Welcome to Open Enrollment Loyola University Medical Center!

Welcome to Open Enrollment Loyola University Medical Center! CHE Trinity Health and Loyola University Medical Center are pleased to provide you with t...
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Welcome to Open Enrollment Loyola University Medical Center! CHE Trinity Health and Loyola University Medical Center are pleased to provide you with the information you will need to enroll in benefits for next year. Throughout the rest of this communication, you will see CHE Trinity Health and Loyola University Medical Center referred to as simply CHE Trinity Health. If you have more questions after reviewing this guide, refer to the “For More Information” section to learn where you can get answers.

Who Is Eligible

What’s Inside What’s New for 2015

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Other Information About Enrolling

3

Health Care Reform Update Medical Coverage

4 5

Medical Plan Highlights

6

More About the Health Savings PPO

8

Take the Health Assessment

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Dental Coverage

11

Vision Care Coverage

12

Flexible Spending Accounts

13

Life Insurance

14

Time Away from Work

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Legal Plan and Voluntary Benefits

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How to Enroll

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For More Information

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Important Reminders

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Benefit Medical, dental and vision coverage

Hours Requirement Regularly scheduled full- or part-time colleague with 40 or more budgeted hours per pay period

Eligible adult: You may cover your spouse or Eligible Adult. An Eligible Adult is an adult who resides and has financial interdependence with the colleague, and is not a tax-qualified dependent or related by blood, adoption or marriage to the colleague.

Dependents Dependent children are eligible for coverage through the end of the Plan Year in which they turn age 26, regardless of marital status, student status, residency, financial dependency or other requirements provided they meet both of the following criteria:

Other New hires must satisfy the required waiting period

They are: • Your or your eligible adult’s natural

children; • Your or your eligible adult’s legally

adopted children or children placed with you or your eligible adult for adoption; or • Children for whom you or your eligible adult are the court-appointed legal guardian. They are not otherwise covered under the Plan or any other group health plan offered by the Employer

Flexible spending accounts

Regularly scheduled full- or Can submit claims for eligible part-time colleague with 40 or dependents more budgeted hours per pay period

New hires must satisfy the required waiting period

Life insurance

Regularly scheduled full- or Can elect coverage for your spouse or part-time colleague with 40 or eligible children more budgeted hours per pay period

New hires must satisfy the required waiting period

Short-term disability

Regularly scheduled, full- or part-time colleague with 40 or more budgeted hours per pay period

Not applicable

You become eligible the first day of the month following 30 days of employment. Management colleagues eligible on date of hire.

Long-term disability

Regularly scheduled full- or part-time colleaguewith 40 or more budgeted hours per pay period

Not applicable

Verifying your dependents If you add a new dependent, you must show the appropriate documents to your Human Resources department by Nov. 12, 2014. To obtain a full list of documentation requirements and resources available to obtain this documentation, visit your benefits website.

Loyola University Medical Center

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What’s New for 2015 • You have the opportunity to choose from three all new medical plan options for 2015: the Traditional PPO Plan, the Health Savings PPO Plan (which includes a health savings account) and the Essential PPO Plan. See the Medical Coverage section for more information on these plan options. Keep in mind, because these medical plan options are all new for 2015, you must make a medical plan election, including if you want to waive coverage. If you don’t make a medical election, you will not have medical coverage. All colleagues enrolled in a new medical plan will receive a new insurance card for 2015. • The Essential PPO Assist Plan will replace the medical discount program. See page 7 for more information about the Essential PPO Assist Plan. • As part of the medical plan designs for 2015, you will now share in the cost of services when you utilize Tier 1 providers: CHE Trinity Health facilities and aligned providers. Keep in mind, even with the new cost-sharing structure, you will still pay less when you use CHE Trinity Health facilities and aligned providers. • We are pleased to introduce our clinically-integrated network (CIN) structure for our medical plan options. The CIN joins local physicians and health care providers with our Regional Health Ministry (RHM) into a single care management system using a common set of quality measurements to ensure high quality, cost-efficient care.

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• If you enroll in the Health Care Flexible Spending Account (HCSA), you will receive a new debit card from WageWorks, called the WageWorks Health Card. Watch for your new card in the mail before Jan. 1, 2015. Your 2015 debit card will have the CHE Trinity Health logo on it. If you made a 2014 HCSA contribution, be sure to hold onto your current WageWorks debit card because it will be the card you need to use to access your 2014 HCSA through March 2015. Also, remember to create a new online account at www.wageworks.com. • You will need to make an election for dental coverage for 2015 because CHE Trinity Health is offering two new dental plan options this year administered by Delta Dental – the High Plan and the Standard Plan. The High plan includes an adult orthodontics benefit and a higher annual non-orthodontics out-of-pocket maximum. • The vision provider and plan design are not changing, but you will still need to make an election for vision coverage for 2015 because there is a new vision coverage level available. • We are changing our life insurance program to Prudential to harmonize across the system. These changes include an adjustment in basic life insurance to 1x annual base salary, an increase in the colleague supplemental life election, and a new coverage amount for spouse and child supplemental life.

Loyola University Medical Center

Other Information About Enrolling If you don’t enroll Open enrollment is mandatory for 2015. This means that you must enroll if you want to choose your own benefit options. If you wish to participate or continue your benefits next year you must complete your enrollment by Nov. 5, 2014 at 12 midnight CST.

Benefit elections are effective for the entire year Remember, the benefits you elect during open enrollment will be in effect from Jan. 1 through Dec. 31, 2015. Open enrollment is your only opportunity during the year to make elections for your 2015 benefits unless you experience a qualified family status change. If you experience a qualified family status change or certain employment status changes and provide any required documentation to your Human Resources representative within 30 days of the event, you will be allowed to make certain benefit changes as long as they are consistent with the status change. For example, if you get married during the plan year, you’ll be able to add your spouse/eligible adult to your coverage within 30 days of the marriage. For more information on qualified family status changes, visit loyola.wired or http://mybenefits.trinity-health.org.

Open Enrollment is mandatory for 2015 This means that you must enroll by Nov. 5, 2014 if you want to choose your own benefit options for 2015. Even if you are going to waive coverage, you still need to complete your open enrollment elections and select “Waive”.

