2015 Benefit Highlights Mayo School of Graduate Medical Education Residents and Fellows, Mayo School of Health Sciences Residents and Fellows, Research Fellows, Sr. Fellows, Associates and Temporary Professionals Mayo Clinic in Arizona, Florida, and Rochester benefits TO BUILD ON
Table of Contents Who is Eligible to Enroll? 1 Medical Plan Options 2 Medical Plan Premiums 4 Medical Plan Prescription Drugs 5 Dental Plans 6 Dental Plan Premiums 7 Flexible Spending Accounts (FSA) 8 Financial and Retirement 8 Time Away from Work 9 Survivor s Benefits and Optional Insurance 9 Work-Life Balance 10 Health and Wellness 11 Employee Services 11 Working at Mayo Clinic is making a difference. It s providing the highest quality patient care by placing the needs of the patient first. At Mayo Clinic, you ll discover a culture of teamwork, professionalism and mutual respect and most importantly, a lifechanging career. We are excited to share with you in the following pages a highlight of the wide variety of benefits offered to Mayo Clinic Appointees. This is the first of many tools and resources that we offer to help you manage your health and finances so that you can focus on the needs of the patient.
Who is Eligible to Enroll? Make sure you and your loved ones are covered. Your benefits commence on your first day of employment with Mayo Clinic. As life is full of change, Mayo Clinic also has an annual Open Enrollment for medical, dental and other benefits that gives you a chance to review and update your benefit elections to keep in step with your needs. You also have options to change your benefits when an eligible life event occurs. You are a benefits-eligible employee if your Full Time Equivalent (FTE) is 0.5 or greater. That means that you are on file with Human Resources as having a work schedule that is 40 hours pay iod or more. A 0.4 FTE working extra hours does not qualify as benefits-eligible. For coverage, eligible members include: A spouse or same-sex domestic partner (in states where same-sex marriage has not been legalized*) Biological or legally adopted children, and stepchildren (including children of same-sex domestic partner in states where same-sex marriage has not been legalized*) who are under age 26 An eligible child over the age of 26 who is physically or mentally incapable of self-support may continue coverage according to plan guidelines. Contact the Employee Service Center (ESC) for more information. Health Savings Account IRS guidelines outline eligibility requirements for participating in a Health Savings Account (HSA). To participate in a HSA, you must be enrolled in the Mayo Basic Plan option. You cannot open a HSA if you are: Covered under a health plan by your spouse or same-sex domestic partner that is not a High-Deductible Health Plan (HDHP) A student at Mayo Clinic College of Medicine Claimed as a dependent on another son s federal tax return A resident of Alabama, California or New Jersey Mayo Basic Plan You cannot enroll in the Mayo Basic Plan if you are: Participating in a Health Care Flexible Spending Account. This applies to you and your spouse or same-sex domestic partner (in states where same-sex marriage has not been legalized*). Participating in the Mayo Reimbursement Account. This applies to you and your spouse or same-sex domestic partner (in states where same sex marriage has not been legalized*). * Additional pawork is required for same-sex domestic partners in states where same-sex marriage has not been legalized. Children of a same-sex domestic partner must be financially dependent on the employee. Supporting documentation will be requested by Human Resources. 2015 Benefit Highlights - Mayo Clinic Appointees 1
Medical Plans At Mayo Clinic, the needs of the patient come first and that includes you and your. That s why all Mayo Medical Plan options cover the same services. No need to compare your medical plan options based on services. Instead, look at the cost-sharing amounts the premiums, deductibles, copayments, and out-of-pocket maximums to determine what meets your preferences or needs. Cost-sharing Amounts Annual Deductible Annual Out-of-Pocket Maximum Mayo Premier Mayo Select Mayo Basic $300 son; $600 $2,000 son; $4,000 $450 son; $900 $3,000 son; $5,000 Out-of- Network $900 son; $1,800 $4,000 son; $6,000 $800 son; $1,600 $3,500 son; $7,000 $1,200 son; $2,400 $4,500 son; $8,000 Out-of- Network $1,600 son; $3,200 $5,500 son; $9,000 Employee: $1,700 E+Child(ren): $3,400 E+Spouse: $3,400 Family: $3,400 