Benefits Employee
Guide 2016
Benefits Your Employee
Guide 2016
Huntington Hospital
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Table of Contents Introduction.............................................................................................................................................................. 1 Enrollment................................................................................................................................................................ 2 Eligibility.................................................................................................................................................................. 3 Medical Plans........................................................................................................................................................... 6 Prescription Drugs Plan............................................................................................................................................ 9 Dental Plans........................................................................................................................................................... 11 Vision Plan............................................................................................................................................................. 13 2016 Benefit Premium Rates................................................................................................................................... 14 Life Insurance Plan................................................................................................................................................. 16 Accidental Death & Dismemberment (AD&D) Plan................................................................................................ 17 Long Term Disability (LTD) Plans........................................................................................................................... 19 Flexible Spending Accounts (FSA)........................................................................................................................... 20 Huntington Memorial Hospital Retirement Savings Plan, 403(b)............................................................................. 23 Voluntary Benefits.................................................................................................................................................. 24 Paid Time Off and Sick Leave................................................................................................................................. 25 Employee Resources............................................................................................................................................... 27 Glossary................................................................................................................................................................. 29 Important Notices................................................................................................................................................... 30 Contact Information................................................................................................................................................ 38
If you and/or your dependents have Medicare or you will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see page 34 for more details.
This brochure highlights the core benefits of Huntington Hospital’s Employee Benefit Program. It is designed to assist you in selecting benefits for you and your family. This booklet does not include plan details or specific rules, which are provided in the legal documents such as: Summary Plan Descriptions (SPD), and Evidence of Coverage (EOC), and plan contracts. If there are any inconsistencies between this brochure and the legal plan documents, the plan documents will prevail. Huntington Hospital reserves the right to change, discontinue or increase contributions for benefits at any time.
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Introduction Your 2016 Employee Benefits Huntington Hospital offers a broad range of options through the benefit program. Employees can choose from a number of options, including medical, dental, vision, life, accidental death & dismemberment insurance, long term disability, and dependent life insurance. In addition, we provide health care and dependent care reimbursement accounts to assist employees in managing their out-of-pocket expenses with before-tax dollars. The Huntington Memorial Hospital Retirement Savings Plan, 403(b) allows you to voluntarily save with beforetax dollars for your retirement. Your benefit depends on your contributions, hospital matching and nonmatching contributions, and any growth in the value of your account. This allows you to shelter part of your income from taxes today, while building significant savings for a more financially secure future.
Huntington Hospital also offers a number of Work-Life benefits, including wellness and disease management programs, an employee assistance program, tuition reimbursement, convenient concierge services, and much more. If you are a newly eligible employee enrolling for the first time or are re-enrolling during Open Enrollment, this guide will provide you with the information you need to complete the process.
IMPORTANT If this is your first enrollment opportunity, you must enroll by the Enrollment Deadline indicated in your benefits packet. If you do not, you will be enrolled in the Default Plan, which provides for minimal benefit coverage (Page 2). You will not be able to change your coverage until the next open enrollment period, unless you have a Qualifying Life Event.
Fidelity Customer Service 800.343.0860 https://nb.fidelity.com/public/nb/hmh/home
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Huntington Hospital
Enrollment How to Enroll 1. Review your Plan Comparison or Benefits Guide online for information on each of the offered benefits, eligibility requirements and coverage levels. 2. Enroll on-line at www.hhbenefits.com. • From your preferred browser, enter www. hhbenefits.com into the web address line. This will take you to Huntington Hospital’s benefits web site.
• You are scheduled to work at least 20 hours per week. Note: Benefits will terminate at midnight for you and your eligible dependents on date of termination or loss of benefit status. Refer to page 31 for COBRA Continuation Rights. COBRA is administered by Keenan HealthCare. Once you select the plan in which you wish to enroll, you then determine the coverage level from among the following categories:
• Click on “Enroll Now” button and click on “2016”.
• Employee only
• Enter your six digit employee number and then the last four digits of your Social Security number.
• Employee + Child(ren)
• Once you are finished with your selections, ”print a copy” of the Confirmation Statement (you will also receive a copy of the Confirmation Statement in the mail). Click on ”Finish” to complete your enrollment. Enrollment will not be processed if you do not click on “Finish.”
• Employee + Domestic Partner and Child(ren)
• Log out of the site. If you have any questions or need assistance with enrolling on-line, contact the Benefits Department at 626.397.3626.
• Employee + Spouse • Employee + Spouse and Child(ren) • Employee + Domestic Partner
Default Plan If you do not enroll or do not waive your coverage options when you are first eligible for benefits, you will be enrolled in the Default Plan. Once enrolled in this plan, you will not be able to make any changes to the Default Plan unless you experience a qualifying life event or until the next Open Enrollment period.
Eligibility requirements vary for different benefit plans. The following information applies to your health, life and disability benefit plans. Eligibility guidelines for other benefits can be found in the applicable section of this guide.
Medical
Huntington Choice $250 Deductible Plan (employee only coverage)
Eligible Employee
Dental
No coverage
Vision
No coverage 1 x annual salary, minimum $20,000, up to $50,000 1x annual salary, minimum $20,000, up to $50,000 40% of base salary
You are eligible to participate in the benefit plans on the first of the month after date of hire or status change if: • Your position status is a full-time or part-time benefit eligible position; and
Huntington Hospital
Default Plan
Life Insurance AD&D LTD Flex Credits
Not eligible
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Eligibility Dependent Coverage
Children
Employees who are eligible for health coverage may also cover eligible dependents. You must enroll yourself and your eligible dependents within the designated period in order for your dependents to be covered. Eligible dependents are defined as:
Children under age 26 are eligible for coverage if they meet one of the following criteria: • Your dependent children including: –– Biological children,
• Your legal spouse
–– Legally adopted children,
• Your legal married partner
–– Children placed in your home for adoption,
• Domestic partner (for eligibility, see below).
–– Children for whom you are appointed as Legal Guardian,
• Your child(ren) or your domestic partner’s child(ren), up to age 26 (upon attainment of age 26, children are no longer eligible). • Stepchild(ren), legally adopted child(ren) or in the process of being legally adopted, and any child for whom you are the Legal Guardian with a Court Order. Proof of Relationship You are required to submit proof of your relationship to the dependents that you elect to cover under any of the Health Insurance plans. The following documents are accepted (according to the relationship): • Marriage Certificate • Copy of Page 1 of your most recent filed Federal Tax Return listing spouse, domestic partner and/ or dependents • Birth Certificate (must list names of parents) –– Birth Certificates will be required for all child(ren) who are not listed on your Federal or State Tax Return • Legal Adoption Documentation (final adoption documents or confirmation of placement for adoption purposes)
–– Children who must be covered under the plan due to a Qualified Medical Child Support Order, –– Stepchildren who are primarily supported by you, and –– A child who reaches age 26 if he/she is mentally or physically disabled and incapable of self-support, provided that the disabled child was covered with benefits prior to becoming age 26. Supporting documentation from a physician will be required. Domestic Partner • Definition of a Domestic Partner –– At least 18 years of age, –– Share a common residence for at least one year, –– Are jointly responsible for each other’s basic living expenses, –– Are both capable of consenting to the domestic partnership,
• Legal Guardianship Documentation
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Eligibility (continued) Dependent Coverage (continued)
–– A child who reaches age 26 if he/she is mentally or physically disabled and fully dependant on you or your domestic partner for financial support and care, provided that the disabled child was covered with benefits prior to becoming age 26. Supporting documentation from a physician will be required.
–– Are same sex or opposite sex domestic partners –– Are not married or a member of another domestic partnership, and –– Are not related by blood in a way that would prevent you from being married in the State of California. • Proof of Relationship –– You must submit a signed Domestic Partner Affidavit to the Benefits Department, stating the Domestic Partner’s name and Social Security Number, and –– A copy of the Certificate of Domestic Partner Registry, if applicable. –– A copy of Page 1 of your most recently filed Federal or State Income Tax Return if applicable, or –– Proof of documentation. For example, a mortgage or lease agreement, utility bill or credit card statement that shows proof that you share a common residence and are financially interdependent and have been for at least 12 months. • Children of a Domestic Partner Children of a domestic partner are eligible for coverage if they meet all of the following requirements and the domestic partner is enrolled for coverage.
• Cost of Domestic Partner Coverage If you enroll your domestic partner in Huntington Hospital benefits, you will pay the same employee contribution amount for health benefits as you would for a spouse.
However, because of federal tax law, coverage for your domestic partner and his or her children, if applicable, generally will be deducted from your paycheck on an “after-tax” basis, and the value of Hospital provided coverage will result in “Imputed Income” to you. Imputed Income is additional income which is added to your wages and on which you will pay federal taxes. The amount will be reflected on your paycheck. In effect, imputed income will be added to your taxable income that is used by the IRS to determine your federal income tax liability.
If you and your partner are California registered domestic partners, the value of the coverage will not be imputed into your income for California income tax purposes. When enrolling your domestic partner, it is important that you let us know if you are registered domestic partners.
–– Child(ren) under age 26 who depend on you or your domestic partner for financial support and are not eligible for coverage under another employer health plan, or
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Eligibility (continued) Qualifying Life Events The elections that you make during Open Enrollment or at initial benefits eligibility will remain in effect for the entire calendar year. During that time, if your life or family status changes according to the recognized events listed here, you are permitted to revise your benefit coverage to accommodate your new situation. You can make benefit changes by contacting the Benefits Department and providing the appropriate documentation within 31 days of the event. IRS regulations govern under what circumstances you may make changes to your benefits, which benefits you can change and what kinds of changes are permitted.
