2017 TEBP Summary Plan Description
Table of Contents
Getting Started
Eligibility and Enrollment ............................................................................................................ 2 -
17
Health
Medical....................................................................................................................................... 18 -
55
Prescription Drug ....................................................................................................................... 56 -
74
Dental ......................................................................................................................................... 75 - 100
Employee Assistance Program (EAP) ..................................................................................... 100 - 102
Vision........................................................................................................................................ 103 - 112
Life Events ................................................................................................................................ 113 - 189
Other Information (includes information on claims appeals, COBRA, HIPAA, and ERISA)...... 190 - 225
Financial
Spending Accounts and Health Reimbursement Account...................................................... 226 - 251
Life and Accidental Death and Dismemberment.................................................................... 252 - 254
Business Travel Accident ......................................................................................................... 255 - 270
Appendix 1
Note: The Tenet Employee Benefit Plan (TEBP) also includes the Short-Term Disability, Long-Term
Disability, Critical Illness, and Long-Term Care programs. Information on these programs, along with a
detailed companion document to the Life and Accidental Death and Dismemberment section above,
may be accessed via MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees.
{00014391.DOCX-}
1
Eligibility & Enrollment Summary Plan Description
About This Summary Plan Description (SPD)
The Tenet Employee Benefit Plan (TEBP) is a comprehensive welfare benefits program intended to
qualify as a cafeteria plan within the meaning of Internal Revenue Code (IRC) section 125. The TEBP is
maintained by Tenet Healthcare Corporation (Tenet) for the benefit of its employees and the employees
of its participating affiliates.
This document, together with the benefits booklets for the Short-Term Disability, Long-Term Disability,
Critical Illness, Life/Accidental Death and Dismemberment, and Long-Term Care programs, serves as the
summary plan description (SPD) for the TEBP and summarizes key provisions of the TEBP. You can
obtain more information about the TEBP by reviewing the official plan documents for the TEBP. If there
is any discrepancy between this online SPD and the official plan documents for the TEBP, the official plan
documents will govern. For more information on obtaining the official plan documents, see the Other
Information section of this SPD site.
Note: Please keep in mind that there may be Tenet facilities or subsidiaries that do not participate in
the TEBP. Please check with the Human Resources department at your facility for more information.
Who’s Eligible?
Employees
You’re eligible to enroll in the Tenet Employee Benefit Plan (TEBP) and the component benefit programs
offered through it as long as you are an employee (as defined below) and you meet the eligibility
requirements of the specific benefit program at issue:
Benefit Program
Eligibility Requirements
Health Care Programs

You’re classified4 by Tenet as a full-time
employee.

You’re classified4 by Tenet as a part-time 1
employee (other than a Tenet Physician
Resource (TPR) employee).

With respect to the Medical and the
Prescription Drug Programs only, you're
determined to work 30 hours or more per
week in accordance with Tenet's "ACA
Compliance Full-Time Employee
Determination Policy" (i.e. you are an "ACA
Full-Time Employee") attached as Appendix 1
to this SPD.

With respect to the Prescription Drug
Program, you are enrolled in a Medical
Benefit Program option. See the Prescription





Medical (including the Health
Reimbursement Account Program1)
Employee Assistance Program (EAP)2
Prescription Drug
Dental
Vision
Spending Accounts


Health Care and Dependent Care Spending
Accounts
Health Savings Account (HSA)3
{00014391.DOCX-}
2
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Benefit Program
Eligibility Requirements
Drug section of this SPD for more
information.
Protection Plans

Basic Life/Accidental Death and
Dismemberment (AD&D)

Long-Term Care
Protection Plans





Supplemental Life and Accidental Death and
Dismemberment (AD&D)
Business Travel Accident
Accident
Short- and Long-Term Disability
Critical Illness

With respect to the Health Reimbursement
Account Program, you are enrolled in either
the Gold or Health & Reimbursement
coverage option under the Medical Benefit
Program.

All employees are automatically enrolled in
the EAP (regardless of employee
classification).

You’re classified4 by Tenet as a full-time
employee.

You’re classified4 by Tenet as a full-time
employee.

You’re classified4 by Tenet as a part-time 1
employee (other than a Tenet Physician
Resource (TPR) employee).4 Please note:
Eligibility for Protection Plans for union
employees classified as part-time 1
employees is subject to the terms of the
applicable collective bargaining agreement
and may not be available to all union parttime 1 employees.
1You
must be enrolled in either the Gold or Health & Reimbursement Medical Program option in order to have an account
under the Health Reimbursement Program.
2
You and your household residents may access EAP benefits without being enrolled in one of the Tenet Medical Program
options.
3HSAs
have been listed for informational purposes only. HSAs are savings accounts established by employees and are not
an ERISA benefit program established or maintained by Tenet or its affiliates. To establish an HSA, an employee must be
enrolled in the Silver or Health & Savings Plan Medical Program option.
4Classification
by Tenet as a full-time, part-time 1, or part-time 2 employee is based on Tenet's determination as to
anticipated scheduled hours and is not impacted by the fact that you may, on occasion, work more or less than your
anticipated scheduled hours. Be sure to check with your local Human Resource department to determine your
classification, and keep in mind that classification criteria may differ from facility to facility.
Only employees of Tenet (and, as described above, their dependents and/or household
members) are eligible to participate in the TEBP. An "employee" of Tenet includes any
individual employed or formerly employed by Tenet (and its affiliates or subsidiaries who
participate in the Plan). The term "employee does not include any individual 1) who is a leased
employee or who is determined by Tenet to be an independent contractor (even if such leased
employee or independent contractor is later determined to be an employee by the IRS, DOL, a
court, or Tenet), or 2) whose terms of employment are governed by a collective bargaining
agreement, unless that agreement provides for coverage in the Plan.
{00014391.DOCX-}
3
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Guidelines About Part-Time 1 Employee Eligibility
Part-time 1 employees are not eligible for basic life insurance, basic accidental death and
dismemberment (AD&D) or long-term care. While part-time 1 employees are generally eligible for
Critical Illness and Short-and-Long-Term Disability, certain exclusions may apply for union employees
based on the terms of applicable collectively bargained agreements.
Dependents
Because having good care and financial protection are also important for your loved ones, Tenet allows
you to cover your dependents under certain benefit programs.
Benefit Program
Dependents Eligible for Coverage
Health Care Programs







Medical
Employee Assistance Program
(EAP)
Prescription Drug
Dental
Vision1
Spending Accounts


Health Care and Dependent
Care Spending Accounts
Health Savings Account (HSA)2
{00014391.DOCX-}


Your legal same- or opposite-sex spouse.
Your same- or opposite-sex domestic partner, provided he
or she meets Tenet's domestic partner policy requirements
Your married and unmarried children up to age 26.
Your mentally or physically disabled child, if the disability
occurred prior to attainment of age 26.
(There are special provisions that may affect your child’s
eligibility. See “Special Situations That Can Affect Eligibility”
for more information.)

If you have enrolled in either the Gold or Health &
Reimbursement option under the Medical Benefit
Program, eligible health care expenses incurred by your
dependent may be reimbursed under your Health
Reimbursement Account (HRA), as long as your dependent
qualifies as your federal tax dependent within the meaning
of Internal Revenue Code (IRC) section 152 (determined
without regard to IRC sections 152(b)(1), (b)(2), and
(d)(1)(B)).

With respect to the EAP only, all members of your
household are eligible for coverage, regardless of whether
they are your dependents.

Eligible expenses incurred by your dependent may be
reimbursed under the Spending Accounts, as long as your
dependent qualifies as your federal tax dependent within
the meaning of IRC section 152, determined without
regard to IRC sections 152(b)(1), (b)(2), and (d)(1)(B)).
(Note: Although Tenet allows you to cover your domestic
partner, and in some cases, the children of your domestic
partner, under certain of its benefit programs, expenses
incurred with respect to these individuals are not eligible
for reimbursement under the spending accounts unless
4
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Benefit Program
Dependents Eligible for Coverage
such individuals qualify as your federal tax dependents as
noted above.)
Protection Plans

Life/Accidental Death and
Dismemberment (AD&D)



Long-Term Care Program


Accident
Critical Illness

1See
For the Life/Accidental Death and Dismemberment
(AD&D) Program: Refer to the Life and AD&D section of
this SPD.
For the Long-Term Care Program: You must contact the
carrier to purchase an individual policy for any dependents
you wish to cover. You can obtain coverage for the
following dependents, provided they are under age 85:
o Your legal same- or opposite-sex spouse
o Your same- or opposite-sex domestic partner,
provided he or she meets the applicable domestic
partner requirements
o Your parents, stepparents or grandparents (natural or
adoptive)
For the Critical Illness Program: If you have enrolled, you
may enroll your spouse. Additionally, your dependent
children will automatically be covered at 25% of your
coverage level. Refer to the Benefits Booklet for this
program for more information, which is incorporated by
reference into this SPD.
also "Special Rule for Dependent Coverage under the Vision Program Only" below.
2HSAs
have been listed for informational purposes only. HSAs are savings accounts established by employees and are not an
ERISA benefit program established or maintained by Tenet Healthcare Corporation or its affiliates. To establish an HSA, an
employee must be enrolled in the Silver or Health & Savings Plan Medical Program option.
Eligible Dependent Children
“Children” include your natural children, stepchildren, foster children and legally adopted children
(including those children whose legal adoption proceedings are in progress) and children for whom you
or your spouse serve as permanent legal guardian.
Qualified Medical Child Support Order
If you separate or divorce, you may be required by the court to continue your children’s health care
coverage. The document that mandates this is called a Qualified Medical Child Support Order (QMCSO).
You may request a copy of Tenet’s QMCSO procedures free of charge from the Plan Administrator.
Special Rule for Dependent Coverage under the Vision Program Only
Your unmarried grandchildren may be covered up to age 26, regardless of their student status. To enroll
grandchildren, you must provide verification that they are your dependent for federal income tax
purposes.
Domestic Partners
For your domestic partner to be covered under the Medical Program (including the Prescription Drug
Program) and the Dental and Vision Programs, you and your domestic partner must:
 Consider each other life partners,
{00014391.DOCX-}
5
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
 Both be age 18 or older (or, if younger, the age at which a marriage would be permitted in the state
of residence),
 Not be blood related (to a degree that would prohibited if married),
 Have lived together for at least 6 months,
 Share the same permanent address,
 Be mentally competent,
 Not be legally married to or in a domestic partnership with anyone else,
 Not have had another domestic partner within the past six months, and
 Share necessities of life and financial interdependence (shown by at least two of the following):
 A joint bank account, credit account or loan,
 Joint vehicle ownership,
 Joint ownership, mortgage or lease of a residence,
 Evidence of common household expenses, such as utilities or phone,
 Wills naming each other as executor and/or beneficiary,
 Granting each other power of attorney,
 Designating each other as a beneficiary under a retirement benefit account, or
 Evidence of other joint financial responsibility.
Regardless of whether you and your domestic partner meet the above list of criteria, your domestic
partner will be eligible for coverage under the Medical Program (including the Prescription Drug
Program) and the Dental and Vision Programs, if you and your domestic partner are registered as
domestic partners with any state or local government registry recognizing domestic partnerships
(assuming you meet the requirements of such government registry). For information on whether your
domestic partner is eligible for coverage under Long-Term Care or Life/Accidental Death and
Dismemberment (AD&D), please see the sections of this TEBP SPD that cover these benefit programs.
Unless your domestic partner qualifies as a “dependent” under section 152 of the Internal Revenue
Code (IRC), you may be treated as receiving “imputed income” for federal income tax purposes with
respect to the benefits provided to your domestic partner. (Note that the factors used to determine
“dependent” status under the IRC may differ depending on the type of benefit program at issue. For
more information on determining whether your domestic partner is a dependent within the meaning of
the IRC, please contact your tax advisor.) Imputed income is the difference between the value of the
benefit provided to your domestic partner and the amount that you have paid for that benefit. You must
pay federal income taxes (including Social Security tax and Medicare tax) on your imputed income.
Similar treatment may apply for state and local income-tax purposes, to the extent applicable. Further, if
your domestic partner does not qualify as your federal tax dependent (determined in accordance with
IRC section 152 but without regard to IRC 152(b)(1), (b)(2), and (d)(1)(B)), expenses your domestic
partner incurs cannot be reimbursed under the Health Reimbursement Account or the other spending
account programs. A copy of the “Tenet Criteria for Domestic Partnership Status,” which discusses
these tax implications in more detail, is available on MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees. You must submit a Domestic Partner Affidavit along with
any required documentation to obtain coverage. For more information on federal, state or local taxation
of domestic partner benefits, please contact your tax advisor. If you are legally married to your
domestic partner, to avoid imputed income, you should enroll your partner as your spouse rather than
as a domestic partner.
Who’s Not Eligible?
You’re not eligible for the Tenet benefit programs under the TEBP if you’re a:
 Member of a collective bargaining unit (unless your collective bargaining agreement specifically
provides for coverage under the Tenet benefit programs),
{00014391.DOCX-}
6
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
 Part-time 2 employee (which includes a per diem employee, temporary employee, a student, or an
intern), except with respect to coverage under the EAP,
 Part-time 1 employee employed as a Tenet Physician Resource (TPR),
 Leased employee or independent contractor (even if you are later determined to be an employee by
Tenet, the IRS, the DOL, or a court),
 An employee of a Tenet facility or subsidiary that is not a participating employer in the TEBP; or
 An Employee who does not work in the United States.
Special Situations That Can Affect Eligibility
There are certain circumstances that can affect your dependent coverage. Here’s an overview of some
of them:
Your Situation
If Your Child Is
Mentally or
Physically
Disabled
What You Need to Know
 A child up to age 26 who is mentally or physically disabled can enroll and
continue in medical and dental coverage.
 A child older than age 26 who is mentally or physically disabled can enroll
and/or continue coverage in medical and dental coverage, if the mental or
physical disability occurred prior to child's attainment of age 26.
What You Need to Do
 Provide your medical and/or dental carrier with proof of your child’s
disability by the required deadline.
If You Have
a Family
Member in the
Military
Service
What You Need to Know
 Although family members who are in active military service with the
armed forces of any country may be covered as dependents in Tenet
benefit programs (subject to the eligibility requirements of each program),
many programs exclude from coverage illnesses, injuries, or conditions
resulting from such service.
What You Need to Do
 See the individual benefit program SPD sections for more information.
What You Need to Know
 If you and your spouse are both Tenet employees and eligible for the
Tenet benefit programs, there are special enrollment guidelines you’ll
need to follow.
What You Need to Do
If You and Your
 You can each elect coverage as an employee or one of you can choose to
Spouse Both
be covered as a dependent of the other. However, you can be covered
Work for
only once — you can’t be covered both as an employee and as a
dependent of your spouse.
Tenet*
 You and your spouse can each cover different children; however, each
child can be covered only once.
 If you or your spouse is ineligible for Tenet benefit programs as an
employee, the ineligible spouse can be enrolled in coverage as a
dependent of the eligible spouse.
If You and Your
Child Both
{00014391.DOCX-}
What You Need to Know
 The same eligibility rules that apply to married Tenet couples also apply if
you and your dependent child are both employed by Tenet.
7
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Your Situation
Work for
Tenet*
What You Need to Do
 Please see rules for Tenet married couples noted above.
*For information about Basic Life and AD&D eligibility, please see the Life and AD&D section.
A Word About Medicare Eligibility (Medical Plans Only)
At age 65 (or earlier for some people), you become eligible for Medicare Part A, Medicare Part B,
Medicare Advantage (Part C) and Medicare Part D coverage. In brief, here’s how each works:
 Medicare Part A covers hospitalization and is free.
 Medicare Part B covers outpatient services and requires you to pay a premium.
 Medicare Advantage (Part C) covers both hospitalization and outpatient services and requires you to
pay a premium. To receive coverage, you enroll in one of the private health plans that contracts with
Medicare. Many of these plans also offer prescription drug coverage.
 Medicare Part D provides stand-alone prescription drug coverage for the Medicare plans that don’t
offer it. To receive coverage, you enroll in one of the private drug plans Medicare has approved and
you are required to pay a premium.
Being Medicare-eligible can affect your coverage under the Tenet Medical and Prescription Drug
Programs.
If You Choose
to Be Covered …
Here’s What Happens …
By Both Medicare and the
Tenet Medical Plan and
Prescription Drug Program
The Medical Plan and Prescription Drug Program will remain
“primary” — that is, they will pay benefits first — as long as you
remain an active employee or are under a severance agreement
and to the extent required by the Medicare Secondary Payer rules
and any other applicable federal statutory or regulatory
requirements. For details, please refer to “When You’re Covered
by Another Medical Plan (Coordination of Benefits)” in the
Medical and Prescription Drug sections of this SPD.
You need to notify the MyBenefits Customer Support Center
within 31 days after electing Medicare as your only coverage.
By Medicare Only
Your coverage under the medical plan for you and your
dependents will stop on the date your Medicare coverage goes
into effect. Your dependents can continue medical coverage under
COBRA if they wish. Refer to the Other Information section of this
SPD site for more details on COBRA coverage and what it costs.
There are important deadlines to consider when deciding whether to enroll in Medicare Part D. If you
don’t sign up for Medicare Part D when first eligible, and later decide to enroll, you may then have to
pay more for Medicare Part D coverage, depending on whether you were covered under a plan offering
“creditable coverage.” For example, if you become Medicare-eligible and remain covered under a Tenet
Medical Program and Prescription Drug Program that provides creditable coverage, you can sign up later
for Medicare Part D without incurring the added cost. These coverage rules also apply to your spouse if
{00014391.DOCX-}
8
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
he or she is Medicare-eligible. If you have any questions about Medicare benefits and costs, please
contact your local Social Security office. For more information regarding creditable and non-creditable
coverage, see the Other Information section of this SPD.
Life and Work Changes May Affect Benefits Eligibility!
In today’s world, change is a fact of life. You may experience life event changes (for example, getting
married, gaining a dependent or taking a leave of absence), as well as changes to your work
schedule. You should be aware that these changes may affect your eligibility for benefits. To find out
what these changes are and how they affect you, please refer to the Life Events section of this SPD.
When You Can Enroll
For Tenet’s core plans — basic life, basic accidental death and dismemberment (AD&D), business travel
accident and the Employee Assistance Program (EAP) —enrollment is automatic, if you’re eligible for
these programs. You don’t need to do a thing! (You may, however, select a beneficiary for the
Life/AD&D and business travel accident programs. See the specific SPD sections for these programs and
the Life Events section for additional information on selecting a beneficiary.) For all other Tenet benefit
programs, you have the option to elect or decline coverage.
Enrolling When You’re First Eligible
You’ll receive an Enrollment communication by mail after your hire date. To enroll for coverage under
any of the Tenet benefit programs, simply follow the instructions provided in the communication. You
must enroll within 31 days of receiving the Enrollment communication.
Once you enroll, your elections stay in effect for the rest of the calendar year, except in the case of
special circumstances. For more details, please refer to “When You Can Change Your Coverage
Elections” below.
Enrolling During Annual Enrollment
Each year, during Annual Enrollment, you’ll have an opportunity to elect, change or cancel your health
care and other benefit coverage. All changes made during the Annual Enrollment period will take effect
on January 1 of the following calendar year (or possibly later for non-group health plan elections that
require evidence of insurability).
Enrolling in Long-Term Care and Supplemental Life
If you don’t enroll when you’re first eligible but enroll during any following Annual Enrollment period,
you’ll be required to submit an application that includes evidence of insurability (EOI). If the application
you submit during the Annual Enrollment period is accepted, your coverage will be effective on January
1 or on the date approved as noted in Unum’s acceptance letter, whichever date is later.
If you enroll at any other time during the year, your elections stay in effect for the rest of the calendar
year, unless you have a change in employment status that makes you ineligible for coverage. If you
become ineligible for coverage, you will need to apply for individual coverage under a group conversion
policy if you wish to maintain coverage.
You may enroll your eligible dependents for long-term care coverage at any time during the year after
you become eligible. However, they must each fill out a separate enrollment form to send to Unum,
Tenet’s long term care and life insurance carrier. Your covered dependents will receive all plan
{00014391.DOCX-}
9
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
information and instructions directly from Unum. Unum will also bill them separately for the cost of
their long-term care coverage.
Don’t Miss Your Enrollment Deadline!
Be sure to enroll on time. If you don’t enroll by the date communicated, you can’t enroll for health
care coverage until the next Annual Enrollment period, except as outlined under When You Can
Change Your Health Care Coverage Elections. If you don’t enroll for Long-Term Care and
Supplemental Life when you are first eligible, you will have to submit evidence of insurability.
Declining Coverage
If you have other healthcare coverage — for example, from your spouse’s employer — you may choose
to waive any or all of your Tenet health care coverage. However, if your health care needs change during
the year, remember that you can make changes to your coverage during the year only if you:
 Have a change in your employment status that changes your benefits eligibility,
 Experience a life event and advise us within 31 days, or
 Are eligible for a special enrollment.
The coverage change you elect must be consistent with the life event. In the absence of one of the
situations above, you must wait until the next Annual Enrollment period to make a health care coverage
election. For more information on life events, see “When You Can Change Your Coverage Elections” and
the Life Events section of this SPD.
When Coverage Begins
The date your coverage begins depends on when you enroll. Coverage for your enrolled eligible
dependents begins on the same day as your coverage begins, assuming you enroll your dependents at
the same time you enroll.
Benefit Program
Coverage Begins …
Health Care Programs


