochester General Hospital offers to our employees. 5

6 When you enroll in our benefits, you can also cover your spouse, your domestic partner, your natural-born children, legally adopted children, stepchildren, or children of your domestic partner. Children can remain on the medical and vision plan up to age 26; they can remain on the dental plan up to age 23. If you cover a domestic partner, there are tax implications that you need to be aware of. The IRS requires that if a domestic partner does not qualify as your tax dependent, you must pay the incremental cost of covering your domestic partner and his or her children on an after-tax basis. Also, the value of your domestic partner s benefit that is provided for by the Health System will be treated as taxable income (also called imputed income) for federal and state tax purposes. You will pay federal, Social Security, and other payroll taxes on this additional amount throughout the year. The Health System will report these taxes on your W-2 form at the end of each year. You should consult the Benefit Decision Guide for more information on eligible dependents. 6

7 We offer a single medical plan for employees scheduled to work 20 or more hours per week. If you elect coverage, it will begin on your date of hire. When you use the medical plan, you have the flexibility to access two networks of providers: the RRHS Domestic Network or the Excellus BCBS PPO Network. The RRHS Domestic Network includes services received from RRHS providers at RRHS facilities. When you use the RRHS Domestic Network, you will have lower out-of-pocket costs for health services. The Excellus BCBS PPO Network is comprised of providers and facilities who do not participate in the RRHS Domestic Network, and you will typically pay higher out-of-pocket costs when you receive care. If you do not use either the RRHS Domestic Network or the Excellus BCBS PPO Network, your services will be considered Out of Network with no coverage for nearly all services. 7

8 When using RRHS providers and facilities, you will pay a lower copay for services than if you went to a non-rrhs provider. The medical plan covers certain preventive care like annual physicals and immunizations at 100% and provides protection if you or a family member has a chronic illness or becomes ill or injured. Pediatric services will follow the lower copay structure regardless of where you have services. Services not offered by an RRHS provider or facility will follow the RRHS Domestic Network copay structure. Urgent care services are covered under the medical plan. In order to take advantage of the lower copay for urgent care services, employees must use Rochester Immediate Care located in Greece, Henrietta and Webster. The copay for any other urgent care facility will follow the Excellus BCBS network copay. 8

9 When you use the Excellus BCBS Network you are choosing providers who do not participate in the RRHS Domestic Network. With the Excellus BCBS network, you will typically pay higher out-of-pocket costs when you receive care. You can utilize both networks for you and your family s care. For example, your primary doctor can be a participant in the RRHS Domestic Network, but you choose to see a specialist who is in the Excellus BCBS PPO Network. You have the flexibility to choose a provider; however, it is important to consider the out of pocket costs associated with each network. Please refer to the Medical Plan Summary in the 2015 Health Care & Benefit Information Guide for the copays associated with each network. 9

10 To find a provider in the RRHS Domestic Network or to verify that your provider is in the RRHS Domestic Network, you can access the listing of providers by going to the Human Resources portal page, clicking on Benefits, the Medical sub category, and then the RRHS Domestic Network of Providers. You can also call to find out which Primary Care Physician is accepting new patients. 10

11 We encourage our employees to have prescriptions filled at one of our apothecaries. They are located in Rochester General Hospital, Unity St. Mary s, and Park Ridge. If you are taking a medication that is on the Maintenance Medication List, you must have the prescription filled at one of the apothecaries, or through Prim or Wegmans Home Delivery mail order in order to receive insurance coverage. The Maintenance Medication List is located in the Health Care & Benefit Information Guide. Any medications not listed on the Maintenance Medication List may be filled at any retail pharmacy. However, you will pay a lower copay when your medications are filled at The General Apothecary, Unity St. Mary s Apothecary, Park Ridge Apothecary, or through Prim or Wegmans Home Delivery. Information and order forms for the Mail Order vendors can be found on the Human Resources portal page by clicking Benefits, the Medical sub category, and then selecting either Prim or Wegmans Home Delivery. More information about the Medical plan is available in the Benefits Decision Guide. 11