Marital / Domestic Partnership Status Changes Qualifying Events • Marriage/registration of domestic partnership • Death of spouse/domestic partner • Divorce/termination of domestic partnership • Spouse/domestic partner/adult child up to age 26 gains or loses coverage from another source • Spouse/domestic partner’s employer’s Open Enrollment
Covered Dependents Changes Qualifying Events • Birth or adoption of a child • Death of dependent child • Dependent becomes ineligible for coverage
• All changes must be consistent with the qualified life event. • In most cases, you cannot change your benefit plans, but may modify the level of your coverage. In other words, you can add or delete dependents, enroll or dis-enroll yourself or dependents, but not switch carrier or plan. • Any changes in benefit levels must be completed within 31 days of the qualifying life event.
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Medical Plans
Medical benefits provide you and your eligible dependents access to quality health care and protection against the cost of illness or injury. Huntington Hospital offers exceptional medical plans and various coverage levels from which to choose. The medical programs we offer give you full access to medical care from any physician or hospital within the Anthem Blue Cross Prudent Buyer Network. Anthem Blue Cross Prudent Buyer utilizes an extensive network of hospitals and physicians, but the ultimate choice is yours. You don’t need to select a primary care physician and you don’t need to obtain a referral to see a specialist. Additionally, you can maximize your benefits by using Huntington Hospital or its designated ancillary service providers. Prescription coverage is included.
Waive Medical Coverage If you already have medical coverage from another source, you may choose to waive medical coverage. You can elect this option online when completing your benefits enrollment. You must provide proof of other medical coverage. If you waive your medical coverage you will receive before-tax flex credits to purchase other benefits, or receive taxable cash back. Your next opportunity to enroll in a medical plan will be during the next Open Enrollment period, unless you have a qualifying life event. The Keenan Employee Benefits Third Party Administrator (TPA) is the medical claims administrator and can be reached at the number below. Keenan Customer Service 888.884.8083 www.keenan.com/benefits/hh
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Medical Plans (continued) Huntington Choice – $250 Plan Benefits
Huntington Hospital
In-Network Anthem Blue Cross
• Individual
None
$250
• Family (first 3 members)
None
$750
• Individual
None
$2,000
• Family (first 3 members)
None
$6,000
$20 copay
$20 copay
Urgent Care
Not Available
$20 copay
Specialist Office Visit
Not Available
$40 copay
Chiropractic
Not Available
Acupuncture
Not Available
Annual Deductible
Annual Out-of-Pocket Limit
Physician Office Visit • Applicable facility charges are the member’s responsibility *
$40 copay (maximum 24 visits annually) $40 copay (maximum 12 visits annually)
Annual Wellness Exam and Screening (as appropriate to age)
Covered at 100%
Well Child Care (as appropriate to age)
Not Available
$20 copay
Inpatient Hospital
Covered at 100%
$250 per admission, then covered at 80%*
Outpatient Hospital
Covered at 100%
Covered at 80%*
Home Health
Not Available
Covered at 80%*
Hospice Care
Not Available
Covered at 80%*
Lab and X-Ray
Covered at 100%
Covered at 80%*
Not Available
Covered at 80%*
Durable Medical Equipment Emergency Room Ambulance
Up to a maximum $500
$100 copay – waived if admitted Not Available
Covered at 100%
Covered at 100%
$20 copay
Covered at 100%; 30 visits maximum/calendar year
$20 copay plus 20%; 30 visits maximum/calendar year*
$500 copay
Not covered
Hearing Aids
Not Available
$2,000 allowance every 2 years *
Foot Orthotics
Not Available
Up to $1,000 Lifetime *
Mental Health Outpatient Physical /Occupational Therapy Bariatric/Lap-Band Surgery
* Subject to deductible and coinsurance Note: A covered member will receive maximum cost savings when receiving services at Huntington Hospital or Huntington Ambulatory Surgical Center. This is a brief summary of the benefits available under the Huntington Hospital medical plans. In the event of a discrepancy between this summary and the Plan Document, the Plan Document will prevail. Huntington Hospital retains the right to modify or eliminate these or any other benefits at any time and for any reason. Prescription and other copays do not apply to out-of-pocket maximums. Wellness includes all appropriate screenings requested by your Physician. 80% paid by plan/20% participant responsibility, after deductible has been met.
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Medical Plans (continued) Huntington Choice – $500 Plan Benefits
Huntington Hospital
In-Network Anthem Blue Cross
• Individual
None
$500
• Family (first 3 members)
None
$1,500
None
$3,000
None
$9,000
Annual Deductible
Annual Out-of-Pocket Limit • Individual • Family (first 3 members) Physician Office Visit • Applicable facility charges are the member’s responsibility * Urgent Care
$25 copay
$25 copay
Not Available
$25 copay
Specialist Office Visit
Not Available
$45 copay
Chiropractic
Not Available
Acupuncture
Not Available
$45 copay (maximum 24 visits annually) $45 copay (maximum 12 visits annually)
Annual Wellness Exam and Screening (as appropriate to age)
Covered at 100%
Up to a maximum $500
Well Child Care (as appropriate to age)
Not Available
$25 copay
Inpatient Hospital
Covered at 100%
$250 per admission, then Covered at 60%*
Outpatient Hospital
Covered at 100%
Covered at 60%*
Home Health
Not Available
Covered at 60%*
Hospice Care
Not Available
Covered at 60%*
Lab and X-Ray
Covered at 100%
Covered at 60%*
Not Available
Covered at 60%*
Durable Medical Equipment Emergency Room Ambulance
$100 copay – waived if admitted Not Available
Covered at 100%
Covered at 100%
$25 copay
Covered at 100%; 30 visits maximum/calendar year
$25 copay plus 40%; 30 visits maximum/calendar year*
$500 copay
Not covered
Hearing Aids
Not Available
$2,000 allowance every 2 years *
Foot Orthotics
Not Available
Up to $1,000 Lifetime *
Mental Health Outpatient Physical /Occupational Therapy Bariatric/Lap-Band Surgery
* Subject to deductible and coinsurance Note: A covered member will receive maximum cost savings when receiving services at Huntington Hospital or Huntington Ambulatory Surgical Center. This is a brief summary of the benefits available under the Huntington Hospital medical plans. In the event of a discrepancy between this summary and the Plan Document, the Plan Document will prevail. Huntington Hospital retains the right to modify or eliminate these or any other benefits at any time and for any reason. Prescription and other copays do not apply to out-of-pocket maximums. Wellness includes all appropriate screenings requested by your Physician. 60% paid by plan/40% participant responsibility, after deductible has been met.
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Prescription Drugs Plan Prescription drugs and some vaccinations are available to you if you are enrolled in either medical plan. This program uses the Express Scripts Network. Express Scripts Plan Benefits
Retail (30-day Supply)
Mail Order (90-day Supply)
Generic
$5
$5
Brand Formulary
$40
$88
Non-Formulary
$75
$175
Certain compound medications will no longer be covered by your prescription benefit. If you are prescribed one of these drugs and it is not covered, consult with your physician about a new prescription for an FDA-approved drug. For any questions regarding a drug’s availability, contact Express Scripts Customer Service.
Filling Your Prescription You can have your prescription filled through Express Scripts Home Delivery mail service or at a participating retail pharmacy. The pharmacy service is most convenient when filling your short-term or immediate prescriptions. If you need medication on an on-going basis, your doctor can prescribe up to a 90-day supply for home delivery. Home delivery will save you both time and money. The Express Scripts Prescription Drug benefit includes two programs, Select Home Delivery and Step Therapy. These programs make prescription drugs more affordable for you and helps the organization control the rising cost of medications.
educates, and encourages patients to convert select maintenance medications to the Express Scripts Home Delivery Pharmacy. By using Home Delivery, patients save time and money by eliminating the need to go to a participating retail pharmacy for their monthly maintenance medications. How it Works • You must notify Express Scripts every 12 months from the date you first fill your maintenance medication prescription of your choice of home delivery or retail pharmacy. • You may opt out for one maintenance prescription, all maintenance prescriptions, or pick and choose. If you opt out, your choice is valid for one year from the time you fill your prescription. At the end of the year, you will be sent a communication requesting your choice once again. • The plan will allow two retail fills of your maintenance medication. • If Express Scripts has not heard your decision by your third fill, you will be charged full price for your medicine until you contact Express Scripts with your decision. Express Scripts Member Choice Center can be reached at 888.772.5188. • You may select to change your preferred option at any time by mail, e-mail or fax. Certain specialty medications are provided by Accredo. These medications are limited to a 30-day supply. None of these prescriptions are impacted by the Select Home Delivery program.
Select Home Delivery is a program that targets,
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Express Scripts Customer Service
Accredo / Specialty Drugs Customer Service
866.778.3785
800.803.2523
Huntington Hospital
Prescription Drugs Plan (continued) Step Therapy is a program designed especially for people who take prescription drugs regularly to treat ongoing medical conditions, such as arthritis and high blood pressure. The program is a new approach to getting you the prescription drugs you need, with safety, cost and – most importantly – your health in mind. How it Works In Step Therapy, drugs are grouped in categories, based on cost: Step 1 – Front-line drugs: These are generic drugs proven safe, effective, and affordable. These medicines should be tried first because they can provide the same health benefit as more expensive medications, at a lower cost. Step 2 and 3 – Back-up drugs: Step 2 and Step 3 medications are brand-name medications, such as those you see advertised on tv. There are lower-cost brand medications (Step 2) and higher-cost brand medications (Step 3). Back-up medications always cost more than front-line medications.
Huntington Hospital
• If your patient history shows use of the first or second line drug within the last 130 days, the claim will process for Step 3 medications at a higher co-pay. • When the pharmacy receives your prescription for an eligible medication, a pharmacy representative will contact you and your doctor to request a new prescription for a front-line drug. • Your doctor writes you a new prescription for a front-line drug covered by your plan’s Step Therapy program. • If your doctor decides your current drug is medically necessary, he or she can ask for an override. • You may want to let your doctor know that your prescription plan uses Step Therapy and that your pharmacist may require additional information.
