Employee Benefits Guide

2014 – 2015 Benefits for 2014 – 2015 Plan Year Just as UNM Hospitals is committed to providing top quality healthcare services to our customers, UNM Hospitals is also committed to providing a comprehensive benefits program to our employees. Our benefits program reflects that UNM Hospitals commitment… blending a core level of protection with a variety of optional benefit choices. Some benefits are provided at no cost to you. You can then add to that core level of protection by choosing additional benefits that fit your own personal situation. UNM Hospitals also provides retirement savings plans which help you reach your own personal capital accumulation goals. Your benefits needs are as unique and individual as the life you lead, and they probably will change over time. UNM Hospitals benefits respond to your personal needs… both for this year and in the years to come… because the UNM Hospitals benefits program is flexible. Each year, as your needs change, you can put together a new package of benefits. This guide gives you an overview of the benefits available to you as an employee, outlines the options available to you and your family, and explains how to enroll.

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Table of Contents Benefits at a Glance ...................................................................................................3 Eligibility and Enrollment..........................................................................................5 Changing Your Elections ...........................................................................................6 Medical Benefits ........................................................................................................7 Standard Network Summary of Benefits ...................................................................8 Extended Network Summary of Benefit ..................................................................10 Dental Summary of Benefits ....................................................................................12 Vision Summary of Benefits ....................................................................................13 Flexible Spending Accounts ....................................................................................14 Life Insurance ..........................................................................................................20 Disability Coverage..................................................................................................21 Cancer, ICU, Heart Plans .........................................................................................21 LegalShield Services ................................................................................................21 Retirement Plan ........................................................................................................22 403(b) and 457(b) Retirement Plans ........................................................................23 Tuition Reimbursement .......................................................................................... 24 Employee Assistance Program (EAP) .....................................................................24 Important Plan Information......................................................................................25 Customer Service Contacts ......................................................................................26 Rate Sheet.................................................................................................................27 Important Notice ......................................................................................................29

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Benefits at a Glance Type of Benefit

Date of Participation

Standard (Lobo Care) Network Medical Plan Option

First of the month following date of hire

Extended Network Medical Plan Option

First of the month following date of hire

Prescription Plan

First of the month following date of hire

Dental Plan

First of the month following date of hire

Vision Plan

First of the month following date of hire

Healthcare & Dependent Care Spending Accounts

First of the month following date of hire

Life Insurance Accidental Death & Dismemberment Supplemental Life Insurance

First of the month following date of hire First of the month following date of hire First of the month following date of hire

Outline of Benefits Available Employee and covered dependents have the option of seeking care from UNM Hospitals and First Choice Providers Employee and covered dependents may seek care from UNM Hospitals and First Choice Providers plus entire Blue Cross Blue Shield of New Mexico HMO Network Enrollment in a medical plan makes you automatically eligible to participate in the prescription drug card and mail order program When you join the dental plan, you may seek care from the dental care provider of your choice (There is no “network” from which you must choose) Coverage includes examinations, lenses, frames, contact lenses, and discounted LASIK surgery Employee can pay for unreimbursed medical expenses, co-payments, deductibles, and dependent care with pre-tax dollars Use of Flex Debit Card An amount equal to annual base salary An amount equal to the life insurance coverage Employee can purchase additional insurance through a voluntary program for self or dependents

Who Pays for Plan UNM Hospitals pays for individual coverage for full-time employees

UNM Hospitals and employee

Included in medical plans

UNM Hospitals pays for individual coverage for full-time employees

Employee

Employee UNM Hospitals pays administration expenses

UNM Hospitals UNM Hospitals Employee UNM Hospitals pays administration expenses

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Benefits at a Glance Type of Benefit

Date of Participation

Long-Term Disability

First of month following one year from date of hire

Cancer/Heart/ICU Plans

First of month following date of hire

Retirement Plans  403(b)  457(b)

LegalShield

First of the month following date of hire

Tuition Reimbursement

After 6 months of service

Employee Assistance Program

Date of hire

Outline of Benefits Available Qualified disability after 180 days - employee will receive 60% of base salary up to $8,500 per month

Employee can elect voluntary coverage for cancer, intensive care, and heart services Employee has the option to defer income into a pretax account and/or an after tax account (Roth) for both plans

Employee can elect voluntary coverage for legal services Reimbursement for successful completion of approved coursework Confidential advisory program designed to assist employees experiencing personal, family, or workrelated problems. Available 24 hours a day through a toll free number

Who Pays for Plan UNM Hospitals Employee pays tax on LTD premiums so that benefit can be paid without being taxable income Employee

UNM Hospitals makes contributions to the 403(b) plan after employee completes one year of eligible service Employee can make contributions to the 403(b) and 457(b) plans Employee

UNM Hospitals and employee UNM Hospitals

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Eligibility and Enrollment Who Can Be Covered? You, your spouse (or domestic partner), and dependent children (including natural children, legally adopted children, step-children, and foster children) may be eligible for coverage based on the following requirements:    

You- must be a full-time or part-time employee. Benefits eligibility is based on assigned FTE. See the Eligibility Requirements Chart below. Your spouse- must be your legal spouse. Your domestic partner- must establish domestic partnership with HR. See policy HR-135 Domestic Partners. Your dependent child(ren)- Dependent child(ren) are covered until the end of the month in which they turn 26.