12 We offer two dental plans, a low and a high plan, for employees scheduled to work 20 or more hours per week. If you elect coverage, it will begin on your date of hire. You can see any Excellus BCBS dental provider in order to have coverage in the dental plan. 12

13 This slide summarizes your out-of-pocket costs under both dental plan options. There are a few differences between the two plans, which are highlighted in green: There is a deductible difference between the two plans. The coverage for basic services, such as fillings and root canals, is different. The low plan covers 50% of the cost and the high plan covers 80% of the cost. In both instances, you would be responsible for the deductible and any remaining cost. The low plan does not cover orthodontia services, but the high plan will cover up to $1,500 of services. Lastly, the annual maximum for the low plan is $1,000 per covered person per year; for the high plan, the annual maximum per covered person per year is $1,500. More information about the dental plan is available in the Benefits Decision Guide. 13

14 We offer one vision plan for employees scheduled to work 20 or more hours per week. If you elect coverage, it will begin on date of hire. The vision benefit, offered through EyeMed, provides you and your family members with savings for eye care expenses such as routine eye exams, eyeglass frames and lenses, and contact lenses. Routine vision screens can help ensure your eyes stay healthy and detect potential problems early. 14

15 Your out-of-pocket costs for vision services depends upon whether your provider is an EyeMed provider. If you use an in-network provider, you will follow the In-Network Member Cost column. If you elect to use a non-participating provider, you will need to pay for the services out of pocket and submit a claim form for reimbursement based on the Out of Network Reimbursement column. The claim form can be found on the Human Resources Portal in the Benefits section and vision subsection. To find a participating EyeMed Provider, go to enter your zip code, and search for a provider in the Insights Network. 15

16 The medical plan offers a small vision benefit, so make sure that you present both your medical and vision cards at the time you receive vision services. There is more information about the vision plan in the Benefits Decision Guide. 16

17 Employees scheduled to work 20 or more hours per week are eligible to enroll in a Flexible Spending Account (FSA). If you enroll in an FSA, the effective date will be your date of hire. We offer two types of Flexible Spending Accounts to help with your out-of-pocket expenses for health care and dependent care services. These accounts can help you achieve significant savings by paying for eligible expenses with pre-tax dollars deducted from your paycheck in equal amounts throughout the year. The FSA can be used for eligible expenses that you or your tax dependents incur. Domestic partner expenses are not eligible for reimbursement through the FSA unless your domestic partner is your tax dependent. You may need to consult a tax advisor for more information. 17

18 You can contribute up to $2,550 to your Health Care FSA, which will help to pay for eligible out-of-pocket medical, dental, and vision expenses for you and your tax dependents. Certain over the counter drugs are also eligible for reimbursement but only with a prescription from your physician. A full list of eligible expenses can be found on the IRS website. Under the health care FSA, your annual election is available immediately. For example, let s say that on January 1 you elect to set aside $200 for the year in your Health Care account. On January 3 you purchase new glasses that cost $150. You can use your Health Care FSA on January 3 for your glasses even though you haven t had that much come out of your paycheck yet. Each pay period, your payroll deduction will fund the deficit in your account. 18

19 You can contribute up to $5,000 annually to your Dependent Care FSA, or up to $2,500 if you are married and filing taxes separately. Eligible dependent care expenses are those incurred when caring for your tax dependents while you or, if married, you and your spouse work outside the home or attend school full time. Eligible dependent care expenses may include: Care at a licensed nursery school, day camp or daycare center After school programs or summer day camps for children under age 13 Agency or association fees required to obtain the services of a dependent care provider Household services related to the care of an elderly or disabled adult who is your dependent Under the Dependent Care FSA, you need to accumulate a balance in your account and may only be reimbursed up to your account balance once the expense is incurred. Please note that due to IRS regulations, highly compensated employees may be limited to the amount they can contribute to the Dependent Care FSA. You will be notified if your annual Dependent Care FSA election needs to be reduced as a result of IRS nondiscrimination testing. 19

