2015

®

Employee Benefits

Guide

2 Table of Contents Eligibility and Enrollment___________ 1

Long Term Care, Whole Life, Accident, and Critical Illness________________ 13

Medical and Prescription Plans_______ 2 Additional Benefits_______________ 14 Wellness Program and Resources_____ 8 Employee Assistance Program_______ 15 Dental Insurance_________________ 9 HealthPark_____________________ 15 Vision Insurance_________________ 10 Retirement Investment Plan_________ 15 Disability Insurance_______________ 11 Important Contacts_______________ 16 Life and AD&D Insurance___________ 12 Legal Notices____________________ 17

New for 2015 In this valuable reference guide, we have included explanations of the benefit programs, important plan information, contact addresses, phone numbers, web addresses, and comparison charts. It is important that you review this guide so you can fully understand the benefit programs offered to you through Owensboro Health, especially since we’re making some changes this year. • Focus on using your benefits wisely: Your benefits are an important part of your total compensation, but they’re only as valuable as your understanding of them. Knowing how to be a wise consumer of your benefits will save you and Owensboro Health money. • Two new Account Based Health Plan (ABHP) medical options, replacing the old PPO medical plan: In order to support our focus on wise benefits usage, we’re offering ABHPs that allow you to control how your benefit dollars are spent. • Earn lower health premiums through healthier lifestyles Owensboro Health will introduce a tobacco-free discount on health premiums. Read more about the Tobacco Free certification to learn how to qualify.

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1 Eligibility and Enrollment Guidelines All enrollments must be completed online at www.owensborohealth.hrintouch.com When does coverage start?

Making enrollment changes during the year

Employees are eligible for benefits the first of the month following 30 days of employment as an Eligible Employee or the first of the month after changing to a full or part-time status. For employees with a qualifying event, benefits will be effective the first of the month following the qualifying event.

In most cases, your pre-tax benefit elections are irrevocable and remain the same for the entire year (January 1 – December 31). During each Open Enrollment period, you will have the opportunity to review your benefit elections and make changes for the coming year.

Who is eligible for coverage?

If you do not make a benefit election during the 2015 Open Enrollment or during your initial enrollment period after you are hired, you and any dependents will not have coverage effective January 1, 2015, and you must wait until the following Open Enrollment period to elect or change your coverage unless a status change or HIPAA qualifying event is applicable.

Employees: Full time employees (.9 or 1 FTE) and part-time employees (.5-.8 FTE) are eligible to receive Owensboro Health medical insurance. Employees in a PRN status are not eligible to receive health benefits. Dependents: • Children up to age 26 are eligible for coverage. Medically incapacitated children over the age of 26 are also eligible, provided the dependent was covered and disability occurred before age 26. • Legally married spouses without access to medical coverage or with access to medical coverage that is significantly higher than the Owensboro Health premium (see below). If the “Employee Only” premium at the spouse’s employer is less than $300 per month, the spouse cannot be on the Owensboro Health health plan. Employees who enroll a spouse for coverage must complete The Spousal Verification Form indicating the spouse’s status (unemployed, disabled, selfemployed, working at Owensboro Health or employed). If the spouse is employed, documentation must be provided indicating the cost of “Employee Only” coverage at the spouse’s employer. The information provided will be verified. Falsification of the document is grounds for disciplinary action up to and including termination of employment.

Certain coverages allow limited changes to elections during the year. These benefits include the medical, vision, and dental plans. Under these benefits, you may make changes to your elections only during the year if you have a status change or HIPAA qualifying event. Status Changes include: • Marriage, divorce, or legal separation • Gain or loss of an eligible dependent for reasons such as birth, adoption, placement for adoption, court order, disability, or death • An event that causes a dependent to satisfy or cease to satisfy the eligibility requirements of the Plan, such as reaching the dependent age limits or any similar circumstance • Changes in your spouse’s employment or benefit coverage that affect benefits eligibility • Changes in a dependent’s benefits eligibility The change to your benefit elections must be consistent with the qualifying event. You have 30 days from the date of a qualifying event to make your election changes. Visit www.owensborohealth.hrintouch.com or call 1-855-244-5948 to make a change. The date of the qualifying event will be the effective date of the change.

Facts to Remember Life insurance changes are submitted to underwriting and are subject to approval. Your on-line enrollment/changes must be completed and documentation provided within 30 days after your hire date or qualifying event (marriage, divorce, birth or adoption of child, or loss of insurance). If an employee and their spouse both work at Owensboro Health, they may only be enrolled in one medical plan. Spouses of employees who are eligible for health insurance coverage with their employer may not be eligible to be on the Owensboro Health health insurance.

Owensboro Health | 2015 Employee Benefits

2 Medical Plans Your cost for coverage is based on the plan you choose and your level of coverage. The table below shows the employee cost per pay period and employee monthly cost. When choosing a plan, consider more than contributions. Both ABHPs are similar in the way the benefits are applied, but you’ll see differences in the deductible and out-of-pocket maximum amounts, as well as contributions. Talk with your covered family members about what health care expenses you expect to incur this year, and look at the out-of-pocket maximum (the most you’ll pay in a year, so the “worst case scenario”) to see which ABHP is right for you and your family. Remember: Premiums are deducted from the first and last pay vouchers. Medical Rates: 2015 Contributions ABHP 1 Full-Time Non-Smoker Total Cost Employee Only Employee + Spouse

Employer Cost

Employee Cost / Month

Part-Time Non-Smoker Employee Cost / Pay Period

Employer Cost

Employee Cost / Month

Employee Cost / Pay Period

$637.00

$467.00

$170.00

$85.00

$422.00

$215.00

$107.50

$1,337.00

$982.00

$355.00

$177.50

$897.00

$440.00

$220.00

Employee + Child(ren)