Eligibility Requirements

Benefit

Medical Dental Prescription Vision Flexible Spending Accounts Life Insurance AD&D Vol. Supplemental Life Insurance Long-Term Disability Cancer, Heart & ICU LegalShield 403(b) 457(b) Tuition Reimbursement Employee Assistance Program

.75 - 1.0 FTE Full-Time (30-40 hours per week)

.5 - .7 FTE Part-Time (20-29 hours per week)

Casual Pool (or less than 20 hours per week)

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

N N N N N N N N N N N Y Y N Y

Legend Y Yes, eligible to participate N No, not eligible to participate

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Changing Your Elections The benefit coverage you elect is in effect for the entire plan year, August 1, through July 31. According to IRS rules, you cannot make coverage changes during the year unless you experience a qualifying event. Qualifying events include:    

 

 



Marriage, separation, legal divorce or annulment, establishment of DP status; Birth, legal adoption of a child, or placement of a child with you for legal adoption; Death of your spouse/DP, dependent child, or other qualified dependent; Change in you or your spouse’s/DP’s employment status that results in a change in coverage – termination or commencement of employment; commencement of or return from unpaid leave of absence and a change in work-site, including a change in an individual’s employment status with the consequence that the individual becomes (or ceases to be) eligible under the plan; Change in your dependent child’s’ status – e.g. your dependent child reaches the age limit for coverage, up to age 26 Family Status Change events that result in “special enrollment rights” under the Health Insurance Portability and Accountability Act; o Special enrollment rights are available during the year to you and your dependents who lose coverage if you enroll within 31 days after losing the other coverage and you showed the other coverage as the reason that you did not take the coverage when you were first eligible; or o If you are not enrolled for health care coverage and you get married or have or adopt a child, you can enroll yourself and your eligible dependents within 31 days of the event. Family and Medical Leave Act (FMLA) – certain election changes are permitted when you start an FMLA leave and when you return from an FMLA leave; Judgment, decree or order resulting from a divorce, legal separation, annulment or change in legal custody (including a QMCSO) that required accident or health coverage for an employee’s child or foster child who is a dependent of the employee; You, your spouse or your dependent become entitled to or lose eligibility for Medicare or Medicaid.

Coverage changes you make must be consistent with your qualifying event as described in IRS guidelines. For example, if you get married, you can add your spouse as a dependent to your medical plan coverage, however you cannot change the medical plan option in which you have enrolled. You must submit the qualifying event forms within 31 days of the qualifying change. If you miss this 31-day period, you may make changes during the next annual enrollment period. Contact Benefits at 272-2325 for more information. 6| P a g e

Medical Benefits You have a choice of two medical plan options: 1. Standard (LoboCare) Network 2. Extended Network There are two basic differences between the plans: 1. Standard LoboCare Plan – Provides two levels of coverage:  Lobo Care Network (generally UNM Hospitals providers) provides maximum plan benefits  Out-of-Network (generally all other providers) provides lower benefits. May require deductibles and limited coverage of services. 2. Extended Network – Provides three levels of coverage:  LoboCare Network (generally UNM Hospitals providers) provides maximum plan benefits  Extended Network (generally the BCBS network) provides lower benefits  Out-of-Network (generally providers who are neither LoboCare nor BCBS network) provides the lowest benefits. May require deductibles and limited coverage of services. Refer to the Summary of Benefits Coverage at the end of this document.

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UNM Hospitals (UNMH)

Administered by:

Standard (LoboCare) Network Summary of Benefits This is a summary only that lists the deductible, out-of-pocket maximum, copayment and coinsurance amounts, and provides a brief description of UNM Hospitals Standard (LoboCare) Network benefits. UNM Hospitals Standard (LoboCare) Network Benefits

Member’s Share of Covered Charges Standard Network (In-Network Services)

Out-of-Network Services *

$250 ($500 Family Aggregate)

$1,500 ($3,000 Family Aggregate)

$5,000 per individual $10,000 per family

$10,000 per individual

Primary Care Physician (PCP) and OB/GYN Office Visit

$30 per visit

40%*

Specialist Physician Office Visit

$40 per visit

40%*

$30 (or $40 specialist) per visit

40%*

$30 initial visit only $30 per visit

40%* 40%*

$0 copay (included in office visit)

Not Covered

$40 per visit

Not Covered

No Charge

Not Covered

Acupuncture (max. 20 visits/year)

$40 per visit after deductible

Not Covered

Spinal Manipulation**

$40 per visit after deductible

Not Covered

Calendar Year Deductible Calendar Year Out-of-Pocket Maximum (Includes copayments, deductible and coinsurance only. Does NOT include drug charges, noncovered charges, or penalty amounts. In-Network and Out-of-Network amounts do not cross-apply.)

Office Surgery (including casts, splints, and dressings) Maternity Prenatal & Post-Partum Visits Mental Health and Chemical Dependency Services Allergy Injections, Serum; Therapeutic Injections Allergy Testing Preventive Care Services Adult Wellness/Physical Exams; Well Child Care; Immunizations; Preventive Lab Tests and X-Rays (mammogram, pap tests, urinalysis, etc.); Routine Colonoscopy (outpatient/office); Smoking/Tobacco Cessation Counseling; Vision & Hearing Screenings

Ambulance Services: Ground and Emergency Air Emergency Room Treatment

Ground $75 or Air $125 after deductible $300 per visit after deductible (copay waived if admitted)

Urgent Care Facility – UNM Hospitals facility

$75 per visit after deductible

N/A

Urgent Care Facility – All other urgent care facilities

$100 per visit after deductible

40%*

Home Health/Home I.V. Care (max. 100 visits/year) **

$30 per visit after deductible

40%*

$0 copay after deductible

40%*

Hospice Services** (up to 7 days of respite care)

Inpatient Hospital/Facility Services** (See “Transplant Services,” if applicable.) Medical/Surgical, Mental Health/Chemical Depend$500 per admission after deductible (no ency, and Maternity-Related Room and Board, Covcharge for inpatient physician services) ered Ancillaries; Inpatient Physical Rehabilitation $0 copay after deductible Skilled Nursing Facility (max. 60 days/lifetime) ** $350 facility copay after deductible Surgery (Outpatient/Ambulatory Surgical Center) ** $0 copay after deductible Observation Room Treatment (no emergency room)

40%* 40%* 40% * 40%*

Blue Cross and Blue Shield of New Mexico (BCBSNM) is a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association.