Adding family members If you’re adding family members to your benefit plan for the first time during this year’s open enrollment, you’re required to provide written documentation (for example, marriage certificate or birth certificate) verifying their dependent status to Human Resources no later than Nov. 12, 2014. If you don’t submit the required documentation by the deadline, your dependents will not be enrolled for coverage for 2015, and you’ll be required to wait until next year’s open enrollment period to add them to the plan – provided they remain eligible, and you provide written documentation verifying their dependent status at that time. You are required to provide a Social Security number for each of your dependents over the age of one in order for them to be covered. Please provide any missing Social Security numbers to Human Resources. Please note, you have the option to purchase coverage for your spouse/eligible adult and dependents. If you and your spouse/eligible adult both work for CHE Trinity Health, and are benefits eligible, you cannot elect dual coverage (enrolled as a colleague and a dependent). In addition, only one of you will be able to elect coverage for your child(ren). To view the complete eligibility rules and documentation requirements for you and your family members, visit loyola.wired or http://mybenefits.trinity-health.org.

Choose your Primary Care Physician (PCP) Maintaining a relationship with your PCP is important because they are trained to recognize any health problems you may have. A PCP is the doctor you see for most services, including annual check-ups. Your PCP can also help you identify and meet your health goals and help you prevent serious, long-term health conditions. And, by following their preventive recommendations, they can help keep your health care costs low. CHE Trinity Health encourages you to select a PCP and develop a relationship with them. To find an in-network physician and provider, visit your benefits website.

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Update on the Affordable Care Act

Women’s Preventive Care under the Affordable Care Act

Each year during open enrollment, CHE Trinity Health gives an update on the health care reform law, officially called the Affordable Care Act (ACA).

Part of the Affordable Care Act (ACA) (also known as health care reform) requires employers to cover certain women’s preventive care services, including contraception, under health insurance benefits at no charge.

The law was put in place to make sure citizens have access to health insurance they can afford. Since Jan. 1, 2014, the law has required that most U.S. citizens and legal resident aliens have health insurance whether they get it from an employer, a private insurance company or from the government. If they do not have health insurance, they may have to pay a tax penalty. As a colleague at CHE Trinity Health, here is how the law may affect you: • CHE Trinity Health will continue to offer health insurance for U.S. colleagues who are benefits eligible. During open enrollment, you can choose the CHE Trinity Health medical plan that works best for you and your family. • Effective Jan. 1, 2015, as a result of the ACA, employers will be required to offer medical and prescription coverage to employees who work more than 30 hours a week or more than 130 hours per month. Colleagues who work an average of 30 hours a week over a rolling 12-month period will be eligible for medical coverage through CHE Trinity Health. • A CHE Trinity Health medical plan may be your best option for coverage. You will probably continue to hear a lot about the health insurance marketplace that has been set up in each state to help people find health insurance for 2015. If you are benefits eligible, a CHE Trinity Health medical plan will likely be the more cost-effective option. CHE Trinity Health will continue communicating with you about your benefits coverage as we remain committed to providing you with the latest information. In the meantime, if you have questions, please contact your Human Resources representative.

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As a health ministry of the Catholic Church, we have engaged in extensive advocacy with the support of the Catholic Health Association, to find an acceptable resolution to this issue. The final rules from the U.S. Health and Human Services, Treasury and the Department of Labor give an accommodation to certain religious and religiously-affiliated organizations, like CHE Trinity Health, to provide an exemption from the requirement to provide contraceptive coverage to employees as preventive health services. The intent of the rules is to accommodate the moral perspectives of certain religiously-affiliated employers while also providing for the preventive health care needs of their employees who may not share the employers’ religious beliefs. In 2015, your medical/pharmacy benefit provider will continue to provide these benefits as mandated by the ACA. CHE Trinity Health colleagues will be provided with access to these benefits, but they will not be paid for by CHE Trinity Health or its health plans. Contact your medical/pharmacy benefit provider for further details.

Introducing Clinically-Integrated Network in 2015 CHE Trinity Health is pleased to introduce our Clinically-Integrated Network (CIN) structure for our medical plan options in 2015. A CIN joins local physicians and health care providers that have made a decision to partner with a Regional Health Ministry (RHM) to deliver services focused on high quality and cost-efficient care designed to improve the health of those we serve. Seeking care within the CIN can help you and your physician make health care decisions that ensure that you are accessing the right care, at the right time in the right setting. In addition, by utilizing our CIN you will pay less out of pocket for the care you receive, because all of the CIN providers are in our Tier 1 network. The Affordable Care Act is changing the way we provide care. As a result, there have been many changes designed to help increase health care quality and reduce the cost in order to make it more affordable. Our health care organization is changing in order to deliver better care at a reduced cost and with an improved, people-centered care experience. There are a lot of changes happening on the health care landscape. We believe putting them in place will better position our organization to keep our colleagues and their families healthier, fulfill our Mission, meet our nation’s needs and improve the health of the millions of people and the hundreds of communities we serve. If you have questions about these changes, please contact your Human Resources representative.

Loyola University Medical Center

Watch the Video to Learn More

Medical Coverage CHE Trinity Health is offering you three medical plan choices for 2015 which supports our efforts to provide a common experience for all colleagues and provide meaningful choices. All three plans are administered by BlueCross BlueShield and support our new clinically-integrated network structure. The three medical plan options are the Traditional PPO, the Health Savings PPO, and the Essential PPO. Each plan offers these three tiers so you can pay less by receiving care from network providers.

Scan the tag with your smartphone to download and view a video about your 2015 medical plan choices. Get the free mobile application at http://gettag.mobi. If you don’t have a smartphone, visit your benefits website to view the video.

• Tier 1, or the CHE Trinity Health network providers, are facilities or physicians aligned with our organization that provide you with the most cost-effective care. For services unavailable through CHE Trinity Health network providers, select BlueCross BlueShield Providers will be available at the Tier 2 benefit level. • Tier 2 includes select BlueCross BlueShield Providers (facilities and physicians) not listed under Tier 1. Tier 2 providers can save you money, but not as much as using our Tier 1 network. • Tier 3 providers are out-of-network providers and this Tier provides the lowest level of coverage. You can use these facilities and physicians for care, but you will pay the most out of your pocket when you do.