$1,210.00

$890.00

$320.00

$160.00

$805.00

$405.00

$207.50

Employee + Family

$1,974.00

$1,449.00

$525.00

$262.50

$1,324.00

$650.00

$325.00

Medical Rates: 2015 Contributions ABHP 1 Full-Time Smoker

Employee Only

Part-Time Smoker

Total Cost

Employer Cost

Employee Cost / Month

Employee Cost / Pay Period

Employer Cost

Employee Cost / Month

Employee Cost / Pay Period

$637.00

$467.00

$220.00

$110.00

$422.00

$265.00

$132.50

Employee + Spouse

$1,337.00

$982.00

$405.00

$202.50

$897.00

$490.00

$245.00

Employee + Child(ren)

$1,210.00

$890.00

$370.00

$185.00

$805.00

$455.00

$232.50

Employee + Family

$1,974.00

$1,449.00

$575.00

$287.50

$1,324.00

$700.00

$350.00

Medical Rates: 2015 Contributions ABHP 2 Full-Time Non-Smoker Total Cost Employee Only Employee + Spouse

Employer Cost

Employee Cost / Month

Part-Time Non-Smoker Employee Cost / Pay Period

Employer Cost

Employee Cost / Month

Employee Cost / Pay Period

$598.00

$493.00

$105.00

$52.50

$443.00

$155.00

$77.50

$1,254.00

$1,044.00

$210.00

$105.00

$949.00

$305.00

$152.50

Employee + Child(ren)

$1,135.00

$945.00

$190.00

$95.00

$855.00

$280.00

$140.00

Employee + Family

$1,851.00

$1,546.00

$305.00

$152.50

$1,401.00

$450.00

$225.00

Medical Rates: 2015 Contributions ABHP 2 Full-Time Smoker

Part-Time Smoker

Total Cost

Employer Cost

Employee Cost / Month

Employee Cost / Pay Period

Employer Cost

Employee Cost / Month

Employee Cost / Pay Period

$598.00

$493.00

$155.00

$77.50

$443.00

$205.00

$102.50

Employee + Spouse

$1,254.00

$1,044.00

$260.00

$130.00

$949.00

$355.00

$177.50

Employee + Child(ren)

$1,135.00

$945.00

$240.00

$120.00

$855.00

$330.00

$165.00

Employee + Family

$1,851.00

$1,546.00

$355.00

$177.50

$1,401.00

$500.00

$250.00

Employee Only

Owensboro Health | www.owensborohealth.hrintouch.com

3 All coinsurance in this chart refers to the amount Owenboro Health pays after the deductible is met. You pay the remaining percentage of coinsurance costs. 2015 Medical Plan Comparison Chart ABHP 1 Owensboro Health Facility

Owensboro Health Employed and Active Medical Staff

ABHP 2

In-Network

Out-ofNetwork

Owensboro Health Facility

Owensboro Health Employed and Active Medical Staff

Out-ofNetwork

In-Network

Deductible - Individual - Family

$1,400 $2,800 - aggregate

$2,800 $5,600

$2,000 $4,000 - aggregate

$4,000 $8,000

Annual Out-ofPocket Max - Individual - Family

$3,400 $6,800 - aggregate

$6,800 $13,600

$4,000 $8,000 - aggregate

$8,000 $16,000

Covered at 100%

Not covered

Covered at 100%

Not covered

Benefits Routine Preventive Care Office Visit - Primary Care - Specialist

Deductible, then $10 copay Deductible, then $20 copay

Deductible, then $25 copay Deductible, then $35 copay

Deductible, then 50% Deductible, then 50%

Deductible, then $10 copay Deductible, then $20 copay

Deductible, then $25 copay Deductible, then $35 copay

Deductible, then 50% Deductible, then 50%

Inpatient

Deductible, then 95%

Deductible, then 90%

Deductible, then $150 copay/day and 75%

Deductible, then $150 copay/day and 25%

Deductible, then 95%

Deductible, then 90%

Deductible, then $150/day and 75%

Deductible, then $150/day and 25%

Outpatient Surgery

Deductible, then 95%

Deductible, then 90%

Deductible, then $500 copay and 75%

Deductible, then $750 and 25%

Deductible, then 95%

Deductible, then 90%

Deductible, then $500 and 75%

Deductible, then $750 and 25%

Outpatient Services

Deductible, then 95%

Deductible, then 90%

Deductible, then $100 copay and 75%

Deductible, then $250 and 25%

Deductible, then 95%

Deductible, then 90%

Deductible, then $100 and 75%

Deductible, then $250 and 25%

Emergency Room X-Ray and Lab

Deductible, then 90% Deductible, then 95%

Deductible, then 75%

Deductible, then 90%

Deductible, then $100 and 75%

Deductible, then $100 and 25%

Deductible, then 95%

Deductible, then 75%

Deductible, then $100 and 75%

Deductible, then $100 and 25%

2015 Prescription Drug Plan Comparison Chart: Both ABHP1 and ABHP2 Owensboro Health Pharmacy

In-Network Pharmacies

$5 copay after deductible

$25 copay after deductible

Retail (34 day supply, not to exceed 100 units) Generic Brand - Formulary Brand - Non-Formulary

$20 copay after deductible

$40 copay after deductible

50% after deductible ($30 min - $100 max)

50% after deductible ($60 min - $100 max)

Mail Order (90 day supply) Generic

$10 copay after deductible

$50 copay after deductible

Brand - Formulary

$40 copay after deductible

$80 copay after deductible

50% after deductible ($60 min - $200 max)

50% after deductible ($120 min - $200 max)

Brand - Non-Formulary

All costs in this chart, including copays, refer to the amount you pay after the medical deductible is met. Owensboro Health pays the remaining percentage of coinsurance costs.

Once you meet the deductible, co-pays are waived at the following locations: • MultiCare Madisonville (Urgent Care Only) • MultiCare Ohio County (Urgent Care Only) • MultiCare Tell City • MultiCare Owensboro

• Wal-Mart Clinics - Newburgh, In - Owensboro-Hwy 54

- Henderson, Ky - Owensboro-Frederica

IMPORTANT CHANGE! Beginning January 1, 2015, this health plan will not cover facility charges at Deaconess or St. Mary’s Hospitals in Evansville, IN or Riverview Surgery Center in Rockport, IN. ER and physician charges will be covered.