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UNM Hospitals Standard (LoboCare) Network Benefits Non-Routine Colonoscopy Lab, X-Ray, Diagnostic Tests (office, outpatient, freestanding facilities)** PET Scans, CT Scan ** Magnetic Resonance Imaging (MRI)

Member’s Share of Covered Charges Standard Network

Out-of-Network

$100 copay after deductible

40% *

20% after deductible ($1,000 annual out-of-pocket limit)

40%*

$200 copay after deductible $250 copay after deductible

Infertility Services, including drugs and injections (lifetime max. of 12 attempts per employee/spouse) **

50% after deductible

Not Covered

Medical Supplies, Durable Medical Equipment, Prosthetics, Orthotics **

20% after deductible

40%*

$40 per visit after deductible

40%*

Short-Term Rehabilitation (Physical, Occupational, and Speech Therapy, Outpatient/Office)** (max. 35 visits/year) Other Therapy, Outpatient Treatment Facility**

40%* No charge 20% after deductible Usual copays based on type of service TMJ, Dental-Related Accident, Oral Surgery ** 40%* and place of treatment Transplant Services ** (Must be received at a facility that contracts as a Standard or Extended Network provider for the transplant being received, including a facility in the national BCBS transplant network.) Chemotherapy, Radiation, Inhalation Therapy Dialysis

Cornea, Kidney, and Bone Marrow, Heart, HeartLung, Liver, Lung, and Pancreas-Kidney (Max. $5,000 per transplant for lodging expenses and $5,000 per transplant for travel expenses.)

Usual copays based on place of treatment and type of service

Not Covered

Prescription Drugs, Insulin, Diabetic Supplies, Enteral Nutritional Products, Special Medical Foods, & Smoking/Tobacco Cessation Note: Deductible does not apply and copayments are not applied to the out-of-pocket limit nor waived once the limit is met. Certain drugs, nutritional products/special medical foods, and certain injectable medications require preauthorization. Covered drugs and other items must be purchased at a pharmacy that participates in the Retail Pharmacy/ Specialty or Mail Order Service programs. (BCBSNM has contracted with a separate program for administration of the prescription drug benefits.)

Prescription Plan Copayments: Generic Drug Brand Name Drug On Drug List (no generic available) Drug Not On Drug List (brand-name with generic equivalent available) Specialty Medications (may require preauthorization; Mail-Order does not apply) Nonprescription enteral nutritional products and special medical foods (preauthorization required)

Retail 30-day $10 $40

Mail-Order 90-day $20 $80

$70

$140

20% or $250 whichever is less 20%

* Member’s share of out-of-network covered services after deductible is met. Member also pays difference between the covered charge, as determined by the Claims Administrator, and the provider’s billed charge. ** These services require preauthorization from BCBSNM or benefits will be reduced or denied. See a benefit booklet for full limitations and requirements. Note: You do not need a PCP referral in order to receive benefits at the Standard (LoboCare) Network level of coverage. You may visit any Standard (LoboCare) Network provider and receive Standard (In-Network) benefits for covered services. If you choose to visit a provider who is not a member of the Standard (LoboCare) Network, however, you will have to first meet a deductible and pay a percentage of covered charges (some exceptions, such as for emergency care are explained in the member’s benefit booklet). Out-of-network providers may bill you for amounts that are over the covered charge. This amount can sometimes be significant, and is not applied to your outof-pocket limit. Also, some benefits are available only if received from Standard (LoboCare) Network providers. Note: BCBSNM provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims, except as may be specified in the Administrative Services Agreement.

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UNM Hospitals (UNMH)

Administered by:

Extended Network Summary of Benefits

This is a summary only that lists the deductible, out-of-pocket maximum, and copayment and coinsurance amounts, and provides a brief description of UNM Hospitals Extended Network benefits.

UNM Hospitals Extended Network Benefits

Member’s Share of Covered Charges In-Network Services Standard Network

Extended Network

$250 ($500 Family Aggregate)

Calendar Year Deductible

Out-of-Network Services * $1,500 $3,000 Family Aggregate

Calendar Year Out-of-Pocket Maximum*** (Includes copayments, deductible and coinsurance only. Does NOT include drug charges, noncovered charges, or penalty amounts. In and Out- of-Network amounts do not cross-apply.