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Dental Plans There are three dental plans from which you can choose – Delta Preferred Plus, Delta Preferred or DeltaCare USA. All plans offer a benefit towards basic preventive services for cleaning and office visits. Additional benefits are provided based on the plan you choose.
Delta Preferred Plus/ Delta Preferred Option (DPO) With these plans, you have the freedom to visit any licensed dentist, anywhere in the U.S. For maximum benefits you can choose one of the more than 10,000 in-network dental offices throughout California. You can also visit one of the nearly 148,000 Delta Premier dentist offices, which offer affordable rates. To use the plan, simply make an appointment with your selected dentist. During your first appointment, provide your dentist with Group Number 4844-0001 for the Delta Preferred Plan or 4844-0015 for the Delta Preferred Plus Plan and your Social Security Number and date of birth. No enrollment card is issued.
DeltaCare USA (DHMO) DeltaCare USA offers cost-effective, comprehensive benefits through one of the largest HMO networks in California, with nearly 3,840 general dentists. To receive dental services, you and your covered family members select a dentist who participates in the DeltaCare network. You pay a set copay for each covered dental procedure. There are no annual deductibles or maximums on general services. Many diagnostic and preventive services are covered at 100%. After you enroll, you will receive a DeltaCare USA membership card and “Evidence of Coverage” that fully describes the benefits of your dental plan. It will also contain the name and phone number of your network dentist and the Group Number 964-0003.
DeltaCare USA Customer Service 800.422.4234 www.deltadentalins.com (Group Number 70964-00003)
Delta Dental Customer Service 800.765.6003 www.deltadentalins.com (Group Number 04844-00001) Preferred (Group Number 04844-00015) Preferred Plus
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Waive Dental Coverage If you waive your dental coverage, you will receive before-tax flex credits to purchase other benefits, or receive taxable cash back. Your next opportunity to enroll in a dental plan will be during the next Open Enrollment period, unless you have a Qualifying Life Event.
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Dental Plans (continued) Coverage Plan Benefits
Delta Preferred Plus
Delta Preferred
DeltaCare USA DHMO
In Network
Out-ofNetwork*
In Network
Out-ofNetwork*
In Network
• Individual
$50
$50
$50
$50
None
• Family
$100
$100
$100
$100
None
Benefit Maximum
$2,000 per person per calendar year
$2,000 per person per calendar year
$1,200 per person per calendar year
$1,200 per person per calendar year
None
Diagnostic and Preventive Care
100% no deductible; every six months
100% no deductible; every six months
100% no deductible; every six months
100% no deductible; every six months
100% every six months
100%
80%
85%
80%
100%
Out-ofNetwork
Annual Deductible
Basic Benefits Crowns, Jackets, Cast Restoration, and Implants
70%
50%
50%
50%
Copay varies; see description of benefits; implants not covered
Prosthodontic Benefits
70%
50%
50%
50%
Copay varies; see description of benefits
50% $2,000 lifetime max per person
50% $2,000 lifetime max per person
50% $1,000 lifetime max per person
50% $1,000 lifetime max per person
Copay $350 – start-up $1,600 – child $1,800 – adult
100%
100%
100%
100%
$5 copay
Orthodontic Benefits Emergency Treatment *
Dental services, which are not performed by your network dentist or without prior authorization by DeltaCare USA, will not be covered.
Plan pays $100 max/12 months
If you choose an out-of-network, non-Delta Dental dentist, you will be responsible for the difference between the fee allowed by Delta Dental and your dentist’s actual fee.
In the event of a conflict between this information and Huntington Hospital’s contract with Delta Dental, the terms of the contract will prevail.
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Vision Plan VSP Choice
you see a non-VSP provider, you’ll need to submit your receipts for reimbursement along with an out-ofnetwork claim form. No ID card will be provided.
The vision plan is offered through Vision Service Plan (VSP), and provides coverage for vision exams, lenses, frames and contacts. The plan provides savings on eye examinations, contact lenses, lens options and accessories, as well as a discount on laser vision correction procedures. VSP Choice Preferred Providers are located in retail, neighborhood, medical and professional settings with 41,000 access points nationwide.
Waive Vision Coverage If you waive your vision coverage, you will receive beforetax flex credits to purchase other benefits, or receive taxable cash back. Your next opportunity to enroll in a vision plan will be during the next Open Enrollment period, unless you have a Qualifying Life Event.
How it Works You may see any vision provider but you will receive the highest benefit when you see a VSP network provider. When you receive services from a network provider, VSP will handle all paperwork for you. If
Plan Coverage
VSP Customer Service 800.877.7195 www.vsp.com
VSP Participating Provider
Non-Participating Provider
• Exam
Every 12 months *
Every 12 months *
• Lenses
Every 12 months *
Every 12 months *
Service Period
• Frames
Every 24 months *
Every 24 months *
100% after $20 copay
Up to $45 after $20 copay
• Single Vision
100%
Up to $45
• Bifocal
100%
Up to $65
• Trifocal
100%
Up to $85
100% Up to $140 plus 20% off out-of-pocket costs
Up to $125
Copay will never exceed $60
Up to $105
100%
Up to $210
$140 allowance **
Up to $105
Up to 15% discount at selected laser centers
None
Exam Lenses
• Lenticular Frames
Up to $47
Contacts • Exam and Fitting • Medically Necessary • Elective Laser Surgery *
From your last date of service.
** In lieu of lenses and frames. In the event of a conflict between this information and Huntington Hospital’s contract with VSP, the terms of the contract will prevail.
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2016 Benefit Premium Rates 2016 Rates Without Wellness Participation Coverage Category
Total Bi-Weekly Price Tag
Huntington Hospital Cost Bi-Weekly
Employee Cost Bi-Weekly
2016 Rates With Wellness Participation * Huntington Hospital Cost Bi-Weekly
Employee Cost Bi-Weekly
FT
PT
FT
PT
FT
PT
FT
PT
$236.40
$190.40
$167.40
$46.00
$69.00
$205.40
$182.40
$31.00
$54.00
$510.04
$398.04
$347.04
$112.00
$163.00 $413.04
$362.04
$97.00
$148.00
$446.89
$346.89
$302.89
$100.00
$144.00 $361.89
$317.89
$85.00
$129.00
$756.16
$594.16
$518.16
$162.00
$238.00 $609.16
$533.16
$147.00 $223.00
$510.04
$398.04
$347.04
$112.00
$163.00 $413.04
$362.04
$97.00
$756.16
$594.16
$518.16
$162.00
$238.00 $609.16
$533.16
$147.00 $223.00
$0.00
$20.00
$18.00
($20.00)
($18.00)
$20.00
$18.00
($20.00) ($18.00)
$223.45
$191.45
$170.45
$32.00
$53.00
$206.45
$185.45
$17.00
$38.00
$481.98
$402.98
$355.98
$79.00
$126.00 $417.98
$370.98
$64.00
$111.00
$422.07
$351.07
$311.07
$71.00
$111.00 $366.07
$326.07
$56.00
$96.00
$715.14
$603.14
$533.14
$112.00
$182.00 $618.14
$548.14
$97.00
$167.00
$481.98
$402.98
$355.98
$79.00
$126.00 $417.98
$370.98
$64.00
$111.00
$715.14
$603.14
$533.14
$112.00
$182.00 $618.14
$548.14
$97.00
$167.00
$0.00
$20.00
$18.00
($20.00)
($18.00)
$18.00
($20.00) ($18.00)
Huntington Choice $250 Deductible • Employee Only • Employee + Spouse • Employee + Child(ren) • Employee + Family • Employee + Domestic Partner** • Employee + Domestic Partner and Child(ren)** Waive Coverage (Benefits) Huntington Choice $500 Deductible • Employee Only • Employee + Spouse • Employee + Child(ren) • Employee + Family • Employee + Domestic Partner** • Employee + Domestic Partner and Child(ren)** Waive Coverage (Benefits)
$20.00
$148.00
* Completion of the biometric screening, personal health assessment (PHA) and earning 100 wellness points during specified period is required to qualify for the premium reduction. Refer to page 27 for more detailed information. ** Imputed Income
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2016 Benefit Premium Rates (continued)
Coverage Category
Total Bi-Weekly Price Tag
Huntington Hospital Cost Bi-Weekly Full-Time Part-Time
Employee Cost Bi-Weekly Full-Time
Part-Time
DeltaCare USA • Employee Only
$7.99
$7.99
$7.99
$0.00
$0.00
• Employee + Spouse
$13.72
$10.47
$9.72
$3.25
$4.00
• Employee + Child(ren)
$14.47
$10.47
$9.72
$4.00
$4.75
• Employee + Family
$19.77
$10.77
$10.02
$9.00
$9.75
• Employee + Domestic Partner**
$13.72
$10.47
$9.72
$3.25
$4.00
• Employee + Domestic Partner and Child(ren)**
$19.77
$10.77
$10.02
$9.00
$9.75
$0.00
$8.00
$7.00
($8.00)
($7.00)
• Employee Only
$20.54
$14.24
$13.40
$6.30
$7.14
• Employee + Spouse
$42.11
$15.11
$13.86
$27.00
$28.25
• Employee + Child(ren)
$44.18
$14.18
$13.18
$30.00
$31.00
• Employee + Family
$63.68
$15.68
$14.68
$48.00
$49.00
• Employee + Domestic Partner**
$42.11
$15.11
$13.86
$27.00
$28.25
• Employee + Domestic Partner and Child(ren)**
$63.68
$15.68
$14.68
$48.00
$49.00
• Employee Only
$33.92
$14.38
$13.54
$19.54
$20.38
• Employee + Spouse
$68.98
$15.38
$14.13
$53.60
$54.85
• Employee + Child(ren)
$72.38
$14.46
$14.10
$57.92
$58.28
• Employee + Family
$104.02
$16.08
$15.08
$87.94
$88.94
• Employee + Domestic Partner**
$68.98
$15.38
$14.13
$53.60
$54.85
• Employee + Domestic Partner and Child(ren)**
$104.02
$16.08
$15.08
$87.94
$88.94
• Employee Only
$3.34
$2.97
$2.97
$0.38
$0.38
• Employee + Spouse
$5.34
$1.09
$0.84
$4.25
$4.50
• Employee + Child(ren)
$5.46
$1.10
$0.85
$4.36
$4.61
• Employee + Family
$8.80
$1.82
$1.57
$6.98
$7.23
• Employee + Domestic Partner**
$5.34
$1.09
$0.84
$4.25
$4.50
• Employee + Domestic Partner and Child(ren)**
$8.80
$1.82
$1.57
$6.98
$7.23
$0.00
$2.00
$2.00
($2.00)
($2.00)
Waive Coverage (Benefits) Delta Preferred
Delta Preferred Plus
Vision Service Plan (VSP)
Waive Coverage (Benefits)
** Imputed Income
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Huntington Hospital
Life Insurance Plan Life insurance provides protection for those who depend on you financially. Your needs vary greatly upon age, number of dependents, dependent ages and your financial situation. Unum Life Insurance Company of America is the carrier for the life insurance offered by Huntington Hospital. The life insurance is offered on two levels, basic and optional. Dependent life insurance is also available.