Employee: $5,000 E+Child(ren): $10,000 E+Spouse: $10,000 Family: $10,000 Employee: $1,900 E+Child(ren): $3,800 E+Spouse: $3,800 Family: $3,800 Employee: $6,000 E+Child(ren): $11,000 E+Spouse: $11,000 Family: $11,000 Out-of-Network Employee: $2,100 E+Child(ren): $4,200 E+Spouse: $4,200 Family: $4,200 Employee: $7,000 E+Child(ren): $12,000 E+Spouse: $12,000 Family: $12,000 Physician Visits a. Primary care b. Express care c. Urgent care d. Specialty care Preventive Care Services See Preventive Care Services chart Mayo Premier Mayo Select Mayo Basic b. $0 c. $0 b. $0 c. $0 Out-of- Network b. $0 c. $0 b. $0 c. $0 Out-of- Network $0 $0 NC $0 $0 NC $0 $0 NC Out-of- Network Diagnostic Tests and Labs 20% 20% 40% 20% 20% 40% 20% 20% 40% Maternity Care Services a. Prenatal and postnatal visits b. Delivery, inpatient services Emergency Services a. Emergency transportation to nearest qualified facility (includes air ambulance when authorized) b. Emergency room facility/ professional (physicians, nurses, etc.) b. $75 b. $75 b. $75 b. $75 b. $75 b. $75 * * * *After deductible is met. 2015 Benefit Highlights - Mayo Clinic Appointees 2 NC = Not covered
Inpatient Hospital Services Prior authorization required by the Plan for services. Outpatient Hospital & Ambulatory Services Mayo Premier Mayo Select Mayo Basic Out-of- Network Out-of- Network 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% 20% 20% 40% Out-of- Network Rehabilitative Therapy, Chiropractic Care and Acupuncture Services a. Physical therapy (PT), Occupational therapy, Speech therapy b. Chiropractic care Limit of 20 spinal manipulations year ; 20-visit limit for PT ; 20-visit limit for PT ; 20-visit limit for PT c. Acupuncture Limit of 20 visits year c. NC c. NC c. NC c. NC c. NC c. NC Continued Care a. Home health care (90-day limit year) b. Home infusion therapy c. Hospice care (inpatient) d. Hospice care (outpatient) e. Skilled nursing care facility (30-day limit year) e. 40% e. 40% e. 40% Note: Custodial care not covered. Infertility Services Office visits and outpatient or hospital procedures 50% for eligible services 50% for eligible services NC 50% for eligible services 50% for eligible services NC 50% for eligible services 50% for eligible services NC Up to $15,000 lifetime maximum Mental Health and Chemical Dependency Services a. Specialty care visit b. Inpatient c. Outpatient d. Non-Residential Structured Treatment Program e. Residential Structured Treatment Program e. 40% e. 40% e. 40% Special Services a. Chemotherapy/radiation therapy b. Disposable supplies c. Durable, non-durable medical equipment d. Orthotics and prosthetics e. Tobacco cessation e. $0 e. $0 e. NC e. $0 e. $0 e. NC e. $0 e. $0 e. NC f. Tobacco Treatment Program f. $0 f. $0 f. NC f. $0 f. $0 f. NC f. $0 f. $0 f. NC NC = Not covered 2015 Benefit Highlights - Mayo Clinic Appointees 3
What you ll pay for Medical Plan Premiums in 2015 Mayo reviews the costs of Mayo Medical Plan options annually, adjusting premiums and/or cost-sharing amounts when necessary. Medical premiums are outlined in the table below with both pre-tax monthly and -pay-iod amounts. If you choose benefit coverage, the appropriate pre-tax premium rate will be deducted from your paycheck. Full-Time Employee Premiums (0.75-1.0 FTE) Mayo Premier Mayo Select Mayo Basic Monthly Per Pay Period Monthly Per Pay Period Monthly Per Pay Period Employee $86 $43 $48 $24 $12 $6 Employee + Child(ren)* $171 $85.50 $95 $47.50 $23 $11.50 Employee + Spouse* $154 $77 $86 $43 $21 $10.50 Family* $257 $128.50 $143 $71.50 $35 $17.50 Part-Time Employee Premiums (0.50-0.74 FTE) Employee $129 $64.50 $72 $36 $18 $9 Employee + Child(ren)* $257 $128.50 $143 $71.50 $35 $17.50 Employee + Spouse* $231 $115.50 $129 $64.50 $32 $16 Family* $386 $193 $215 $107.50 $53 $26.50 Spousal Surcharge: A $50 pre-tax monthly surcharge will be added to the medical plan for employees covering a spouse or same-sex domestic partner* who is offered medical coverage through his/her employer, does not elect that coverage, and is instead covered under the Mayo Medical Plan. Note: The premium is taken out of the first two pay iods month, so the amount shown pay iod is taken out of your paycheck 24 times year. *Same-sex domestic partners and their children are also eligible for coverage in states where same-sex marriage has not been legalized. 2015 Benefit Highlights - Mayo Clinic Appointees 4