$5,000 per individual $10,000 per family

$5,000 per individual $10,000 per family

$10,000 per individual

Primary Care Physician (PCP) and OB/GYN Office Visits

$30 per visit

$45 per visit

40%*

$40 per visit

$60 per visit

40%*

$30 (or $40 specialist) per visit

$45 (or $60 specialist) per visit

40%*

$30 initial visit only $30 per visit

$45 initial visit only $45 per visit

40%*

$0 copay (included in office visit)

$0 copay (included in office visit)

Not Covered

$40 per visit

$60 per visit

Not Covered

No Charge

No Charge

Not Covered

Acupuncture (max. 20 visits/year)

$40 per visit after deductible

$60 per visit after deductible

Not Covered

Spinal Manipulation **

$40 per visit after deductible

$60 per visit after deductible

Not Covered

Specialist Physician Office Visit Office Surgery (including casts, splints, and dressings) Maternity Prenatal & Post-Partum Visits Mental Health and Chemical Dependency Services Allergy Injections, Serum; Therapeutic Injections Allergy Testing Preventive Care Services Adult Wellness/Physical Exams; Well Child Care; Immunizations; Preventive Lab Tests and X-Rays (mammogram, pap tests, urinalysis, etc.); Routine Colonoscopy (outpatient/office); Smoking/Tobacco Cessation Counseling; Vision & Hearing Screenings

Ambulance: Ground & Emergency Air

40%*

Ground $75 or Air $125 after deductible

Emergency Room Treatment

$300 per visit after deductible (copay waived if admitted)

$300 per visit after deductible (copay waived if admitted)

Urgent Care Facility – UNM Hospitals facility

$75 per visit after deductible

N/A

N/A

Urgent Care Facility – All other urgent care facilities

$100 per visit after deductible

$100 per visit after deductible

40%*

Home Health Care/Home I.V. Care (max. 100 visits/year) **

$30 per visit after deductible

$45 per visit after deductible

40%*

$0 copay after deductible

$0 copay after deductible

40%*

Hospice Services (up to 7 days of respite care) **

Inpatient Hospital/Facility Services ** (See “Skilled Nursing Facility” for skilled nursing facility admissions. See “Transplant Services,” if applicable.) Medical/Surgical, Mental Health/Chemical $500 per admission after deductible $600 per admission after deductible Dependency and Maternity-Related Room and (no charge for inpatient physician (no charge for inpatient physician 40%* Board and Covered Ancillaries; Physical services) services) Rehabilitation Skilled Nursing Facility (max. 60 days/lifetime) ** Surgery (Outpatient/Ambulatory Surgical Center)**

$0 copay after deductible

$0 copay after deductible

40%*

$350 facility copay after deductible

$600 facility copay after deductible

40%*

Blue Cross and Blue Shield of New Mexico (BCBSNM) is a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,

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UNM Hospitals Extended Network Benefits Observation Room (no emergency room) Non-Routine Colonoscopy Lab, X-Ray, Other Diagnostic Tests (office, outpatient, freestanding facilities)**

Member’s Share of Covered Charges In-Network Services Standard Network Extended Network

Out-of-Network Services*

$0 copay after deductible

$0 copay after deductible

40%*

$100 copay after deductible

$200 copay after deductible

40%*

20% after deductible

20% after deductible

*

$1,000 annual out-of-pocket limit

PET Scan, CT Scan**

40%*

$200 copay after deductible $250 copay after deductible

$200 copay after deductible $300 copay after deductible

Infertility Services, including drugs and injections (lifetime max. of 12 attempts per employee/spouse) **

50% after deductible

Not Covered

Not Covered

Medical Supplies, Durable Medical Equipment, Prosthetics, Orthotics **

20% after deductible

20% after deductible

40%*

$40 per visit after deductible

$60 per visit after deductible

40%*

No charge 20% after deductible

No charge 20% after deductible

40%*

Magnetic Resonance Imaging (MRI)

Short-Term Rehabilitation (Physical, Speech, Occupational Therapy, Outpatient/Office)** (max. 35 visits/year) Other Therapy, Outpatient Treatment Facility** Chemotherapy, Radiation, Inhalation Therapy Dialysis

Usual copays based on type of service and place of treatment 40%* TMJ, Dental-Related Accident, Oral Surgery** Transplant Services ** (Must be received at a facility that contracts as a Standard or Extended Network provider for the transplant being received, including a facility in the national BCBS transplant network.) Cornea, Kidney, and Bone Marrow, Heart, Heart-Lung, Liver, Lung, and PancreasKidney (Max. $5,000 per transplant for lodging expenses and $5,000 per transplant for travel expenses.)

Usual copays based on place of treatment and type of service

Not Covered

Prescription Drugs, Insulin, Diabetic Supplies, Enteral Nutritional Products, Special Medical Foods, & Smoking/Tobacco Cessation Note: Deductible does not apply and copayments are not applied to the out-of-pocket limit nor waived once the limit is met. Certain drugs, nutritional products/special medical foods, and certain injectable medications require preauthorization. Covered drugs and other items must be purchased at a pharmacy that participates in the Retail Pharmacy/ Specialty or Mail Order Service programs. (BCBSNM has contracted with a separate program for administration of the prescription drug benefits.)