Medical (including
Health Reimbursement
Account)

Employee Assistance
Program (EAP)
Prescription Drug
Dental
Vision



Spending Accounts


Health Care and
Dependent Care
Spending Accounts
Health Savings Account
(HSA)
{00014391.DOCX-}


When you first join Tenet: For all Health Care Programs with the
exception of the EAP, your coverage begins on your 31st day as a fulltime or part-time 1 employee, provided you’ve enrolled within the
first 31 days of employment. In the case of the EAP, you and your
eligible dependents are covered starting on your first day of
employment.1
When you become eligible due to a change in your employment
status or transfer into an eligible group (i.e. full-time or part-time
1): Your coverage begins 31 days after the change, provided you’ve
enrolled within 31 days of the change in status or transfer into an
eligible group.
You become eligible for the Medical Program and Prescription Drug
coverage because you are determined to be an ACA Full-Time
Employee: Coverage will begin on the date specified in Tenet's "ACA
Compliance Full-Time Employee Determination Policy" attached as
Appendix 1 to this SPD.
For the Health Care Plans and Spending Accounts
10
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Benefit Program
Coverage Begins …
Protection Plans


Basic Life/Accidental
Death and
Dismemberment
(AD&D)

Short- and Long-Term
Disability


Accident
Critical Illness
When you experience a life event: Your coverage begins as of the
date of the qualifying status change, provided you report the life
event by going to MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees or calling the
MyBenefits Customer Support Center at 1-877-468-3638 within 31
days after the event.
HIPAA Special Enrollment (Medical Program Only)
 When you become eligible for HIPAA special enrollment: Your
coverage begins as of the date of the event or the date you lost your
other coverage, whichever is later, provided you report the life
event by going to MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees or calling the
MyBenefits Customer Support Center at 1-877-468-3638 within 30
days after the event. (Note: There is a 60-day enrollment period for
the following HIPAA special enrollment events: Loss of eligibility
under a state Medicaid or CHIP program or becoming eligible for
state premium assistance under Medicaid or CHIP.)
Actively At Work Requirement for Certain Plans
You must be actively at work for your coverage under certain
insured protection programs (including, but not necessarily limited
to, the Basic Life/Accidental Death and Dismemberment (AD&D),
Critical Illness, Accident, Short-Term and Long-Term Disability
Programs) to begin. Please check the benefits booklet or SPD
section for the specific insured program for additional information.

Long-Term Care Program

When you first join Tenet: Your coverage begins on your 31st day as
a full-time employee (as classified by Tenet), provided you’ve
enrolled and you’re actively at work.

After 31 days from your hire date: Your coverage begins on the date
your long-term care application, including evidence of insurability, is
accepted and approved by Unum.
1Residents
may be eligible to purchase health coverage beginning on the first day of employment. Coverage will be provided on
an after-tax (not pre-tax) basis until the 31st day of employment. Please contact the MyBenefits Customer Support Center for
more information.
Leave of Absence during Eligibility Period
If you haven’t satisfied the 30-day benefit eligibility period and you take a personal or extended leave of
absence, any employment time you had with Tenet prior to your leave will count toward satisfying the
benefit eligibility period upon your return. Your coverage will begin once you have returned to work
(and completed the 30-day benefit eligibility period).
When You Can Change Your Coverage Elections
Generally, your benefit elections stay in effect for the entire calendar year. However, certain life events
can make a change in coverage necessary. To make sure the benefits you have match your needs, Tenet
allows you to change your health care elections if you experience a life event or qualify for a special
enrollment under the Health Insurance Portability and Accountability Act (HIPAA).
{00014391.DOCX-}
11
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
With life events or special enrollments, you can choose to elect or waive health care coverage or add or
drop dependents
Life Events (Qualified Status Changes)
The change you wish to make must be related to the life event. You’ll need to report the life event by
going to MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees or calling
the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days of the event.
The coverage change you make will go into effect on the date of the life event, provided you make the
coverage changes within the 31-day window. If you miss this 31-day deadline, you’ll have to wait until
the next Annual Enrollment period to change your health care coverage. (Note: There is a 60-day
enrollment period for the following HIPAA special enrollment events: Loss of eligibility under a state
Medicaid or CHIP program or becoming eligible for state premium assistance under Medicaid or CHIP.)
Here’s a list of some life events that may affect your health care coverage (for more details, please see
the Life Events section of the SPD).
Life Event
Description
Adoption/Birth of Child
You have a baby or legally adopt a child. Legally adopted children
include those children whose legal adoption proceedings are in process.
Change in Your Child’s
Status
Your child loses eligibility if he or she reaches the maximum age limit.
Death of Dependent
Your spouse/domestic partner/child dies.
Divorce or Dissolution of
Domestic Partnership
You divorce, legally separate or receive an annulment. If you end your
domestic partnership, you may drop your domestic partner’s coverage.
Employment Status
(Yours)
You’re rehired (if you’re receiving severance) or you become eligible for
benefits through a new employer.
OR
There is a change in your employment status.
Employee Status (Your
Spouse’s or Domestic
Partner’s)
Your spouse gains employment or becomes eligible for benefits through
his or her employer.
OR
Your spouse’s/domestic partner’s employment ends or he or she is no
longer eligible for benefits through his or her employer.
Leave of Absence
You go on a leave of absence.
Legal Custody
There’s a change in the legal custody of your dependents.
Marriage
You marry or reconcile after a legal separation.
Medicare Eligibility
You or your spouse becomes eligible for Medicare and elects Medicare
as sole medical coverage (applicable to Medical Program changes only).
Qualified Medical Child
Support Order (QMCSO)
A Qualified Medical Child Support Order (QMCSO) requires you to
provide health care coverage for your child(ren) or ends the
{00014391.DOCX-}
12
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Life Event
Description
responsibility of providing health care coverage for your child(ren). The
Plan Administrator will determine whether a QMSCO is qualified.
You intend to enroll in a
Health Insurance
Marketplace Plan
You may be able to revoke your Medical Benefit Program coverage if
you intend to enroll in a Health Insurance Marketplace Plan during the
Marketplace annual enrollment or a special enrollment. You may also
be able to revoke your Medical Benefit Program coverage if you intend
to enroll in a Marketplace place because your hours have dropped or
you expect them to drop below 30 hours per week. Please see the Life
Events section of this SPD for additional details and requirements.
If You Gain a New
Dependent Through …
Your Dependent’s Health Care Coverage Begins …
Marriage
On the date you get married, provided you report your life event and
make any new benefit elections through MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer employees or by calling
the MyBenefits Customer Support Center at 1-877-468-3638 within 31
days of your marriage.
Birth, Adoption or
Placement for Adoption
On the date of the birth, adoption or placement for adoption, provided
you report your life event and make any new benefit elections through
MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees or by calling the MyBenefits Customer Support Center at 1877-468-3638 within 31 days of the event date.
Please Be Aware ...
You must report your life event by going to MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees or calling the MyBenefits Customer Support Center at 1877-468-3638 within 31 days of a life event.
When You Gain a New Dependent
If you’re adding a dependent and you’re eligible for coverage under any of the health care plans, you
may — within 31 days of the event — elect coverage for your new spouse or child (including a child who
becomes a dependent as a result of your marriage). You may enroll a new domestic partner mid-year if
the domestic partner qualifies as your federal tax dependent within the meaning of IRC section 152
(determined without regard to IRC section 152(b)(1), (b)(2), and (d)(1)(B)).
If you’re not currently enrolled in the health care plans, you’ll need to enroll yourself to elect coverage
for your spouse, domestic partner and/or children.
{00014391.DOCX-}
13
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Special HIPAA Enrollment (Medical and Prescription Drug)
If You Lose Other Coverage
Tenet also allows for a special enrollment in a Tenet medical plan option if you or your dependents are
covered under other medical coverage and then lose that coverage during the year. You may enroll,
provided you and your dependents are eligible for coverage under the medical plan option and:
 You or your dependents were covered under another group medical plan or had other medical
coverage at the time you were previously offered coverage under the Tenet benefit plans,
 Your expiring medical coverage (such as COBRA coverage) has been exhausted and it ended due to
loss of eligibility (such as a change in your employment status or other change in the medical
coverage of your spouse/domestic partner or child) or the employer contributions for coverage
ceased, and
 You request coverage under Tenet’s medical plan no later than 31 days (60 days in the case of a
HIPAA special enrollment that is loss of eligibility under a state Medicaid or CHIP program or
becoming eligible for state premium assistance under Medicaid or CHIP) after your prior coverage
ends.
Your dependents can be enrolled in the plan only if you’re currently enrolled or if you and your
dependents enroll in the plan at the same time. If you qualify, you may request a change in the level of
coverage, such as from “employee only” to “family.” You may also elect to enroll yourself and/or your
dependents in the plan. If you make a change in coverage, your new coverage will become effective on
the date you lost your other coverage.
{00014391.DOCX-}
14
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
When Coverage Ends
Your coverage under the Tenet benefit plans will end as follows:
Benefit Plan
If you . . .
When Coverage Ends
Health Care Plans
 Medical (including the
Health Reimbursement
Account)
 Prescription Drug
 Dental
 Vision

Terminate
employment,

Have a status
change from fulltime to part-time 2 ,

Have a status
change from parttime 1 to part-time
2,

With respect to the
Medical Program
and the Prescription
Drug Programs only,
cease to be an ACA
Full-Time Employee,
or

With respect to the
Health
Reimbursement
Account Program,
cease to be covered
under either the
Gold or Health &
Reimbursement
Medical Program
option coverage
option.
Generally, your and your dependent’s coverage
ends on the last day of the month in which the
last pay period ends based on the effective date
of your termination of employment or effective
date of your status change. However, with
respect to the Medical Program and the
Prescription Drug Program, if you are losing
coverage due to a change in status from full-time
or part-time 1 to part-time 2, or if you are losing
coverage because of a drop in hours that causes
you to cease being an ACA Full-Time Employee,
coverage will end as of the date specified in
Tenet's ACA Compliance Full-Time Employee
Determination Policy attached as Appendix 1 to
this SPD. Coverage under the Health
Reimbursement Account Program ends on the
date you cease to be covered under either the
Gold or Health & Reimbursement Medical
Program coverage option.
Spending Accounts
 Health Care Spending
Account
Employee Assistance
Program (EAP)
{00014391.DOCX-}

Terminate
employment
Please refer to the Life Events section of the SPD
for more information.
Coverage ends upon termination or at the end of
the COBRA continuation period, if applicable.
15
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Benefit Plan
Coverage Ends the Earliest of:
Health Care Plans
 Medical (including the Health
Reimbursement Account)
 Prescription Drug
 Dental
 Vision
For You



The date contributions for coverage stop,
Spending Accounts
 Health Care Spending Account

The date your severance period under a severance
agreement ends (see "If You're Receiving Severance
Below" for more information and exceptions),


The date you die, or
Protection Plans
 Basic Life/Accidental Death and
Dismemberment (AD&D)
 Short- and Long-Term Disability
 Long-Term Care Program
 Accident
 Critical Illness
 Business Travel Accident
Employee Assistance Program
Spending Accounts
Dependent Care Spending Account
The date the plan is terminated,
The date you become ineligible for coverage for any
reason, including a plan amendment,
With respect to the Health Reimbursement Account
Program, the date you cease to be covered under
either the Gold or Health & Reimbursement Medical
Program coverage option.
For Your Dependent