Mayo Medical Plan Comparisons of Prescription Drug Coverage Mayo Select/Mayo Premier * Mayo Basic * Prescription Drug Coverage Mayo Mail Service (up to 100-day supply) Mayo Outpatient Pharmacy (up to 100-day supply except where indicated) Catamaran Pharmacy (up to 34-day supply) Mayo Mail Service (up to 100-day supply) Mayo Outpatient Pharmacy (up to 100-day supply) Catamaran Pharmacy (up to 34-day supply) Formulary generic and preferred drug (Tier I) $10 maximum $10 maximum up to 34-day supply $10 maximum 5% 10% 25% Formulary Brand or injectable drug (Tier II) 25% ($10 minimum) 30% ($10 minimum) 40% ($15 minimum) 25% 30% 40% Formulary non-preferred drug (Tier III) 40% ($10 minimum) 40% ($10 minimum) 50% ($15 minimum) 40% 40% 50% Non-formulary drug (Tier IV)** 50% ($10 minimum) 50% ($10 minimum) 60% ($15 minimum) 50% 50% 60% Deductible None Combined with medical deductible Annual out-of-pocket maximum Combined with medical out-of-pocket maximum * Specialty prescriptions are covered under the Mayo Medical Plan when purchased at the Mayo Specialty Pharmacy as well as any participating Mayo Clinic or Mayo Clinic Health System outpatient pharmacy. ** Non-formulary (Tier IV) prescriptions do not apply to the Mayo Premier or Mayo Select plans out-of-pocket maximums. 2015 Benefit Highlights - Mayo Clinic Appointees 5
Dental Plans Healthy teeth are a part of wellness. Mayo Clinic provides two dental options for all benefits-eligible employees to choose from. Delta Dental Delta Dental is an option that is a cost-sharing plan with a participating provider network. This plan provides flexibility, network savings and preventive services. Mayo Reimbursement Account (MRA) The MRA is an annual $1,150 employer contribution (prorated based on start date) that can be used toward dental and vision expenses. You have the choice of any provider. Delta Dental Mayo Reimbursement Account* Deductible $50 son / $150 N/A Annual Maximum (paid by plan) $1,000 son calendar year $1,150 calendar year Preventive (exams/cleaning) $0 $0** Basic Services 20% $0** Major Restorative Services (crowns/inlays) 50% $0** Lifetime Orthodontic Maximum (paid by plan) $1,500 individual lifetime $1,500 individual lifetime Vision Expenses N/A $0** *Not available if enrolled in Mayo Basic medical plan. **Results in $0 employee responsibility when services are reimbursed with MRA dollars. Month of Enrollment MRA Proration Amount Month of Enrollment MRA Proration Amount Month of Enrollment MRA Proration Amount January $1,150.00 May $766.66 September $383.33 February $1,054.17 June $670.83 October $287.50 March $958.33 July $574.99 November $191.67 April $862.50 August $479.16 December $95.83 2015 Benefit Highlights - Mayo Clinic Appointees 6
Dental Plan Premiums for 2015 Dental premiums are outlined in the table below with both pre-tax monthly and -pay-iod amounts. If you choose benefit coverage, the appropriate pre-tax premium rate will be automatically deducted from your paycheck. Delta Dental Mayo Reimbursement Account (MRA) Full-Time Employee Premiums (0.75-1.0 FTE) Monthly Per Pay Period Monthly Per Pay Period Employee $9 $4.50 $4 $2 Employee + Child(ren)* $18 $9 $4 $2 Employee + Spouse* $27 $13.50 $4 $2 Family* $35 $17.50 $4 $2 Part-Time Employee Premiums (0.50-0.74 FTE) Employee $9 $4.50 $4 $2 Employee + Child(ren)* $27 $13.50 $4 $2 Employee + Spouse* $36 $18 $4 $2 Family* $48 $24 $4 $2 *Same-sex domestic partners and their children are also eligible for coverage in states where same-sex marriage has not been legalized. Note: The premium is taken out of the first two pay iods month, so the amount shown pay iod is taken out of your paycheck 24 times year. 2015 Benefit Highlights - Mayo Clinic Appointees 7
Flexible Spending Accounts (FSA) Flexible Spending Accounts (FSA) are a benefit that can help you stretch your dollars. With an FSA, you can set aside pre-tax dollars through payroll to help pay for eligible expenses incurred by you or your. It is called a voluntary benefit because you choose to establish and fund it yourself. Health Care FSA* The Health Care FSA mits a reserve of pre-tax income (up to $2,500 maximum annual contribution employee) to pay for eligible medical and/or dental expenses incurred but not covered by other plans. Staff with a Health Care FSA will be allowed to roll-over $500 year. *Health Care FSA benefit is not available to participants in Mayo Basic. Dependent Care FSA The Dependent Care FSA mits a reserve of pre-tax income (up to $5,000 maximum annual contribution household) to pay for eligible child or other dependent care expenses. Financial and Retirement Mayo Clinic administers a competitive, predictable and market-leading salary program with regular increases, given satisfactory formance. Mayo Clinic also provides a comprehensive and competitive retirement package that will assist you in achieving your sonal financial security for your retirement. Pension Plan (Research Associates only) Mayo Clinic is among the few U.S. companies who continue to provide a pension benefit at no cost to their employees. The Mayo Clinic Pension is a defined benefit plan where contributions are made by your employer. Your final benefit payout can be predicted because it is determined by a formula rather than by investment results. 