Prescription Drug Plan Generic Drug Brand Name Drug On Drug List (no generic available) Drug Not On Drug List (brand-name with generic equivalent available) Specialty Medications (may require preauthorization; MailOrder does not apply) Nonprescription enteral nutritional products and special medical foods (preauthorization required)

Retail 30-day $10 $40

Mail-Order 90-day $20 $80

$70

$140

20% or $250 whichever is less 20%

Member’s share of out-of-network covered services after deductible is met. Member also pays difference between the covered charge, as determined by the Claims Administrator, and the provider’s billed charge. ** These services require preauthorization from BCBSNM or benefits will be reduced or denied. See a benefit booklet for full limitations and requirements. *** In- and Out-of-Network out-of-pocket amounts do not cross apply. Note: Extended Network members have access to the entire HMO statewide network, subject to normal plan provisions (preauthorization requirements, etc.). However, by using providers affiliated with the Standard Network, you may have lower out-of-pocket expenses. You do not need a PCP referral in order to receive benefits at the Extended Network or Standard Network level of coverage. You may visit any Standard Network provider and receive Standard Network benefits for covered services. If you choose to visit a provider who is not a member of the Standard Network, but is a member of the BCBSNM Network (Extended Network), you will receive Extended Network benefits for covered services. If you choose a provider that belongs to neither network, you will receive Out-ofNetwork benefits for covered services. However, you will have to first meet a deductible and pay a percentage of covered charges (some exceptions, such as for emergency care are explained in the member’s benefit booklet). Outof-network providers may bill you for amounts that are over the covered charge. This amount can sometimes be significant, and is not applied to your out-of-pocket limit. Also, some benefits are available only if received from Network (either Extended or Standard) providers. Note: BCBSNM provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims, except as may be specified in the Administrative Services Agreement.

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Vision Summary of Benefits

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Flexible Spending Accounts UNM Hospitals offers Flexible Spending Accounts – the Healthcare Spending Account and the Dependent Care Spending Account – for you to pay certain expenses with pre-tax dollars. Here is how the spending accounts work:

Decide How Much to Deposit

Use your Flex Debit Card to file a claim when you have expenses

Receive payment

Estimate the predictable medical and/or dependent care expenses you expect to have between August 1 and July 31. Then, decide how much you want to deposit to each account through payroll deductions. If your healthcare or dependent care provider accepts debit cards, you can use the Flex Debit Card. You can use the Flex Debit Card to directly pay for eligible out-of-pocket medical, dental and vision care expenses and/or dependent care expenses with no claim form to file and no waiting for reimbursement. The debit card is issued as a convenience to you. However, use of the card is not mandatory. If you do not want to use the card, destroy it and you may file your reimbursement requests with the claims administrator on paper claim forms. If your health or dependent care provider does not accept debit cards, you will need to submit your claim form and documentation of the expense for reimbursement. Your eligible expenses are paid or reimbursed from your spending accounts. If you terminate your employment with UNM Hospitals during the year, only charges incurred while you are an active employee are eligible for reimbursement, unless you continue to make deposits under COBRA (for Healthcare Spending Accounts only).

You may participate in either or both accounts and may choose to deposit up to:  

$104.16 per pay period into your Healthcare Spending Account and $208.33 per pay period into your Dependent Care Spending Account

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The IRS requires that you use the funds in your spending accounts for expenses that you incur prior to the end of the plan year with a grace period through October 15 of the calendar year. If you decide to contribute to either or both accounts, you should carefully estimate your expenses for the coming year. The accounts operate on a “use it or lose it basis,” meaning you forfeit any money you have left in your accounts after all of your eligible expenses for the year have been paid. Only expenses incurred can be paid from your spending accounts and all reimbursement requests must be filed within 90 days of the end of the plan year or any remaining funds will be forfeited. If you participate in both accounts, you may not transfer money between the accounts.

Example of Savings Here is an example of how much you can save and the additional amount of take-home pay you will have by participating in the Spending Accounts. This example assumes you earn $30,000 per year and participate in both types of accounts. With Spending Accounts $30,000 - $5,000 - $2,500 $22,500 - $3,375 - $1,721 _______ _______ $17,404 $1,699

How Much You Can Save Annual pay Before-tax Dependent Care Spending Account Before-tax Healthcare Spending Account Taxable Pay Federal tax withholding Social Security (FICA) After-tax Dependent Care costs After-tax Healthcare costs Take Home Pay Savings

Without Spending Accounts $30,000 _______ _______ $30,000 - $4,500 - $2,295 - $5,000 - $2,500 $15,705 $0

As you can see, by participating in the Spending Accounts you reduce your taxes and increase your spendable pay by $1,699 in this example. WHAT IS A HEALTHCARE SPENDING ACCOUNT? A Healthcare Spending Account is an account to which you contribute part of your pay before Social Security, Medicare and Federal Income (withholding) Tax, to pay for qualified medical, dental and certain vision expenses for yourself and/or your dependents.

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WHAT ARE QUALIFIED MEDICAL-DENTAL EXPENSES? Qualified medical-dental expenses are those expenses for services incurred during the plan year for the diagnosis, treatment or prevention of disease, and for treatments affecting any part or function of the body. The expense must alleviate or prevent a physical defect or illness. Expenses solely for cosmetic reasons generally are not eligible. (See next page for partial listing). Expenses paid by insurance are not eligible. Qualified vision expenses include prescription glasses and contacts. HOW DO I USE THE FLEX DEBIT CARD? Give the provider (doctor, hospital, pharmacist, etc.) your medical ID card first. When they ask you to pay your portion of the co-pay or deductible give them the Flex Debit Card. You can also use your card to pay for your portion of the eligible expenses by calling in or writing your card number on a “balance due” statement from the provider. Remember, you can only do this if the service was performed or expense incurred during the plan year. Keep all receipts, (such as medical, dental, prescription drug, and bills for glasses and contacts). This is required by the IRS, and the Plan Administrator may ask for them to verify your claim. If you do not have the receipts, you will be required to reimburse the plan. HOW CAN I DETERMINE THE BALANCE IN MY ACCOUNT? The card will not work if you go over your available balance. You can check your account balance 24 hours a day by visiting http://www.shdr.com/flex and follow the instructions. WHAT INFORMATION IS NECESSARY WHEN SUBMITTING A REQUEST FOR REIMBURSMENT IF THE PROVIDER DOES NOT ACCEPT THE DEBIT CARD? A. B. C. D. E.