The date you lose coverage for any of the reasons listed
above,

The date your dependent no longer qualifies as an
eligible dependent, or

For dependents who are covered during the course of
adoption proceedings, the date adoption proceedings
are discontinued if they do not result in finalization of
the adoption.
On December 31 of the calendar year, even if
contributions stop on your last day worked or, if earlier,
the date the plan is terminated.
Other Reasons Coverage Ends
In addition to the reasons listed above, you and your dependents may lose coverage under the TEBP if
any of the following occur:
 You permit an unauthorized person to use your ID card or you use another person’s ID card
 You knowingly give the Claims Administrator false material information including, but not limited to,
false information relating to another person’s eligibility or status as a dependent
 You commit an act of physical or verbal abuse that imposes a threat to Tenet’s staff, the Claims
Administrator’s staff, a Provider or another Covered Person, or
 You violate any terms of the Tenet Employee Benefit Plan.
{00014391.DOCX-}
16
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
Coverage Cancellation Questions
If you believe your coverage or that of your dependents has been cancelled incorrectly, contact My
Benefits by going to MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees
or by calling the MyBenefits Customer Support Center at 1-877-468-3638.
If You’re Receiving Severance
If you’re laid off and receiving severance, you can continue coverage for all benefit plans, except for the
business travel accident and disability plans, until the end of your severance period, provided you were
covered on your last day worked. HSA participants will no longer receive employer HSA contributions.
Once your severance period ends, you can continue health care coverage under COBRA for your
remaining COBRA coverage period (see the Other Information section of this TEBP SPD for more
information on COBRA).
Extending Your Medical Coverage
If you’re hospitalized when your medical coverage is scheduled to end, your coverage will continue until
you are discharged from the hospital. However, the medical plan will cover only eligible expenses
related to that hospitalization.
Extending Your Dental Coverage
The Dental Benefit Program will not pay benefits for services received or dental expenses incurred after
the date your dental coverage (or your dependent’s coverage, as applicable) ends. However, because
Tenet wants you to receive appropriate treatment for your dental needs, the Dental Benefit Program
will pay for eligible expenses incurred while you (or your dependent, as applicable) were covered under
the Dental Benefit Program, as long as the procedure to which those expenses relate is completed
within 31 days after the date your coverage (or your dependent’s coverage, as applicable) ends. An
expense is incurred at the following times:
 If the expense is for an appliance (or change to an appliance), at the time the impression is made;
 If the expense is for a crown, bridge or cast restoration, at the time the tooth or teeth are prepared;
 If the expense is for root canal therapy, at the time the pulp chamber is opened; and
 If the expense is for any other dental service, at the time the service is performed or the supply is
furnished.
Continuing Your Health Care Coverage Through COBRA
Under certain circumstances, you and/or your covered dependents have the right to continue health
care coverage for a period of time after your coverage has ended. Refer to the Other Information
section of this SPD site for more information on COBRA.
Converting Your Protection Benefits to Individual Policies
Generally, if your employment with Tenet ends, your benefit coverage will end. Under certain
conditions, you may be able to apply for individual coverage for yourself or for your dependents under
certain of the Tenet protection plans. If conversion is available, you (or your dependent) must apply for
a conversion policy by the applicable deadline.
{00014391.DOCX-}
17
----------------------------------------------------------- ELIGIBILITY & ENROLLMENT SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------
For more details on whether conversion is available and the requirements for conversion to an
individual policy (including deadlines for requesting conversion), please refer to the applicable SPD
sections for the Tenet protection plans.
{00014391.DOCX-}
18
Medical Summary Plan Description
About This Summary Plan Description (SPD)
We are pleased to provide the Tenet Medical Benefit Program, which offers health coverage to
eligible employees and their eligible Dependents. The Tenet Medical Benefit Program is a component
program in the Tenet Employee Benefit Plan (TEBP), a comprehensive welfare benefits plan intended
to qualify as a cafeteria plan within the meaning of Internal Revenue Code (IRC) Section 115. Under
the Tenet Medical Benefit Program, you may select one of the following medical care options:








Platinum
Gold
Silver
Bronze
Health & Savings Plan (HSP)*
Health & Reimbursement Plan (HRP)*
PPO*
EPO*
*Option availability varies by location. Please see the Benefits Guide, which you may obtain by
visiting MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees, for a
listing of options available at your facility.
This document summarizes key provisions of the Tenet Medical Benefit Program and the medical care
options listed above, and it serves as part of the Summary Plan Description (SPD) for the TEBP. You
can obtain more information about the Medical Benefit Program, the TEBP, and the other component
programs offered under the TEBP by viewing the complete SPD for the TEBP. If there is any
discrepancy between the TEBP SPD (including this Medical Benefit Program section) and the official
plan documents (including collective bargaining agreements, if any) for the TEBP, the official plan
documents will govern. For more information on obtaining the official plan documents, see the Other
Information section of the TEBP SPD.
Note: The medical benefits provided under the following fully insured Medical Benefit Program
options (available only at certain Tenet locations or facilities) are summarized in separate summary
plan description (SPD) documents:



Fallon Direct
Fallon Select
Blue Shield HMO
In addition, the Medical Benefit Program options administered by Health Plans, Inc. (the Harvard
Plan options, which are available only at certain Tenet locations or facilities) are also summarized in
separate medical SPD documents.
Employees who are enrolled in one of the fully insured options, Greenshield, or in an option
administered by Health Plans, Inc. should refer to the separate medical SPD document for such
option, available at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees. Unless provided otherwise, all other provisions of the TEBP SPD remain applicable to
such employees.
{00014391.DOCX-}
19
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
The TEBP SPD is designed to meet your information needs and the disclosure requirements of the
Employee Retirement Income Security Act of 1974 (ERISA). It supersedes any previous printed or
electronic SPD for the TEBP. It does not serve as a contract of or for employment.
Tenet Healthcare Corporation and its subsidiaries and affiliates who have adopted the TEBP are
referred to in this SPD as “Tenet,” “Employer,” or “Company.” (Please keep in mind that there may
be Tenet facilities or subsidiaries that do not participate in the TEBP. Please check with the Human
Resources department at your facility for more information.) Capitalized words in this Medical Benefit
Program section of the TEBP have special meaning and are defined below under “Glossary.” The
words “you” and “your” as used in this Medical Benefit Program section refer to “Covered Persons”
(as defined in the Glossary).
You should read this entire SPD section carefully and share it with your family. This Medical Benefit
Program section of the TEBP SPD includes summaries of:




Who is eligible for the Medical Benefit Program
Services that are covered under the Medical Benefit Program options, called Covered Health
Services
Services that are not covered under the Medical Benefit Program options, called Exclusions
Your rights and responsibilities under the Medical Benefit Program
If you have any questions after reading this material in this Medical Benefit Program section of the
TEBP SPD, please call the My Benefits Customer Support Center at (877) 468-3638, or for online
assistance, access the My Benefits link at MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees.
How to Use This SPD
 Read the entire SPD, and share it with your family.
 Many of the sections of this SPD are related to other sections. You may not have all the
information you need by reading just one section.
 You can access this SPD and any future amendments on this site or request printed copies by
contacting the MyBenefits Customer Support Center at 1-877-468-3638.
 Capitalized words in the SPD have special meaning and are defined in the Glossary.
 If eligible for coverage, the words "you" and "your" refer to Covered Persons as defined in the
Glossary.
 Tenet Healthcare Corporation is also referred to as Company.
Introduction to the Medical Benefit Program
This section of the SPD includes:




Quick Facts: Who You Can Cover, Cost of Coverage, When Coverage Begins, and When Coverage
Ends
The factors that impact your cost of coverage
Instructions and timeframes for enrolling yourself and your eligible Dependents in the Medical
Benefit Program
When you can make coverage changes under the Medical Benefit Program.
Quick Facts
{00014391.DOCX-}
20
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
Who You
Can Cover

Benefit Eligible Employee and eligible Dependents 
Cost of
Coverage

You and Tenet share the cost of your medical coverage.
When
Coverage
Begins
When
Coverage
Ends

Generally, on the 31st day after you begin employment as a full-time or
Part-time 1 benefit eligible employee, provided you’ve enrolled. For an
explanation of benefit eligible employees, see the definition of “Benefit
Eligible” in the Glossary below and the Eligibility and Enrollment section
of this TEBP SPD.1 

If you become eligible because you are determined to be an ACA FullTime Employee, coverage will begin on the date specified in Tenet's
"ACA Compliance Full-Time Employee Determination Policy" attached as
Appendix 1 to this SPD.

Coverage for your Dependents will start on the date your coverage
begins, provided you have enrolled them in a timely manner.

Coverage for newly eligible Dependents begins on the date they become
eligible and Dependent documentation has been received and verified
(through birth, adoption, etc.), provided you enroll them within 31 days
(as applicable, see the Life Events section of the TEBP SPD for more
information) of the date they become eligible.

When coverage ends depends on various factors. Please refer to When
Coverage Ends below, and in the Eligibility and Enrollment section of the
TEBP SPD, for detailed information on when coverage for you and your
Dependents ends.

In some circumstances, you or your Dependents may be eligible to
continue your medical coverage under the Consolidated Omnibus
Budget Reconciliation Act (COBRA) of 1985, as amended. For more
information on COBRA coverage, please see the Other Information
section of this TEBP SPD.
1Residents
may be eligible to purchase health coverage beginning on the first day of employment. Coverage will be
provided on an after-tax (not pre-tax) basis until the 31st day of employment. Please contact the MyBenefits Customer
Support Center for more information.
Cost of Coverage
You and Tenet share in the cost of the Medical Benefit Program. Your contribution amount depends
on the medical care option you select and the family members you choose to enroll.
Your contributions for your coverage and for coverage for your dependents (including your spouse
and legal same-sex spouse) are typically deducted from your paychecks on a before-tax basis. Beforetax dollars come out of your pay before federal income and Social Security taxes are withheld - and in
most states, before state and local taxes are withheld. This gives your contributions a special tax
advantage and lowers the actual cost to you. However, your contributions for Domestic Partner
coverage (and for coverage for any other dependent who is not your federal tax dependent) will be
deducted from your paychecks on an after-tax basis unless your Domestic Partner qualifies as your
federal tax dependent within the meaning of IRC section 152 (determined without regard to IRC
sections 152(b)(1), (b)(2), and (d)(1)(B)). For more information in determining whether your Domestic
Partner or other dependent qualifies as your federal tax Dependent, contact your tax advisor.
{00014391.DOCX-}
21
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
Your contributions are subject to review and Tenet reserves the right to change your contribution
amount from time to time.
You can obtain current contribution rates by calling the MyBenefits Customer Support Center at 1-877468-3638 or accessing your personal enrollment information from MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees.
How to Enroll
1. Enroll online at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees or call the MyBenefits Customer Support Center at
1-877-468-3638.
2. Complete an enrollment transaction within the applicable deadline (generally, 31 days of the date
you first become eligible for coverage under the Tenet Medical Benefit Program—see the Life
Events section of this SPD for more specific information). If you do not enroll within the
applicable deadline you will need to wait to make your benefit elections until the next Annual
Enrollment period or the date you incur a change of family status or HIPAA special enrollment
event entitling you to a mid-year enrollment. For more information on change of family status
and HIPAA special enrollment events, see the Life Events section of the TEBP SPD.
Each year during Annual Enrollment, you have the opportunity to review, change, or cancel your
healthcare coverage. All changes made during the Annual Enrollment period will take effect on
January 1 of the following calendar year.
Important
If you wish to change your benefit elections following your marriage, birth or adoption of a child,
or other family status change or HIPAA special enrollment event, you must complete your
enrollment transaction online at MyTenet.com for Tenet colleagues and HealthyatTenet.com for
Conifer employees or call the MyBenefits Customer Support Center at 1-877-468-3638 within 31
days of the event and request your change. Otherwise, you will need to wait until the next Annual
Enrollment period to change your elections.
Changing Your Coverage
Please refer to the Life Events section of the TEBP SPD for more information on making coverage
changes outside of an Annual Enrollment period.
How the Medical Benefit Program Works
This section includes information on:
 Network and out-of-network benefits
 Eligible Expenses
 Annual Deductible
 Co-Insurance
 Out-of-Pocket Maximum
Network Benefits
As a participant in the Medical Benefit Program, you have the freedom to choose the physician or
health care professional you prefer each time you need to receive Covered Health Services. The choices
you make affect the amounts you pay, as well as the level of Benefits you receive and any benefit
limitations that may apply.
{00014391.DOCX-}
22
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
You are eligible for the in-network level of Benefits under this Plan when you receive Covered Health
Services from physicians and other health care professionals who are Network Providers. Network
Providers are those that are contracted with the network(s) indicated on the Medical ID card. For all
Covered Health Services, Network Providers must accept a reduced rate (“Negotiated Rate”) as their
charge for services rendered and cannot bill for the difference between the charge and the Negotiated
Rate.
All Tenet facilities will be Network Providers and are generally reimbursed at a higher reimbursement
level than contracted Network providers.
Keep in mind, a Provider’s status as a Network Provider may change. To verify a provider’s status as a
Network Provider or to request a directory, you can call member services at the toll-free number on
your ID card or use the My Benefits link from the home page of MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees. Generally, when you receive Covered Health Services from
a Network Provider, you pay less than you would if you receive the same care from an Out-of-Network
Provider. Therefore, in most instances, your out-of-pocket expenses will be less if you use a Network
Provider.
Out-of-Network Benefits
Payment for Covered Health Services rendered by an Out-of-Network Provider will be based
on the Provider’s Reasonable and Customary (R&C) Charge. The Out-of-Network Provider may
bill for charges in excess of the R&C Charge, and such amounts will be your responsibility.
Covered Health Services provided by Out-of-Network Providers will generally be covered at a
lower benefit level than services received from a Network Provider, and any amounts not
covered by the Tenet Medical Benefit Program will be your responsibility. These amounts
could be significant and will not count towards your Out-of-Pocket Maximum. You may want
to ask an Out-of-Network Provider about its charges before you receive care. Emergency
services received at an Out-of-Network Hospital will be covered at the same cost-sharing level
as if they were incurred in network ; however, you may be billed for the difference between
the Out-of-Network Provider’s billed charges and the amount collected from the Plan and from
you (through cost-sharing).
Out-of-Network Exception Process
 Claims are to be Pre-Certified prior to the service.
 You should call the carrier to request an authorization to see an Out-of-Network Provider.
 You should be able to inform the Claims Administrator if this is a one-time visit, or if there will be
ongoing treatment.
 The Claims Administrator will search within a 45-mile radius from your home to determine if a
Network Provider can be located.
o If a Network Provider is found within the 45-mile radius, the Participant will be instructed to
see the Network Provider for in-network benefits. The Out-of-Network Provider will not be
authorized for in-network benefits, and if the Participant chooses to see the Out-of-Network
Provider regardless, benefits will be paid at the lower Out-of-Network levels.
o If no Network Provider is found within the 45-mile radius, and the requested Out-of-Network
Provider has a valid tax id number, the Claims Administrator will authorize the visits, and
benefits will be paid at the Network Provider level, for covered services.
o If a valid Taxpayer ID number is not given, then the Provider’s information should be obtained,
so that an out bound call can be made to the Provider to obtain the necessary information.
{00014391.DOCX-}
23
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
If a Participant receives services from an Out-of-Network Provider and he or she feels that the claim
should be considered as in-network, the Participant should call member services at the toll-free
number on their ID card and speak with the Claims Administrator and request an appeal.
Eligible Expenses
Eligible Expenses are charges for Covered Health Services (provided while you are covered under the
Tenet Medical Benefit Program) that are determined in accordance with the definition in the Glossary.
For certain Covered Health Services, the Plan will not pay for any Eligible Expenses until you have met
your Annual Deductible. See below for more information on the Annual Deductible. We have delegated
to the Claims Administrator the initial discretion and authority to decide whether a treatment or supply
is a Covered Health Service and whether and what portion of the charges incurred are Eligible
Expenses.
Don’t Forget Your Medical ID Card
Remember to show your medical ID card every time you receive health care services from a
Provider. If you do not show your ID card, a Provider has no way of knowing that you are enrolled
under the Plan.
Annual Deductible
The Annual Deductible is the amount you must pay each calendar year for Covered Health Services
before the Tenet Medical Benefit Program begins paying benefits. For medical coverage options
providing benefits for both Network and Out-of-Network services, there are separate Network and Out
of Network Annual Deductibles, and expenses applied to one deductible do not count towards the
other. (For example, any expenses applied to your Network deductible do not also apply to your Outof-Network Deductible.) The amounts you pay toward your Annual Deductible accumulate over the
course of the calendar year.
You and your covered family members may need to meet the Annual Deductible every calendar year.
Each medical care option under the Medical Benefit Program requiring an Annual Deductible offers a
family deductible, so you never have to pay more than the annual family deductible for that option,
regardless of how many family members you’ve enrolled in the Medical Benefit Program.
Certain services are not subject to the Annual Deductibles. See “Medical Benefit Program Options:
Highlights” for more information.
Co-insurance
Co-insurance is the percentage of Eligible Expenses that you are responsible for paying. Co-insurance is
a fixed percentage that applies to certain Covered Health Services after you meet the Annual
deductible. Not all Covered Health Services are subject to a co-insurance requirement. See “Medical
Benefit Program Options: Highlights” for more information.
Co-insurance — Example
Example: Let’s assume that you receive Benefits for a Physician’s office visit from a Network
Provider. Since your Medical Benefit Program pays 80% after you meet the Annual Deductible, you
are responsible for paying the other 20%. This 20% is your Co-insurance.
{00014391.DOCX-}
24
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
Out-of-Pocket Maximum
The annual Out-of-Pocket Maximum is the most you pay each calendar year for Covered Health
Services provided by a Network Provider. If your network eligible out-of-pocket expenses in a calendar
year exceed the Out-of-Pocket Maximum, the Medical Benefit Program pays 100% of your Eligible
Expenses for in-network Covered Health Services through the end of the calendar year.
Covered Expenses charged by Network Providers apply toward both the network individual and family
Out-of-Pocket Maximums.
The following identifies what does not apply toward your In-Network Out-of-Pocket Maximum:
 Co-insurance and/or co-pays and related fees for using Out-of-Network Providers
 Amounts you pay that are above the R&C Charge for an Out-of-Network service
The Out-of-Pocket Maximum amount varies depending on the Medical Benefit Program you have
selected. For the 2017 Plan Year, the Out-of-Pocket Maximum will not be higher than $7,150 for selfonly coverage and $14,300 for any coverage level other than self-only. The self-only Out-of-Pocket
Maximum applies to each covered individual, regardless of whether enrolled in self-only or family
coverage. If you are enrolled in a Medical Benefit Program option that is a high deductible health plan
with HSA, for the 2017 Plan Year, the Out-of-Pocket maximum will not be higher than $6550 for selfonly coverage and $13,100 for any coverage level other than self-only.
Medical Benefit Program Options: Highlights
This section of the SPD includes tables describing the Annual Deductibles, Out-of-Pocket Maximums,
co-pays, and Co-insurance rates that apply when you receive certain Covered Health Services under the
Tenet Medical Benefit Program.
Please see “Plan Coverage Details” for more information (including restrictions, limitations and prior
authorization/notification requirements) pertaining to the Benefits offered under the Tenet Medical
Benefit Program. Participant’s who are enrolled in one of the Fallon, HMO or Harvard medical plan
options should refer to the separate medical SPD document for such option.
Notes:
1. The purpose of this section is to provide highlights of the Tenet Employee Benefit Plan. If there is any
discrepancy between the information provided and the official TEBP and Medical Benefit Program plan
documents, the official plan documents will govern.
2. Not all Medical Benefit Program options are offered at all locations. Please contact your HR representative
to determine the options offered at your location.
3. For specific information on the prescription drug coverage offered under each Medical Benefit Program
option, see the Prescription Drug Benefit Program SPD section of the TEBP.
Plan Coverage Details
This section includes information on:
 Covered Health Services for which the Plan pays Benefits; and
 Covered Health Services that require you to notify the Claims Administrator before you receive
them, and any reduction in Benefits that may apply if you do not call the Claims Administrator.
Services that are not covered by any medical care option offered under the Tenet Medical Benefit
Program are described in the Exclusions section.
With respect to Covered Health Services, the Plan will pay only for Eligible Expenses. All Benefits paid
will be subject to the Plan's cost-sharing requirements (i.e. co-pay, co-insurance). Cost-sharing
{00014391.DOCX-}
25
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
requirements for each Medical Plan coverage option are set forth in the applicable Medical Plan
Overview, which you may obtain at MyTenet.com for Tenet colleagues and HealthyatTenet.com for
Conifer employees.
Acupuncture Services
The Medical Benefit Program pays for Acupuncture Services for pain therapy provided that the service
is performed in a Provider’s office by a Provider who is either practicing within the scope of his/her
license (if state license is available) or who is certified by a national accrediting body such as one of the
following:




Doctor of Medicine
Doctor of Osteopathy
Chiropractor, or
Acupuncturist
The Medical Benefit Program also pays for Acupuncture services for treatment of nausea as a result of:
 Chemotherapy
 Early Pregnancy, and
 Post-operative procedures
Benefits for Acupuncture and Chiropractic Care are limited to a combined 20 visits per calendar year.
Ambulance Services — Emergency Only
The Plan covers Emergency Ambulance Services and transportation provided by a licensed Ambulance
Service to the nearest Hospital that offers Emergency health services. See the “Glossary” for the
definition of Emergency.
Ambulance Service by air is covered in an Emergency if ground transportation is impossible, or would
put your life or health in serious jeopardy. If special circumstances exist, the Claims Administrator may,
at the Plan’s discretion, pay Benefits for Emergency air transportation to a Hospital that is not the
closest Facility to provide Emergency health services.
Chiropractic Care
The Medical Benefit Program pays Benefits for Chiropractic Treatment when provided by a Network or
Out-of-Network Chiropractic specialist in the specialist’s office. Covered Health Services include
chiropractic and osteopathic manipulative therapy.
The Claims Administrator has the right to deny Benefits if treatment ceases to be therapeutic and is
instead administered to maintain a level of functioning or to prevent a medical problem from occurring
or recurring.
Benefits include diagnosis and related services. Benefits for Acupuncture and Chiropractic are limited
to a combined 20 visits per calendar year.
Dental Services
In certain circumstances dental services are covered under the Medical Benefit Program. For services
covered under the Dental Benefit Program please see the Dental Benefit Program Section.
 Dental services are covered by the Tenet Medical Benefit Program (as “office visits” or inpatient or
outpatient care, as appropriate) when all of the following are true:
{00014391.DOCX-}
26
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
o
o
o
o
Treatment is necessary because of accidental damage to a sound, natural tooth
Dental damage does not occur as a result of normal activities of daily living or extraordinary use
of the teeth
Dental services are received from a Doctor of Dental Surgery or a Doctor of Medical Dentistry,
and
The dental damage is severe enough that initial contact with a Physician or dentist occurs
within 72 hours of the accident
The following dental services are also covered by the Medical Benefit Program:
 Dental transplant preparation
 Initiation of immunosuppressives (medication used to reduce inflammation and suppress the
immune system), and
 Direct treatment of acute traumatic Injury, cancer or cleft palate
Before the Medical Benefit Program will cover treatment of an injured tooth, the dentist must certify
that the tooth is virgin or unrestored, and that it:






Has no decay
Has no filling on more than two surfaces
Has no gum disease associated with bone loss
Has no root canal therapy
Is not a dental implant, and
Functions normally in chewing and speech
Dental services for final treatment to repair the damage must be started within three months of the
accident and completed within 12 months of the accident.
Please contact your Claims Administrator for any questions related to your coverage.
Durable Medical Equipment (DME)
The Medical Benefit Program pays for Durable Medical Equipment (DME) that is, in the determination
of the Claims Administrator, medically necessary and:






Ordered or provided by a Physician for outpatient use
Used for medical purposes
Not consumable or disposable
Not of use to a person in the absence of a Sickness, Injury, Pregnancy or disability
Durable enough to withstand repeated use, and
Appropriate for use in the home
If more than one piece of DME can meet your functional needs, you will receive Benefits only for the
most Cost-Effective piece of equipment. Benefits are provided for a single unit of DME (example: an
insulin pump) and for repairs of that unit.
Examples of DME include but are not limited to:






Equipment to administer oxygen
Wheelchairs
Hospital beds
Delivery pumps for tube feedings
Braces that straighten or change the shape of a body part
Braces that stabilize an injured body part, including necessary adjustments to shoes to
accommodate braces
 Equipment for the treatment of chronic or acute respiratory failure or conditions
 Ostomy supplies, and
{00014391.DOCX-}
27
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
 Shoe orthotics
The Plan also covers tubings, nasal cannulas, connectors and masks used in connection with DME
Note: DME is different from prosthetic devices — see “Prosthetic Devices” in this section.
Benefits for wigs are limited to $1,000 per covered person per lifetime.
Benefits are provided for the replacement of a type of Durable Medical Equipment once every three
calendar years or as medically necessary.
Please remember
To avoid unexpected out of pocket expenses, for Out-of-Network Benefits, you must notify the
claims administrator if the purchase, rental, repair or replacement of DME will cost more than
$1,000.
Emergency Health Services
The Medical Benefit Program covers outpatient Emergency treatment at a Hospital or Alternate Facility
when required to stabilize a patient or initiate treatment due to a medical Emergency.
As used herein, a medical Emergency is a serious medical condition or symptom resulting from Injury,
Sickness, Pregnancy, mental illness, or substance abuse which arises suddenly and in the judgment of a
reasonable person, requires immediate care and treatment, generally received within 24 hours of
onset, to avoid jeopardy to life or health.
Emergency care in the emergency department of a Hospital will not be covered unless the condition is
determined to be a medical Emergency. Emergency care received from an Out-of-Network Hospital
will be covered at the same cost-sharing level as if provided in network; however, you may be billed for
the difference between the Out-of-Network Provider’s billed charges and the amount collected from
the Plan and from you (through cost-sharing).
If you are admitted as an inpatient to a Hospital within 24 hours of receiving treatment for an
Emergency Health Service, you will not have to pay the Fee for Emergency Health Services. However,
you will be required to pay the Deductible, Co-insurance and/or co-pay amount, if any, for your
Emergency treatment as well as any of the above amounts applicable to your Inpatient Stay in the
Hospital. As long as your admission is due to the Emergency (as noted above), Benefits will paid at the
network rate, even if you are admitted to an out-of-network hospital. However, if you are admitted to
an out-of-network hospital, and your physician determines that it is medically appropriate to transfer
you to a network Hospital, your Benefits for the Inpatient Stay from that date will be paid at the Out-ofNetwork level if you choose to remain at the out-of-network hospital.
Hearing Care
Initial pair and one replacement of hearing aids, assistive devices and amplifiers per lifetime.
Home Health Care
Covered Health Services are services that a Home Health Agency provides if you are homebound due to
the nature of your condition. Services must be:
 Ordered by a Physician
 Provided by or supervised by a registered nurse in your home
 Not considered Custodial Care, as defined in the Glossary, and
{00014391.DOCX-}
28
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
 Provided on a part-time, intermittent schedule when Skilled Home Health Care is required. Refer to
the Glossary for the definition of Skilled Home Health Care
The Claims Administrator will decide if Skilled Home Health Care is needed by reviewing both the
skilled nature of the service and the need for Physician-directed medical management.
Any combination of Network and Out-of-Network Benefits is limited to 120 visits per calendar year.
One visit equals four hours of Skilled Home Health Care services.
For Out-of-Network Benefits, please notify the Claims Administrator five business days before receiving
services.
Hospice Care
Hospice care is an integrated program recommended by a Physician which provides comfort and
support services for the terminally ill. Hospice care can be provided on an inpatient or outpatient basis
and includes physical, psychological, social and spiritual care for the terminally ill person, and shortterm grief counseling for immediate family members. Benefits are available only when hospice care is
received from a licensed hospice agency. For Out-of-Network Benefits, please notify the Claims
Administrator five business days before receiving services. The Claims Administrator will advise you of
the out-of-pocket costs for home hospice care visits.
Hospital — Inpatient Stay
The Medical Benefit Program will pay Benefits for an Inpatient Stay at a Hospital for the following:
 Services and supplies received during an Inpatient Stay; and
 Room and board in a semi-private room (a room with two or more beds).
The Medical Benefit Program will pay for a private room only if a private room is necessary according to
generally accepted medical practice.
Benefits for an Inpatient Stay in a Hospital are available only when the Inpatient Stay is necessary to
prevent, diagnose or treat a Sickness, Injury, Pregnancy, mental illness, or substance abuse disorder.
Benefits for Hospital-based Physician services are described in this section under Professional Fees for
Surgical and Medical Services.
Professional fees for mental health and substance abuse disorder benefits are described in the
Managed Behavioral Health Care section of this SPD.
Benefits for Emergency admissions and admissions of less than 24 hours are described under
Emergency Health Services and Outpatient Surgery, Diagnostic and Therapeutic Services, respectively.
Please remember, for out-of-network benefits,
you must notify the Claims Administrator as follows:
 For elective admissions: five business days before admission
 For Emergency care that results in an Inpatient admission (also termed non-elective
admissions): within two business days, or as soon as is reasonably possible
Injections in a Physician’s Office
Benefits are paid by the Plan for injections administered in the Physician’s office, for example allergy
immunotherapy, when no other health service is received.
What is Co-insurance?
{00014391.DOCX-}
29
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
Co-insurance is the amount you pay for a Covered Health Service, not including the co-pay and/or
the Deductible.
For example, after satisfying your Deductible, if the Plan pays 80% of Eligible Expenses for care
received from a Network Provider, your co-insurance is 20%.
Kidney Dialysis
All Covered Persons receiving outpatient dialysis treatment will be subject to the Medical Benefit
Program’s case management provisions, negotiations and other Plan services which the Plan Sponsor
may elect to apply in the exercise of its discretion. Payment for both Network and Out-of-Network
Outpatient Dialysis Treatment will be based on the Outpatient Dialysis Reasonable and Customary
Charge, as defined herein. The Plan shall pay no more than the Outpatient Dialysis Reasonable and
Customary Charge in connection with Outpatient Dialysis claims, after deduction of all amounts subject
to Deductible, Co-insurance, or applicable Co-payments.
Managed Behavioral Health Care
The Medical Benefit Program will pay Benefits for Managed Behavioral Health Care. The program
offers convenient and confidential access to mental health professionals. The Plan covers Inpatient and
Outpatient Facility services as well as Professional fees. For specific plan details, contact the Claims
Administrator by calling member services at the toll-free number on your ID card.
Maternity Services
The Medical Benefit Program will pay Benefits for Maternity Services. This includes all maternityrelated medical services for prenatal care, postnatal care for the mother, delivery, and any related
complications, except that any service which is required by law to be covered at 100% as “preventive
care” will be paid at 100% without cost-sharing.
The Plan will pay Benefits for an Inpatient Stay of the following durations:
 48 hours for the mother and newborn child following a vaginal delivery, or
 96 hours for the mother and newborn child following a cesarean section delivery
These are federally mandated requirements under the Newborns’ and Mothers’ Health Protection Act
of 1996. If the mother agrees, the attending Physician may discharge the mother and/or the newborn
child earlier than these minimum timeframes.
If you are treated out-of network and expect your stay will be longer than the times noted above,
please contact your Claims Administrator to ensure the plan pays at the highest coverage level.
Note: Although your Dependent children enrolled in the Medical Benefit Program will receive Benefits for
Maternity Services, a child of your Dependent Child (i.e. your grandchild) is not eligible to be enrolled in the
Medical Benefit Program (unless that grandchild is your adopted child, foster child or child in which you have
legal guardianship).
Nutritional Counseling
The Medical Benefit Program will pay for Covered Health Services provided by a registered dietician in
an individual session if you have a medical condition that requires a special diet. Some examples of
such medical conditions include:
 Diabetes mellitus
{00014391.DOCX-}
30
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------







Coronary artery disease
Congestive heart failure
Severe obstructive airway disease
Gout (a form of arthritis)
Renal failure
Phenylketonuria (a genetic disorder diagnosed at infancy), and
Hyperlipidemia (excess of fatty substances in the blood)
Benefits are limited to twelve individual sessions in your lifetime for each medical condition requiring a
special diet.
Obesity Surgery
The Plan covers surgical treatment of morbid obesity. Services are subject to the guidelines of the
appropriate Claims Administrator or medical carrier for your selected Medical Benefit Program option.
Please consult the Plan Administrator or your Claims Administrator/medical carrier for more
information. To locate the Claims Administrator/medical carrier for your selected Medical Benefit
Program option, please see the "Claims Administrator" paragraph under "Important Administrative
Information: ERISA" below. You may also obtain contact information for your medical carrier or Claims
Administrator at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees.
Outpatient Surgery, Diagnostic and Therapeutic Services
The Medical Benefit Program will pay Benefits for Outpatient Surgery and Diagnostic and Therapeutic
Services, including the following:








Surgery and related services
Lab and radiology/X-ray
Mammography testing, other than as described under Preventive Care in this section
Computerized tomography (CT) scans
Position emission tomography (PET) scans
Magnetic resonance imaging (MRIs)
Nuclear medicine, and
Other diagnostic tests and therapeutic treatments (including cancer chemotherapy or intravenous
infusion therapy)
Benefits include only the Facility charge and the charge for required services, supplies and equipment.
Benefits for the professional fees, including a surgeon’s fee related to Outpatient Surgery, Diagnostic
and Therapeutic Services are described under Professional Fees for Surgical and Medical Services in this
section. When these services are performed in a Physician’s office, Benefits are described under
Physician’s Office Services as follows.
Physician’s Office Services
The Medical Benefit Program will pay Benefits for Covered Health Services received in a Physician’s
office, including the following:
 Evaluation and treatment of a Sickness, Injury and Pregnancy; and
 Vision and hearing screenings, which could be performed as part of an annual physical examination
in a Provider’s office (vision screenings do not include refractive examinations to detect vision
impairment).
Benefits for preventive services are described under Preventive Care in this section.
{00014391.DOCX-}
31
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
Preventive Care
The Medical Benefit Program will cover any service considered to be “preventive care” within the
meaning of Department of Labor regulation section 2590.715-2713 (or successor regulation) at 100%
without cost-sharing, as long as those services are covered by a Network Provider. If services are
provided by an Out-of-Network Provider, the member will be responsible for the full cost of the
service. The services considered to be “preventive care” may change over time, and if they do, the
coverage of such services under the Medical Benefit Program will also change. For a description of
services currently considered to be “preventive care,” see
https://www.healthcare.gov/coverage/preventive-care-benefits/
Professional Fees for Surgical and Medical Services
The Medical Benefit Program pays professional fees for surgical procedures and other medical care
received from a Physician in a Hospital, Skilled Nursing Facility, Inpatient Rehabilitation Facility,
Alternate Facility, outpatient surgery Facility, or birthing center.
When these services are performed in a Physician’s office, Benefits are described under Physician’s
Office Services in this section.
Prosthetic Devices
Benefits are paid by the Medical Benefit Program at the same levels as Durable Medical Equipment for
Prosthetic Devices and appliances that replace a limb or body part, or help an impaired limb or body
part work. Examples include, but are not limited to:
 Artificial limbs
 Artificial eyes, and
 Breast prosthesis following mastectomy as required by the Women’s Health and Cancer Rights Act
of 1998, including mastectomy bras and lymphedema stockings for the arm
If more than one Prosthetic Device can meet your functional needs, Benefits are available only for the
most Cost-Effective prosthetic device. The device must be ordered or provided either by a Physician, or
under a Physician’s direction.
Benefits are provided for the replacement of a type of Prosthetic Device once every five calendar years
or as medically necessary.
Reconstructive Procedures
Reconstructive Procedures are services performed when a physical impairment exists and the primary
purpose of the procedure is to improve or restore physiologic function for an organ or body part.
Improving or restoring physiologic function means that the organ or body part is made to work better.
An example of a Reconstructive Procedure is surgery on the inside of the nose so that a person’s
breathing can be improved or restored.
Benefits for Reconstructive Procedures include breast reconstruction following a mastectomy and
reconstruction of the non-affected breast to achieve symmetry. Replacement of an existing breast
implant is covered by the Medical Benefit Program if the initial breast implant followed mastectomy.
There may be times when the primary purpose of a procedure is to make a body part work better.
However, in other situations, the purpose of the same procedure is to improve the appearance of a
body part. A good example is upper eyelid surgery. At times, this procedure will be done to improve
{00014391.DOCX-}
32
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
vision, which is considered a Reconstructive Procedure. In other cases, improvement in appearance is
the primary intended purpose, which is considered a Cosmetic Procedure. This Plan does not provide
Benefits for Cosmetic Procedures, as defined in the Glossary.
Please remember that you must notify the claims administrator five business days before
undergoing a Reconstructive Procedure. When you provide notification, the Claims Administrator
can determine whether the service is considered reconstructive or cosmetic. Cosmetic Procedures
are always excluded from coverage.
Rehabilitation Services — Outpatient Therapy
The Medical Benefit Program provides Benefits for short-term outpatient Rehabilitation Services for
the following types of therapy:






Physical
Occupational
Speech
Pulmonary rehabilitation, and
Cardiac rehabilitation
Cognitive therapy
For all Rehabilitation Services, a licensed therapy Provider, under the direction of a Physician, must
perform the services. The Plan gives the Claims Administrator the right to exclude from coverage
Rehabilitation Services that are not expected to result in significant physical improvement in your
condition within two months of the start of treatment. In addition, the Claims Administrator has the
right to deny Benefits if treatment ceases to be therapeutic and is instead administered to maintain a
level of functioning or to prevent a medical problem from occurring or recurring.
Any combination of Network and Out-of-Network Benefits are limited to 60 visits per calendar year for
physical, occupational and speech Therapy combined and for pulmonary rehabilitation and cardiac
rehabilitation combined.
Speech Therapy for Children
Benefits are paid for services of a licensed speech therapist for treatment given to a child whose speech
is impaired due to one of the following conditions:




Infantile autism
Development delay or cerebral palsy
Hearing impairment, or
Major Congenital Anomalies that affect speech, such as, but not limited to, cleft lip and cleft palate
Any combination of Network and Out-of-Network Benefits are limited to 60 visits per calendar year for
physical, occupational, cognitive, and speech Therapy combined.
{00014391.DOCX-}
33
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
Skilled Nursing Facility/Inpatient Rehabilitation Facility Services
Facility services for an Inpatient Stay in a Skilled Nursing Facility or Inpatient Rehabilitation Facility are
covered by the Medical Benefit Program. Benefits include:
 Services and supplies received during the Inpatient Stay; and
 Room and board in a semi-private room (a room with two or more beds).
Benefits are available when Skilled Nursing and/or Inpatient Rehabilitation Facility services are needed
on a daily basis. Benefits are also available in a Skilled Nursing Facility or Inpatient Rehabilitation
Facility for treatment of a Sickness, Injury, Pregnancy, mental health or substance use disorder that
would have otherwise required an Inpatient Stay in a Hospital.
The intent of skilled nursing is to provide Benefits if, as a result of an Injury, illness, Pregnancy, mental
health or substance use disorder, you require:
 An intensity of care less than that provided at a general acute Hospital but greater than that
available in a home setting; or
 A combination of skilled nursing, rehabilitation and Facility services.
You are expected to improve to a predictable level of recovery. Where Hospice Care is required, it is
covered under certain conditions and at different coverage levels.
Note: The Plan does not pay Benefits for Custodial Care or Domiciliary Care (as such terms are defined in the
Glossary), even if ordered by a Physician.
Any combination of Network and Out-of-Network Benefits is limited to 60 days per calendar year.
For out- of-network benefits, you must notify the Claims Administrator as follows:
 For elective admissions: five business days before admission;
 For an Inpatient admission following emergency care (also termed non-elective admissions):
within two business days or as soon as is reasonably possible.
If you don’t notify us, your Benefits may be subject to a penalty. (Note: The penalty will not apply
if the Inpatient admission constitutes “emergency services” (within the meaning of Department of
Labor regulation section 2590.715-2719A(b)(4)(ii) or successor regulation) necessary to stabilize the
patient.
Transplantation Services
Inpatient Facility services (including evaluation for transplant, organ procurement and donor searches)
for transplantation procedures must be ordered by a Provider. Benefits are available for any of the
organ and tissue transplants listed below when the transplant meets the definition of a Covered Health
Service and is not Experimental and Investigational, or Unproven:




Heart
 Kidney
 Liver/kidney
 Intestinal
Heart/lung
 Kidney/pancreas
 Liver/intestinal
Lung
 Liver
 Pancreas
Bone marrow (either from you or from a compatible donor) and peripheral stem cell transplants,
with or without high dose chemotherapy. Not all bone marrow transplants meet the definition of a
Covered Health Service — please see below.
The Plan has specific guidelines regarding Benefits for transplant services. Contact the Claims
Administrator by calling member services at the toll-free number on your ID card.
{00014391.DOCX-}
34
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------------------------
The search for bone marrow/stem cells from a donor who is not biologically related to the patient is a
Covered Health Service.
Benefits are also available for cornea transplants that are provided by a Network Provider at a Network
Hospital.
If you or a family member needs an organ or bone marrow transplant, the Claims Administrator can put
you in touch with quality treatment centers around the country.
Please remember, if transplant services are to be provided Out-of-Network, you must notify the
Claims Administrator as soon as the possibility of a transplant arises (and before the time a pretransplantation evaluation is performed at a transplant center).
Urgent Care Services
The Medical Benefit Program provides Benefits for services, including professional services, received at
an Urgent Care Center, as defined in the Glossary. When Urgent Care services are provided in a
Physician’s office, the Plan pays Benefits as described under Physician’s Office Services earlier in this
section.
Exclusions - What the Medical Plan Will Not Cover
This section includes information on:
 Services,
 Supplies, and
 Treatments that are not Covered Health Services, except as may be specifically provided for in Plan
Coverage Details
The Plan does not pay Benefits for any of the following services, treatments or supplies even if they are
recommended or prescribed by a Provider or are the only available treatment for your condition.
Alternative Treatments






Acupressure
Aromatherapy
Hypnotism
Massage therapy
Rolfing (holistic tissue massage), and
Other forms of alternative treatment as defined by the National Center for Complementary and
Alternative Medicine of the National Institutes of Health
Comfort and Convenience
Supplies, equipment and similar incidentals for personal comfort. Examples include:








Television
Telephone
Air conditioners
Beauty/barber service
Guest service
Air purifiers and filters
Batteries and battery chargers
Dehumidifiers and humidifiers
{00014391.DOCX-}
 Ergonomically correct chairs
 Non-Hospital beds and comfort beds
 Devices and computers to assist in communication and
speech, and
 Home remodeling to accommodate a health need
(including, but not limited to, ramps, swimming pools,
elevators, handrails, and stair glides).
35
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Dental
 Dental care, except as identified under Dental Services in Plan Coverage Details
 Services for the evaluation and treatment of temporomandibular joint syndrome (TMJ), when the
services are considered medical or dental in nature, including oral appliances
 Preventive dental care
 Diagnosis or treatment of the teeth or gums. Examples include:
o Extractions (including wisdom teeth)
o Restoration and replacement of teeth
o Medical or surgical treatments of dental conditions, and
o Services to improve dental clinical outcomes
 Dental implants and braces
 Dental X-rays, supplies and appliances and all associated expenses, including hospitalizations and
anesthesia, and
 Treatment of congenitally missing (missing at birth), malpositioned, or super numerary (extra)
teeth, even if part of a Congenital Anomaly
Drugs




Prescription Drugs for outpatient use that are filled by a prescription order or refill
Self-injectable medications
Non-injectable medications given in a Physician’s office except as required in an Emergency, and
Over the counter drugs and treatments
Experimental and Investigational, or Unproven Services
Experimental and Investigational Services or Unproven Services, unless the Medical Benefit Program
has agreed to cover them as stated in the Glossary.
This exclusion applies even if Experimental and Investigational or Unproven Services are the only
available treatment options for your condition.
Foot Care
 Routine foot care, except when needed for severe systemic disease. Routine foot care services that
are not covered include:
o Cutting or removal of corns and calluses
o Nail trimming or cutting. and
o Debriding (removal of dead skin or underlying tissue)
 Hygienic and preventive maintenance foot care. Examples include:
o Cleaning and soaking the feet
o Applying skin creams in order to maintain skin tone, and
o Other services that are performed when there is not a localized Sickness, Injury or symptom
involving the foot
 Treatment of flat feet
 Treatment of subluxation (joint or bone dislocation) of the foot
 Shoes (standard or custom), lifts and wedges, and
 Shoe Orthotics that are not prescribed by a Physician
{00014391.DOCX-}
36
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Jawbone Surgery
 Diagnosis or treatment of the jawbones, except as treatment of obstructive sleep apnea, congenital
anomaly or orthognathic surgery to correct underbite or overbite, and
 Upper and lower jawbone surgery except as required for direct treatment of acute traumatic
Injury, tumor or cancer
Medical Supplies and Appliances
 Devices used specifically as safety items or to affect performance in sports-related activities, and
 Prescribed or non-prescribed medical supplies, except for ostomy bags and related supplies.
Examples of supplies that are not covered include, but are not limited to:
o Elastic stockings and ace bandages, and
o Tubings, nasal cannulas, connectors and masks that are not used in connection with DME.
Not Medically Necessary
Expenses for services, supplies, appliances, equipment, medications, or treatments that are not
medically necessary.
Nutrition and Health Education
 Megavitamin and nutrition based therapy
 Nutritional counseling for either individuals or groups, except as defined under Nutritional
Counseling in Plan Coverage Details
 Food of any kind, unless it is the only source of nutrition or unless it is specifically created to treat
inborn errors of metabolism such as phenylketonuria (PKU). Foods that are not covered include:
o Enteral feedings and other nutritional and electrolyte formulas, including infant formula and
donor breast milk
o Foods to control weight, treat obesity (including liquid diets), lower cholesterol or control
diabetes
o Oral vitamins and minerals
o Meals you can order from a menu, for an additional charge, during an Inpatient Stay, and
o Other dietary and electrolyte supplements
 Health club memberships and programs, and spa treatments, and
 Health education classes unless offered by the Claims Administrator or its affiliates, including but
not limited to asthma, smoking cessation, and weight control classes
Pregnancy and Infertility
 Elective abortion
 Health services and associated expenses for infertility treatments including, but not limited to:
o In vitro fertilization (IVF)
o Gamete intrafallopian transfer (GIFT)
o Zygote intrafallopian transfer (ZIFT)
o Artificial insemination
o Embryo transport, and
o Donor ovum and semen and related costs including collection, preparation and storage of
 Surrogate parenting
 The reversal of voluntary sterilization
{00014391.DOCX-}
37
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
 Artificial reproductive treatments done for genetic or eugenic (selective breeding) purposes
 Services provided by a doula (labor aide), and
 Parenting, pre-natal or birthing classes
Physical Appearance
Cosmetic Procedures, as defined in the Glossary, are excluded from coverage. Examples include:












Liposuction
Pharmacological regimens
Nutritional procedures or treatments
Tattoo or scar removal or revision procedures (such as salabrasion, chemosurgery and other such
skin abrasion procedures)
Replacement of an existing intact breast implant if the earlier breast implant was performed as a
Cosmetic Procedure
Physical conditioning programs such as athletic training, bodybuilding, exercise, fitness, flexibility,
and diversion or general motivation
Weight loss programs whether or not they are under medical supervision or for medical reasons,
even if for morbid obesity
Wigs, or permanent loss of hair from an accidental Injury, in which case the Plan pays up to a
maximum of $1,000 per Covered Person per lifetime
Treatments for hair loss
A procedure or surgery to remove fatty tissue such as panniculectomy, abdominoplasty,
thighplasty, brachioplasty, or mastopexy
Varicose vein treatment of the lower extremities, when it is considered cosmetic, and
Treatment of benign gynecomastia (abnormal breast enlargement in males)
Providers
Services:
 Performed by a Provider who is a family member by birth or marriage, including your Spouse,
Domestic Partner, brother, sister, parent or child
 A Provider performs on himself or herself
 Performed by a Provider with your same legal residence
 Ordered or delivered by a Christian Science practitioner
 Performed by an unlicensed Provider or a Provider who is operating outside of the scope of his/her
license
 Provided at a diagnostic Facility (Hospital or otherwise) without a written order from a Provider,
and
 Ordered by a Provider affiliated with a diagnostic Facility (Hospital or otherwise), when that
Provider is not actively involved in your medical care:
o Prior to ordering the service, or
o After the service is received
This exclusion does not apply to mammography testing.
Services Provided Under Another Plan
Services for which coverage is available:
 Under another plan, except as described in Coordination of Benefits (COB)
 Under workers’ compensation or similar legislation if you could elect it, or could have it elected for
you; and
 For treatment of military service-related disabilities when you are legally entitled to other
coverage, and facilities are reasonably accessible
{00014391.DOCX-}
38
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Transplants
Organ and tissue transplants, including multiple transplants, are excluded, except as identified under
Transplantation Services in Plan Coverage Details.
Notwithstanding the above, organ and tissue transplants will be excluded if they are:
 Determined by the Claims Administrator not to be proven procedures for the involved diagnoses or
inconsistent with the diagnosis of the condition;
 Mechanical or animal organ transplants, except for services related to the implant or removal of a
circulatory assist device (a device that supports the heart while the patient waits for a suitable
donor heart to become available), or
 Donor costs for organ or tissue transplantation to another person (these costs may be payable
through the recipient’s benefit plan)
Travel and Lodging
 Health services provided in a foreign country, unless in an Emergency; and
 Travel or transportation expenses, even if ordered by a Physician
Vision and Hearing
 Routine eye examinations
 Purchase and fitting cost of eyeglasses and contact lenses
 Purchase cost of hearing aids, assistive devices and amplifiers, except for the initial pair and one
replacement, and
 Surgery and other related treatment that is intended to correct nearsightedness, farsightedness,
presbyopia and astigmatism including, but not limited to, procedures such as laser and other
refractive eye surgery and radial keratotomy
All Other Exclusions
 Autopsies and other coroner services and transportation services for a corpse
 Charges for:
o Missed appointments;
o Room or facility reservations;
o Completion of claim forms;
o Record processing; or
o Services, supplies or equipment that are advertised by the Provider as free;
 Charges by a Provider sanctioned under a federal program for reason of fraud, abuse or medical
competency
 Charges prohibited by federal anti-kickback or self-referral statutes
 Chelation therapy, except to treat heavy metal poisoning
 Custodial Care as defined in the Glossary, or services provided by a personal care assistant
 Diagnostic tests that are:
o Delivered in other than a Physician’s office or health care Facility, and
o Self-administered home diagnostic tests, including but not limited to HIV and Pregnancy tests
 Domiciliary Care, as defined in the Glossary;
 Growth hormone therapy;
 Expenses for health services and supplies:
o That do not meet the definition of a Covered Health Service in the Glossary
{00014391.DOCX-}
39
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
o