20 Certain IRS rules apply to Flexible Spending Accounts. The accounts are designated as use it or lose it plans meaning that if you do not use all of the money you set aside in these accounts, you will forfeit it. Be sure to carefully estimate your expenses for health and dependent care; you may not change your election amounts during the year unless you have a qualifying event. For each calendar year, claims should be incurred between January 1 and December 31 of that year to be eligible for reimbursement. We offer a 2 ½ month grace period after the end of the calendar year (until March 15) to use any remaining funds in your Health Care FSA. You must file all claims by April 30 of the following calendar year. Any money that remains in your FSA after this deadline will be forfeited. If you sign up for a Health Care or Dependent Care FSA, Lifetime Benefit Solutions, our FSA administrator, will send you two debit cards to use as an easy and convenient way to pay for health care and dependent care expenses. Use the debit card to access your FSA funds to pay for eligible expenses you or a covered family member incur. Remember to always keep receipts of your expenses in case documentation is requested. If you do not use your FSA debit card, you may file a claim for reimbursement of your eligible expenses. You can submit your claim either online at or by completing a reimbursement form and submitting it to Lifetime Benefit Solutions. You can elect to have your reimbursements direct deposited into your bank account or have a check mailed to your home. 20

21 Claim forms and the FSA direct deposit forms are located on the Human Resources Portal Page in the Benefits category and FSA subcategory. 20

22 Employees scheduled to work 30 or more hours per week are eligible for life and accidental death & dismemberment (AD&D) insurance. Coverage in these benefits will be effective 30 days after date of hire. AD&D insurance is a bit different from life insurance. AD&D provides benefits if you die or suffer a covered loss as the result of an accident. A covered loss could be sight out of one or both eyes, loss of a hand or foot, loss of speech or hearing in one or both ears, and such. The Health System provides a core benefit; you can purchase additional insurance for yourself, your spouse or domestic partner, and for your child or children. Your core, supplemental, and spousal/domestic partner life insurance and accidental death & dismemberment insurance will automatically reduce at age 70 and again at age 75. The reduction at age 70 is to 65% of pre-age 70 amount; the reduction at age 75 is to 50% of pre-age 70 amount. 21

23 The Health System provides eligible employees with $25,000 of core life insurance at no cost to you. If you feel you need additional life insurance above what is provided by the Health System, you can purchase additional coverage for yourself in increments of $25,000 up to a maximum of the lesser of $750,000 or 5 times your salary. The rates for this insurance are based on your age on January 1. The Guarantee Issue amount is an amount of insurance that is available without regard to heath status. The Guarantee Issue amount for supplemental life insurance is 4 times your salary or $375,000 of coverage. Any amount requested above the Guarantee issue will require you to complete and submit an Evidence of Insurability (or EOI) form to the insurance carrier. For example, let s say your salary is $50,000 and you want to purchase the most life insurance available to you. The maximum amount of life insurance that you can purchase for yourself is $250,000; this is 5 times your salary. You will receive $200,000 of coverage without providing Evidence of Insurability (this is 4 times your salary). The remaining $50,000 of requested coverage is subject to you providing the Evidence of Insurability form to the insurance carrier and the insurance carrier approving you for the additional amount. If they approve your request, you will begin paying for a total of $250,000 of coverage. If they don t approve your request, you will still have the $200,000 of coverage you are enrolled in; you will not forfeit that amount. If you do not opt to purchase life insurance when you are initially eligible for the coverage, that 22

24 is, at time of new hire, you can request to purchase it in the future but you would need to provide Evidence of Insurability to the insurance carrier. 22

25 You can purchase life insurance coverage for your spouse or domestic partner in increments of $5,000 up to a maximum of 50% of your supplemental life insurance amount. The maximum amount of spousal/domestic partner life insurance is $375,000. The Guarantee Issue is an amount of insurance that is available without regard to heath status. The Guarantee Issue amount for spousal/domestic partner life insurance is $30,000. Any amount requested above the Guarantee issue will require your spouse/domestic partner to complete and submit an Evidence of Insurability (or EOI) form to the insurance carrier. The rates for spousal/domestic partner life insurance are based on the employee s age on January 1. You must be enrolled in supplemental life insurance for yourself in order to purchase spousal/domestic partner life insurance. If you do not opt to purchase spousal life insurance when you are initially eligible for the coverage, that is, at time of new hire, you can request to purchase it in the future but your spouse/domestic partner would need to provide Evidence of Insurability to the insurance carrier. 23