How the medical plan works Traditional PPO If you elect coverage under the Traditional PPO, you pay for a portion of the medical services you receive until you meet the annual deductible. Then, coinsurance begins up to the annual out-of-pocket maximum.

Health Savings PPO With the Health Savings PPO, you pay much less per pay period for coverage – leaving more money in your paycheck – and you have access to a Health Savings Account (HSA) to help pay for current and future medical expenses. Here’s how it works:

First

You pay the full cost of medical and prescription expenses until you reach the annual deductible (Note: preventive care services and certain preventive 90-day generic prescriptions do not require you to pay the deductible).

Second

Once you meet the deductible, you pay coinsurance until you reach the out-of-pocket maximum.

Third

Once you reach the out-of-pocket maximum, CHE Trinity Health pays 100% of all remaining eligible expenses during the year.

To learn more about the Health Savings PPO, see page 6 of this enrollment guide.

If you enroll in the Health Savings PPO, you will automatically have an HSA. CHE Trinity Health and Loyola University Medical Center contributes to your HSA to help you pay for expenses toward your annual deductible and out-of-pocket maximum. You can also contribute to this account to build savings for current and future medical expenses. We encourage you to consult with a tax advisor for IRS rules and tax implications related to HSAs.

Essential PPO The Essential PPO works the same as the Traditional PPO where you pay a portion of the medical services you receive until you meet the annual deductible. Then, coinsurance begins. If you elect the Essential PPO, you pay less in premium contributions than in the Traditional PPO, however, your out-of-pocket costs are higher.

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Medical Plan Highlights For more information about your medical plan options, visit your benefits website. Traditional PPO

Medical Plan Highlights

Tier 1

Health Savings PPO

Tier 2

CHE Trinity Healthfunded account Single Family

Tier 3

N/A

Tier 1

Tier 2

Essential PPO Tier 3

Health Savings Account (HSA) $650 $1,300

Tier 1

Tier 2

Tier 3

Health Reimbursement Account (HRA), if you qualify $750 $1,500

Annual deductible Individual Family

$250 $500

$750 $1,500

$1,500 $3,000

$1,300 $2,6001

$2,500 $5,0001

$3,500 $7,0001

$1,000 $2,000

$2,500 $5,000

$4,000 $8,000

Coinsurance

10%*

20%*

40% R&C*

10%*

20%*

40% of R&C*

20%*

30%*

40% R&C*

Preventive care

0% no deductible

0% no deductible

40% R&C*

0% no deductible

0% no deductible

40% R&C*

0% no deductible

0% no deductible

40% R&C*

Office visit

PCP: $20 Specialist: $30

PCP: $30 Specialist: $40

40% R&C*

10%*

20%*

40% R&C*

20%*

30%*

40% R&C*

Urgent care visit

0% after $35 copay

bug 10%*

0% after $40 copay

Emergency room

0% after $100 copay

10%*

0% after $100 copay

Inpatient admission

None**

$500**

$1,000**

None**

$500**

$1,000**

None**

$750**

$1,000**

Outpatient admission

$50**

$100**

$200**

None**

$100**

$200**

$50**

$100**

$200**

$2,500 $5,000

$4,750 $9,500

$9,500 $19,000

$2,600 $5,200

$5,000 $10,000

$7,000 $14,000

$3,500 $7,000

$5,500 $11,000

$9,000 $18,000

Out-of-pocket maximum (includes deductible, copayments, and coinsurance) Individual Family Prescription drug Retail/In-house pharmacy (34-day supply) Generic Brand formulary Brand non-formulary (90-day supply) Generic Brand formulary

Brand non-formulary

$10 20% ($30 min., $80 max.) 40% ($60 min., $100 max.)

Mail $25 / In-house $30 20% Mail ($75 min., $200 max.) In-house ($90 min., $240 max.) 40% Mail ($150 min., $250 max.) In-house ($180 min., $300 max.)

20%†, 0% after out-of-pocket max. (Deductible and out-of-pocket max. based on Tier 1)

20%†, 0% after out-of-pocket max.

(Deductible and out-of-pocket max. based on Tier 1)

$10 25% ($30 min., $80 max.) 50% ($60 min., $120 max.)

Mail $25 / In-house $30 25% Mail ($75 min., $200 max.) In-house ($90 min., $240 max.) 50% Mail ($150 min., $300 max.) In-house ($120 min., $360 max.)

The full family deductible must be met even if only one person in the family is receiving care. *Subject to deductible. **Subject to deductible and coinsurance. †Select, generic preventive drugs are covered at 100% and are not subject to the annual deductible. See loyola.wired or My Benefits for the complete list of eligible drugs. 1

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Loyola University Medical Center

Paying for medical coverage Contribution levels for the medical plans are based on the Social Security taxable wage base ($117,000 for 2014, indexed annually) to ensure our benefit plan cost-sharing model is appropriately aligned with our colleagues’ income levels. The amount you pay for medical coverage is based on your annual base salary (your base rate of pay times your budgeted hours) and your participation in the Health Assessment (HA). If at any time during the 2015 plan year, you earn $117,000 or more, you will pay a higher premium contribution per pay period for your medical insurance. Traditional PPO Full-time Your per pay period cost

With HA

Without HA

Health Savings PPO

Part-time With HA

Without HA

Full-time With HA

Without HA

Essential PPO

Part-time With HA

Without HA

Full-time With HA

Without HA

Part-time With HA

bug

Colleague only Colleague plus spouse/eligible adult

bug Without HA

Please contact your Human Resources representative for medical plan rates.

Colleague plus child(ren) Colleague plus family

Need help with your health care costs? You may be eligible for the Essential PPO Assist plan if you meet certain income requirements. It is the same as the Essential PPO, but includes a CHE Trinity Health-funded Health Reimbursement Account (HRA), to help you pay for your health care costs at the time of service. You do not make contributions to the HRA under the Essential PPO Assist plan. To participate in the Essential PPO Assist, you must apply for and meet specific income and eligibility guidelines. To learn more about the qualifications please see the application form on loyola.wired or My Benefits. You can apply for the Essential PPO Assist by completing an application form and submitting it with a copy of your most recent Federal Income Tax Form 1040 or 1040EZ to Human Resources by Nov. 12, 2014. Please note, the Essential PPO Assist Plan replaces the medical discount program. NOTE: Even if you think you qualify for the Essential PPO Assist, you should elect the medical plan you think will be best for you and your family – which could be the Traditional PPO, the Health Savings PPO, or the Essential PPO. If you qualify for the Essential PPO Assist plan, you will be moved to the Essential PPO Assist plan. Otherwise, you will remain in the plan you elected during open enrollment.