That are received as a result of war or any act of war, whether declared or undeclared, while
part of any armed service force of any country
o That are incurred while on active duty with the armed service force of any country
o That are received after the date your coverage under the Tenet Medical Benefit Program ends,
including health services for medical conditions which began before the date your coverage
under the Tenet Medical Benefit Program ends
o For which you have no legal responsibility to pay, or for which a charge would not ordinarily
o be made in the absence of coverage under this benefit Plan
o That exceed Eligible Expenses or any specified limitation in this SPD, or
o For which an Out-of-Network Provider waives the Fee, Annual Deductible or Co-insurance
amounts
Medical and surgical treatment of snoring, except when provided as a part of treatment for
documented obstructive sleep apnea (a sleep disorder in which a person regularly stops breathing
for 10 seconds or longer). Appliances for snoring are always excluded
Physical, psychiatric or psychological exams, testing, vaccinations, immunizations or treatments
when:
o Required solely for purposes of career, education, sports or camp, employment, insurance,
marriage or adoption; or as a result of incarceration
o Conducted for purposes of medical research
o Related to judicial or administrative proceedings or orders, or
o Required to obtain or maintain a license of any type
Private duty nursing
Respite care
Rest cures
Sex transformation operations
Speech therapy to treat stuttering, stammering, or other articulation disorders, except to the
extent such therapy is necessary for the treatment of a disability within the meaning of section
1557 of the Affordable Care Act and the regulations issued thereunder and is otherwise a Covered
Health Service
Spinal Treatment to treat a condition unrelated to alignment of the vertebral column
Storage of blood, umbilical cord or other material for use in a Covered Health Service, except if
needed for an imminent surgery
The following treatments for obesity:
o non-surgical treatment, even if for morbid obesity, and
o surgical treatment of obesity unless you meet the definition of obese as defined in Plan
Coverage Details
Coverage of Ineligible Expenses
Notwithstanding the foregoing, in certain circumstances, for reasons such as overall cost savings or
medical treatment efficiency, the Medical Benefit Program may, in the sole discretion of the Plan
Administrator, provide Benefits for services that would otherwise not be Covered Health Services. The
fact that the Medical Benefit Program does so in any particular case shall not in any way be deemed to
require the Medical Benefit Program to do so in other similar cases.
Coordination of Benefits (COB)
All benefits provided under the Tenet Medical Benefit Program are subject to Coordination of Benefits
(“COB”).
COB provisions apply when the Covered Person is covered by the Tenet Medical Benefit Program and
another benefit plan (“Other Benefit Plan”).
{00014391.DOCX-}
40
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
The provisions establish which plans have primary and secondary responsibility for coverage, and the
rules under which payment is made.
If you are an active Tenet employee… The Tenet Medical Benefit Program is primary.
If you are the dependent of a Tenet
employee and you are covered under
another plan as an active employee…
The Tenet Medical Benefit Program is secondary.
The plan of the parent whose birthday falls earlier in the
year is primary; if both parents have the same birthday,
the plan that has covered the child longer is primary. For
an eligible child of divorced or separated parents, the
primary plan would be determined in the following order:
If you have dependent children…
1. As ruled by the court through a separation agreement,
divorce settlement, Qualified Medical Child Support
Order, etc. (a copy of the court ruling will be required
when submitting claims for your dependent child).
2. The plan of the parent with legal custody. In the case of
joint custody, the plan of the parent with whom the
child spends the majority of his or her time.
3. The plan of the spouse of the parent with legal custody.
4. The plan of the parent without custody.
If the condition is
automobile-related…
Medical coverage under automobile insurance is always
primary.
For participants in the Detroit Medical Center (DMC)
medical plan coverage under automobile insurance is
always secondary.
If your other coverage does not
include Coordination of Benefits…
Plans without a COB feature are always primary. The Tenet
Medical Benefit Program would be secondary.
If your other plan states it will pay no
benefits at all if you have other
coverage…
That plan is primary. The Tenet Medical Benefit Program
will be secondary.
If you’re also covered under a
government plan…
Coverage under a government plan is always primary
(unless otherwise required by law). If you are enrolled in
Medicare, benefits will be coordinated in accordance with
the Medicare Secondary Payer rules (and any other
applicable federal statutory or regulatory requirements).
When Medicare is to be the primary payer, this Medical
Benefit Program will base payment upon benefits that
would have been paid by Medicare under Parts A and B,
regardless of whether or not you are enrolled under both
of these parts.
If payment of the claim cannot be
determined by the above rules or the
plans do not agree…
The plan that has covered the individual for the longer
period of time is the primary plan, and the plan that has
covered the individual for the shorter period of time is the
secondary plan.
Payment Rules:
1. If the Tenet Medical Benefit Program is primary, it will pay benefits as if there is no secondary plan.
{00014391.DOCX-}
41
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
2. If the Tenet Medical Benefit Program is secondary, the rules of the plan with the higher Allowable
Expense will be used to determine what the Tenet Medical Benefit Program will pay.
3. Regardless of whether primary or secondary, the Tenet Medical Benefit Program will reduce or
eliminate payment as needed to prevent a greater amount of benefits being paid by both plans,
than would otherwise be paid by a single plan. This is sometimes referred to as Non-Duplication of
Benefits.
The following example illustrates the payment rules that are followed when the Tenet Medical Benefit
Program is secondary:
Tenet Medical Benefit Program
Provider charges =
Allowable Expense is =
Other Benefit Plan
$150
$90
Plan pays 80%
Provider charges =
$150
Allowable Expense is =
$100
Plan pays 90%
Coordination of Benefits
Provider charges =
$150
Tenet Allowable Expense (at Primary level) =
$90
Other Benefit Plan pays (at Primary level) 90% =
-$90
Balance =
$0
Tenet Medical Benefit Program pays =
$0
Note: The example is intended to help illustrate how primary and secondary coverage is administered.
The actual amounts paid are subject to a number of other factors including co-pays, deductibles and
out of pocket limits, unpaid balances, credits, etc.
Definitions
As used in this section, the following terms are defined as:
“Other Benefit Plan” means any arrangement providing health care benefits or services, including but
not limited to: group, blanket, or franchise insurance coverage; group or individual practice or other
prepayment coverage; labor management trusteed plans; union welfare plans; employer organization
plans, or employee benefit organization plans; or any tax supported or governmental program.
“Allowable Expenses” means any Reasonable and Customary charges that would be considered Eligible
Expenses incurred while the Covered Person is covered under this Plan. When this Plan is secondary,
Allowable Expenses includes any expenses used to satisfy a deductible, co-insurance or co-payment
requirement under any Other Benefit Plan except for any deductible, co-insurance or co-payment
requirement under Personal Injury Protection, no-fault, medical payments provision, or any other
category (including such benefits mandated by law) of any automobile or vehicle insurance plan.
Automobile Limitations
This Medical Benefit Program shall always be considered secondary regardless of the Covered Person’s
election under Personal Injury Protection (PIP) or any no-fault coverage with the automobile carrier.
{00014391.DOCX-}
42
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
The Medical Benefit Program will not cover the cost of health care expenses resulting from accidental
bodily injuries arising out of a motor vehicle accident to the extent that such services or expenses are
payable under any Personal Injury Protection, no-fault, medical payments provision, or any other
category (including such benefits mandated by law) of any automobile or vehicle insurance plan.)
When medical payments coverage is available under the vehicle insurance, the Medical Benefit
Program shall pay excess benefits only, without reimbursement for vehicle plan deductibles or other
out-of-pocket requirements under the vehicle plan.
For participants in the Detroit Medical Center (DMC) medical plan this Medical Benefit Program shall always
be considered primary regardless of the Covered Person’s election under Personal Injury Protection (PIP) or
any no-fault coverage with the automobile carrier. The Medical Benefit Program will cover the cost of
health care expenses resulting from accidental bodily injuries arising out of a motor vehicle accident.
When Coverage Ends
This section describes:
 When coverage ends in the cases of a disabled child or hospitalization
 Where to find additional information on when coverage ends
 How to continue coverage after it ends
Coverage for a Disabled Child
If an unmarried Dependent child with a mental or physical disability reaches an age when coverage
would otherwise end, the Medical Benefit Program will continue to cover the child, as long as:




The child was disabled prior to attaining age 26;
The child is unable to be self-supporting due to the mental or physical disability
The child depends mainly on you for support
You provide to the Claims Administrator proof of the child’s incapacity and dependency within 31
days of the date coverage would have otherwise ended because the child reached a certain age,
and
 You provide proof, upon the Claims Administrator’s request, that the child continues to meet these
conditions
If you do not supply such proof in a timely manner, the Medical Benefit Program will no longer pay
Benefits for that child.
Extended Coverage for Hospital Inpatient Stay
If a covered Person is confined to a Hospital on the date benefits terminate, medical coverage will
continue until the Covered Person is discharged from the Hospital.
When Coverage Ends
When coverage ends for you and your eligible Dependents is based on specific Life Events and the rules
governing the administration of each of the programs under the TEBP. Please refer to the Eligibility and
Enrollment section of this TEBP SPD for detailed information on when coverage for you and your
Dependents ends.
{00014391.DOCX-}
43
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Continuing Coverage Through COBRA
For more information on continuing your coverage through COBRA, please refer to the Other
Information section of the TEBP SPD.
Other Important Information
This section includes:
 Court-ordered Benefits for Dependent children
 The future of the Plan
Qualified Medical Child Support Orders (QMCSOs)
A qualified medical child support order (QMCSO) is a judgment, decree or order issued by a court or
appropriate state agency that requires a child to be covered for medical benefits. Generally, a QMCSO
is issued as part of a paternity, divorce, or other child support settlement.
If the Medical Benefit Program receives a medical child support order for your child that instructs the
Plan to cover the child, the MyBenefits Customer Support Center will review it to determine if it meets
the requirements for a QMCSO. If it determines that it does, your child will be enrolled in the Medical
Benefit Program as your Dependent, and the Plan will be required to pay Benefits as directed by the
order. If you are not currently enrolled in a Medical Benefit Program, you will also need to be enrolled.
You many obtain, without charge, a copy of the procedures governing QMCSOs from the MyBenefits
Customer Support Center.
Note: A National Medical Support Notice will be recognized as a QMCSO if it meets the requirements of a
QMCSO.
Future of the Plan
Although the Company expects to continue the Medical Benefit Program and the TEBP indefinitely, it
reserves the right to discontinue, alter or modify the Medical Benefit Program and the TEBP in whole or
in part, at any time and for any reason, in its sole determination.
The Company’s decision to terminate or amend the Medical Benefit Program and/or the TEBP may be
due to changes in federal laws governing employee benefits, the requirements of the Internal Revenue
Code or ERISA, or any other reason. If the Company does change or terminate the Medical Benefit
Program and/or the TEBP, it may decide to set up a different plan providing similar or different
benefits.
If this Medical Benefit Program is terminated, Covered Persons will not have the right to any other
Benefits from the Medical Benefit Program, other than for those claims incurred prior to the date of
termination, or as otherwise provided under the Medical Benefit Program. In addition, if the Medical
Benefit Program is amended, Covered Persons may be subject to altered coverage and Benefits.
The amount and form of any final Benefit you receive will depend on any document or contract
provisions governing the TEBP and the Medical Benefit Program and Company decisions.
How to File a Claim
See the Other Information section of this SPD for information on filing a claim (and appealing a denied
claim) for benefits under the Medical Benefit Program.
{00014391.DOCX-}
44
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Glossary
This section includes definitions of terms used throughout this SPD.
Many of the terms used throughout this Medical Benefit Program section of the TEBP SPD may be
unfamiliar to you or have a specific meaning with regard to the way the Medical Benefit Program is
administered and how Benefits are paid. This section defines terms used throughout this Medical
Benefit Program section of the TEBP SPD, but it does not describe the Benefits provided by the Medical
Benefit Program.
Alternate Facility
A health care facility that is not a Hospital and that provides one or more of the following services on
an outpatient basis, as permitted by law:
 Surgical services
 Emergency health services, or
 Rehabilitative, laboratory, diagnostic or therapeutic services
Annual Deductible (or Deductible)
The amount you must pay for Covered Health Services in a calendar year before the Medical Benefit
Program will begin paying Benefits in that calendar year. The Deductibles for each Medical Plan
Program option may be found under “Medical Benefit Program Options: Highlights.”
Annual Enrollment
The period of time, determined by Tenet Healthcare Corporation, during which eligible Employees may
enroll themselves and their Dependents under the Medical Benefit Program.
Benefit Eligible
Generally, you’re eligible to participate in the Tenet Medical Program if you are classified by Tenet as a
full-time or part-time 1 employee (other than a Tenet Physician Resource (TPR) employee).
(Determination of full-time or part-time 1 status is based on anticipated scheduled hours and is not
impacted by the fact that you may, on occasion, work more or less than your anticipated scheduled
hours.) You are also eligible to participate in the Tenet Medical Program if you're determined to work
30 hours or more per week in accordance with Tenet's "ACA Compliance Full-Time Employee
Determination Policy" attached as Appendix 1 to this SPD. If you meet either of these eligibility
requirements, you’re considered “benefit eligible.”
Benefits
Medical Benefit Program payments for Covered Health Services, subject to the terms and conditions of
the Medical Benefit Program.
Body Mass Index (BMI)
A calculation used in obesity risk assessment which uses a person’s weight and height to approximate
body fat.
BMI
See Body Mass Index (BMI).
CHD
See Congenital Heart Disease (CHD).
{00014391.DOCX-}
45
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Chiropractic Care
Detection or correction, by manual or mechanical means, of bone or joint dislocation(s) (subluxation) in
the body to remove nerve interference or its effects. The nerve interference must be the result of, or
related to, distortion, misalignment or subluxation of, or in, the vertebral column.
Claims Administrator
The person or entity to which responsibility for certain Medical Benefit Program claims administration
services has been delegated by the Plan Administrator. There may be more than one Claims
Administrator for the Medical Benefit Program.
Clinical Trial
A scientific study designed to identify new health services that improve health outcomes. In a Clinical
Trial, two or more treatments are compared to each other and the patient is not allowed to choose
which treatment will be received.
COBRA
See Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
Co-insurance
The percentage of Eligible Expenses you are required to pay for certain Covered Health Services as
described in How the Medical Benefit Program Works.
Company
Tenet Healthcare Corporation.
Congenital Anomaly
A physical developmental defect that is present at birth and is identified within the first twelve months
of birth.
Congenital Heart Disease (CHD)
Any structural heart problem or abnormality that has been present since birth. Congenital heart
defects may:
 Be passed from a parent to a child (inherited)
 Develop in the fetus of a woman who has an infection or is exposed to radiation or other toxic
substances during her pregnancy, or
 Have no known cause
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
A federal law that requires employers to offer continued health insurance coverage to certain
employees and their dependents whose group health insurance has been terminated.
Cosmetic Procedures
Procedures or services that change or improve appearance without significantly improving
physiological function, as determined by the Claims Administrator. Reshaping a nose with a prominent
bump is a good example of a Cosmetic Procedure because appearance would be improved, but there
would be no improvement in function like breathing.
{00014391.DOCX-}
46
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Cost-Effective
The least expensive equipment that performs the necessary function. This term applies to Durable
Medical Equipment and prosthetic devices.
Covered Health Services
Those health services and supplies that are:
 Provided for the purpose of preventing, diagnosing or treating Sickness, Injury, Pregnancy, mental
illness, substance abuse, or their symptoms
 Included in Medical Benefit Program Options: Highlights and Plan Coverage Details
 Provided to a Covered Person who meets the Medical Benefit Program’s eligibility requirements, as
described under Eligibility in the Eligibility and Enrollment section of the TEBP SPD, and
 Not identified in Exclusions
Covered Person
Either an enrolled Employee or an enrolled Dependent only while enrolled or eligible for Benefits under
the Medical Benefit Program.
Custodial Care
Services that do not require special skills or training and that:
 Provide assistance in activities of daily living (including but not limited to feeding, dressing, bathing,
ostomy care, incontinence care, checking of routine vital signs, transferring and ambulating)
 Do not seek to cure, or which are provided during periods when the medical condition of the
patient who requires the service is not changing, or
 Do not require continued administration by trained medical personnel in order to be delivered
safely and effectively
Dependent
An individual who meets the eligibility requirements specified in the Medical Benefit Program, as
described under Eligibility above. Also, see the Eligibility and Enrollment section of the TEBP SPD. A
Dependent does not include anyone who is also enrolled as an Employee. No one can be a Dependent
of more than one Employee.
DME
See Durable Medical Equipment (DME).
Domestic Partner
Your Domestic Partner as described under "Domestic Partners" in the Eligibility and Enrollment section
of the TEBP SPD.
Domiciliary Care
Living arrangements designed to meet the needs of people who cannot live independently but do not
require Skilled Nursing Facility services.
Durable Medical Equipment (DME)
Medical equipment that is all of the following:
 Ordered or provided by a Physician for outpatient use
 Used for medical purposes
{00014391.DOCX-}
47
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------