The date the service was incurred must be during the current Plan Year. The type of service(s) performed. The cost of the service(s) performed. Your signature and the date on the claim form. Fax the form to the plan administrator at 1-252-293-9048 or 1-252-293-9049

CAN I REVOKE MY ANNUAL ELECTION AMOUNT? Generally no. However, if you do have a change in status (marriage, divorce, birth, adoption, unpaid leave of absence, change of employment status of you or your spouse from full-time to part-time or vice-versa) you can revoke your annual elected amount and make a new election for the remainder of the plan year, provided your change is consistent with the event. Contact benefits at 272-2325 for more information. WHAT IS THE “USE IT OR LOSE IT” PROVISION? 16| P a g e

You may submit claims for expenses incurred through the last day of the plan year. Generally, you will have a 90-day grace period after the end of the plan year to submit the Reimbursement Request form. IRS regulations stipulate that any unused or unclaimed balances remaining in your account are forfeited. WHAT IF I TERMINATE OR RETIRE AND HAVE MONEY IN MY ACCOUNT? Only expenses incurred prior to termination date can be reimbursed. WHEN DO I ELECT TO PARTICIPATE? Each year, during the flexible spending account open enrollment period, you must make a new election for the upcoming plan year. ARE THERE ANY NEGATIVES? You must use all the funds for eligible expenses during the plan year. Unused funds are forfeited to your employer. Your Social Security benefits may be slightly reduced due to lower contributions to that account. WHAT EXPENSES ARE NOT ELIGIBLE? A) B) C) D)

Insurance Premiums Expenses reimbursed by other sources or insurance Expenses not incurred during the plan year Expenses incurred for a domestic partner

WHAT HAPPENS WHEN MY CLAIM FOR HEALTHCARE REIMBURSEMENT ARE GREATER THAN THE AMOUNT OF MONEY DEPOSITED IN MY ACCOUNT? Your annual elected amount is available from the 1st day of the plan year (i.e., you can be reimbursed $200 even though you have only contributed $100 of your annual election amount to your account by the date of your claim). EXAMPLES OF QUALIFYING HEALTHCARE EXPENSES:        

Insurance deductible and co-payments Alcohol, drug or chemical dependency treatment Prescriptions, prescribed vitamins which are not available over-the-counter, birth control pills Chiropractor, osteopath, acupuncturist, etc. Dental treatments (x-rays, fillings, crowns, etc.) Eyeglasses, contacts, vision exams and optometrists Hearing aids, assistance and aids for the handicapped Doctor and hospitalization expenses and services 17| P a g e

     

Lab fees, physical exams, x-rays and vaccinations Over-the-counter medicines for a specific illness or injury, if prescribed Nursing services Mental health services Surgery, sterilization, gynecology, obstetrics, anesthesia FOR A COMPLETE LISTING OF ELIGIBLE EXPENSES VISIT http://shdr.com/shdr/sponsors-participants/flexible-benefits/eligible-expenses.asp

WHAT IS A DEPENDENT CARE SPENDING ACCOUNT? A Dependent Care Spending Account is an account to which you contribute part of your pay before Social Security, Medicare and Federal Income (withholding) tax to pay for qualified child and dependent care expenses. A qualifying person is:  

Your dependent who was under the age 13 when the care was provided and for whom you can claim an exemption, Your spouse who was physically or mentally unable to care for himself or herself, and for whom you can claim an exemption (or could claim an exemption except the dependent had $2,650 or more of gross income). See instructions on IRS form 2441 for other rules and exceptions.

HOW MUCH CAN I USE? The IRS currently allows a yearly maximum of $5,000 per year per family or $2,500 if you are married filing a separate return. WHAT EXPENSES ARE/ARE NOT ELIGIBLE FOR REIMBURSEMENT?    

  

Only qualifying expenses incurred during the plan year Expenses must be work-related (if married, both you and your spouse must work, be looking for work, or be a full-time student) Expenses must be for a qualified dependent’s care Your dependent must be under the age of 13 (If over the age of 13, your dependent must be physically or mentally incapable of caring for himself or herself. Note: This could include parents who are dependents.) Care can be provided inside or outside your home You can include part of the expense for household services if they are at least partly for the wellbeing and protection of a qualifying dependent Count the taxes you pay on wages you pay a person for qualifying child and dependent care expenses. 18| P a g e

    

DO NOT count the cost of education for kindergarten or higher. (Before and after school care is okay.) DO NOT count the cost of overnight camp DO NOT count transportation costs DO NOT include expenses incurred while you are not working due to illness or injury DO NOT count any amounts you pay to: (1) A dependent for whom you can claim an exemption, and (2) Your child who is under age 19 at the end of the plan year

WHY SHOULD I PARTICIPATE? In most cases, you will realize greater tax savings by participating in this plan than by claiming the tax credit on your 1040. Refer to IRS publication 503. HOW DOES THE PLAN WORK? Each pay period, UNM Hospitals will withhold from your pay the amount you elected during the annual enrollment. No FICA or Income Taxes will be deducted from this elected amount. These contributions will be held in a disbursement account in your name until withdrawn for qualifying expenses. CAN I REVOKE MY ANNUAL DEPENDENT CARE ELECTION AMOUNT? The IRS allows changes for: marriage, divorce, birth or adoption of a child, change in your or your spouse’s employment status, unpaid leave of absence, and changes in day care rates which are beyond your control. Otherwise your election amount remains the same throughout the plan year. WHAT HAPPENS IF I DO NOT INCUR MY ENTIRE ELECTED AMOUNT? Unused or unclaimed balances are forfeited. (“Use it or lose it”) You should be conservative when determining your annual election amount. WHAT IF I TERMINATE OR RETIRE AND HAVE MONEY IN MY ACCOUNT? Your contributions will cease and you will have until the end of the plan year to submit claims for expenses incurred while you were employed.