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More about the Health Savings PPO The Health Savings PPO is a consumer-driven health plan which gives you the opportunity to participate in a plan where your health care costs are more closely determined by your decisions. Here are some reasons to consider choosing the Health Savings PPO in 2015:

“ “ “ “

I liked that I saved money in premium contributions – spending money only when I used medical care.



I can really save for my health care expenses when I use the HSA.



It’s great that CHE Trinity Health makes its full contribution to my HSA in January.



For certain generic preventive drugs, I didn’t have to pay my deductible before the plan started paying those expenses.



How the deductible works The Health Savings PPO Plan includes a combined deductible. A combined deductible means the full family deductible must be met even if only one person in the family is receiving care. Coinsurance begins once the combined deductible has been met. 8

How the Health Savings Account (HSA) works When you enroll in the Health Savings PPO plan, you automatically have a Health Savings Account (HSA) through Health Equity to help you pay for current or future health care costs. CHE Trinity Health will make a full contribution to your account in January based on the coverage level you elect. In addition, you can also contribute to this account up to IRS limits: Coverage Level

CHE Trinity Health Loyola University Medical Center Contributions† Colleague only $650 All other coverage levels $1,300

Your Voluntary Contributions*†

Total IRS Allowed HSA Contributions

$2,700 $5,350

$3,350 $6,650

*If you are 55 or older, you can contribute an additional $1,000 in catch-up contributions to your HSA. †May be subject to state taxation.

Questions about the HSA How do I get an HSA? To be eligible for the HSA, you must enroll in the Health Savings PPO. In addition, you cannot have coverage under any other medical plan, such as Medicare, TRICARE, or coverage through a spouse’s health plan. Who can use funds in my HSA? You and your dependents can pay for medical, dental and vision expenses with funds in your HSA. Dependents must be claimed on your tax return. Why would I contribute to my HSA? Contributions to the HSA are a great way to save on taxes. With the HSA, you do not pay taxes on the amount you contribute through payroll deductions, the amount you withdraw for medical expenses, and the interest you earn in the account (up to amounts set by federal law). Keep in mind that you can change the amount you contribute to your HSA at any time during the plan year. How can I use the money in my HSA? You may use the HSA to pay for qualified medical expenses now and during retirement for you and your qualified dependents.

How do I pay for medical expenses with my HSA? When you receive eligible health care services, you can pay for those services with your HSA debit card, or through several online and smartphone app options. You’ll receive more information about your payment options if you enroll in the Health Savings PPO with the HSA. What happens if I don’t use all the money in my HSA each year? Any money you do not use during the year is carried over, without any limits. Remember, you own the money in your HSA and it is yours to keep – even when you change jobs or retire. Can I enroll in the Health Care Spending Account (HCSA) if I have an HSA? When you enroll in the Health Savings PPO which includes the HSA, you will not have access to the health care spending account (HCSA). However, the HSA may be seen as having more advantages over the HCSA including: • The opportunity to carry over savings from year to year – you do not forfeit any amount in your HSA at the end of the plan year (if you are currently enrolled in the HCSA, you must utilize your account funds by Dec. 31, 2014); • Contributions of up to $6,650 in tax-free HSA dollars each year (the HCSA maximum is $2,500); • Your HSA dollars are saved in a bank account that may earn interest.

How do I know if the Health Savings PPO, including an HSA, is right for me? Your medical plan choice depends on your personal situation. If you answer “yes” to some of these questions, the Health Savings PPO plan is right for you: • Would you like to have lower per pay period contributions deducted from your paycheck? • Do you want to save on taxes by contributing to the HSA for your health care costs? • Do you need a way to pay for future health care costs? • Can you see your HSA balance growing as you keep making contributions each year? We encourage you to consult with a tax advisor for IRS rules and tax implications related to an HSA.

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For more information about the Health Savings PPO, including the Health Savings Account (HSA), visit www.healthequity.com or loyola.wired or http://mybenefits.trinity-health.org.

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Take the Health Assessment The Health Assessment (HA) asks about your health habits and lifestyle to help identify some of your health needs. Your answers are kept secure and confidential; summary data is used to identify areas of focus for future wellness and prevention programs. When you and your covered spouse/eligible adult take the HA you will maintain your 30 percent premium contribution discount for the rest of 2015. For current BlueCross BlueShield users, you and your covered spouse/eligible adult can take the HA from Oct. 1, 2014 through Jan. 31, 2015. Your covered spouse/eligible adult must register separately using their BlueCross BlueShield ID card. New BlueCross BlueShield users will be able to take the HA from Jan. 1 through Jan. 31, 2015 because your BlueCross BlueShield benefit will not be available until Jan. 1, 2015. Information collected in this assessment will not affect your participation in the plan or negatively impact your health care costs. It will be kept confidential and shared only with a BCBS Blue Health Connection Nurse who will help colleagues make choices that improve health and quality of life, and may be used to develop future health and wellness programs for colleagues. Please note, beginning in 2015 there will no longer be a Nurse Health Coach call requirement. To continue receiving the per pay period discounted premium contributions for the remainder of the year, both you and your covered spouse/eligible adult will need to complete an online Health Assessment at BCBSM.com by Jan. 31, 2015. NOTE: Remember to retain proof of completion for your records.

Here’s how to complete the HA:

1

Log on to www.bcbsm.com.

2

Under Health and Wellness tab, click on “BlueHealthConnection.” NOTE: You will receive a screen that indicates “you are leaving this website.” This is correct, click OK.

3

Answer the questions on the screens and click “Continue” on each screen. If updating a current HA, be sure to update at least one field in the assessment so it will reflect the most recent date.

4

Once you are finished answering the questions, you will be provided an overall risk score. The following screens have information for you to take better control of your health risks and lifestyle behaviors.

5

Caution – the assessment is not complete until you see your certificate on the screen. Print this and keep it for your records.