26 You can purchase life insurance coverage for your child or children in an amount of $2,000 or $4,000. The rate is the same regardless of the number of children you cover. Children can be covered under this insurance up to age 19 or age 25 if they are a fulltime student. You must be enrolled in supplemental life insurance for yourself in order to purchase child life insurance. 24

27 The Health System provides eligible employees with $25,000 of core Accidental Death & Dismemberment (AD&D) insurance at no cost to you. If you feel you need additional AD&D insurance above what is provided by the Health System, you can purchase additional coverage for yourself in increments of $25,000 up to a maximum of $250,000. You can also purchase AD&D coverage for your spouse/domestic partner in increments of $5,000 to a maximum of $125,000, not to exceed 50% of your supplement AD&D coverage. Lastly, you can purchase AD&D coverage for your child or children in increments of $2,000 to a maximum of $40,000, not to exceed 50% of your supplemental AD&D coverage. You must be enrolled in supplemental AD&D insurance for yourself in order to purchase spousal/domestic partner and/or child AD&D insurance. 25

28 The Health System provides benefits for qualified short-term disabilities. The shortterm disability (STD) benefit is effective after 6 months of employment for benefit eligible employees scheduled to work 20 or more hours per week. If you qualify for short-term disability, the first seven consecutive calendar days of you absence are unpaid; however, you may use PTO or accrued vacation time, if available, during those days. The next 25 weeks of your approved STD leave are paid at 60% of your base salary. Eligible employees are automatically enrolled in the STD plan, and the cost of this coverage is fully paid by the Health System. If you do not meet the eligibility requirement for short-term disability coverage, you may be eligible for New York State Statutory Disability benefits. 26

29 Long-term disability (LTD) coverage enables you to continue to receive income when an extended disability prevents you from working. Employees who are scheduled to work 30 or more hours per week are eligible for LTD coverage; it is effective after 30 days of employment. The LTD benefit becomes payable after you have been totally disabled for 180 days and your short term disability is exhausted. Most LTD benefits will continue for as long as you are disabled, up to age 65. The benefit payable to you will be reduced by income you receive from other sources such as Worker s Compensation and Social Security disability benefits. 27

30 The Health System provides eligible employees with a core LTD benefit equal to 40% of base salary up to a monthly maximum of $1,500. You can purchase additional LTD coverage that will bring your coverage to 60% of your base salary up to a maximum of $10,000 per month. When considering whether to purchase additional LTD coverage, keep in mind these questions: Does the core LTD benefit offer you enough money to provide for the needs of you and your family in the event you become totally disabled? Would you be able to provide for those needs if your only source of income were from the core LTD and Social Security disability benefits? If the answers to these questions are no, purchasing the additional LTD coverage may make sense for you. If you opt to not purchase the additional LTD coverage when you are initially eligible to, that is, at time of new hire, you can purchase it in the future but you would need to provide Evidence of Insurability to the insurance carrier. 28

31 The Pension Plan is a company funded defined benefit plan that provides retirement income based on your pay and years of credited service. You will earn a year of credited service for each calendar year in which you work at least 1,000 hours. Per diem employees may work enough hours to participate in the Pension Plan. 29

32 Employees are automatically enrolled in the plan after completing one year of credited service and will be vested after five years of credited service. If you work five years of 1,000 hours or more, you are fully vested in the Pension Plan. Vesting means you are entitled to receive a benefit from the plan at retirement. Details of the Pension Plan can be found on the Human Resources portal page. 30