403(b) and 401(k) Retirement plans The optional 403(b) or 401(k) plan allows contributions of pre-tax or post-tax Roth dollars to an investment plan administered by Fidelity Investments. There are many investment options to choose from, including a self-directed brokerage account. You may generally defer up to 50% of annual salary or the annual IRS limit, whichever is less. The IRS limit for 2015 is $18,000 or $24,000 if you are 50 years of age or older. Enrollment is automatic at a 4% contribution rate of salary. Mayo Clinic will match 403(b)/401(k) contributions (Research Associates only) based on length of pension benefit service. Financial Engines As an added benefit, asset management services are available through Financial Engines, LLC. The first $5,000 is managed at no charge; otherwise a fee of $3.00 $1,000 invested is charged up to $100,000. You may opt out of this service at any time. 2015 Benefit Highlights - Mayo Clinic Appointees 8
Time Away From Work Benefit Contribution by Description of Benefit ARIZONA FLORIDA ROCHESTER Short-Term Disability Long-Term Disability Mayo $0.38 $100 of monthly benefit Short-term disability covers the first three months of disability with full stipend/salary if stipend is paid by Mayo Clinic. If you are enrolled in the term life and disability insurance program, long-term disability benefits will commence after the first three months of total disability. Benefit allowable is 180% of stipend/salary subject to a maximum benefit of $55,000 year. If disabled term life, dental, hospitalization, major medical insurance coverage may be continued through arrangements with the Department of Human Resources. Survivor s Benefits and Optional Insurance Mayo Clinic offers employee paid optional insurance to care for yourself and loved ones and provide financial security should the unexpected occur. Employee Paid Optional Insurance Benefit Employee Cost Description of Benefit ARIZONA FLORIDA ROCHESTER Term Life Insurance Additional Plan Term Life Insurance Professional Liability Insurance Voluntary Accidental Death & Dismemberment (AD&D) Insurance Excess Personal Liability Long-Term Care Insurance Auto/Home/ Renter s Insurance $2.18 month/ single coverage $3.09 month/ married coverage $2.18 month $4.37 month $6.55 month No cost $0.15 $10,000 coverage/month $22 or $32 month Rates based on age at date of issue Varies Appointee: $50,000 death benefit Family: $25,000 death benefit on spouse $10,000 death benefit for each child Must be enrolled in the basic plan to be eligible Additional $50,000 death benefit on appointee Additional $100,000 death benefit on appointee Additional $150,000 death benefit on appointee Coverage for event regardless of when claim is made. You can purchase additional Voluntary AD&D coverage at a rate of $0.15 $10,000 of coverage. Coverage is available in $10,000 or $25,000 increments, up to a maximum of $225,000. Hirman Insurors provides protection of $3 million or $5 million in umbrella insurance coverage, beyond requisite sonal homeowner/renter and automobile insurance limits. Voluntary Group Long-Term Care Insurance through CNA Insurance Company is available to you as a benefits-eligible Mayo Clinic employee. It also is available to your spouse or same-sex domestic partner (in states where same-sex marriage has not been legalized), parents, grandparents and in-laws. Policies are underwritten by the Travelers Insurance Company with Hirman Insurors (FL - Auto Only). Premiums for this coverage are deducted from your payroll deposit. Identity Theft Insurance $69 year Identify Theft Insurance covers expenses that could be incurred in your efforts to restore your financial health and credit history after an identity theft. There is a $500 deductible, with coverage of up to $25,000 for reimbursement of expenses, and up to $100,000 for fraudulent charges (over and above insurance coverage provided by policyholder s financial institution). 2015 Benefit Highlights - Mayo Clinic Appointees 9