Owensboro Health | 2015 Employee Benefits

4 Understanding Your Health Savings Account (HSA) Both ABHPs allow you to set up a Health Savings Account (HSA) administered by Bancorp. This account can help alleviate qualified health care expenses you may incur. You may elect to make your own pre-tax contribution to this account by: • Automatic payroll deductions • Deposits from another bank account such as saving or checking accounts, one time or on a recurring basis • Mailing a check with a contribution/deposit form The maximum contribution to your account cannot exceed the IRS yearly limit ($3,350 Single/$6,650 Family in 2015). Employees age 55 and older can contribute an additional $1,000, known as a “catch-up” contribution. Any money remaining in your HSA at the end of the year will roll over for use in future years, accruing tax free interest, and allowing you to accumulate savings.

Remember to keep your receipts for HSA funds with copies of your tax returns. While you will not be asked to provide receipts, you may need them in case of an IRS audit. Click here for a list of eligible expenses. How Does it Work? The HSA is easy to use. Access the funds you set aside quickly and conveniently with your HSA debit card. Use your debit card just as you would a traditional bank debit card, swiping it at the point-of-sale. Just like a traditional bank account, the funds must be available in your HSA at the time you use your debit card. Owensboro Health will be funding your HSA in 2015 based on the table below. Annual income is calculated using base rate pay times authorized hours (FTE). HSA Funding for both ABHP1 and ABHP2 Income Level

Employee Only

Employee + Dependents $1,500

Up to $35,000

$750

$35,000 - $70,000

$625

$1,250

$70,000 - $125,000

$500

$1,000

$0

$0

Over $125,000

Owensboro Health | www.owensborohealth.hrintouch.com

5 Understanding Your Health Savings Account (HSA) How is an HSA like a 403(b)? One way many people use the HSA is to save for medical costs after retirement. Some studies estimate that a 65-year-old couple retiring in 2015 will need $240,000 to cover future medical costs, not including the cost of Long Term Care. Check out the comparison below of traditional 403(b) accounts to see if the HDHP with HSA plan may be right for you.

2015 maximum tax-free employee contribution 2015 catch-up tax-free contribution Who contributes Can I use my money anytime?

Can it be invested? Can I take it with me if I leave Owensboro Health? Early withdrawal penalties Required minimum distributions Will I be taxed when I use my money?

403(b)

HSA

$18,000

$3,350 for individual, $6,650 for family, including the Owensboro Health contribution

Ages 50 and over: $6,000

Ages 55 and over: $1,000

You and Owensboro Health

You and Owensboro Health

No, not before age 59½ without penalties. Exceptions are made for loans and hardship withdrawals

Yes, accessible at any age for health care expenses

Yes

Yes, once balance reaches $2,500

Yes, your money is yours. Owensboro Health contributions are yours after you are vested

Yes, the money is yours to keep

10% penalty if used before age 59½

None for health care expenses. 20% penalty if used for non-health care expenses before age 65

At age 70½

No minimum distributions

Yes, unless contributions were made as Roth or after-tax

No, not if the money is used for health care expenses

Ineligible to Contribute to an HSA Only you can make the right healthcare coverage decision for you and your family. Evaluate all the options to determine the best one based on your personal situation, including Owensboro Health plans, Medicare (if you qualify), a spouse’s plan, or coverage available through the state’s Health Insurance Marketplace. If you are enrolled in Medicare, you may not contribute to a Health Savings Account, per IRS rules. Visit www.healthcare.gov for information about Medicare eligibility, laws governing consumer plans and HSAs, and the Marketplace. Federal regulations note that certain other individuals are not eligible to contribute to an HSA: • Individuals enrolled in Medicare • Individuals covered under a non-HSA-qualified plan, such as a spouse’s nonhigh deductible health plan or Tricare if eligible due to military service • Individuals who are claimed as a dependent on someone else’s tax return. • An individual whose spouse is enrolled in a Traditional Flexible Spending Account, even if no claim is submitted.

Owensboro Health | 2015 Employee Benefits

6 Anthem HealthLink Pre-Certification Requirements All Inpatient Hospital and standard pre-certifications must be pre-certified through Anthem HealthLink. Pregnancy related admissions for delivery will not require certification unless the confinement exceeds 48 hours for a vaginal delivery or 96 hours for a cesarean section delivery. • Regardless of whether you go to a network provider or a non-network provider, pre-certification is required for certain care and services. A service must be pre-certified to confirm the service is an eligible benefit under the applicable Certificate of Coverage, including medical necessity and/or experimental/investigational benefit determination. • It is the member’s responsibility to ensure any procedure in question has been pre-certified. Please ask your physician if the procedure he/she is recommending is included in the list below. • To ensure trouble-free claims administration, it is recommended that you pre-certify benefits as soon as possible prior to the date of service. • When you or a covered family member need to pre-certify benefits, your physician, you or a representative must follow the following steps before expenses are incurred: - Call the toll-free Pre-certification number on your ID card; - Identify yourself as a Owensboro Health member and give the group number and member ID number on the front of your ID card; - State that you are calling to pre-certify benefits; - Be prepared to provide information about the scheduled admission or procedure, including: - Patient name; - Hospital or site where the procedure will be performed; - Diagnosis code of the procedure (from physician); - Full name, address and phone number of the attending or requesting physician. Anthem will send a letter to you and the physician or facility to certify or deny benefits for the admission or procedure. In the case of a denial, the letter will explain the basis for the decision, invite you to provide additional information for Anthem’s review that might change the decision, and outline appeal procedures. Services Requiring Pre-Certification

• Occupational Therapy

Inpatient Services and Procedures (except in a physician’s office or emergency situation*):

• Physical Therapy

• Bariatric Surgery

Ambulatory Diagnostic Imaging:

• Lumbar Spine Surgery • Elective Hospital Admission • Rehabilitation facility admission • Emergency Hospital Admission* • Skilled nursing facility admission • Hospice Care • Transplants • Long-Term Acute Care Admission Ambulatory Surgical Procedures: • Bariatric surgery • Cartilage transplant knee • Lumbar spine surgery • Nasal septoplasty • Rhinoplasty • Sinus endoscopy • Sleep apnea surgery – AUP/UPPP, Nasal, and Uvulopalatoplasty Ancilliary Services: • Home Infusion Services • Home Health Services • Home Hospice

Owensboro Health | www.owensborohealth.hrintouch.com

• Speech Therapy • MRA of the head and/or neck • MRI of the brain • MRI of the spine-cervical, thoracic, lumbar, sacral • PET scan Durable Medical Equipment: • Bone stimulator • Cardio/external defibrillator • Cochlear implant • Cooling devices (i.e. polar care) • CPAP/BIPAP • Electric scooter • Functional electrical stimulator bike • Limb prosthetic • Myoelectric prosthetic • Neuromuscular stimulator • TENS unit • Wheelchair (custom) • Wheelchair (power) • Wound vacs *Emergency hospital admissions do not follow the same pre-certification procedures, but should be called in as soon as possible.