Basic Coverage 1x Your Annual Salary Minimum $20,000, up to $50,000 Huntington Hospital provides a basic level of coverage at no cost to you. Basic coverage is effective the same time you become eligible for benefits, provided that you are actively at work.
Optional Coverage Employee-Paid Up to a maximum of $500,000 You may choose from the following options, if newly eligible: • 1x your annual base salary • 2x your annual base salary • 3x your annual base salary • 4x your annual base salary • 5x your annual base salary How the Optional Life Insurance Works Optional coverage is available for one, two, three, four or five times your annual base salary, not including overtime or additional compensation up to a maximum of $500,000. Your salary amount is rounded to the next highest $1,000 and premiums are deducted on an after tax basis. Example: Your annual base salary is $32,970, and you elect two times your annual salary, your coverage would be $66,000. This coverage would be in addition to your basic coverage benefit.
Huntington Hospital
As a new employee optional coverage becomes effective on your benefit eligibility date if you are actively at work. You may increase your coverage by one level annually during Open Enrollment. Reduced levels of coverage apply to employees who are 70 years of age and older. Benefit levels reduce to 65% at age 70. Once the employee has attained age 75, the amount of life insurance will be a $3,000 maximum benefit. (Contact the Benefits Department for more details.)
Dependent Life Insurance Coverage Life insurance coverage is available for your spouse, domestic partner and/or your eligible child(ren). • $5,000 for spouse, domestic partner and/or child(ren) • $10,000 for spouse, domestic partner and/or child(ren) • $20,000 for spouse or domestic partner • Children: Coverage is available to age 19, or to age 26 if a full-time student. Contact the Benefits Department for more details. • For children under six months of age, the total benefit is $700. • It is the employee’s responsibility to notify the Benefits Department when your dependent no longer meets the eligibility requirements. • Proof of eligibility is required at the time of a claim. If your employment ends or you are working less than the minimum number of hours under the terms of the policy, you may elect portable coverage for yourself and your dependents. Please contact Unum Customer Service for more details.
Unum Customer Service 800.421.0344 www.unum.com
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AD&D Plan Accidental Death and Dismemberment (AD&D) benefits provide a benefit to you or your beneficiary if you are dismembered or die in an accident. Unum Life Insurance Company is the carrier for the AD&D benefit offered. AD&D coverage is offered on two levels, basic and optional.
Basic Coverage 1x Your Annual Salary Minimum $20,000, up to $50,000 Huntington Hospital provides a basic level of coverage at no cost to you. Basic coverage is effective the same time you become eligible for benefits, provided that you are actively at work.
Optional Coverage Employee-Paid Up to a maximum of $500,000 You may choose any of the following options. • 1x your annual base salary • 2x your annual base salary • 3x your annual base salary • 4x your annual base salary • 5x your annual base salary How the Optional AD&D Insurance Works Optional coverage is available for one, two, three, four or five times your annual base salary, not including overtime or additional compensation up to a maximum of $500,000. Your salary amount is rounded to the next highest $1,000 and premiums are deducted on an after tax basis. Example: Your annual base salary is $32,970 and you elect two times your annual salary, your coverage would be $66,000. This coverage would be in addition to your basic coverage.
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Optional Dependent Coverage/ Spouse or Domestic Partner You may elect coverage in increments of $5,000 to a maximum of $300,000.
Optional Dependent Coverage/ Child(ren) You may elect coverage in increments of $5,000 to a maximum of $50,000. Coverage is available to age 19, or to age 26 if a fulltime student. Reduced levels of coverage apply to employees who are 70 years of age and older. Benefit levels reduce to 65% at age 70. Once the employee has attained age 75, the amount of AD&D will be a $3,000 maximum benefit. (Contact the Benefits Department for more details.)
Your Beneficiary for Life and AD&D You can designate your beneficiary by completing and submitting a Unum Life/AD&D Insurance Beneficiary form to the Benefits Department at any time. Make sure your beneficiary form is always current. You are always the beneficiary for dependent life and dependent AD&D coverage. Important Information about Designation of Beneficiaries • Primary Beneficiary(ies) means the person(s) you choose to receive your life and AD&D insurance benefits upon your death. Please specify the percentage of the benefit you want paid to each beneficiary; these percentages should be whole percentages that total 100%. If any primary beneficiary is disqualified or dies before you, his/her percentage of the benefit will be paid to the remaining primary beneficiary(ies).
Huntington Hospital
AD&D Plan (continued) • Contingent Beneficiary(ies) means the person(s) you choose to receive your life and AD&D insurance benefits only if all primary beneficiaries are disqualified or die before you. Please specify the percentage of the benefit you want paid to each beneficiary; these percentages should be whole percentages that total 100%. If any contingent beneficiary is disqualified or dies before you, his/her percentage of the benefit will be paid to the remaining contingent beneficiary(ies) or your estate. • Minor Beneficiary(ies). When you designate minors as beneficiaries, it is important to understand that insurance benefits may not be released to a minor child. They may, however, be paid to a court appointed guardian of the child’s estate. The regulations governing minor beneficiaries vary by state. • Trust. You may designate a valid trust as a beneficiary. Types of Coverage Information • Basic Life is life insurance provided by your employer for which they pay the premiums. • Supplemental Life is life insurance elected by you for which you pay the premiums. • Basic AD&D is Accidental Death & Dismemberment coverage provided by your employer for which they pay the premiums. • Supplemental AD&D is Accidental Death & Dismemberment coverage for which you pay the premiums. • If you wish to designate different beneficiaries for any of the above coverages, please complete a separate Unum Beneficiary Designation form.
Huntington Hospital
General Information • Updates to Your Beneficiary Designation. You can change your beneficiary designation at any time. You may wish to review your designation periodically. • Consult an Attorney. This information is not intended to be relied on as legal advice. You may wish to get the assistance of an attorney to help ensure your beneficiary designation correctly reflects your intentions. Please Note: The Life and AD&D Plans have a twoyear contestability period. If a claim is filed within 24 months of the benefit amount being increased, UNUM reserves the right to complete a contestability review and determine the amount of the benefit that should be paid. For additional information please contact UNUM, our Life and AD&D Plan Administrator, at 800-421-0344 or call the Benefits Department at 626-397-3626.
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Long Term Disability Plans Long Term Disability (LTD) coverage can be one of the most important benefits you choose; it provides you and your family with financial protection if you are ever unable to work due to illness or injury. The LTD plan pays a monthly benefit after you have been totally or partially disabled for 180 days (provided all plan requirements are met). If you are disabled for longer than 180 days you receive a percentage of your pay. LTD pay is reduced by other sources of income you receive such as State Disability, or Workers’ Compensation or any Social Security disability or
LTD Options
pension income received by you or your family.
You may choose to increase your coverage level as follows:
Your duration of benefits is based on your age when the disability occurs. Your LTD benefits are payable for the period during which you continue to meet the definition of disability. If your disability occurs before age 60, benefits will be payable until age 65. If your disability occurs at or after age 60, benefits would be paid according to a benefit duration schedule.
Basic Coverage Huntington Hospital provides a basic level of coverage at no cost to you. Basic coverage is effective the same time you become eligible for benefits, provided you are actively at work. • 40% of monthly earnings (maximum $1,000 per month)
• 50% of monthly base pay (maximum $7,500 per month) • 60% of monthly base pay (maximum $13,000 per month) You may increase your coverage one level each year during Open Enrollment. However, if you are not actively at work due to illness or injury, any increase in coverage will begin on the date you return to work. Some disabilities may not be covered or may have limited coverage under this plan. For more details, please refer to the Summary Plan Description available on-line and in the Benefits Department.
Unum Customer Service 800.421.0344 www.unum.com
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Huntington Hospital
Flexible Spending Accounts The Flexible Spending Account is administered by Keenan Employee Benefits TPA. The Health Care Account and the Dependent Care Account allow you to reduce your taxable income by paying for out-of-pocket health care and dependent care expenses with beforetax dollars. Since these accounts are to be used for predictable expenses, careful planning should help you avoid any forfeiture. Use the Flexible Account forms, available on the benefits website or in the Benefits Department, to help estimate your future expenses.
• You can deposit from $100 to $2,550 per year ($3.85 - $98.08 per biweekly pay period).
Note: Domestic Partners and children of Domestic Partners do not qualify and are not eligible for reimbursement.
• All expenses must be incurred during the plan year. Once your employment terminates or you change to non-benefit eligible status, your “plan year” will end on the termination or status change date. Eligible expenses must be incurred on or before that date.