Work-Life Balance Whether searching for activities, finding child care for a sick child, or finding the right caregiver for an older member, resources are available to help. Benefit Contribution By Description of Benefit Leisure and Lifestyle Activities Program Sick Child Care Mayo Mayo and Employee ARIZONA FLORIDA ROCHESTER Free and discounted events and services, including special attractions, events, group banking, and services discounts (child-care facilities, hotels, etc.) Please contact local HR for more info. Bright Horizons is the service provider in Florida. You may use up to 80 hours of care annually. Sick child care is provided in the staff member s home at $8 hour. Children s R&R is a free, on site sick child care center staffed by nurses. Backup Child Care Mayo and Employee Please contact local HR for more info. Bright Horizons is the service provider in Florida. You may use up to 80 hours of care annually at the rates of $8 hour for in-home care and $6 hour for center-based care. There is no age limitation. Bright Horizons is the service provider in Rochester. The number of backup child care days is 20 child, year at the rates of $15/ day for one child and $20/day for two or more. Children ages 6 weeks to 12 years are eligible. Child and Elder Care Referral Mayo and Employee Please contact local HR for more info. Child and adult/elder care options are available and service is provided by Bright Horizons. Child and adult/elder care options are available and service is provided by LifeCycleConnect. 2015 Benefit Highlights - Mayo Clinic Appointees 10
Health and Wellness Mayo Clinic encourages healthy living at all three campuses. Benefit Contribution By Description of Benefit ARIZONA FLORIDA ROCHESTER Fitness Facilities Employee Mayo Clinic has partnered with dozens of local fitness clubs to offer discounts on enrollment fees and monthly membership dues. Mayo Clinic has partnered with dozens of local fitness clubs to offer discounts on enrollment fees and monthly membership dues. The Dan Abraham Healthy Living Center (DAHLC) is Mayo Clinic s onsite facility for wellness practice, education, and research. The facility provides an enjoyable, accessible environment for individuals and groups to learn and practice healthy living through quality facilities and effective programs and services. The facility offers incentive-based membership fees. Employee Services Benefit Contribution By Description of Benefit ARIZONA FLORIDA ROCHESTER Adoption Assistance Employee Assistance Program (EAP) Mayo Mayo Mayo Clinic offers an Adoption Assistance Plan that provides financial assistance to help meet the cost of adoption by reimbursing you up to $10,000 adoption. Mayo Clinic also offers you up to $500 for the adoption of a stepchild. Employees and their members have access to employer paid, confidential services for individual,, marital, stress and job-related concerns; chemical dependency assessment. 24-hour crisis line (AZ and FL). Parking and Commuting Mayo & Employee Mayo Clinic offers a van pool program for only $35 month. Valley Metro bus passes are available for $10 month. Mayo Clinic offers a car pool program with preferential parking. Mayo Clinic also provides free car starting services for your sonal safety and security. Mayo Clinic provides subsidized bus passes and alternative parking options. Mayo also provides free car-starting and door-unlocking service year-round for your sonal safety and security. 2015 Benefit Highlights - Mayo Clinic Appointees 11
Notes 2015 Benefit Highlights - Mayo Clinic Appointees 12
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This is a high-level summary of certain Mayo Clinic benefits. The summary may or may not be applicable to union employees. It is intended for general information purposes only and should not be considered legal, investment or other benefits advice. This guide is not a legal Summary Plan Description or plan document. If there is a conflict with this information and an official plan document, the official plan document is controlling. Mayo Clinic reserves the right to terminate or amend the Plans at any time, in whole or in part, for any reason. Any such amendment or termination may apply to current and future participants, current and future retirees, covered spouses, beneficiaries and dependents. MC1090-109rev0115