7 Pharmacy Services Owensboro Health’s Outpatient Pharmacy Check out the Owensboro Health Outpatient Pharmacy to fill your prescriptions. They will do their best to find you a low out-of-pocket cost for your prescription. You may receive a 90-day supply of maintenance medication for two monthly co-pays through the Outpatient Pharmacy. You may also use the Owensboro Health Outpatient Pharmacy to fill your prescription through mail order. Hours are: Monday through Friday, 7 a.m. to 7 p.m. Saturday and Sunday 9 a.m. to 5 p.m. Stop by or call 270-417-6701 to place your prescription. Retail Pharmacy With over 60,000 pharmacies in our network, it is more than likely the pharmacy you are currently using will be an LDI participating pharmacy. You may contact LDI directly to determine if your independent pharmacy participates in the network. Mail Order Prescriptions You may contact LDI anytime to have your prescriptions transferred to LDI’s mail order service. You may receive a 90-day supply of maintenance medication for two monthly co-pays through LDI’s mail order service. Prescriptions are mailed in confidential, secure packaging to your home. Turn-around time for mail order service is within 24-hours of receipt. LDI makes the switch from retail to mail order easy! Simply call (866) 516-3121 and LDI will transfer your prescription or contact your doctor for a new prescription. Mail Orders can be placed by: • Telephone: Call 1-866-516-3121 (24 hours a day). • Fax: 1-314-652-3126 • Internet: at www.ldirx.com. Click on ‘Order Refills.’ The online mail order form is designed to safeguard your medical and credit card information. • Mail: Complete the LDI Mail Order form and send it directly to LDI. Forms can be found at www.ldirx.com. Step Therapy Owensboro Health practices step therapy. Step therapy is the practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and progressing to other more costly or risky therapy, only if necessary. The aims are to control costs and minimize risks.

Preferred Formulary Our Preferred Drug List includes those drugs available to you at the most affordable cost. It is one of the best ways to maximize your prescription drug benefits. The drug list, developed by physicians and pharmacists on our national Pharmacy and Therapeutics committee, includes a wide selection of generic and brand name prescription medications commonly prescribed by physicians. The Preferred Drug List is available on the LDI website at www.ldirx.com.

Owensboro Health | 2015 Employee Benefits

8 Humana Vitality Wellness Humana Vitality In 2014, Owensboro Health introduced Humana Vitality, a program to help you know your health, improve your health, and earn rewards. This year we are continuing to use the Humana Vitality program to help promote a healthy lifestyle. To get started, register by logging on to www.HumanaVitality.com or by calling 800-708-1105. Then, take your health assessment to determine your Vitality Age, set your goals, make healthy changes, and track your progress. As you complete healthy activities, you will earn Vitality Points and Vitality Bucks which you can cash in to collect rewards. Earning Incentives Everyone will begin with a Vitality Status of Blue. As you earn points by completing health activities such as getting your flu shot, participating in physical activity, or getting a CPR certification, you will progress through the Vitality Status levels: Bronze, Silver, Gold, and Platinum. You can also earn points just by having healthy measures such as a healthy weight, blood pressure, or cholesterol level. When you are ready to cash in your Vitality Bucks for your reward, you will be able to select from rewards such as gift cards, movie tickets, and even Ipads! Why is my Vitality Status Important? In 2015, you may receive a wellness incentive which will be added to your HSA account in January based on your participation level in Vitality, as of December 31, 2014. Beginning in 2016, your HSA contribution will be tied to the Vitality Status you achieve in 2015. More information will be forthcoming in 2015. Start earning you Vitality Points today! 2015 Wellness Incentive Levels of Participation Blue

Incentive added to HSA (with Spouse) $0

Bronze

$50 / $100

Silver

$100 / $200

Gold

$150 / $300

Platinum

$200 / $400

Owensboro Health | www.owensborohealth.hrintouch.com

9 Dental Delta Dental is available to you in Low, Medium, or High Options. Dependent children may be covered up until age 26. Delta Dental members using participating providers enjoy the following:

Healthy Mouth, Healthy Body

• No deductibles/No claim forms • No pre-existing condition clauses • Exams, x-rays, and routine cleanings are covered at 100% with few limitations

Healthy Mouth, Healthy BodyParticipants with the following conditions are eligible for extra cleanings: Diabetics or pregnant women with periodontal disease, individuals with renal failure/dialysis, individuals with suppressed immune systems, head and neck radiation patients, and individuals at risk for infective endocarditis.