Health Care Account (HCA) To help pay for your eligible out-of-pocket, nonreimbursed medical, dental, vision, and prescription drug expenses for you and your family, Huntington Hospital offers a Health Care Account (HCA). Due to Health Reform, the maximum allowed annual contribution in a health care account is $2,550. Health FSA $500 Carryover: Your FSA plan allows a carryover of up to $500 of unused amounts remaining in your Health FSA account to be used in the following year. Your FSA administrator will pay claims from the carryover amount first and then, only after exhausting the carryover amount, from the current year contributions. How it Works • You make before-tax deposits (through payroll deduction) to your Health Care Spending Account.
Access your Health Care Spending Account online at www.mywealthcareonline.com/Keenan/ Employer ID: KHC7000
Huntington Hospital
• Using a debit card provided for this purpose, you can pay for incurred expenses – tax-free. Due to IRS regulations, all HCA receipts, including debit card receipts, must be submitted to Keenan for verification. The debit card is available for managing cash only. Receipts are still required to complete the transaction, except for flat copays.
What Expenses Can Be Reimbursed In general, the money in your Health Care Account can be used for eligible expenses that are not paid for by your medical, vision or dental plan. Some examples include: • Chiropractor – Out-of-Network • Eye glasses/Contact lenses • Medical, dental, vision and prescription copays, deductibles and coinsurance • Laser eye surgery Certain over-the-counter (OTC) drugs and medicines (with the exception of insulin) will require a physician’s prescription to be considered a reimbursable expense under a Flexible Spending Account. Eligible incurred expenses may be submitted for reimbursement through March 31st of the following plan year. Terminated employees or employees who lose coverage have 90 days from the date of termination or loss of coverage to submit a claim for reimbursement.
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Flexible Spending Accounts (continued) Dependent Care Account (DCA) You can use a Dependent Care Account to make before-tax deposits to be reimbursed for expenses for annual child care expenses (i.e., day care center, nursery, pre-school, after-school care, etc.) and annual elder care services (i.e., day care center or in-home care) so that you, or if you are married, you and your spouse can work. Eligible Dependents The DCA can only be used to reimburse expenses for the care of eligible dependents: • Children under age 13 who qualify as dependents on your federal income tax return. If a child reaches age 13 during the plan year, the benefit will no longer be effective. • Other qualifying family members who are physically or mentally incapable of caring for themselves and who qualify as dependents on your tax return. Qualifying Care • The care must be necessary so that you or your spouse can work, actively look for work, or attend school full-time. • Care can be given in a private home (including your own) or in a day care setting. • Overnight camp expenses are not reimbursable.
How it Works • You make before-tax contributions (through payroll deduction) to your Dependent Care Account. • You can deposit from $100 to $5,000 per year ($3.85 - $192.30 per biweekly pay period). In some cases, your maximum annual contribution may be less than $5,000. –– For example, if you are married and your spouse contributes to a similar account, your combined contributions may not exceed $5,000 per year. –– If you are married but file separate tax returns, your annual contribution is limited to $2,500. –– Your contributions cannot exceed the amount of your income or your spouse’s income, whichever is lower. • For reimbursement of an eligible expense, you pay the charges and then submit a claim form for reimbursement to Keenan. • Y ou must include an original receipt from your dependent care provider and report the provider’s taxpayer ID number or Social Security number on your claim form. • You will lose your eligibility to participate in the Dependent Care Account (DCA) if you are out on leave of absence greater than 30 days.
• Homes and centers caring for more than six people must meet state and local license requirements. • You may also use the account if your spouse is disabled or a full-time student for at least five months during the year.
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Huntington Hospital
Flexible Spending Accounts (continued)
IRS Rules for HCA and DCA The Internal Revenue Service governs spending accounts and the following rules apply (see IRS guidelines for further specifics): • Dependent Care Account – Any unused balance in this account at the end of the plan year must be forfeited. • Health Care Account – Any unused balance in excess of the allowable $500 carryover in this account at the end of the plan year must be forfeited. • Your deposit amount cannot be changed, stopped, or started during the year for any reason, unless you have a change in family or job status.
Huntington Hospital
• Only those items that are considered tax deductible for the IRS as listed in Publication 502 are eligible for reimbursement. • If you use the DCA account, you cannot take the entire IRS child care tax credit at the end of the year. • The account can reimburse for expenses for legal dependents but does not recognize Domestic Partner status. Therefore, you cannot be reimbursed for a domestic partner’s or domestic partner’s child’s health care expenses. • Spending account balances do not earn interest.
Keenan Customer Service 888.884.8083 www.keenan.com/benefits/hh
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HMH Retirement Savings Plan, 403(b) Eligibility Criteria
Huntington Memorial Hospital Non-Matching
Upon employment the hospital will auto-enroll you in the retirement savings plan and 4% of your eligible earnings will be deferred from each paycheck to your retirement savings account.
Sources of Contribution to 403(b) Employee • You control the amount you defer • Minimum deferral rate is 1% of eligible earnings • The maximum contribution amount is determined by the Internal Revenue Service • Your contribution is taken out each pay period • You determine the investment selections • You may be eligible for “catch up” contributions • Contact Fidelity Investments if you want to opt out of contributing to your retirement savings plan Huntington Memorial Hospital Matching • When you defer to your retirement savings account and meet the eligibility requirements, the hospital makes a matching contribution • Eligibility requirements include being at least 21 years of age, one retirement plan year of service, and at least 1,000 hours worked in a year • The hospital’s matching contribution is equal to 50% of your deferral, up to a maximum matching contribution of 2% of eligible earnings • The matching amounts are shown in the following table:
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Employee Deferal
Hospital Contributes to your Retirement
1% 2% 3% 4%
0.5% 1.0% 1.5% 2.0%
• The hospital makes a non-matching contribution to your retirement savings account that is based upon your years of service • Eligibility requirements are 21 years of age, one retirement plan year of service, and 1,000 hours worked in a year • The amount the hospital contributes is shown in the following table: Years of Service
Hospital Contributes to your Retirement
1-4 5-9 10-14 15-19 20-24 25 or more
1% 2% 3% 4% 5% 6%
Vesting You always have 100% ownership of the money you contribute to your retirement savings plan and its earnings. Funds that Huntington Memorial Hospital contributes become yours (vest) over time according to your retirement plan years of service. Please refer to the following vesting schedule: Retirement Plan Years of Service*
Percent of Hospital Contribution
2 years 3 years 4 years 5 years 6 years
20% 40% 60% 80% 100%
* One year of vesting service is earned if a minimum of 1,000 hours is worked in the calendar year.
To schedule an appointment with our on-site Fidelity Representative please call 800.642.7131. For all other retirement savings plan inquiries please contact Fidelity Customer Service at 800.343.0860.
Huntington Hospital
Voluntary Benefits In addition to your Huntington Hospital Benefits Plans, you may purchase additional Voluntary Benefits coverage. These benefits are not subsidized or sponsored by Huntington Hospital, but are offered to employees in order to meet individual needs. Voluntary benefits are:
Voluntary benefits are not part of Huntington Hospital’s Health & Welfare benefit plans. As a convenience, Huntington Hospital administers payroll deductions for such voluntary benefits. All inquiries regarding voluntary benefits should be made to the appropriate vendor.
• Flexible – you can select the type of coverage that meets your needs
Additional information is available at www.hhbenefits.com or directly through the appropriate vendor.
• Portable – you can take the policy with you if you leave Huntington Hospital • Convenient – premiums are collected via payroll deduction In 2016, the following Voluntary Benefits are offered: • Accident Insurance (Aflac) • Life Insurance (Aflac) • Personal Cancer Indemnity Plan (Aflac) • Personal Recovery Plus (Aflac) • Personal Short-Term Disability Insurance (Aflac) – Note: The plan does not integrate with State Disability or any other private group plan. It does not cover work related illness or injury. • Specified Health Event/Hospital Intensive Care (Aflac) • Auto Insurance, Homeowners and Renters Insurance (MetLife) • Pet Insurance (MetLife) • Prepaid Legal Service and Identity Theft (Prepaid Legal)
Huntington Hospital
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Paid Time Off and Sick Leave The Paid Time Off (PTO) program allows for time off for vacation, first 24 hours of an illness, holiday, family emergencies, religious observances and personal reasons, all in one program. This gives you more flexibility in scheduling time off to meet family needs and balance your work and personal life.
Eligibility All full-time and part-time employees scheduled to work at least 20 hours per week are eligible. Per diem, extra help and temporary employees are not eligible for PTO or Extended Illness Reserve (EIR). You begin accruing PTO and EIR once you meet the eligibility requirements. You must, however, have at least 28 days of continuous employment before you can begin to use PTO or EIR.
PTO Accrual The PTO plan combines sick, vacation, and holidays into one account of paid days off according to the following accrual schedule. Part-time employees receive a prorated accrual amount based on the number of hours worked per pay period.
Years of Service
Accrual Rate/ Pay Period
Maximum Annual Accrual
Total Maximum Hours
< 5 years
7.70 hours
200 hours
300 hours
5 - 9.9 years
9.23 hours
240 hours
360 hours
10+ years
10.77 hours
280 hours
420 hours
California Paid Sick Leave (PSL) California Paid Sick Leave will be provided to all eligible employees in compliance with California’s Healthy Workplace Healthy Family Act (HWHFA). This benefit is integrated with the Hospital’s Extended
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Illness Reserve policy. Please refer to HR Policy 876 Extended Illness Reserve (EIR) for more details.
Extended Illness Reserve (EIR) Full-time employees may accrue up to 48 EIR hours per year. EIR hours are prorated for part-time employees based on the number of hours worked per pay period. There is no maximum number of EIR hours that can be accrued. EIR hours must be used to supplement State Disability or Workers’ Compensation in the event of extended illness, not to exceed 100% of pay. In addition, you can use half of your annual EIR accrual (maximum 24 hours per year) to care for an eligible family member. An employee must notify their manager and CareWorksUSA at 855.783.9584 immediately for absences of more than 3 days to request disability time off. Refer to Human Resources Policy No. 876 for more detailed information.