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Life Insurance Life Insurance and Accidental Death & Dismemberment (AD&D) for You UNM Hospitals provides one time your annual salary in Basic Life Insurance coverage and if you are deceased or disabled under the terms of AD& D, the benefit is doubled. The coverage is at no cost to you. You may purchase more Life Insurance coverage by electing Supplemental Employee Life Insurance coverage. If you die, your beneficiary will receive the amount of your Life Insurance. AD&D also pays a benefit if you die as a result of an accidental injury. If you suffer a covered injury, such as the loss of a limb or an eye, you would receive a portion of your AD&D benefits. Under current tax law, if your Basic Life Insurance coverage is more than $50,000, you will be taxed for the value of the coverage above $50,000. This means the value of your Basic Life Insurance that exceeds $50,000 will be treated as additional compensation for federal income tax and Social Security tax (FICA) purposes. The value of your life insurance will be determined using age-based rates set by the IRS. You may purchase Supplemental Life Insurance from $10,000 - $500,000, in increments of $10,000. Evidence of Insurability 



If you are currently enrolled for supplemental employee life coverage and wish to increase your coverage level at open enrollment time, you must submit medical evidence of insurability (Personal Health Application). If you are a newly eligible employee you must submit medical evidence of insurability only if your elected coverage will exceed $250,000.

Life Insurance for your Family If you elect to purchase Supplemental Employee Life Insurance, you may also purchase life insurance for your spouse and child(ren). This coverage would pay a benefit to you in the event that your covered spouse or child dies. You pay the full cost of this coverage with after-tax dollars. Your choices for Life Insurance for your family are: Spouse You may elect coverage for your spouse in $10,000 increments to a combined maximum of $250,000 or the amount equivalent to the employee’s Supplemental Life coverage, whichever is less. Medical evidence of insurability is required for coverage amounts in excess of $100,000. You pay the full cost for this coverage. Spouse rate is based on the level of coverage and their age.

Child(ren) You may buy life insurance for your eligible children. Children up to the age of 6 months are covered for $1,000. Children 6 months to age 26 are covered for $2,500.

You pay the full cost for this coverage with aftertax dollars. If you insure more than one child, you still pay one premium per pay period regardless of the number insured.

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Disability Coverage UNM Hospitals provides Long-Term Disability (LTD) coverage at no cost to you. The LTD Plan provides 60% of your base monthly pay, to a maximum of $8,500 per month. Benefits under this plan are coordinated with any other source of disability benefits you may be eligible to receive (such as Social Security or Workers’ Compensation). The 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.

Cancer, ICU, Heart Plans The Cancer and Intensive Care Plans are optional coverages which reimburse you up to a specified amount based on the actual treatments/services received. These optional coverages pay benefits in addition to any other benefits you are eligible to receive. Coverage includes: inpatient benefits, transportation and lodging benefits, and surgical and treatment benefits. You may choose this benefit for yourself as well as your entire family. Washington National is the Plan administrator of this benefit. To apply for coverage, you must call Joan Buckner at 505-821-3971. Once approved, UNM Hospitals will be notified of payroll deduction amounts.

LegalShield Services UNM Hospitals offers you the option to participate in a prepaid group legal plan through Legal Shield. The plan covers you, your spouse and eligible dependents. This plan provides easy, affordable access to professional legal counsel for legal advice and consultation on nearly all personal legal matters. The coverages include preventive legal services, will preparation, motor vehicle legal defense, trial defense services, audit services and more. The LegalShield component provides members with 24-hour access to a toll-free number for attorney assistance in case of emergency. An identity theft component is also available through Kroll Advisory Solutions with two levels of coverage, both with comprehensive restoration.

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Retirement Plan Although your retirement may be decades away, planning for a successful retirement should begin early in your working career. Many people don’t realize that Social Security will not provide a sufficient income when they retire. In fact, Social Security currently provides only about 25% - 40% of the retirement income the average American needs. Your retirement plan has 2 components: 1. UNM Hospitals begins contribution to the 403b pre-tax plan after you have completed one year of eligible service. Once you have completed 5 years of eligible service you are 100% vested in the UNM Hospitals contributions. 2. You may also make contributions to the retirement plan through convenient payroll deductions. You have two contribution options:

a. 403(b)  Savings can be made pre-tax  Savings can be made after-tax (Roth Plan) b. 457(b)  Savings can be made pre-tax  Savings can be made after-tax (Roth Plan)

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403(b) and 457(b) Retirement Plans Retirement Plans At-A-Glance Eligibility