6

If you have questions regarding your health assessment or are experiencing difficulties logging into BCBS, contact BCBS Web support at 1-888-417-3479.

Remember, if you do not complete the HA by Jan. 31, 2015, your per pay period premium contributions will increase beginning with the first pay that includes Mar. 1, 2015, and continue through the remainder of the 2015 plan year. You will not have the option to lower your premium contributions until the 2016 plan year.

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Be a smart health care consumer As you know, the cost of high-quality health care continues to increase each year. Being a smart consumer means getting the best price on something you need, whether it’s a new car or health care. Being a smart health care consumer doesn’t mean you should avoid trips to the doctor – it means making the best decisions about when to go to the doctor. Regular checkups can improve your health and extend your life. By getting the recommended exams and tests, you increase your chances of discovering problems before an illness significantly affects your health. Plus, preventive care is beneficial not only to your physical well-being, it also makes sense for your financial health because generally, it’s covered by your medical plan. For more information on preventive care benefits, visit loyola.wired or http://mybenefits.trinity-health.org. An easy way to be a smart health care consumer is to choose a CHE Trinity Health Tier 1 provider when you or a family member needs medical care. Besides receiving excellent care at our own facilities, you receive the highest level of benefits while paying the lowest available copayment and coinsurance amounts.

Discounted prescriptions available at your Loyola Outpatient Pharmacy Remember, purchasing your medications at your Loyola Outpatient Pharmacy may save you money– up to a 20 percent colleague discount. Also, you can fill prescriptions for up to a 90-day supply of your medications at our own pharmacy. See your Loyola Outpatient pharmacist for more information. REMINDER: A 90-day supply of maintenance medication can only be purchased through CVS mail order or at the onsite Pharmacy and not at retail.

Maintenance Choice program for your maintenance medications Our prescription drug plan requires that you receive your maintenance medications* in 90-day supplies through your on-site pharmacy or through the CVS Caremark Mail Service Pharmacy. Once you reach your plan limit (initial fill and 2 refills) for filling 30-day supplies at a retail pharmacy, you will pay the full cost of your medications if you do not move your prescription to one of the long-term options listed here. *A maintenance medication is a long-term medication taken regularly for chronic conditions or long-term therapy.

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Loyola University Medical Center

Dental Coverage You have a choice between two new Delta Dental plan options: the High plan and the Standard plan. Visit www.deltadentalmi.com for providers in your area. You will need to make a dental election for 2015. Your benefits from last year will NOT carry over. Dental Plan Highlights

High Plan Participating Dentist

Standard Plan

Nonparticipating Dentist

Participating Dentist

Nonparticipating Dentist

Annual deductible Individual

$25

$50

$50

$100

Family

$50

$100

$100

$150

Class I - Preventive services

100% covered

100% covered

100% covered

100% covered

($0 colleague cost)

(Usual and Customary

($0 colleague cost)

(Usual and Customary

20% after deductible

20% after deductible

40% after deductible

40% after deductible

50% after deductible

50% after deductible

rates apply) Class II - Basic services Class III - Major restorative services

40% after deductible

40% after deductible

Class IV - Orthodontics

50% after deductible

50% after deductible

rates apply)

Not covered

Maximums Per person annual (non-orthodontics)

$1,750

$1,250

$1,500

$1,000

Per person lifetime (orthodontics)

$1,500

$1,500

Not applicable

Not applicable

Your per pay period cost Colleague only Colleague plus spouse/eligible adult

Please contact your Human Resources representative for dental plan rates.

Colleague plus child(ren) Colleague plus family

NOTES: When you receive services from a non-participating dentist, you will be responsible for the difference between what your dentist charges and the non-participating dentist fee. Fluoride treatments are covered once every 12 months to age 14. Bitewing x-rays are covered once every 12 months.

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For more information about your dental plan options or about Delta Dental, visit loyola.wired or http://mybenefits.trinity-health.org.

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Vision Care Coverage You have a choice between two United Health Care vision plan options: the High plan and the Standard plan. Visit www.myuhcvision.com for providers in your area. You will need to make a vision election for 2015. Your benefits from last year will NOT carry over. UHC Vision Plan Highlights

High Plan

Standard Plan

In-network

Out-of-network (reimbursement schedule)

In-network

Out-of-network (reimbursement schedule)

Benefit frequency

Calendar year

Vision exam

Covered in full

Calendar year

Calendar year

Calendar year

Up to $40

$10 copayment

Up to $40

Pair of lenses Single vision Bifocal

Up to $40 $0 copayment

Trifocal

Up to $60 Up to $80

Up to $80 The preferred price is a

Covered frame

$50 wholesale allowance

Non-covered frame

at independent locations

Contact lenses

Up to $40 $0 copayment

Up to $80

Lenticular Frames

Up to $60

Up to $80 The preferred price is a $50 wholesale allowance

Up to $45

at independent locations

or a maximum of $150

or a maximum of $150

of retail allowance at retail

of retail allowance at retail

locations

locations

$0 copay

$0 copay

Up to $45

(in lieu of eyeglasses)

$200 allowance toward

Elective

contact lenses, fitting/

Up to $200

contact lenses, fitting/

Up to $175

evaluation fees and two

Up to $210

evaluation fees and two

Up to $210

Necessary

$175 allowance toward

follow-up visits instead

follow-up visits instead

of glasses once every 12

of glasses once every 12

months. Up to 8 boxes

months. Up to 6 boxes

of contact lenses are

of contact lenses are

included. Additional pair of eyeglasses

included.

20% discount

20% discount

20% discount

20% discount

or contact lenses Additional lense options

The following lens

The following lens options

options are covered in

are covered in full:

full: standard scratch-

standard scratch-resistant

resistant coating, standard

coating, standard

basic and high-end

polycarbonate lenses.

progressive lenses, standard polycarbonate lenses, standard antireflective coating, UV, tints, photochromic, Transitions®, edge coating Your per pay period cost Colleague only Colleague plus spouse/eligible adult

Please contact your Human Resources representative for vision plan rates.

Colleague plus child(ren) Colleague plus family

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For more information about your vision care plan options, visit loyola.wired or http://mybenefits.trinity-health.org.