Bereavement Pay Full-time employees are provided three days bereavement leave without loss of pay for the purpose of attending to arrangements and travel related to an immediate family member’s death. Part-time employees are provided two days. Immediate family members are defined as spouse, domestic partner, parent, parent-in-law, child, sibling (including step-brother/sister), grandparent, or grandchild. Bereavement pay is prorated for part-time employees based on the number of hours worked per pay period. An employee must notify their manager immediately to request bereavement time off. Refer to Human Resources Policy No. 879 for more specific information.
Huntington Hospital
Paid Time Off and Sick Leave (continued) Jury Duty
Leaves of Absence
All full-time and part-time employees are eligible for jury duty pay. Temporary, per diem, and extra help employees are not eligible. If called to serve on jury duty, an employee will be paid up to a maximum of five (5) scheduled work days in a calendar year, regardless of the entire length of jury duty.
Huntington Hospital provides leave of absences to eligible employees in accordance with state and federal law and regulations, and in accordance with Hospital Policy. Eligibility requirements, benefits, compensation, and rights upon return from leave vary by type of leave.
If an employee is summoned for jury duty, he/she must notify their manager immediately. Refer to Human Resources Policy No. 878 for further information.
An employee must notify their manager and CareWorksUSA 855.783.9584 immediately to request any Leave of Absence. For more detailed information regarding Leaves of Absence, please refer to Human Resources Policy No. 877.
Huntington Hospital
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Employee Resources Huntington Hospital strives to attract people of the highest skill-level, commitment, and personal standards. The hospital is committed to improving the health and well-being of Huntington Hospital employees through health education and programs that support positive lifestyle changes, resulting in improved employee health, productivity, retention, and healthcare cost savings. The following programs and services are intended to help employees meet their commitments both on the job and in their personal lives.
assessment through HealthFitness. A third step is required to continue to earn your medical premium discount in 2017 – earn 100 wellness points by August 31, 2016. Deadlines and details for each step will be provided by the Benefits Department.
Huntington Hospital – Wellness PATH Participate Actively Toward Health
The EAP is a confidential assistance program available to all Huntington Hospital employees and their dependents. The EAP provides easy access to a behavioral health professional who can offer employees and their families support and direction with personal concerns.
As part of the Wellness PATH Program, Huntington Hospital offers a number of employee wellness and disease management programs and resources: • Lifestyle coaching programs • Condition management programs • Weight Watchers at Work Program • On-site yoga, core conditioning and zumba classes • Fitness challenges • Healthy menu options in the cafeteria • Annual Health and Wellness fair • On-site flu vaccinations and other immunizations • Discounts on membership fees to various fitness centers Employee Participation Incentive Newly eligible employees must complete the following two steps within 90 days of their date of hire or status change to a benefit-eligible position in order to receive a bi-weekly $15 medical premium discount during 2016. Once these two required steps are complete, the premium discount is effective 90 days after hire or status change to a benefit-eligible position. 1) complete a biometric screening, 2) complete an on-line health 27
Employees who waive medical plan enrollment, residents, and per diem employees are also encouraged to participate by completing all three steps.
Employee Assistance Program (EAP)
The EAP offers a range of services, at no charge, to assist individuals with personal concerns. These services include problem assessment, short-term counseling, information about and referral to community resources and treatment programs, educational materials and follow-up.
Blood Donor Services Huntington Hospital uses over 10,000 blood products a year in caring for the community, yet only 3% of the eligible donors in California give blood. Your donation is truly an act of kindness that makes a difference. The Blood Donor Center encourages employees, their friends and families to donate blood. All blood donors will receive a thank you gift. You may contact the Donor Center at 626.397.5422.
Concierge Services The on-site concierge provides time-saving services such as dry cleaning, car wash and oil changes, postal service, film developing, internet research, gift wrapping, discounted theme park and movie tickets and much more.
Huntington Hospital
Employee Resources (continued) There is no extra charge for these services. You pay only the cost of the work you have requested. You may contact Concierge Services at 626.397.8777.
Discounts As a Huntington employee, you are eligible for various discounts: • 20% discount in the cafeteria • 10% on most items in the Gift Shop • Discounts for amusement parks and movie theater tickets • Discounts on membership fees to various fitness centers
Credit Union You are eligible for credit union banking services effective upon employment. You may apply for loans after six months of employment. You may contact First City Credit Union at 800.944.2200.
Spiritual Care You are always welcome to discuss your spiritual needs and concerns with the chaplain in confidence. The chaplain is trained to work with a variety of faith traditions, and will work with you to contact additional resources, as needed. The Chapel/Meditation Room is located adjacent to the Wingate lobby. Additional written resources are also available on a variety of topics such as grief, stress, prayer, etc. Spiritual Care may be reached at 626.397.5051.
Rideshare We encourage employees to find alternatives to driving to work alone. If you carpool, walk or bike to work, or take public transportation, you may be eligible
Huntington Hospital
for our Rideshare Program. Incentives may include preferred parking, discounted bus and train tickets, and Huntington concierge dollars. For more information on the program or to explore your commute options, please contact the Employee Transportation Coordinator in Concierge Services at 626.397.8777.
Parking Facilities Free parking is available in designated employee parking areas.
Tuition Reimbursement Program The Tuition Reimbursement Program provides eligible employees with the opportunity to obtain, maintain, or improve job-related capabilities through participation in courses of study at accredited colleges, universities and organizations specializing in job and careerrelated education and training. Huntington Hospital offers reimbursement for tuition and books for qualified courses to regular full-time and part-time employees. The reimbursement amount is from $1,500 to $2,500 per calendar year, based on years of service. Benefits are prorated for part-time employees based on scheduled hours. Contact the Benefits Department at 626.397.3582 to learn more or to apply. All Tuition Reimbursement requests must be pre-approved prior to commencement of class. Reimbursement will be made as follows for full-time employees: • Three (3) months to five (5) years of service, $1,500 per calendar year • F ive (5) to ten (10) years of service, $2,000 per calendar year • Ten (10) years or more of service, $2,500 per calendar year
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Glossary Accidental Death & Dismemberment Insurance (AD&D) A component of the life insurance coverage. In the event of a participant’s accidental death or if a participant loses a limb or other vital function, benefits will be paid according to a schedule.
Domestic Partner An unmarried individual who resides together with an unmarried covered employee at the same address in a committed relationship and who has so resided with such employee continuously for no less than one year.
After-Tax Dollars Salary dollars from which Federal, State and Social Security taxes have already been deducted.
Flex Credits Dollars provided to you when you waive medical, dental and/or vision benefits.
Annual Maximum The most the plan will pay for some covered services in the calendar year in which your benefit elections are in effect. Annual Out-of-Pocket Maximum The highest amount you are required to pay in coinsurance and deductibles for any covered expenses in a calendar year. Base Salary For Life, AD&D and LTD insurance, your salary is your annual base pay. Changes in base pay will be reflected in the following year’s Open Enrollment. Before-Tax Dollars Income on which no Federal or State tax is paid when used to purchase a benefit option or placed in a reimbursement account under a qualified flexible benefits program.
Imputed Income Hospital provided contributions for medical, dental and vision coverage for a domestic partner and a domestic partner’s child(ren) are considered imputed income and are subject to Federal, Social Security and Medicare taxes and any other required payroll tax. For further information, contact your Tax Consultant. Long Term Disability Plan (LTD) In the event you are unable to work for more than 180 days due to an illness or injury, LTD coverage provides replacement income.
Copay Any up-front amount you are required to pay for services, supplies or prescription drugs through your medical, dental, vision or prescription drug plan.
Open Enrollment The annual period of time during which employees have an opportunity to review, change and select benefit plans.
Deductible The amount you are required to pay each year before any payments will be made under the plan for coinsurance and non-Huntington Hospital services.
Reimbursement Account An account that permits you to receive non-taxable reimbursements for IRS approved health care or dependent care expenses. You must authorize before-tax contributions from your pay into
Default Plan The benefits that will be provided to you if you do not enroll or do not waive benefits before your enrollment deadline date.
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Huntington Memorial Hospital Retirement Savings Plan, 403(b) This is a tax-qualified plan that allows you to voluntarily save for your retirement with before-tax dollars and includes hospital matching and non-matching contributions upon meeting eligibility requirements.
these accounts and then file claims for reimbursement of eligible expenses from your account(s).
Huntington Hospital
Important Notices Statement of Belief – Grandfather Status
apply for this minimum length of stay and early discharge
The Huntington Choice $250 and Huntington Choice $500
is appropriate.
plans are “grandfathered under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care
is only permitted if the attending health care provider, in consultation with the mother, decides an earlier discharge
Women’s Health and Cancer Rights Act (WHCRA) Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prosthetics, and complications resulting from a mastectomy, including lymphedema? For more information, you should review the Summary Plan Description or call your
Act, for example, the elimination of lifetime limits on benefits.
Plan Administrator at 626.397.3626 for more information.
Questions regarding which protections apply and which
Grievance / Appeals
protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health
You have a right to two levels of appeal with our carriers,
plan status can be directed to the plan administrator:
and a right to a response within a reasonable amount of time. However, also know that if a claim is not submitted within a
Gina Imbrenda, Director, Total Rewards, HRIS, Payroll & Concierge
reasonable time, the carriers have a right to deny that claim. The California Department of Managed Health Care (DMHC)
100 W. California Boulevard
is responsible for regulating health care plans. If you have a
Pasadena, CA 91105
grievance against your health plan, you should first telephone
626.397.3626
your health plan and use your plan’s appeal process before
You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 866.444.3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.
contacting the DMHC. Please review each contract for specific procedures on how to submit an appeal to a claim. This does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency or that has not been satisfactorily resolved by your health plan, or that has remained unresolved for more than 30
Newborns and Mothers Health Protection Act (NMHPA)
days, you may call the DMHC for assistance. You may also
A health plan which provides benefits for pregnancy and
medical necessity, coverage decisions for treatments that are
delivery generally may not restrict benefits for a covered pregnancy hospital stay (for delivery) for a mother and her newborn to less than 48 hours following a vaginal delivery or
be eligible for Independent Medical Review for an impartial review of medical decisions made by a health plan related to experimental in nature, and payment disputes for emergency or urgent medical services. The DMHC can be reached at 888. HMO.2219 (TDD 877.688.9891) or www.hmohelp.ca.gov.