Eligible on the first of the month following your date of hire. Participation You will automatically be enrolled in the plan with a 2% contribution unless you opt out. Savings Amount In general, you may contribute a percentage of your pay in whole percentages up to 99% of your eligible earnings. You can participate in either plan or in both plans. The amount you can save is set by the IRS regulation. In 2015, you can save up to $18,000 in the 403(b) and in the 457(b). If you will be age 50 or older at any time in 2015, you can defer up to an additional $6,000 in the 403(b) plan. Choice of Pre-Tax Contributions When you contribute to the plan with pre-tax And dollars, you don’t pay federal income on that After-Tax Contributions money, or its investment returns, until you take it out of your account. Both pre-tax and aftertax contributions can be made. If you contribute with after-tax dollars, you do pay taxes at the time of saving, but savings and investment earnings are not taxed at the time of distribution. Visit the Fidelity website to help you determine what option is best for your unique situation. Investment Choices You have a wide range of investment funds from which to choose. Each fund is designed with specific investment objectives. Your enrollment materials offer more details on your fund choices. Access to Your Account You may access your account information via the internet through www.netbenefits.com. You have access to the Fidelity 403(b)/457(b) customer service toll free number 1-800-3430860 for account information, changing your investments, and other transactions. See the Summary Plan Description on the UNM Hospitals Intranet, Human Resources, under Benefits Now/Retirement

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Tuition Reimbursement Program Eligibility

Regular Full-time or Regular Part-time employees Minimum 6 months service with UNM Hospitals Successful completion of course with grade of C or better

Approval For an application, go to the UNM Hospitals Intranet, Web Based Systems, Tuition Reimbursement Request

Employees must submit an approved request (approval by direct supervisor) to Human Resources prior to enrollment in the course. Required information includes: Name of institution, name of each course requested, course description, course schedule and tuition costs. The employee is responsible for filing application for admission with the Admissions Office of the educational institution, and meeting their student entrance requirements.

Please see HR Policy 370 “Tuition Reimbursement” located on the UNM Hospitals intranet for full details on the tuition reimbursement benefit.

Employee Assistance Program (EAP) The Employee Assistance Program (EAP), administered by Outcomes, Inc. is available to assist you and your eligible dependents with personal issues. Through Outcomes, you have confidential access to fully-licensed professionals who can help with personal issues that affect your health, personal life, family life, work life, or job performance. You can reach the EAP by calling (505) 243-7145, 1-800-677-2947 or by visiting the website www.outcomesnm.org.

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Important Plan Information When your employment with UNM Hospitals ends, you will receive a letter explaining the disposition of your benefits. Depending upon what plans you participated in, you may receive additional mailings from various providers within 30 days of your benefits end date. Remember, your coverage typically will expire at the end of the month following termination. See individual policy guidelines under each plan’s Summary of Plan Documents, on the UNM Hospitals Intranet, Human Resources, under Benefits Now.

Period of Coverage 18-Month COBRA Continuation

29-Month COBRA Continuation

36-Month COBRA Continuation

Qualifying Event COBRA coverage continues for 18 months for you or your covered dependent(s) if your coverage ended because of:  A reduction in hours, or  Termination of employment COBRA coverage continues for a total of 29 months for you and your covered dependent(s) if at the time of the original 18-month COBRA qualifying event:  You or your covered dependent(s) became permanently disabled, according to Social Security, within the first 60 days after the date coverage was lost COBRA coverage continues for 36 months for your covered dependent(s) if one of the following occurs:  You die  You become eligible for Medicare Benefits  You get divorced or legally separated or  Your covered dependent fails to qualify as a dependent

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Customer Service Contacts Plan Benefits Website Benefits Info Line

Administrator UNM Hospitals

Phone Number (505) 272-2325

Website Address and Login Information UNM Hospitals Intranet – Human Resources – Benefits Now or [email protected]

Standard and Extended Medical Plans

Blue Cross Blue Shield of New Mexico

1-800-423-1630

www.bcbsnm.com Select Log In, then choose I’m a Member, and click Register now. Under Plan Information, enter the Group Number (N11003 for Standard or N11004 for Extended), Your Member ID and Home Zip Code. You will then create your member profile and your own user name and password.

Prescription Plan

PrimeMail Rx

1-877-357-7463

www.myprime.com Registration/log in is required in order to obtain information specific to your plan. Click on Register Now to set up your account

Dental Plan

Delta Dental

(505) 855-7111

www.deltadentalnm.com or https://www.consumertoolkit.com First time users need to set up an account to log in.

Vision Plan

VSP

1-800-877-7195

www.vsp.com Click on Members to take you to the log in screen. New members will have to register. Use the last 4 of your social to register and enter your name and date of birth.

Healthcare & Dependent Care Spending Accounts

SHDR

1-800-768-4873 or 1-800-930-2441

www.shdr.com Click on the plan participant drop down box and click “FSA/HRA.” For first time users, the Username is your last name and the last four digits of your social security number. Your Password is the five digit zip code of your mailing address.

Cancer/Heart/ICU Plans

Washington National

1-800-541-2254

www.washingtonnational.com or https://my.onlineservicecenter.com/ Select Policy Holder from the drop down menu to log in. First time users will need to register.

LegalShield

1-800-541-2254

Retirement Plan

Fidelity

Customer Service 1800-343-0860

Employee Assistance Program

Outcomes, Inc.

(505) 243-7145 (800) 677-2947

www.fidelity.com/atwork First time users will need to create a username and password. www.outcomesnm.org

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Important Notice The Benefits Enrollment Guide has been prepared for you as a guide to the various benefits of UNM Hospitals. The contents of this Benefits Enrollment Guide will be changed and updated by UNM Hospitals when necessary. These contents are not intended to create a contract between the Hospital and any employee. Nothing in this document binds the Hospital or any employee to any specific procedures, policies, benefits, working conditions, privileges of employment or definite period of employment.

Last Updated January 12, 2015 29| P a g e