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Health Care and Dependent Care Flexible Spending Accounts You have the opportunity to set aside before-tax money to offset eligible health care or dependent care expenses. There are two different types of Flexible Spending Accounts – a Health Care Spending Account and a Dependent Care Spending Account. How much can I contribute? What expenses will it cover?

Health Care Spending Account (HCSA) Before-tax dollars in any amount between $130 and $2,500

Dependent Care Spending Account (DCSA) Before-tax dollars in any amount between $130 and $5,000

Eligible health care products and services used by you and/or your eligible dependents. Examples include:

Expenses for the care of your eligible dependents (child under age 13 or qualifying adult incapable of self-care) while you work:

• Vision care, including eyeglasses, contact lenses and

saline solution

• Babysitting or au pair services

• Dental care, both preventive and restorative

• Before and after-school programs

• Orthodontia

• Day care and nursery school

• Physical therapy, counseling, or psychological

• Pre-school programs

services • Chiropractic care and acupuncture

• Elder care services

• Copayments, coinsurance and deductibles • Prescribed Over-the-Counter (OTC) medications

When do I have to spend the money? How do I access my FSA savings?

For a list of expenses that are eligible for HCSA reimbursement, visit loyola.wired or http://mybenefits.trinity-health.org. Contributions made to the HCSA during the 2015 calendar year can be used for claims with dates of service between Jan. 1, 2015 and Mar. 15, 2016. You can use a variety of payment options to access your FSA savings. These include the WageWorks Health Card; Pay my Provider, Pay me Back; or the Mobile application.

Contributions made to the DCSA during the 2015 calendar year can be used for claims with dates of services between Jan. 1 and Dec. 31, 2015. You can use a variety of payment options to access your FSA savings. These include Pay my Provider, Pay me Back; or the Mobile application.

Reminders: • If you choose to enroll in the Health Savings PPO medical plan option, you cannot enroll in the HCSA. The Health Savings Account works just like the HCSA but offers additional benefits, such as the opportunity to carry over unused funds, contribute up to $2,700/individual ($5,350/family), plus an additional $1,000 in catch-up contributions if you are age 55 or over, and earn interest on your savings. • You must make health care and/or dependent care spending account elections for 2015 during open enrollment. Your prior year elections will NOT carry forward. • Health Care Spending Account and Dependent Care Spending Account claims for the 2015 plan year must be postmarked on or before Mar. 31, 2016. • All colleagues electing the Health Care Spending Account for 2015 will receive a new debit card to use for expenses in 2015 and beyond.

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For more information about your FSA benefits and to obtain a list of eligible expenses, visit loyola.wired or http://mybenefits.trinity-health.org.

Take advantage of WageWorks mobile site As the nation’s largest independent provider of consumer-directed benefit solutions, WageWorks offers FSA participants the latest technology to make it easier to manage your savings. Their mobile site and new EZ Receipts app offer the following features: • Check your current HCSA and DCSA account balances • Submit HCSA and DCSA claims • Submit WageWorks Health Care card receipts Learn more at www.wageworks.com or contact your Human Resources representative.

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Life Insurance Colleague life insurance options If eligible, you receive employer-provided basic life/AD&D insurance at 1 times your annual base salary. In addition, you have the option to purchase supplemental coverage for yourself in the increments shown in the table below. If you purchase colleague supplemental life insurance and you’re approved, the premium contributions will be deducted from your paycheck on an after-tax basis. If you elect supplemental life insurance and you’re approved, you will be eligible for will preparation services through ComPsych Legal Plans at no charge. To get started, access ComPsych at www.estateguidance.com and enter the CHE Trinity Health Web ID “THWILL” in the Promotional Code box. Colleague Life Insurance Plan Highlights (full- and part-time) Basic life/AD&D (employer-paid)

1 x annual base salary

Supplemental life

One to eight x annual base salary

Supplemental AD&D

One to eight x annual base salary

Maximum amounts

Basic life: $1.5 million Supplemental life: $1.5 million (Combined: $3 million)

Evidence of Insurability

Colleagues with Basic life insurance at 2x annual pay last year, can convert the additional 1x annual pay in Basic life into Supplemental life coverage without completing an Evidence of Insurability.You can increase your Supplemental life election by 1x without Evidence of Insurability. If you waived Supplemental life in the past, you can elect 1x annual pay without Evidence of Insurability. Any other increase in colleague Supplemental life coverage will require you to complete Evidence of Insurability. NOTE: Evidence of Insurability forms should be sent to Prudential Life Insurance by Jan. 9, 2015.

Costs for colleague supplemental life insurance coverage are based on your age as of Jan. 1, 2015 and will be available when you enroll online.

Spouse and/or child life insurance options You have the option to purchase coverage for your dependents. You may elect coverage for your dependents without electing coverage for yourself. If you and your spouse both work for CHE Trinity Health, you cannot elect both Colleague Supplemental Life and Spouse Life coverage for the same person. Also, only one of you will be able to elect coverage for your child(ren). Dependent Life Insurance Plan Highlights (full- and part-time)

Evidence of Insurability

Spouse life1

Child(ren) life2

Coverage amount

Coverage amount

$10,000 $20,000 $50,000 $80,000 $100,000

$5,000 $10,000 $20,000

Any increase in spouse supplemental life coverage will require you to complete an Evidence of Insurability. NOTE: Evidence of Insurability forms should be sent to Prudential Life Insurance by Jan. 9, 2015.

1

Costs for spouse life insurance coverage are based on your age, and will be available when you enroll online.

2

Child(ren) life insurance costs per pay period cover all of your eligible children, and will be available when you enroll online.

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Are your beneficiaries up-to-date? You may want to take a moment to review the beneficiary(ies) you have on file for your basic life coverage. If you haven’t yet designated beneficiaries, your life insurance benefits will be paid according to the plan provisions as outlined in the Summary Plan Description. You’ll have an opportunity to review (and change, if you wish) your life insurance beneficiary(ies) during the open enrollment process.

Mandatory Re-enrollment for Life Insurance Benefits In order to maintain your 2014 supplemental and/or dependent life insurance elections, you must re-enroll by Nov. 5, 2014. You can increase your supplemental life insurance 1x without Evidence of Insurability. If you do not re-enroll in supplemental and/or dependent life insurance coverage by Nov. 5, 2014, effective Jan. 1, 2015, you will only have Basic life insurance equal to 1x your annual base salary.