Delta Dental Online Delta Dental’s website www.deltadentalky.com, (dental network “Premier”) allows you to: • Check covered services • Check deductibles and/or copayments • Check claim status and claim history • Find providers in your area • Request a new id card or print a temporary card Dental Rates: 2015 Contributions Low Option Employer Monthly Cost

Employee Cost/ Month

Medium Option

Employee Cost/ Pay Period

Employee Cost/ Month

High Option

Employee Cost/ Pay Period

Employee Cost/ Month

Employee Cost/ Pay Period

Employee Only

$2.85

$12.98

$6.49

$21.19

$10.60

$25.47

$12.74

Employee + Spouse

$2.85

$30.39

$15.20

$47.65

$23.83

$56.61

$28.31

Employee + Child(ren)

$2.85

$39.89

$19.95

$69.28

$34.64

$82.10

$41.05

Employee + Family

$2.85

$50.93

$25.47

$81.30

$40.65

$96.27

$48.14

2015 Dental Plan Comparison Chart Low Option

Deductible (minor and major services) Annual/Calendar Year Maximum Benefit

Medium Option

High Option

In-Network

Out-ofNetwork*

In-Network

Out-ofNetwork*

In-Network

Out-ofNetwork*

$0

$0

$0

$0

$0

$0

$1,000 per person

$1,500 per person

$1,500 per person

N/A

N/A

$1,500 per person

Orthodontia Lifetime Benefit Routine Diagnostic/Preventive Care (exam, cleanings, x-rays, sealants)

100%

100%

100%

100%

100%

100%

Minor Services (simple extractions, fillings, oral surgery, denture repairs, root canals**)

50%

50%

50%

50%

70%

70%

50%

50%

50%

50%

50%

50%

Major Services (crowns, prosthetics, periodontic services, implants***)

Not covered

Orthodontia

Not covered

Not covered

Coinsurance in this chart refers to the percentage of costs Owensboro Health pays after the deductible is met. You pay the remaining percentage. *In-network dentists have agreed to provide dental care at reduced fees under the plan. If you use a dentist outside of the network, you will be responsible for reasonable/usual and customary (R&C) fees, which are usually higher than negotiated fees. **Low option does not cover root canals ***Medium option does not cover implants

Owensboro Health | 2015 Employee Benefits

10 Vision Coverage for vision examinations and corrective eyewear is available to all benefits-eligible employees and their qualified dependents through Anthem Blue View Vision. You will receive an insurance card with your vision insurance. To find participating providers or claim forms for reimbursement of out of network providers, go online to www.anthem.com and choose “Blue View Vision”. Claim forms for reimbursement of out of network providers can be found at www.anthem.com. Additional lens upgrades are available. Please contact Anthem Blue Vision for more information including cost. Dependent children are eligible to be covered up to age 26. Vision Rates: 2015 Contributions Employee Cost/ Month

Employee cost/ Pay

$7.51

$3.76

Employee Only Employee + One

$13.71

$6.86

Employee + Family

$23.23

$11.62

2015 Vision Plan Comparison Chart Plan Provision

In-Network

Out-of-Network

$10 copay

$50 allowance

Lenses (once every 12 months) - Single Vision - Bifocal - Trifocal

$25 copay $25 copay $25 copay

$50 allowance $70 allowance $90 allowance

Lens Upgrades - Factory Scratch Coating - UV Coating - Tint (Soplid and Gradient) - Standard Anti-Reflective Coating Additional lens upgrades are available

Included $15 $15 $45

Exam (covered once every 12 months) A contact lens fitting and two follow-up visits are available once a comprehensive eye exam has been completed.

Frames (once every 12 months) Contact Lenses (once every 12 months, in lieu of glasses) - Contact fitting fee - Medically Necessary - Elective

Discounts not available

$140 allowance, 20% off balance

$80 allowance

Up to $55 or 10% off retail Covered in full $150 allowance*

Discounts not available $210 allowance $150 allowance

*Contact lens allowance can only be applied toward the first purchase of contacts made during a benefit period. Any unused amount remaining cannot be used for subsequent purchases made during the same benefit period, nor can any unused amount be carried over to the following benefit period.

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11 Disability Insurance Free Long Term Disability (LTD) Owensboro Health purchases LTD insurance for full time employees at no cost to the employee. Long Term Disability replaces up to 60% of the employee’s covered salary ($7,500/month maximum benefit) after the employee has been disabled for 6 months.

Voluntary Short Term Disability (STD) • Available to full time and part-time employees. • Voluntary STD replaces a portion of your paycheck if you become disabled due to a non-work related accident or illness. - Benefits begin after the later of 15 days of disability or after all accrued sick time is exhausted. - Benefits are payable up to 26 weeks, reduced by paid sick time, as long as you are deemed disabled by a healthcare provider. • Cost is based on your age and the amount of weekly benefit you select. • You may purchase a Voluntary STD plan in increments of $100 up to $2,000 that would replace up to, but not more than, 70% of your income. • Monthly premiums are deducted from the first and last voucher of each month. • Deductions are post tax only. • Your premium is based on the following rates:

See the Salary Table below to see how much weekly benefit you may elect: Salary Table Short Term Disability Benefit

Annual Salary of at Least

$100

$7,429

$200

$14,857

$300

$22,286

$400

$29,714

$500

$37,143

$600

$44,571

$700

$52,000

$800

$59,429

$900

$66,857

$1,000

$74,286

Rate per $100 of Weekly Benefit

$1,100

$81,714

$1,200

$89,143

Under 40

$8.76

$1,300

$96,571

40-44

$8.94

$1,400

$104,000

45-49

$10.31

$1,500

$111,429

50-54

$12.65

$1,600

$118,857

55-59

$14.54

$1,700

$126,286

60-64

$17.52

$1,800

$133,714

65-69

$22.87

$1,900

$141,143

70+

$31.67

$2,000

$148,571

Age Group

• Pre-existing conditions may delay your benefit under this plan. If you have a pre-existing condition at the time you are first eligible for this benefit, that condition will not be covered until you have been eligible for the STD benefit for 12 continuous months. To determine pre-existing conditions, Cigna reviews the 3 months prior to your effective date. For example, a pregnancy that begins prior to your effective date will be deemed pre-existing and the pregnancy-related disability will not be eligible for benefits. • Cigna will require evidence of insurability (EOI) if you increase your STD amount or do not enroll when you are initially eligible. EOI application forms will be available to complete. Coverage will not be effective until your EOI has been received and approved by Cigna. See monthly rates for the following benefit choices: • Telephonic Intake of Claims-enrolled employees will be given a toll-free number to call to begin the claim process.

Example: A (.9) full time, 42 year old employee making 15.00 per hour and authorized to work 72 hours per pay period would have the following options: STEP 1: Determine Annual Salary 72 hours x $15.00 hourly rate x 26 pays = $28,080 STEP 2: See Salary Table (Above) to Determine Benefit Maximum The employee may choose a weekly benefit of $100, $200, or $300. STEP 3: Determine Cost from Cost Table $100 cost = $8.94/month $200 cost = $17.88/month $300 cost = $26.82/month

Owensboro Health | 2015 Employee Benefits

12 Life and Accident Insurance Life and accident insurance can provide you with peace of mind that your family will be taken care of in the event of a serious injury or death.