96 hours following a Cesarean section. Also, any utilization review requirements for inpatient hospital admissions will not
Huntington Hospital
30
Important Notices (continued) COBRA Continuation Coverage
If you’re the spouse of an Employee, you’ll become a
This notice has important information about your right
Plan because of the following Qualifying Events:
to COBRA continuation coverage, which is a temporary
Qualified Beneficiary if you lose your coverage under the
extension of coverage under the Plan. This notice explains
• Your spouse dies;
COBRA continuation coverage, when it may become available
• Your spouse’s hours of employment are reduced;
to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can
• Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become legally divorced or legally separated from your spouse.
become available to you and other members of your family when group health coverage would otherwise end. For more
Your Dependent children will become Qualified Beneficiaries
information about your rights and obligations under the Plan
if they lose coverage under the Plan because of the following
and under federal law, you should review the Plan’s Summary
Qualifying Events:
Plan Description or contact the Plan Administrator. WHAT IS COBRA CONTINUATION COVERAGE? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “Qualifying Event.” Specific Qualifying Events are listed later in this notice. After a Qualifying Event, COBRA continuation coverage must be offered to each person who is a “Qualified Beneficiary.” You, your spouse, and your Dependent children could become Qualified Beneficiaries if coverage under the Plan is lost because of the Qualifying Event. Under the Plan, Qualified Beneficiaries who elect COBRA continuation cover must pay for COBRA continuation coverage. If you’re an Employee, you’ll become a Qualified Beneficiary if you lose coverage under the Plan because of the following Qualifying Events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your
• The parent-Employee dies; • The parent-Employee’s hours of employment are reduced; • The parent-Employee’s employment ends for any reason other than his or her gross misconduct; • The parent-Employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.” WHEN
IS
COBRA
CONTINUATION
COVERAGE
AVAILABLE? The Plan will offer COBRA continuation coverage to Qualified Beneficiaries only after the Plan Administrator has been notified that a Qualifying Event has occurred. The Employer must notify the Plan Administrator of the following Qualifying Events:
gross misconduct. • The end of employment or reduction of hours of employment;
31
Huntington Hospital
Important Notices (continued) • Death of the Employee; or
ELECTION AND ELECTION PERIOD
• The Employee’s becoming entitled to Medicare
COBRA continuation coverage may be elected during the
benefits (under Part A, Part B, or both). For all other Qualifying Events (e.g. divorce or legal separation of the Employee and spouse or a Dependent child’s losing eligibility for coverage as a Dependent child), you must notify the Plan Administrator within 60 days after the Qualifying Event occurs. You must provide this notice to: Huntington Hospital Benefits Department 100 W. California Boulevard Pasadena, CA 91109 Life insurance, accidental death and dismemberment benefits and weekly income or long-term disability benefits (if part of the Employer’s Plan) are not eligible for continuation under COBRA. NOTICE AND ELECTION PROCEDURES Each type of notice or election to be provided by a Covered Employee or a Qualified Beneficiary under this COBRA Continuation Coverage Section must be in writing, must be signed and dated, and must be furnished by U.S. mail, registered or certified, postage prepaid and properly addressed to the Plan Administrator. Each notice must include all of the following items: the Covered Employee’s full name, address, phone number and Social Security number; the full name, address, phone number and Social Security number of each affected Dependent, as well as the Dependent’s relationship to the Covered Employee; a description of the Qualifying Event or disability determination that has occurred; the date the Qualifying Event or disability determination occurred on; a copy of the Social Security Administration’s written disability determination, if applicable; and the name of this Plan. The Plan Administrator may establish specific forms that must be used to provide a notice or election.
period beginning on the date Plan coverage would otherwise terminate due to a Qualifying Event and ending on the later of the following: (1) 60 days after coverage ends due to a Qualifying Event, or (2) 60 days after the notice of the COBRA continuation coverage rights is provided to the Qualified Beneficiary. If, during the election period, a Qualified Beneficiary waives COBRA continuation coverage rights, the waiver can be revoked at any time before the end of the election period. Revocation of the waiver will be an election of COBRA continuation coverage. However, if a waiver is revoked, coverage need not be provided retroactively (that is, from the date of the loss of coverage until the waiver is revoked). Waivers and revocations of waivers are considered to be made on the date they are sent to the Employer or Plan Administrator. HOW IS COBRA CONTINUATION COVERAGE PROVIDED? Once the Plan Administrator receives notice that a Qualifying Event has occurred, COBRA continuation coverage will be offered to each of the Qualified Beneficiaries. Each Qualified Beneficiary will have an independent right to elect COBRA continuation coverage. Covered Employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain Qualifying Events, or a second Qualifying Event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. DISABILITY EXTENSION OF THE 18-MONTH PERIOD OF COBRA CONTINUATION COVERAGE If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your
Huntington Hospital
32
Important Notices (continued) entire family may be entitled to get up to an additional 11
District Office of the U.S. Department of Labor’s Employee
months of COBRA continuation coverage, for a maximum
Benefits Security Administration (EBSA) in your area or visit
of 29 months. This disability would have to have started
www.dol.gov/ebsa. (Address and phone numbers of Regional
at some time before the 60th day of COBRA continuation
and District EBSA Offices are available through EBSA’s
coverage and must last at least until the end of the 18-month
website.) For more information about the Marketplace, visit
period of COBRA continuation coverage.
www.HealthCare.gov.
SECOND QUALIFYING EVENT EXTENSION OF 18-MONTH
KEEP YOUR PLAN INFORMED OF ADDRESS CHANGES
PERIOD OF COBRA CONTINUATION COVERAGE To protect your family’s rights, let the Plan Administrator know If your family experiences another Qualifying Event during
about any changes in the addresses of family members. You
the 18 months of COBRA continuation of coverage, the
should also keep a copy of any notices you send to the Plan
spouse and Dependent children in your family can get up to
Administrator for your records.
18 additional months of COBRA continuation of coverage, for a maximum of 36 months, if the Plan is properly notified about the second Qualifying Event. This extension may be available to the spouse and any Dependent children receiving COBRA continuation of coverage if the Employee or former Employee dies; becomes entitled to Medicare (Part A, Part B, or both); gets divorced or legally separated; or if the Dependent child stops being eligible under the Plan as a Dependent child. This extension is only available if the second Qualifying Event would have caused the spouse or
COBRA continuation coverage, if elected within the period allowed for such election, is effective retroactively to the date coverage would otherwise have terminated due to the Qualifying Event, and the Qualified Beneficiary will be charged for coverage in this retroactive period. COST OF CONTINUATION COVERAGE
the Dependent child to lose coverage under the Plan had the
The cost of COBRA continuation coverage will not exceed
first Qualifying Event not occurred.
102% of the Plan’s full cost of coverage during the same
OTHER OPTION BESIDES COBRA CONTINUATION COVERAGE Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.HealthCare.gov. IF YOU HAVE QUESTIONS
33
EFFECTIVE DATE OF COVERAGE
period for similarly situated non-COBRA Beneficiaries to whom a Qualifying Event has not occurred. The “full cost” includes any part of the cost which is paid by the Employer for non-COBRA Beneficiaries. The initial payment must be made within 45 days after the date of the COBRA election by the Qualified Beneficiary. Payment must cover the period of coverage from the date of the COBRA election retroactive to the date of loss of coverage due to the Qualifying Event (or date a COBRA waiver was revoked, if applicable). The first and subsequent payments must be submitted and made payable to the Plan Administrator or COBRA Administrator. Payments for successive periods of coverage are due on the first of each month thereafter,
For more information about your rights under the Employee
with a 30-day grace period allowed for payment. Where an
Retirement Income Security Act (ERISA), including COBRA,
Employee organization or any other entity that provides Plan
the Patient Protection and Affordable Care Act, and other laws
benefits on behalf of the Plan Administrator permits a billing
affecting group health plans, contact the nearest Regional or
grace period later than the 30 days stated above, such period
Huntington Hospital
Important Notices (continued) shall apply in lieu of the 30 days. Payment is considered to be
request enrollment no later than 60 days after the determination
made on the date it is sent to the Plan or Plan Administrator.
for eligibility for such assistance.
The Plan will allow the payment for COBRA continuation
If you have a change in family status such as a new Dependent
coverage to be made in monthly installments but the Plan
resulting from marriage, birth, adoption, or placement for
can also allow for payment at other intervals. The Plan is
adoption, divorce (including legal separation and annulment),
not obligated to send monthly premium notices.
death or Qualified Medical Child Support Order, you may be able to enroll yourself and/or your Dependents. However,
The Plan will notify the Qualified Beneficiary in writing, or
you must request enrollment no later than 31 days after
any termination of COBRA coverage based on the criteria
the marriage, birth, adoption, or placement for adoption or
stated in this subsection that occurs prior to the end of the
divorce (including legal separation and annulment).
Qualified Beneficiary’s applicable maximum coverage period. Notice will be given within 30 days of the Plan’s decision to terminate. Such notice shall include the reason that continuation coverage has terminated earlier than the end of the maximum coverage period for such Qualifying Event and the date of termination of continuation coverage. See the Summary Plan Description for more information.