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For more information about your life insurance benefits or to obtain an Evidence of Insurability form, visit loyola.wired or http://mybenefits.trinity-health.org.

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Time Away From Work At CHE Trinity Health, we are working to harmonize time off benefits across the enterprise. Our goal is to help strengthen and enhance the enterprise and provide our colleagues with meaningful benefits that are competitive and sustainable. Here are some of the benefits you receive as you need time away from work.

Short-term disability Short-term disability (STD) pays a benefit if you are unable to work because of a qualified injury or illness. NOTE: this is an employer provided benefit. No election is required to receive this benefit. Amount of benefit

For non-management colleagues: 50% of base pay

When benefits begin

For non-management colleagues: After a 14 calendar day elimination period following an injury or illness

For management colleagues: 100% of base pay

For management colleagues: First day of injury or illness How long benefits continue

Up to 180 days

Use of PTO time

Non-management colleagues are required to use PTO for days scheduled to work during the first 14 calendar days.

(if you have a frozen sick bank, that time will be exhausted first)

Long-term disability Long-term disability (LTD) pays a benefit if you are unable to work for a long period of time because of a qualified injury or illness. You have the option to elect more LTD coverage through a “buy-up” election during open enrollment. Amount of For non-management colleagues: 50% of base pay employer-provided For management colleagues: 70% of base pay benefit Amount of available ”buy-up” coverage

For non-management colleagues: 66 2/3% of base pay

Cost for “buy-up” coverage

For non-management colleagues:

For management colleagues: This option is not available • Based on your income level • Available when you enroll online

When benefits may begin

After 180 days of disability

How long benefits continue

Benefits continue until you are able to return to work, are deemed no longer disabled, or until age 65 or older, depending on when the disability begins.

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For more information about your disability benefits, visit loyola.wired or http://mybenefits.trinity-health.org.

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Legal Plan You’re eligible for the legal plan if you are a regularly scheduled full- or part-time colleague with 40 or more budgeted hours per pay period, and you have satisfied the required waiting period. You have the option of electing legal coverage through Hyatt Legal. Hyatt Legal Plan Highlights In-network

Out-of-network

All covered services are paid in full No waiting periods No deductibles or copayments No claim forms

You may choose a non-plan attorney and be reimbursed according to a set fee schedule

Following is a brief outline of personal legal services provided: •

Office consultation and telephone advice



Incompetency defense



Consumer protection





Wills and codicils

Document preparation – affidavits, deeds, demand letters, mortgages, notes, powers of attorney



Living wills



Document review



Living trusts



Uncontested divorce



Sale, purchase or refinancing of home



Premarital agreement



Debt collection defense



Uncontested adoption, guardianship or conservatorship



Personal bankruptcy



Name change



Tax audits



Protection from domestic violence



Administrative hearing representation



Property tax assessment



Juvenile court defense



Traffic ticket defense (no DUI)



Eviction defense (tenant only)



Identity theft defense



Tenant negotiation (tenant only)



Immigration assistance



Civil litigation defense

Your per pay period cost Colleague only: Colleague plus family:

Please contact your Human Resources representative for legal plan rates.

! For more information about the legal plan, visit www.legalplans.com.

Voluntary Benefits In addition to your group benefits, CHE Trinity Health has partnered with the Farmington Company to provide eligible colleagues the opportunity to elect personal insurance plans. Individual policy options include: • Life insurance • Accidental Death and Dismemberment (AD&D) Insurance • Cancer insurance • Critical illness insurance • Auto/home insurance • Pet insurance • Short-term disability (for part-time colleagues) • Identity theft insurance For more information, call 1-866-251-9529. Be sure to tell the representative that you are a member of CHE Trinity Health and Loyola University Medical Center.

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Loyola University Medical Center

How to Enroll Step-by-step instructions Colleagues have a convenient way to enroll in benefits online during the Benefits Open Enrollment period. Online benefits enrollment may be accessed from your Loyola work station or any computer within the network. To begin enrollment: 1.

Go to loyola.wired and log into the portal using your Login ID and Password. If you do not have a portal Login ID and Password, or are having difficulty logging into the portal, please contact the Help Desk at X62160.

Open Enrollment is mandatory for 2015 This means that you must enroll by Nov. 5, 2014 if you want to choose your own benefit options for 2015. Even if you are going to waive coverage, you still need to complete your open enrollment elections and select “Waive”.

2.

Click on the icon “Lawson – Log into Lawson Office.”

3.

Choose “Yes” on the “Security Warning” dialog box.

4.

Enter your Portal ID and Password again and click “Login”.

5.

Click on “Employee Self-Service” on the left hand side of the Lawson Portal Home page

6.

Click on “Personal Information”

7.

View “Dependent” information. You must add/review your dependent information for accuracy and change if necessary, before you start the enrollment process. You cannot add dependents after you start the enrollment process. You will need to exit the system and start over.

8.

Once you’ve added/updated dependent information, return to the “Home” tab, under “Employee Self-Service” click on “Benefits,” then click on “Beneficiary.” You must add/review your beneficiary information for accuracy and change if necessary, before you start the enrollment process.

9.

Once you’ve added/updated beneficiary information, return to the “Home” tab, under “Employee Self-Service” click on “Benefits” then click on “Benefits Enrollment,” read the Welcome message, scroll down, then click on “Continue.”

10. You will be prompted throughout the application process to enroll in all benefits. 11. Review your enrollment status. Verify that all information is updated correctly. • When you have completed enrollment, click on update and print your benefit elections. During the two week open enrollment period, you can make as many changes to your benefit elections as you wish. The last day to modify your choices is Nov. 5, 2014. Remember, the enrollment deadline is Nov. 5, 2014 at Midnight. Enrollment tips: 1. If you have questions about your login or password call the Help Desk at 708-216-2160. 2. Do not click on the “Exit” button or you will leave online enrollment without saving any changes to your current elections. 3. Review your benefit elections before printing your confirmation.