Basic Life and Accidental Death & Dismemberment (AD&D) Insurance

Supplemental Life and AD&D

Age Group

Owensboro Health provides this benefit through Cigna to all benefits-eligible employees equal to 1.5 times the employee’s annual salary, up to a $500,000 maximum, at no cost to the employee. For part-time employees (.5-.8 FTE), Owensboro Health will purchase a $25,000 life insurance policy at no cost to the employee.

Employee

Under 20

$0.53

20-24

$0.83

25-29

$0.83

30-34

$0.83

35-39

$1.02

The IRS requires Owensboro Health to report the value of company-paid life insurance in excess of $50,000 per year. The IRS also requires that Owensboro Health subject this amount to an imputed income tax that is age-based. This tax is reflected on your payroll deductions as “group term life” (GTL). Life and AD&D Basic Life and AD&D* Covered in full by Owensboro Health

Supplemental Life and AD&D*

Covered Individual

Coverage/Benefit Amount

Employee

1.5 times employee’s annual salary, up to $500,000 maximum

Employee

$10,000 increments up to $300,000

Spouse

$5,000 up to $50,000, coverage ends at age 70

Child(ren) age 6 months to age 19 (25 if full-time student)

$3,000 up to $10,000

If you need additional life and AD&D coverage, full-time and part-time employees have access to purchase it for yourself and your eligible dependents at discounted group rates. Elect to purchase Supplemental Life Insurance from $10,000 to $300,000 (in $10,000 increments).

Rate per $10,000 of Coverage

40-44

$1.46

45-49

$2.20

50-54

$3.49

55-59

$5.61

Cigna will require evidence of 60-64 $8.60 insurability (EOI) if you increase 65-69 $14.58 your Supplemental Life amount 70-74 $29.73 or do not enroll when you are 75-79 $60.00 initially eligible. Coverage will not be effective until your EOI has been 80-84 $119.31 received & approved by Cigna. New 85-89 $220.00 Hires may purchase up to $300,000 without health questions if they enroll when initially eligible. Premiums are deducted on the first & last pay voucher of the current month. Spouse and Dependent Owensboro Health allows full time and part-time employees to purchase life insurance for their eligible dependents. Dependent Life rates are based on the package you elect, regardless of the presence of an eligible spouse & regardless of number of eligible children. Cigna will require evidence of insurability (EOI) if you increase your Dependent Life amount or do not enroll when you are initially eligible. EOI application forms will be available. Coverage will not be effective until the EOI has been received & approved by Cigna. New Hires may purchase up to $50,000 for their eligible spouse & up to $10,000 for their eligible child(ren) without health questions if they elect when initially eligible. Dependent Life Insurance Classes & Rates Class 1 $50,000 spouse & 10, 000 child(ren)

$4.19/month

Class 2: $20,000 spouse & 10,000 child(ren)

$3.35/month

Class 1: $10,000 spouse & $5,000 child(ren)

$2.68/month

Class 1: $5,000 spouse & $3,000 child(ren)

$1.50/month

If your spouse or eligible dependent(s) are also employees of Owensboro Health, they cannot be covered under you for Dependent Life. Eligible dependent children may only be covered by one employee.

Owensboro Health | www.owensborohealth.hrintouch.com

13 Voluntary Benefits Long Term Care

Whole Life Insurance

Long Term Care (LTC) insurance assists in paying for expenses incurred at a Nursing Home, Assisted Living Facility, or Home Care. Long Term Care is typically not covered by Medicare, Medicare supplements, or traditional health insurance, according to the NAIC Shopper’s Guide to Long Term Care Insurance. The national average for Nursing Home costs in 2001 was $56,000/ year, per US Department of Labor.

Unum’s Whole Life insurance offers protection beyond an individual’s working years, potentially for your lifetime. With a guaranteed death benefit that will never decrease, level premiums that will never increase, cash value accumulation, living benefits and other options, Whole Life goes beyond typical term life insurance.

All active full time and part time employees may purchase LTC insurance. The three year LTC policies are portable, so you can take the policy with you if you change employment or retire. Purchase coverage in increments of $1,000 up to $6,000 per month. Evidence of insurability is required for all LTC applications, so you may or may not qualify after underwriting. Employees may purchase coverage for family members (spouses, children, siblings, parents, grandparents, in-laws) as well as employee coverage. All applicants must submit a LTC Insurance application and Evidence of Insurability. You are not guaranteed coverage, and coverage is not in effect until Unum approves your application. Program information: • To qualify for benefits, a member must be unable to perform 2 Activities of Daily Living (ADL) – bathing, dressing, toileting, transferring, continence or eating without substantial assistance or supervision or have Severe Cognitive Impairment • The elimination period is 90 accumulated days and must be satisfied within a period of 730 consecutive days. Benefits begin the day after the Elimination Period is completed • 50% total home care is included in the program – this means that 50% of the monthly benefit will be available for home care. • The program includes a bed reservation benefit

Rates at your age band are locked in at the inception of the policy and are guaranteed until 12/31/2015. After that, rates can only be changed if UNUM’s entire LTC block in this state has a rate change. UNUM has not had a rate increase on its LTC block to date. Call Unum at 800-227-4165 if interested.

All active full time and part time employees may purchase Whole Life insurance. You may purchase this benefit for yourself, your spouse, and your dependent child. You may elect benefit amounts as outlined: • Employee - $2,000 - $300,000 • Spouse - $2,000 - $75,000 • Child - $5,000 - $50,000

Accident Insurance If you are like most people, you don’t budget for accidents. And when an accident occurs, you may not be thinking about the charges that can accumulate while you’re at the emergency room… the ambulance ride, use of the emergency room, surgery and anesthesia, stitches, cast, wheelchair, crutches, and X-rays. The Accident plan through Unum can pay you a benefit, regardless of other insurance you may have, in the case of an accident. It provides payments directly to you for services such as: • Ambulance and emergency room benefits • Surgery and hospital admission benefits • Accidental common injuries benefit – fractures, lacerations, and burns • Physical therapy, follow-up doctor treatment, and prosthetic devices • Coma and paralysis benefit All active full time and part time employees may purchase Accident insurance. You may purchase this benefit for yourself and your family.