33 Through the 403(b) Plan, you have the opportunity to realize significant savings for your future. All employees are eligible to participate in the 403(b) Plan by making pre-tax payroll deductions into the plan. You will receive a welcome letter from MetLife, our 403(b) administrator, that will include a PIN number allowing you to access the MetLife website and phone system. As a new employee, you will be automatically enrolled in the 403(b) Plan, contributing 2% of your salary on a pre-tax basis to the Target Date fund that is closet to the year you are scheduled to retire based on a retirement date of 65. You may opt out of the plan within 60 days of your date of hire by contacting MetLife directly. Automatic deferrals will begin within 60 days of your hire date, but you can begin deferring earlier by contacting MetLife. 31

34 You can contribute a flat dollar amount or between 1% and 80% of your pay up to the IRS limit which is $18,000 in Employees who will be 50 or older during the calendar year can make additional catch up contributions up to the IRS limit of $6,000 for If you have made contributions to another employer s 403(b) or 401(k) during the calendar year, the amount that you have already contributed plus the amount you are going to contribute in our 403(b) plan cannot exceed the IRS limit. For example, if you are under age 50, worked for Company XYZ for several months at which time you contributed $10,000 pre-tax in 2015, you would only be eligible to contribute $8,000 pre-tax to the Rochester Regional Health 403(b) plan. You may make changes to your contributions or fund elections any time via MetLife s website or by contacting MetLife by phone. 32

35 We have two on-site MetLife representatives who are located in the Parnell building of Rochester General Hospital. They will travel to each of the offsite locations to meet with employees. These MetLife representatives can help you with enrolling in the 403(b) plan, selecting funds, establishing a time horizon, and retirement strategy. 33

36 BalanceWorks, our Employee Assistance Program (EAP), provides employees and their eligible family members with confidential assistance in resolving everyday work and family issues 24 hours a day, 7 days a week. The EAP program not only provides confidential consultations with licensed mental health professionals, but also offers: Personal assistance to conduct research, coordinate events, or plan tasks and projects Financial and legal consultations Child/elder care resources Online access to work/life tools, articles, videos and interactive courses Additional information about the EAP program can be found in the Benefits Decision Guide. 34

37 Under federal law, you can only enroll in benefits as a new hire or during the annual enrollment period each year unless you experience a qualifying event that affects the type of coverage you need. Your change in coverage must be consistent with your change in status. You have 30 days from the event to make these changes (60 days if the change is related to Child Health Plus, Family Health Plus or Medicaid). Some qualifying events include: Marriage, divorce, legal separation, annulment Registration or termination of domestic partnership Birth or adoption of a child Loss or gain of coverage due to your spouse s employment The full list of qualifying events can be found in the Benefits Decision Guide. The changes will need to be made in Workday, our Human Resources system. You can find Knowledge Builders on the Human Resources portal page. These Knowledge Builders will give you step-by-step instructions on how to make changes in Workday. 35

38 403(b) deductions will be withheld from all regular paychecks. The benefit deductions are taken twice a month, or 24 pay periods per year. This means that there will be 3 paychecks in 2015 that medical, dental, vision, life insurance, Accidental Death & Dismemberment, long-term disability, and FSA will not be withheld from your paycheck. 36

39 Next Steps you will need to log onto Workday and make your benefit elections within 30 days of your hire date. You can access Workday by clicking on the logo on the main Portal Page or by using the link that was sent to you by your recruiter. If you are not enrolling in the benefits, you will need to log into Workday and waive the benefits. If you are eligible for the Health System provided life and accidental death & dismemberment insurance, you will need to enter a beneficiary or beneficiaries for these benefits in Workday. Once you have made your benefit elections and entered your beneficiaries, submit your elections, and print a copy of the summary page for your records. You can find the Knowledge Builder for Enrolling in Benefits on the Human Resources portal page. This will give you step-by-step directions to enroll in benefits. Lastly, keep an eye out for the Welcome Letter from MetLife regarding the Automatic Enrollment in the 403(b) plan. All employees, full time, part time, per diem, and interns, will be automatically enrolled in the 403(b) plan. 37

40 If you have questions regarding the benefits or need help enrolling in your benefits, please contact the benefits department via at or by calling