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For More Information We hope this enrollment guide has provided you and your family with all of the information you need to make your benefit elections for 2015. In addition to Open Enrollment, please remember to review and update your personal information, such as your address, phone number, and emergency contacts as necessary. You may update your personal information at any time throughout the year. If you still have questions about your options or the open enrollment process, you can: • Contact the Human Resources Benefits Hotline at 708-216-9401. Benefits meeting schedule: Day Friday, Oct. 10 Monday, Oct. 13 Tuesday, Oct. 14 Thursday, Oct. 16 Wednesday, Oct. 22 Friday, Oct. 24 Tuesday, Oct. 28 Wednesday, Oct. 29 Thursday, Oct. 30 Monday, Nov. 3 Wednesday, Nov. 5 Tuesday, Nov. 11

Time(s) 8:30 a.m. – 9:30 a.m. 10:00 p.m. – 11:00 a.m. 7:30 a.m. – 8:30 a.m. 5:30 p.m. – 6:30 p.m. 3:00 p.m. – 4:00 p.m. 10:00 a.m. – 11:00 a.m. 12:00 p.m. – 1:00 p.m. 1:30 p.m. – 2:30 p.m. 7:30 a.m. – 8:30 a.m. 10:00 a.m. – 11:00 a.m. 5:30 p.m. – 6:30 p.m. 3:00 p.m. – 4:00 p.m.

Room Maguire 2826 Maguire 2826 SSOM Room #160 SSOM Room #160 SSOM Room #190 SSOM Room #190 Maguire 2628 SSOM Room #190 Maguire 2826 Maguire 2826 Maguire 2826 Maguire 2826

• For colleagues who need access to a computer, computer access will be available from 8:00 a.m. – 5:00 p.m. through the Open Enrollment Period, Oct. 22 - Nov. 5, 2014. Please note: there will be no enrollment assistance available in the computer lab. If enrollment assistance is needed, please come to HR. Day Wednesday, Oct. 22 Monday, Oct.27 Tuesday, Oct. 28 Wednesday, Oct. 29 Thursday, Oct. 30 Monday, Nov. 3 Tuesday, Nov. 4 Wednesday, Nov. 5

Room Maguire 3863-1 Maguire 2817 Maguire 2817 Maguire 2817 Maguire 2817 Maguire 2817 Room 2706 – Main Hospital North Door Entrance Maguire 2817

Benefits Contact Information Plan Type Benefits/Eligibility and General Questions Medical Prescription Dental Life Insurance Flexible Spending Accounts Group Legal Plan Vision

Contact LUMC Benefits Department

Phone 708-216-9401

BlueCross BlueShield CVS CareMark Delta Dental PPO Prudential WageWorks Hyatt Legal Plans, Inc. United Health Care

866-917-7537 877-876-6877 800-524-0149 800-524-0542 877-924-3967 800-821-6400 800-638-3120

Website loyola.wired or http://mybenefits.trinity-health.org www.bcbsm.com www.caremark.com/trinityhealth2 www.deltadentalmi.com www.prudential.com www.wageworks.com www.legalplans.com www.myuhcvision.com

Scan the tag below with your smartphone to download the information included on this page. Get the free mobile application at http://gettag.mobi.

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Important Reminders Benefit elections are final for 2015 Remember, the benefits you elect during open enrollment will be in effect from Jan. 1 through Dec. 31, 2015. The choices you make now are final for 2015, because open enrollment is your only opportunity during the year to switch medical, dental or vision plan coverage.

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If you experience a qualified family For more information on qualified status change or certain employfamily status changes, visit loyola.wired or ment status changes and provide http://mybenefits.trinity-health.org. any required documentation to your Human Resources representative within 30 days of the event, you will be allowed to make certain benefit changes that are consistent with the status change. For example, getting married is considered a family status change. If you get married during the plan year you’ll be able to add your spouse/eligible adult to your coverage within 30 days of the marriage.

HIPAA privacy notice is available online CHE Trinity Health takes the security of its colleagues’ and family members’ Personal Health Information (PHI) very seriously. To access a copy of the Health Information Portability and Accountability Act (HIPAA) Privacy Notification, visit http://mybenefits.trinity-health.org. If you are unable to access the HIPAA notice online, contact your Human Resources representative to request a paper copy by mail.

Medical plan election notification When you enroll in a CHE Trinity Health medical plan, the medical plan coverage provides benefits through a clinically integrated network (CIN) of hospitals, physicians, and other health care providers and professionals, including care coordinators and case managers that monitor and coordinate all aspects of your medical care. CHE Trinity Health and Loyola University Medical Center participate in the CIN. When you and your covered dependents receive health care services at facilities or by the colleagues of your employer or a health care provider or professional affiliated with your employer, colleagues of your employer or a health care provider or professional affiliated with your employer will have access to and may use and disclose your and your covered dependents’ personal health information to manage and coordinate your care. Any access to and use and disclosure of protected health information will comply with the privacy and security regulations under HIPAA and any applicable state privacy and security laws.

Plan documents and Summary of Benefits and Coverage (SBC) are available online Health Care Reform legislation requires all employers to provide an easy-to-read summary of their medical plan options called the Summary of Benefits and Coverage (SBC). The SBC provides basic information about your medical plan options, comparison examples, and a glossary of terms. To access a copy of the SBC, visit http://mybenefits.trinity-health.org. If you are unable to access the SBC online, contact your Human Resources representative to request a paper copy by mail.

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Notice: Women’s Health and Cancer Rights Act of 1998 The Women’s Health and Cancer Rights Act of 1998 requires all employers who provide a medical benefit plan to its employees to communicate the coverage provisions established under the Act. CHE Trinity Health’s medical benefit plan provisions are as follows: • The CHE Trinity Health medical benefit plan will not restrict benefits if you or your eligible dependent receives benefits for a mastectomy and elects breast reconstruction in connection with the mastectomy. • Benefits will not be restricted provided that the breast reconstruction is performed in a manner determined in consultation with your (or your eligible dependent’s) physician, and may include: – Reconstruction of the breast on which the mastectomy was performed; – Surgery and reconstruction of the other breast to produce a symmetrical appearance; and – Prostheses and treatment of physical complications of all stages of mastectomy, including lymphedemas. Benefits for breast reconstruction may be subject to appropriate plan coverage provisions and limitations, including annual deductible, copayment and coinsurance provisions that are consistent with those established for other benefits under the plan. If you have any questions about your medical plan provisions relating to the Women’s Health and Cancer Rights Act of 1998, contact your Human Resources representative.

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Loyola University Medical Center