Critical Illness Insurance A severe, life threatening illness or event can happen to anyone at any time. If you or a family member suffers a serious illness, you could be hit hard with medical expenses and reduced income from being out of work. Health benefits can pay part of the medical bill, and income protection can help provide a continuing income, but some expenses may not be covered. The Critical Illness plan offered through Unum rounds out our benefits program by supplementing your medical or disability coverage options by offering you a lump sum benefit if you or a covered family member is diagnosed with a critical illness including but not limited to cancer, heart attack, stroke, organ failure, etc. All active full time and part time employees may purchase Critical Illness insurance. You may purchase this benefit for yourself and your family.

Owensboro Health | 2015 Employee Benefits

14 Additional Benefits COBRA COBRA coverage is available to separated employees (terminated or retired) for up to 18 months provided employment was not terminated for “gross misconduct”. Once you have left employment with Owensboro Health, you will be offered COBRA coverage. Portable Life Insurance Cigna Basic Life and Supplemental Life Insurances offered by Owensboro Health are portable. If you would like to continue your coverage after terminating employment with Owensboro Health, you need to call 1-800-423-1282. Retirement When considering retirement, contact the Owensboro Health Human Resource Office by calling 685-7704. Your HR representative will discuss with you any possible retirement benefits you may have available to you and get you started in the process. Your Health insurance will end with Owensboro Health on the last day of the month in which you retire. At this point, you may apply for COBRA coverage.

Owensboro Health | www.owensborohealth.hrintouch.com

15 Additional Benefits Community Nurse Line The Owensboro Health Call Center has a Community Nurse Line which allows you to speak to a nurse 24 hours a day, 7 days a week, in regards to questions about symptoms you or a family member may be experiencing, or current Health Issues, such as the Swine Flu. The number is 1-877-888-6647.

Employee Assistance and Counseling Services HealthPark The Employee Assistance Program (EAP) is a confidential service that has been established to provide FREE counseling sessions as a benefit to our employees, their spouses and qualified dependents. Appointments are available at the HealthPark in Owensboro and MultiCare in Madisonville. Our counseling services are available to address a full range of issues, including family, marriage and parenting worries, substance abuse issues, workplace crises and conflicts, interpersonal relationships, dealing with chronic illness, grief counseling, depression, anxiety and other emotional stress. Full and part-time employees, spouses and dependents may voluntarily access EAP services by following these steps: • Call Owensboro Health HealthPark EAP provider at 270-688-4811 or 1-800-711-5752 • Identify themselves as an Owensboro Health employee or family member • Schedule an appointment Visits are limited to six (6) sessions per family member, per issue, per calendar year. Additional visits are subject to employee health insurance coverage or at the expense of the employee.

Owensboro Health Employee HealthPark Membership The HealthPark is the only medical based fitness center in the region. With trained, dedicated staff and resources, we are here to assist you in improving your overall health. We are here to help you Move Forward. • MicroFit Health Assessment completed by a trained exercise physiologist, a personalized exercise program and thorough one-on-one introduction to your personal workout on the fitness floor. • 1/10 mile indoor walking/running track • Land and water aerobics classes • Cardiovascular, strength training equipment and free weights • 10-lane, 25 yard indoor swimming pool • Warm water therapy pool • Gymnasium • Men and women’s locker rooms with daily and permanent full-length lockers. Locker rooms include individual showers, wet sauna, massage therapy rooms, whirlpool spa, towel services and toiletries. Enrollment

Monthly Fee

Employee (Full or Part-Time)

$0

$25

Employee (PRN)

$0

$49

Spouse

$0

$45

*Additional Family

$50

$25

Enrollment and monthly rate - not a per child fee. Covers all dependent children 13 and over. Dues for FT and PT employees and eligible family members will be payroll deducted during the last pay period of the month.

Owensboro Health Employee HealthPark Membership: For additional information, call (270) 688-5433.

Owensboro Health | 2015 Employee Benefits

16 Important Contacts

Benefit

Provider

Phone Number

Website or Email Address

Benefit Focus

1-855-244-5948

www.owensborohealth.hrintouch.com

Medical

Anthem Right Choice

1-877-895-6853 Pre-certification: 1-877-284-0102

Medical

Anthem Network Providers

1-800-778-1695

www.owensborohealth.hrintouch.com Choose “Anthem”

Vision

Anthem Blue Vision

1-866-723-0510

www.anthem.com

COBRA

Anthem Right Choice Benefits Administration

1-877-895-6853

Disability (STD, LTD)

Cigna

1-800-352-0611

www.mycigna.com

Life Insurance

Cigna

1-800-352-0611

www.mycigna.com

FMLA

Cigna

1-888-842-4462

www.mycigna.com

Dental

Delta Dental

1-866-480-4871

www.deltadentalky.com Choose “Premier” Network

OH Outpatient Pharmacy LDI Integrated Pharmacy Services

277-417-6701 1-866-516-3121

www.ldirx.com

Long Term Care

UNUM

1-800-227-4165

Accident, Whole Life, Critical Illness

UNUM

1-800-635-5597

Ownesboro Health Human Reources

Benefits: 1-855-244-5948 Retirement: 270-685-7704 Workman’s Comp: 270-685-7702 Leave of Absence: 270-685-7716 Fax: 270-685-7731

Enrollment

Pharmacy

Human Resources

Every effort has been made to ensure this information is accurate. However, the plans are governed by legal documentation and insurance contracts. If there is any difference between the information in this guide and the official plan document, the plan document rules. If changes in the plans are necessary to comply with the law or IRS regulations, you will be notified. Owensboro Health reserves the right to change or terminate any of the plans at any time. Enrollment in these benefits is not a guarantee of benefits or continued employment