Medicare Part D – Important Notice About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Huntington Hospital and
Special Enrollment Rights Notices
about your options under Medicare’s prescription drug
CHANGES TO YOUR HEALTH PLAN ELECTIONS
or not you want to join a Medicare drug plan. If you are
coverage. This information can help you decide whether considering joining, you should compare your current
Once you make your benefits elections, they cannot be
coverage, including which drugs are covered at what cost,
changed until the next Open Enrollment. Open Enrollment
with the coverage and costs of the plans offering Medicare
is held once a year.
prescription drug coverage in your area. Information about
If you are declining enrollment for yourself or your Dependents (including your spouse) because of other health insurance or
where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
group health plan coverage, you may be able to enroll yourself
There are two important things you need to know about
and your Dependents in this plan if there is a loss of other
your current coverage and Medicare’s prescription drug
coverage. However, you must request enrollment no later than
coverage:
31 days after that other coverage ends. 1. M edicare prescription drug coverage became If you declined coverage while Medicaid or CHIP is in effect,
available in 2006 to everyone with Medicare.
you may be able to enroll yourself and/or your Dependents
You can get this coverage if you join a Medicare
in this plan if you or your Dependents lose eligibility for that
Prescription Drug Plan or join a Medicare Advantage
other coverage. However, you must request enrollment no
Plan (like an HMO or PPO) that offers prescription
later than 60 days after Medicaid or CHIP coverage ends.
drug coverage. All Medicare drug plans provide at
If you or your Dependents become eligible for Medicaid or CHIP premium assistance, you may be able to enroll yourself and/or your Dependents into this plan. However, you must
Huntington Hospital
least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
34
Important Notices (continued) 2. Huntington Hospital has determined that the
For example, if you go nineteen months without Creditable
prescription drug coverage offered by Huntington
coverage, your premium may consistently be at least 19%
Hospital Medical Plan is, on average for all plan
higher than the Medicare base beneficiary premium. You
participants, expected to pay out as much as
may have to pay this higher premium (a penalty) as long as
standard Medicare prescription drug coverage pays
you have Medicare prescription drug coverage. In addition,
and is therefore considered Creditable Coverage.
you may have to wait until the following October to join.
Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay
FOR MORE INFORMATION ABOUT THIS NOTICE OR
a higher premium (a penalty) if you later decide to
YOUR CURRENT PRESCRIPTION DRUG COVERAGE
join a Medicare drug plan. WHEN CAN YOU JOIN A MEDICARE DRUG PLAN?
Contact the person listed below for further information. NOTE: You will receive this notice each year. You will also receive it before the next period you can join a Medicare
You can join a Medicare drug plan when you first become
drug plan, and if this coverage through Huntington Hospital
eligible for Medicare and each year thereafter from
changes. You also may request a copy of this notice at any
October 15 to December 7.
time.
However, if you lose your current Creditable prescription
FOR MORE INFORMATION ABOUT YOUR OPTIONS
drug coverage, through no fault of your own, you will also be
UNDER MEDICARE PRESCRIPTION DRUG COVERAGE
eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You”
WHAT HAPPENS TO YOUR CURRENT COVERAGE IF YOU
handbook. You will receive a copy of the handbook in the
DECIDE TO JOIN A MEDICARE DRUG PLAN?
mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
If you decide to join a Medicare drug plan, your current Huntington Hospital coverage may be affected.
FOR MORE INFORMATION ABOUT MEDICARE MEDICARE PRESCRIPTION DRUG COVERAGE
If you do decide to join a Medicare drug plan and drop your current Huntington Hospital coverage, be aware that you and your Dependents may not be able to get this coverage back. WHEN WILL YOU PAY A HIGHER PREMIUM (PENALTY) TO JOIN A MEDICARE DRUG PLAN? You should also know that if you drop or lose your current coverage with Huntington Hospital and don’t join a Medicare
• Visit www.medicare.gov. • Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help. • Call 800.MEDICARE (800.633.4227).
TTY users
should call 877.486.2048.
drug plan within 63 continuous days after your current
If you have limited income and resources, extra help paying
coverage ends, you may pay a higher premium (a penalty) to
for Medicare prescription drug coverage is available. For
join a Medicare drug plan later.
information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 800.772.1213
If you go 63 continuous days or longer without Creditable
(TTY 800.325.0778).
prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage.
35
Huntington Hospital
Important Notices (continued) REMEMBER
CAN I SAVE MONEY ON MY HEALTH INSURANCE PREMIUMS IN THE MARKETPLACE?
Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to
You may qualify to save money and lower your monthly
provide a copy of this notice when you join to show whether
premium, but only if your employer does not offer you
or not you have maintained Creditable coverage and,
coverage, or offers medical coverage that is not “Affordable”
therefore, whether or not you are required to pay a higher
or does not provide “Minimum Value.” If the lowest cost
premium (a penalty).
plan from your employer that would cover you (and not any
____________________________________________________
other members of your family) is more than 9.5% of your household income for the year, then that coverage is not
Date:
October 2015
Affordable. Moreover, if the medical coverage offered covers
Name of Entity/Sender:
Huntington Hospital
less than 60% of the benefits costs, then the plan does not
Contact:
Benefits Department
Address:
100 W. California Boulevard
DOES
Pasadena, CA 91109
ELIGIBILITY FOR PREMIUM SAVINGS THROUGH THE
provide Minimum Value. EMPLOYER
HEALTH
COVERAGE
AFFECT
Phone: 626.397.3626
MARKETPLACE?
Health Insurance Marketplace Coverage Options and Your Health Coverage
Yes. If you have an offer of medical coverage from your
PART A: GENERAL INFORMATION This notice provides you with information about Huntington Hospital in the event you wish to apply for coverage on the Health Insurance Marketplace. All the information you need from Human Resources is listed in this notice. If you wish to have someone assist you in the application process or have questions about subsidies that you may be eligible to receive, you can contact KeenanDirect at 855.653.3626 or at www.KeenanDirect.com. Or contact the Health Insurance Marketplace directly at HealthCare.gov.
employer that is both Affordable and provides Minimum Value, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s medical plan. Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, you may lose the employer contribution (if any) to the employer-offered medical coverage. This employer contribution, as well as your employee contribution to employer-offered coverage, is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an aftertax basis.
WHAT IS THE HEALTH INSURANCE MARKETPLACE? The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins November 15, 2015 for coverage effective in February 15, 2016.
Huntington Hospital
36
Important Notices (continued) PART B: EXCHANGE APPLICATION INFORMATION In the event you wish to apply for coverage on the Exchange, all of the information you need from Human Resources is listed below. If you wish to have someone assist you in the application process or have questions about subsidies that you may be eligible to receive, you can contact KeenanDirect at 855.653.3626 or at www.KeenanDirect.com.
3.
Employer name
4.
Huntington Hospital 5.
Employer address
95-1644036 6.
100 W. California Boulevard 7.
City
Employer Identification Number (EIN) Employer phone number 626.397.3626
8.
Pasadena
State CA
9.
ZIP code 91105
10. Who can we contact about employee health coverage at this job? Benefits Department 11. Phone number (if different from above)
12. Email address
[email protected]
Availability Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices
Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP)
Huntington Hospital Group Health Plan (Plan) maintains
Please see the Summary Plan Description for more
a Notice of Privacy Practices that provides information to
information.
individuals whose protected health information (PHI) will be used or maintained by the Plan. If you would like a copy of the Plan’s Notice of Privacy Practices, please contact Human Resources, 100 W. California Boulevard, Pasadena, CA 91105, 626.397.3626.
37
Huntington Hospital
Contact Information Below is a listing of the toll-free numbers you can call with questions about the plans available to you. You can also use the web-site (if available) to access information from providers for the various plans. Benefit/Provider Huntington Hospital Benefits Department
Phone Number
Web Site
626.397.3626
www.hhbenefits.com
888.884.8083
www.keenan.com/benefits/hh
•
[email protected] Medical • Keenan, Medical Plan Administrators / COBRA • Anthem Blue Cross –– Out-of-Area
www.anthem.com/ca 800.810.2583
http://www.bcbs.com/
• Express Scripts Prescription Drugs
866.778.3785
www.express-scripts.com
–– Accredo / Specialty Drugs
800.803.2523
Wellness PATH • HealthFitness Health Coaching
800.337.8508, option 2
http://hmhwellness.biovia.healthfitness.com/
• LifeBalance (EAP)
877.259.3785
www.LifeBalance.net
• Delta Dental of California (Preferred & Preferred Plus)
800.765.6003
www.deltadentalins.com
• DeltaCare USA (DHMO)
800.422.4234
www.deltadentalins.com
800.877.7195
www.vsp.com
800.421.0344
www.unum.com www.mywealthcareonline.com/keenan/ Employer ID: KHC7000
Dental
Vision • Vision Service Plan (VSP) Basic Life, AD&D, LTD • Unum Life Insurance Company of America Flexible Spending Accounts
888.884.8083
Fidelity • Huntington Memorial Hospital Retirement Savings Plan, 403(b) Voluntary Benefits
800.343.0860
https://nb.fidelity.com/public/nb/hmh/home
• Aflac
714.446.1960
www.aflac.com
• MetLife
800.438.6388
www.metlife.com/mybenefits
• Prepaid Legal Services, Inc. and Identity Theft Shield
800.654.7757
www.seeyourbenefits.com/LegalShieldCA
• ING Customer Service (Voya Financial)
800.537.5024
–– Disability Claims
877.895.4616
–– Cancer
800.301.6416
First City Credit Union
800.944.2200
LA Fitness 24 Hour Fitness Weight Watchers
Huntington Hospital
www.firstcitycu.org
800.LAFITNESS 800.224.0240
www.24hourfitness.com/corporate/ HuntingtonHospital; Code: 17067 http://wellness.weightwatchers.com HMD ID 35322 Passcode: WW35322
38
Arranged by:
Innovative Solutions. Enduring Principles.
2355 Crenshaw Boulevard, Suite 200 Torrance, CA 90501 800.654.8102 License No. 0451271 www.keenan.com
9/2015