Owensboro Health | www.owensborohealth.hrintouch.com

17 Legal Notices Women’s Health and Cancer Rights Act Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2014. Contact your State for more information on eligibility. To see if any more States have added a premium assistance program since July 31, 2014, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa

1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565 ALABAMA – Medicaid

COLORADO – Medicaid

Website: www.medicaid.alabama. gov Phone: 1-855-692-5447

Medicaid Website: www. colorado.gov/ Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943

ALASKA – Medicaid

FLORIDA – Medicaid

Website: http://health.hss.state. ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529

Website: https://www. flmedicaidtplrecovery.com/ Phone: 1-877-357-3268

ARIZONA – CHIP

GEORGIA – Medicaid

Website: www.azahcccs.gov/ applicants Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-4175437

Website: http://dch.georgia. gov/ - Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: 1-800-869-1150

IDAHO – Medicaid

MONTANA – Medicaid

Medicaid Website: http:// healthandwelfare.idaho. gov/Medical/Medicaid/ PremiumAssistance/tabid/1510/ Default.aspx Medicaid Phone: 1-800-926-2588

Website: http:// medicaidprovider.hhs.mt.gov/ clientpages/clientindex.shtml Phone: 1-800-694-3084

INDIANA – Medicaid

NEBRASKA – Medicaid

Website: www.in.gov/fssa Phone: 1-800-889-9949

Website: www.ACCESSNebraska. ne.gov Phone: 1-800-383-4278

IOWA – Medicaid

NEVADA – Medicaid

Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562

Medicaid Website: http://dwss. nv.gov/ Medicaid Phone: 1-800-9920900

KANSAS – Medicaid

NEW HAMPSHIRE – Medicaid

Website: www.kdheks.gov/hcf/ Phone: 1-800-792-4884

Website: www.dhhs.nh.gov/oii/ documents/hippapp.pdf Phone: 603-271-5218

KENTUCKY – Medicaid

NEW JERSEY – Medicaid and CHIP

Website: http://chfs.ky.gov/dms/ default.htm Phone: 1-800-635-2570

Medicaid Website: www.state. nj.us/humanservices/dmahs/ clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: www. njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

LOUISIANA – Medicaid

MAINE – Medicaid

Owensboro Health | 2015 Employee Benefits

18 Website: www.lahipp.dhh. louisiana.gov Phone: 1-888-695-2447

Website: www.maine.gov/ dhhs/ofi/public-assistance/ index.html Phone: 1-800-977-6740 TTY 1-800-977-6741

MASSACHUSETTS – Medicaid and CHIP

NEW YORK – Medicaid

Website: www.mass.gov/ MassHealth Phone: 1-800-462-1120

Website: www.nyhealth.gov/ health_care/medicaid/ Phone: 1-800-541-2831

MINNESOTA – Medicaid

NORTH CAROLINA – Medicaid

Website: www.dhs.state. mn.us/ Click on Health Care, then Medical Assistance Phone: 1-800-657-3629

Website: www.ncdhhs.gov/ dma Phone: 919-855-4100

MISSOURI – Medicaid

NORTH DAKOTA – Medicaid

Website: www.dss.mo.gov/ mhd/participants/pages/hipp. htm Phone: 573-751-2005

Website: www.nd.gov/ dhs/services/medicalserv/ medicaid/ Phone: 1-800-755-2604

OKLAHOMA – Medicaid and CHIP

UTAH – Medicaid and CHIP

Website: www. insureoklahoma.org Phone: 1-888-365-3742

Website: http://health.utah. gov/upp Phone: 1-866-435-7414

OREGON – Medicaid

VERMONT– Medicaid

Website: www. oregonhealthykids.gov www. hijossaludablesoregon.gov Phone: 1-800-699-9075

Website: www. greenmountaincare.org/ Phone: 1-800-250-8427

PENNSYLVANIA – Medicaid

VIRGINIA – Medicaid and CHIP

Website: www.dpw.state. pa.us/hipp Phone: 1-800-692-7462

Medicaid Website: www. dmas.virginia.gov/rcp-HIPP. htm Medicaid Phone: 1-800-4325924 CHIP Website: www.famis. org/ CHIP Phone: 1-866-873-2647

RHODE ISLAND – Medicaid

WASHINGTON – Medicaid

Website: www.ohhs.ri.gov Phone: 401-462-5300

Website: www.hca.wa.gov/ medicaid/premiumpymt/ pages/index.aspx Phone: 1-800-562-3022 ext. 15473

SOUTH CAROLINA – Medicaid

WEST VIRGINIA – Medicaid

Website: www.scdhhs.gov Phone: 1-888-549-0820

Website: www.dhhr.wv.gov/ bms/ Phone: 1-877-598-5820, HMS Third Party Liability

SOUTH DAKOTA - Medicaid

WISCONSIN – Medicaid

Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: www.badgercareplus. org/pubs/p-10095.htm Phone: 1-800-362-3002

Owensboro Health | www.owensborohealth.hrintouch.com

TEXAS – Medicaid

WYOMING – Medicaid

Website: https://www. gethipptexas.com/ Phone: 1-800-440-0493

Website: http://health.wyo. gov/healthcarefin/equalitycare Phone: 307-777-7531

Newborns’ and Mothers’ Health Protection Act Notice Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call your plan administrator.

Notice of Special Enrollment Rights for Medical/Health Plan Coverage If you decline enrollment in a Owensboro Health’ health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in a Owensboro Health’ health plan without waiting for the next open enrollment period if you: • Lose other health insurance or group health plan coverage. You must request enrollment within 30 days after the loss of other coverage. • Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request health plan enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. • Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage. If you request a change due to a special enrollment event within the 30 day timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in Owensboro Health’ medical plan if you become eligible for a state premium assistance program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law. Note: If your dependent becomes eligible for a special enrollment rights, you may add the dependent to your current coverage or change to another health plan.

Medicare Part D Notice If you and/or your dependents have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see Human Resources for more details.

Privacy Practices Notice Owensboro Health offers a notice that describes how medical information about you may be used and disclosed and how you can get access to this information. Please see Human Resources for more details, and review the notice carefully. The privacy of your medical information is important to us.

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