Not consumable or disposable
Not of use to a person in the absence of a Sickness, Injury, Pregnancy or disability
Durable enough to withstand repeated use,; and
Appropriate for use in the home
Eligible Expenses
The charge (or portion of any charge) for a Covered Health Service (provided while the Medical Benefit
Program is in effect) upon which Benefits determinations under the Medical Benefit Program are
based. "Eligible Expenses" will not include any expense for a service that is not medically necessary.
Emergency
A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain)
such that a prudent layperson (not a medical professional) who possesses an average knowledge of
health and medicine, could reasonably expect the absence of immediate medical attention to result in:
 Placing the health of the individual (or, with respect to a pregnant woman, the health of the
woman or her unborn child) in serious jeopardy
 Serious impairment to bodily functions, or
 Serious dysfunction of any bodily organ or part.
Emergency care in the emergency room of a Hospital will not be covered unless the condition is
deemed to be an Emergency in accordance with this definition.
Employee
An "Employee" as defined under "Who's Eligible?" in the Eligibility and Enrollment section of the TEBP
SPD.
Employee Retirement Income Security Act of 1974 (ERISA)
The federal legislation that regulates retirement and employee welfare benefit programs maintained
by employers and unions.
Employer
Tenet Healthcare Corporation, and its subsidiaries and affiliates who have adopted the Plan.
ERISA
See Employee Retirement Income Security Act of 1974 (ERISA).
Experimental and Investigational Services
Medical, surgical, diagnostic, psychiatric, substance abuse or other health care services, technologies,
supplies, treatments, procedures, drug therapies or devices that, at the time the Claims Administrator
makes a determination regarding coverage in a particular case, are determined to be any of the
following:
 Not approved by the U.S. Food and Drug Administration (FDA) to be lawfully marketed for the
proposed use and not identified in the American Hospital Formulary Service or the United States
Pharmacopoeia Dispensing Information as appropriate for the proposed use, or
 Subject to review and approval by any institutional review board for the proposed use, or
 The subject of an ongoing Clinical Trial that meets the definition of a Phase 1, 2 or 3 Clinical Trial set
forth in the FDA regulations, regardless of whether the trial is actually subject to FDA oversight
{00014391.DOCX-}
48
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Notwithstanding the foregoing, a Clinical Trial will not be considered Experimental or Investigational if
it is for the treatment of cancer or another life-threatening disease or condition and either your
referring health care professional conclude that your participation in the trial would be appropriate or
you provide medical or scientific information establishing that participation in the trial is appropriate.
If you have a Sickness, Injury, Pregnancy, mental health condition or substance use disorder that is
likely to cause death within one year of the request for treatment, the Claims Administrator may, at its
discretion, determine that an Experimental and Investigational Service is a Covered Health Service for
that Sickness, Injury, mental health condition, or substance use disorder. For this to take place, the
Claims Administrator must determine that the procedure or treatment is:
 Proved to be safe and promising
 Provided in a clinically controlled research setting, and
 Using a specific research protocol that meets standards equivalent to those defined by the National
Institutes of Health
EOB
See Explanation of Benefits (EOB).
Explanation of Benefits (EOB)
A statement provided by the Claims Administrator to you, your Physician, or another health care
professional that explains:







The Benefits provided
The allowable reimbursement amounts
Deductibles
Co-insurance
Any other adjustments taken
The net amount paid by the Medical Benefit Program, and
The reason(s) why the Plan did not pay for a service
If your claim is denied, the EOB will contain additional information about your claim denial.
(Alternatively, such information may be provided to you in a separate letter.) See the Other
Information section of the TEBP for more information on the claim denials.
Facility
A health care facility that provides one or more of the following services, as permitted by law:
 Surgical services
 Emergency health services, or
 Rehabilitative, laboratory, diagnostic or therapeutic services
Fee
The set dollar amount you are required to pay for Emergency Health Services, Out-of-Network Facility
charges for an inpatient stay, and Out-of-Network Outpatient Surgery, Diagnostic and Therapeutic
Services, as described in Medical Benefit Program Options: Highlights.
Home Health Agency
A program or organization authorized by law to provide health care services in the home.
Hospital
An institution, operated as required by law, which is:
{00014391.DOCX-}
49
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
 Primarily engaged in providing health services, on an inpatient basis, for the acute care and
treatment of sick or injured individuals. Care is provided through medical, diagnostic and surgical
facilities, by or under the supervision of a staff of Physicians, and
 Has 24-hour nursing services
A Hospital is not primarily a place for rest, Custodial Care or care of the aged and is not a Skilled
Nursing Facility, convalescent home or similar institution.
Injury
Bodily damage from trauma other than Sickness, including all related conditions and recurrent
symptoms.
Inpatient Rehabilitation Facility
A Hospital (or a special unit of a Hospital that is designated as an Inpatient Rehabilitation Facility) that
provides physical therapy, occupational therapy and/or speech therapy on an inpatient basis, as
authorized by law.
Inpatient Stay
An uninterrupted confinement, following formal admission to a Hospital, Skilled Nursing Facility or
Inpatient Rehabilitation Facility.
Medicaid
A federal program administered and operated individually by participating state and territorial
governments that provide medical benefits to eligible low-income people needing health care. The
federal and state governments share the program’s costs.
Medical Benefit Program
The Tenet Medical Benefit Program, which is a component program under the Tenet Employee Benefit
Plan (TEBP). The Medical Benefit Program offers the following medical care options which may be
selected by participating employees (as available): Platinum, Gold, Silver, Bronze, Health & Savings
Plan, Health & Reimbursement Plan, PPO, and EPO. Availability of PPO and EPO options varies by
location. Other options may be available to employees at select facilities or locations. Please see the
Benefits Booklet applicable to your facility, which you may obtain at MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees, for a listing of the options available at your location.
Certain Medical Benefit Program options are summarized in separate medical SPD documents. Please
see "About this Summary Plan Description" above for more information.
Medicare
Parts A, B and C of the insurance program established by Title XVIII, United States Social Security Act, as
amended by 42 U.S.C. Sections 1394, et seq. and as later amended.
Negotiated Rate
The rate established by the contract in effect between the Network and the Network Provider.
Under this contract, the Network Provider has agreed to accept a reduced rate (“Negotiated Rate”) as
their charge for services rendered and cannot bill for the difference between the charge and the
Negotiated Rate.
Network Provider
A health care Provider who has:
{00014391.DOCX-}
50
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
 Entered into an agreement with the Claims Administrator or an affiliate to be a Network Provider,
and
 Agreed to accept specified reimbursement rates for Covered Health Services
Orthotics
Devices that straighten or change the shape of a body part, including but not limited to cranial banding
and some types of braces.
Out-of-Network Provider
A health care provider who has not:
 Entered into an agreement with the Claims Administrator or an affiliate to be a Network Provider,
and
 Agreed to accept specified reimbursement rates for Covered Health Services
Out-of-Pocket Maximum
The maximum amount you pay out-of-pocket every calendar year. The Out-of-Pocket Maximum
applies for Network Benefits only. Once you reach the Network Out-of-Pocket Maximum, the Plan pays
Network Benefits at 100% of Eligible Expenses during the rest of that calendar year. (There is no Out-ofPocket Maximum for Out-of-Network Benefits.)
Physician
Any individual who is practicing medicine within the scope of his or her license, and who is licensed to
prescribe drugs. The individual must also be properly licensed and qualified by law to practice in the
state in which the Covered Person receives health services.
Plan Administrator
Tenet Benefits Administration Committee or its designee.
Plan Sponsor
Tenet Healthcare Corporation.
Pregnancy
Includes prenatal care, postnatal care, childbirth and any complications associated with Pregnancy.
Provider
A health care professional or Facility operating as required by law.
Reconstructive Procedure
A procedure performed to address a physical impairment where the expected outcome is restored or
improved function. The fact that a person may suffer psychologically as a result of the impairment does
not classify surgery or any other procedure done to relieve the impairment as a Reconstructive
Procedure.
Reasonable and Customary Charge
The maximum amount of charges for Covered Health Services (other than Outpatient Dialysis Covered
Services) rendered by an Out-of-Network Provider upon which the Medical Benefit Program will base
its Benefits determination. The Reasonable and Customary Charge that applies to a given service,
treatment or supply shall not exceed the general level of charges assessed by Providers rendering the
same type of service, treatment or supplies. The Reasonable and Customary Charge is established using
{00014391.DOCX-}
51
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
historical data collected for charges by Providers within specific geographic areas for the same or
similar services, treatment or supplies. The data may be supplemented with information provided by
independent research firms who specialize in the collection of Provider charge data. Unusual
circumstances that reasonably require additional time, skill or experience for a Provider’s service, are
taken into consideration by the Medical Benefit Program and may result in reimbursement of an
amount above the Reasonable and Customary maximum but not exceeding the actual charge. The
Reasonable and Customary charge does not apply to Network Providers.
Sickness
Physical illness or disease. The term Sickness as used in this SPD does not include mental illness or
substance abuse, regardless of the cause or origin of the mental illness or substance abuse.
Skilled Home Health Care
Skilled nursing, teaching, and rehabilitation services when:
 They are delivered or supervised by licensed technical or professional medical personnel in order to
obtain the specified medical outcome and provide for the safety of the patient
 A Physician orders them
 They are not delivered for the purpose of assisting with activities of daily living, including, but not
limited to, dressing, feeding, bathing or transferring from a bed to a chair
 They require clinical training in order to be delivered safely and effectively, and
 They are not Custodial Care, as defined in this section
Skilled Nursing Facility
A nursing Facility that is licensed and operated as required by law. A Skilled Nursing Facility that is part
of a Hospital is considered a Skilled Nursing Facility for purposes of the Medical Benefit Program.
Spouse
An individual to whom you are legally married, including a same sex legal spouse.
TEBP
The Tenet Employee Benefit Program.
Unproven Services
Health services that, according to prevailing medical research, do not have a beneficial effect on health
outcomes, and are not based on:
 Well-conducted randomized controlled trials, or
 Well-conducted cohort studies
In a randomized controlled trial, two or more treatments are compared to each other, and the patients
are not allowed to choose which treatments they receive. In a cohort study, patients who receive study
treatment are compared to a group of patients who receive standard therapy. In both cases, the
comparison group must be nearly identical to the study treatment group.
If you have a Sickness, Injury, Pregnancy, mental health condition, or substance use disorder that is
likely to cause death within one year of the request for treatment, the Claims Administrator may, at its
discretion, determine that an Unproven Service is a Covered Health Service for that Sickness, Injury,
Pregnancy, mental health condition, or substance use disorder. For this to take place, the Claims
Administrator must determine that the procedure or treatment is:
 Proved to be safe and promising
{00014391.DOCX-}
52
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
 Provided in a clinically controlled research setting, and
 Using a specific research protocol that meets standards equivalent to those defined by the National
Institutes of Health
Urgent Care
Treatment of an unexpected Sickness or Injury that is not life threatening but requires outpatient
medical care that cannot be postponed. An urgent situation requires prompt medical attention to avoid
complications and unnecessary suffering, such as high fever, a skin rash, or an ear infection.
Urgent Care Center
A Facility that provides Urgent Care services, as previously defined in this section. In general, Urgent
Care Centers:
 Do not require an appointment
 Are open outside of normal business hours, so you can get medical attention for minor illnesses
that occur at night or on weekends, and
 Provide an alternative if you need immediate medical attention, but your Physician cannot see you
right away
Important Administrative Information: ERISA
This section includes:
 Plan administrative information, including:
o Plan Sponsor
o Plan Administrator
o Sources of contribution and funding
o Claims Administrator information
o Other administrative information, and
o Your rights under ERISA
You can learn additional information about the Medical Benefit Program by reviewing the other
sections of this TEBP SPD at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees. The complete SPD includes information on eligibility and enrollment, procedures for
appealing claim denials, authority to amend and terminate the TEBP and all of the benefit programs
(including the Medical Benefit Program), COBRA continuation rights, and your rights under the Health
Insurance Portability and Accountability Act (HIPAA).
Here’s a list of some quick facts you may need to know:
Plan Sponsor
Tenet Healthcare Corporation is the Plan Sponsor. You may contact the Plan Sponsor at:
Tenet Healthcare Corporation
Attn: Health and Welfare Benefits Department
1445 Ross Ave., Suite 1400
Dallas, TX 75202
(469) 893-2000
Certain other affiliates and subsidiaries of the Plan Sponsor have adopted the Tenet Employee Benefit
Plan and the Medical Benefit Program as participating employers. A complete list of the employers who
have adopted the Tenet Employee Benefit Plan and the Medical Benefit Program offered thereunder
may be obtained upon written request to the Benefits Administration Committee (the “BAC”), and is
available for examination by participants and beneficiaries at the office of the BAC and certain other
{00014391.DOCX-}
53
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
locations. Likewise, certain labor organizations (unions) have negotiated benefits under the Tenet
Employee Benefit Plan with respect to employees covered by a collective bargaining agreement. A
complete list of Unions who have adopted the Tenet Employee Benefit Plan may be obtained upon
written request to the BAC, and is available for examination by participants and beneficiaries at the
office of the BAC and certain other locations.
Plan Administrator
The Benefits Administration Committee or BAC is the Plan Administrator. You may contact the Plan
Administrator at:
Tenet Healthcare Corporation
c/o Benefits Administration Committee
Attn: Health and Welfare Benefits Department
1445 Ross Ave., Suite 1400
Dallas, TX 75202
(469) 893-2000
The Claims Administrator has been retained to perform the majority of plan administrative functions
for the Medical Benefit Program, including the discretion and responsibility to determine Covered
Persons’ eligibility for and the amount of any Medical Benefit Program Benefits. However, in some
circumstances, the Plan Administrator has reserved the authority to make final claims determinations
under the Medical Benefit Program. See the chart under “Delegation of Authority” in the Other
Information section of the TEBP SPD for more information. The Plan Administrator (and where
delegated, the Claims Administrator) has absolute discretion and authority to construe and interpret
the Medical Benefit Program as described in this SPD. The Plan Administrator’s (and where delegated,
the Claims Administrator’s) interpretation of the Medical Benefit Program as described in this SPD as to
eligibility for and the amount of such Benefits will be binding and conclusive on all persons.
Sources of Contributions and Funding
Benefits under the Medical Benefit Program will be paid as needed directly from the general assets of
the Employer that sponsors the Medical Benefit Program.
Contributions for Medical Benefit Program expenses are obtained from the Employer and from the
participating employees. The Employer evaluates the costs of the Medical Benefit Program based on
projected Medical Benefit Program expenses and determines the amount to be contributed by the
Employer and the amount to be contributed by the participating employees.
Note about COBRA
COBRA premiums will be the Qualified Beneficiaries’ full responsibility and are generally 102% of the
costs for non-COBRA individuals, except in special circumstances where a greater amount is permitted
under COBRA. Refer to the COBRA section of the Other Information section of the TEBP SPD for
additional details.
Claims Administrator
The role of the Claims Administrator is to handle the day-to-day administration of the Medical Benefit
Program’s coverage as described in this SPD. The Claims Administrator has sole and absolute discretion
and authority to construe and interpret the Medical Benefit Program as described in this SPD; except
that the Plan Administrator has retained certain claims authority as stated on the chart under
“Delegation of Authority” in the Other Information section of the TEBP SPD.
{00014391.DOCX-}
54
----------------------------------------------------------------------- MEDICAL SUMMARY PLAN DESCRIPTION, 2017 ----------------------------------------------------------------
Benefits under the Medical Benefit Program will be paid only if the Claims Administrator decides, in its
discretion, that a person is entitled to them. In making any decision, the Claims Administrator may rely
on the accuracy and completeness of any information furnished by the Employer or a Covered Person.
The Claims Administrator’s interpretation of the Medical Benefit Program as described in this SPD as to
the amount of benefits and eligibility will be binding and conclusive on all persons.
The Claims Administrator will not be deemed or construed as an employer for any purpose with respect
to the administration or provision of Benefits under the Medical Benefit Program. The Claims
Administrator will not be responsible for fulfilling any duties or obligations of an Employer with respect
to the Medical Benefit Program.
You may contact the Claims Administrator by calling the toll-free number on your ID card or in writing
at:
Allegian Health Plans
Blue Cross Blue Shield of Texas
P.O. Box 981637
P.O. Box 660044
El Paso, TX 79998-1637
Dallas, TX 75266-0044
CIGNA Healthcare
P.O. Box 182223
Chattanooga, TN 37422-7223
DMC Care Claims Dept
P.O. Box 44290
Detroit, MI 48244
Health Plans, Inc
P.O. Box 5199
Westborough, MA 01581
Anthem Blue Cross Life and Health Insurance
Company
Attn: Appeals
P.O. Box 54159
Los Angeles, CA 90054
Note: Certain options under the Medical Benefit Program are summarized in separate medical SPD
documents. Employees enrolled in one of the following Medical Benefit Program options should refer
to the separate medical SPD for such option, available at MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees, for Claims Administrator contact information: Fallon
Direct, Fallon Select, Blue Shield HMO, or an option administered by Health Plans, Inc. (i.e., the Harvard
Plans).
Agent for Service of Legal Process
Should it ever be necessary, you or your personal representative may serve legal process on the agent
of service for legal process for the TEBP. The TEBP’s Agent of Service is:
Tenet Healthcare Corporation
1445 Ross Ave., Suite 1400
Dallas, TX 75202
(469) 893-2000
Legal process may also be served on the Plan Administrator.
Other Administrative Information
This section of your Medical Benefit Program SPD contains information about how the Medical Benefit
Program is administered as required by ERISA.
Type of Administration
The TEBP Plan and the Medical Benefit Program offered thereunder is a self-funded welfare plan and
the administration is provided through one or more third party administrators.
{00014391.DOCX-}
55
Plan Name:
Tenet Employee Benefit Plan
Plan Number:
515
Employer ID:
95-2557091
Plan Type:
Plan Year:
Welfare benefits plan
January 1 - December 31
Plan Administration:
Source of Plan Contributions:
Self-Insured
Employee and Employer
Source of Benefits:
Employer’s general assets
Your ERISA Rights
For a statement explaining your rights under ERISA, see the Other Information section of the TEBP SPD.
Tax Consequences of Participation in the Medical Benefit Program
In general, you may pay for your premiums in the Medical Benefit Program on a pre-tax basis by
reducing your salary. However, premiums for coverage for a domestic partner (or for any dependent
who does not qualify as your federal tax dependent) will be paid on an after-tax basis, unless your
domestic partner also qualifies as your federal tax dependent (determined without regard to IRC
sections 152(b) (1), (b) (2), and (d) (1) (B), which contain certain exceptions to the definition of
dependent and a gross income limitation). The test for determining whether your domestic partner
qualifies as your federal tax dependent may be different than the test for determining dependent
status under the plan. You should consult with your tax advisor to determine if your domestic partner
qualifies as your federal tax dependent. In addition, if you are a highly compensated employee, there
may be certain circumstances in which you are not eligible to exclude from gross income all or a
portion of the premiums or benefits paid under the Medical Benefit Program. Neither the Plan
Administrator nor your employer can guarantee that the benefits provided to you under the Medical
Benefit Program will be excludable from your gross income for federal and state tax purposes. For
more information on the tax consequences of participating in the Medical Benefit Drug Program,
please see your tax advisor.
{00014391.DOCX-}
56
Prescription Drug Summary Plan Description
About This Summary Plan Description (SPD)
The Prescription Drug Program is a component program in the Tenet Employee Benefit Plan (TEBP). The
TEBP is a comprehensive welfare benefits program intended to qualify as a cafeteria plan within the
meaning of Internal Revenue Code (IRC) section 125.
This information summarizes key provisions of the Prescription Drug Program and serves as part of the
summary plan description (SPD) for the TEBP. You can obtain more information about the Prescription
Drug Program, the TEBP and the other component programs offered under the TEBP by reviewing the
complete SPD for the TEBP. If there is any discrepancy between this online SPD and the official plan
documents for the TEBP, the official plan documents will control. For more information on obtaining
the official plan documents, see the Other Information section of the TEBP SPD.
Plan Highlights
You must be enrolled in a medical coverage option under the Tenet Medical Benefit Program to receive
prescription drug coverage. Your medical plan option, and whether or not you are covered under a
collective bargaining agreement, determines your Prescription Drug Program. For 2017:
 Platinum, Gold, Silver, Bronze, Health & Saving Plan, Health & Reimbursement Plan, and Blue Shield
HMO enrollees are automatically enrolled in the Rx benefit program.
 PPO or EPO enrollees, are automatically enrolled in the Rx benefit program, Rx VII, or Rx VIII
programs depending on the specific PPO or EPO program available for the facility location. Please
see the facility Benefits Booklet, available at MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees, for more information.
Note: The prescription drug benefits provided under the following fully insured Medical Benefit
Program options (available only at certain locations or facilities) are summarized in separate
summary plan description (SPD) documents: Fallon Select and Fallon Direct. Unless provided
otherwise, all other provisions of the TEBP SPD remain applicable.
The Prescription Drug Program offers an easy and convenient way to save on short- and long-term
medication. The program includes a formulary feature that can help you manage your prescription drug
expenses. A “formulary” is a list of commonly prescribed medications — both generic and brand name
— that have been found to be clinically effective, as well as cost effective. By asking your doctor to
prescribe formulary medications when appropriate and discussing with your doctor the use of a generic
medication, you can help keep your out-of-pocket costs lower while maintaining high quality care. The
list of formulary drugs can be accessed by clicking the Prescription Drugs link from the My Benefit Links
box.
There are several components to the Prescription Drug Program:
{00014391.DOCX-}
57
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Retail Prescription Drug
Program
Allows you to purchase up to a 30-day supply of medication at
participating retail pharmacies
il-Order Program
A more cost-effective way for you to purchase up to a 90-day
supply of maintenance medication by having your prescription
drugs sent to you in the mail
Maintenance Choice Program
If you or your dependents use maintenance prescription drugs,
they must be filled through the mail order drug program or at a
CVS pharmacy location only. If applicable, certain Tenet owned
pharmacies are eligible to dispense 90 day maintenance
medications. With each new maintenance prescription, you may
fill your prescription twice at retail before you must transition to a
90-day supply through mail order.
Generic Utilization
Generic prescriptions save you money. Although use of generic
equivalents is recommended, you still have the option to obtain a
brand name prescription if a generic is not your preference.
However, if you choose to obtain a brand name drug when a
generic is available, you may be assessed a penalty on top of the
brand co-pay.
Generic Step Therapy Plans
(GSTP)
Requires the use of cost-effective generic alternatives, within the
same therapeutic class, as first line therapy before targeted brands
are covered.
Specialty Pharmacy
Specialty prescriptions may be filled once at any in-network
pharmacy; however, subsequent fills must be made through mail
order service. You may request that the prescription be sent to
your home address or nearby Caremark/CVS retail store. If the
prescription is not filled through mail-order after the initial fill, the
claim will not be paid. Specialty medications can include drugs that
are very expensive, have limited access, require complicated
treatment regimens, compliance issues, special storage
requirements or manufacturing reporting requirements. Caremark
will notify you if your prescription is categorized as a specialty drug.
Specialty medications may be filled at Tenet-owned, onsite pharmacies. For a list
of eligible onsite pharmacies, please contact your prescription drug carrier.
Introduction to the Prescription Drug Program
This section of the SPD includes:
 Quick Facts: Who You Can Cover, Cost of Coverage, When Coverage Begins, and When Coverage
Ends
 The factors that impact your cost of coverage
{00014391.DOCX-}
58
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
 Instructions and timeframes for enrolling yourself and your eligible dependents in the Medical and
Prescription Drug Benefit Programs
 When you can make coverage changes under the Medical Benefit Program
Quick Facts
Who You Can Cover
Cost of Coverage
When Coverage
Begins
When Coverage
Ends
 You (and your family members) must be enrolled under a Tenet Medical
Benefit Program option to be covered under the Prescription Drug
Program.
 Your coverage category for prescription drugs is determined by your
coverage category for your medical plan, and whether or not you are
covered by a collective bargaining agreement.
 Your contribution to the cost of your prescription drug coverage is
included in the premium you pay for medical coverage.
 Your (or your dependent’s) coverage under the Prescription Drug
Program begins on the day your (or your dependent’s) coverage under
the Tenet Medical Benefit Program begins. If you (or your dependents)
are not enrolled in the Tenet Medical Benefit Program, then you (or
your dependents) will not be covered under the Prescription Drug
Program.
 Coverage for newly eligible dependents begins on the date they become
covered under the Tenet Medical Benefit Program and dependent
documentation has been received and verified (through birth, adoption,
etc.), provided you enroll them within 31 days (as applicable, see the
Life Events section of the TEBP SPD for more information) of the date
they become eligible.
 When coverage ends is dependent on various factors. Please refer to
When Coverage Ends in the Eligibility and Enrollment section of the
TEBP SPD, for detailed information on when coverage for you and your
dependents ends.
 In some circumstances, you or your dependents may be eligible to
continue medical coverage (and the corresponding prescription drug
coverage) under the Consolidated Omnibus Budget Reconciliation Act
(COBRA) of 1985, as amended. For more information on COBRA
coverage, please see the Other Information section of this TEBP SPD.
Cost of Coverage
Your contribution to the cost of your prescription drug coverage is included in the premium you pay for
medical coverage, and depends on the medical care option you select and the family members you
choose to enroll. You and Tenet share in the cost of the Medical Benefit Program.
Your contributions for your coverage and for coverage for your dependents (including your spouse and
legal same-sex spouse) are typically deducted from your paychecks on a before-tax basis. Before-tax
dollars come out of your pay before federal income and Social Security taxes are withheld - and in most
states, before state and local taxes are withheld. This gives your contributions a special tax advantage
and lowers the actual cost to you. However, your contributions for Domestic Partner coverage (and for
{00014391.DOCX-}
59
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
coverage for any other dependent who is not your federal tax dependent) will be deducted from your
paychecks on an after-tax basis unless your Domestic Partner qualifies as your federal tax dependent
within the meaning of IRC section 152 (determined without regard to IRC sections 152(b)(1), (b)(2), and
(d)(1)(B)). For more information in determining whether your Domestic Partner or other dependent
qualifies as your federal tax dependent, contact your tax advisor.
Your contributions are subject to review and Tenet reserves the right to change your contribution
amount from time to time.
You can obtain current contribution rates by calling the MyBenefits Customer Support Center at 1-877468-3638 or accessing your personal enrollment information from MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees.
Out-of-Pocket Maximum
Covered expenses provided by a Network Provider under the Prescription Drug Program are subject to
the Out-of-Pocket Maximum as discussed under "Out-of-Pocket Maximum" in the Medical Benefit
Program SPD section. Please see such section for more information on the Out-of-Pocket Maximum.
How to Enroll
1. Enroll online at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees
or call the MyBenefits Customer Support Center at 1-877-468-3638.
2. Complete an enrollment transaction within the applicable deadline (generally, 31 days of the date
you first become eligible for coverage under the Tenet Medical Benefit Program—see the Life
Events section of this SPD for more specific information). If you do not enroll within the applicable
deadline, you will need to wait to make your benefit elections until the next Annual Enrollment
period or the date you incur a change of family status or HIPAA special enrollment event entitling
you to a mid-year enrollment. For more information on change of family status and HIPAA special
enrollment events, see the Life Events section of the TEBP SPD.
Each year during Annual Enrollment, you have the opportunity to review, change, or cancel your
healthcare coverage. All changes made during the Annual Enrollment period will take effect on January
1 of the following calendar year.
Important
If you wish to change your benefit elections following your marriage, birth or adoption of a child, or
other family status change or HIPAA special enrollment event, you must complete your enrollment
transaction online at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees or call the MyBenefits Customer Support Center at 1-877-468-3638 within the
applicable deadline, which is typically 31 days of the event and request your change. Otherwise,
you will need to wait until the next Annual Enrollment period to change your elections. See the Life
Events section for more specific information.
Changing Your Coverage
Please refer to the Life Events section of the TEBP SPD for more information on making coverage
changes outside of an Annual Enrollment period.
PROFILE: Tony and Sara
Tony and Sara are a young couple who have just started a family with the arrival of their son, Ryan.
Tony works for Tenet, while Sara has a part-time job at a daycare facility. Sara’s employer doesn’t
offer medical or prescription drug benefits to part-time employees. Tony knows his family will be
using brand-name prescriptions on a regular basis for his medical condition. After modeling his
{00014391.DOCX-}
60
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
prescription drug coverage options online, he determines that EPO Rx VII is the best plan for his
family.
How the Retail Program Works
A Look at the Basics
The Retail Prescription Drug Program allows you to purchase up to a 30-day supply of medication. You
simply present your prescription identification (ID) card at a participating pharmacy when you have
your prescription filled.
Annual Deductible
In certain cases you must meet a deductible before the plan begins paying benefits.
 With the Silver, Bronze, or Health & Savings Plan, your preventive prescription drugs are covered
without a deductible. However, you must meet your medical plan deductible for any nonpreventive prescription drugs.
 With the Platinum, Gold, Health & Reimbursement Plan, PPO, or EPO (except for individuals under
the Rx VIII program) your preventive and non-preventive prescription drugs are covered without a
deductible.
 For Rx VIII program enrollees, the deductible is $25 per covered individual. This deductible is
separate from any annual deductible you’re required to satisfy under your medical program option.
It also applies to EACH covered family member.
 A deductible applies to prescription drug benefits provided under the Harvard Advantage Plan.
Please see MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees for
additional information.
Please see the charts below under "Co-pays and Co-Insurance" for additional information.
Co-pays and Co-insurance: Retail (30-Day Supply)
Once the applicable deductible, if any, is satisfied, each prescription filled may be subject to a co-pay or
co-insurance charge. The charts below show the co-pays and co-insurance charges for each
Prescription Drug Program option for a retail 30-day supply:
Rx Benefit: General Tenet Options
Platinum or Gold Plans*
Health & Reimbursement Plan*
EPO Plan*
PPO Plan*
Blue Shield HMO Plan*
Bronze or Silver Plans**
Health & Savings Plan**
Generic
You pay $5 co-pay
You pay $5 co-pay after medical deductible
Formulary
You pay 35% ($30 minimum, $100
maximum)
You pay 35% ($30 minimum, $100
maximum) after medical deductible
Non-Formulary
You pay 50% ($40 minimum, $150
maximum)
You pay 50% ($40 minimum, $150
maximum) after medical deductible
{00014391.DOCX-}
61
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription
drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies
are part of the formulary.
*It is not necessary to meet the medical plan deductible before receiving prescription drug benefits. Prescription co-pays and
co-insurance apply to the medical out-of-pocket maximum.
**Certain preventive medications are available at the co-pay/co-insurance level prior to the satisfaction of the deductible. For
a complete listing of these medications, contact CVS/Caremark at 877-906-3807. Non-preventive prescription costs apply to
the medical plan deductible and out-of-pocket maximum.
Rx Benefit: Harvard Plans - Saint Vincent MNA Union
Saint Vincent Harvard Co-Pay*
Saint Vincent Harvard PPO Select*
Generic
You pay $10 co-pay
You pay $10 co-pay
Formulary
You pay $25 co-pay
You pay $25 co-pay
Non-Formulary
You pay $50 co-pay
You pay $45 co-pay
Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription
drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies
are part of the formulary.
*It is not necessary to meet the medical plan deductible before receiving prescription drug benefits. Prescription co-pays and
co-insurance apply to the medical out-of-pocket maximum.
**Certain preventive medications are available at the co-pay/co-insurance level prior to the satisfaction of the deductible. For
a complete listing of these medications, contact CVS/Caremark at 877-906-3807. Non-preventive prescription costs apply to
the medical plan deductible and out-of-pocket maximum.
Rx Benefit: Harvard Plans—MetroWest MNA Union
Generic
Formulary
NonFormulary
MetroWest Harvard
PPO Select*
MetroWest Harvard
PPO Plus*
MetroWest Harvard
Advantage with HSA**
MetroWest onsite pharmacy
You pay $0
You pay $0
You pay 0% after Tier
2*** deductible
Participating
pharmacy
You pay $10 co-pay
You pay $10 co-pay
You pay 10% after Tier
2*** deductible
MetroWest onsite pharmacy
You pay $20 co-pay
You pay $20 co-pay
You pay 0% after Tier
2*** deductible
Participating
pharmacy
You pay $25 co-pay
You pay $25 co-pay
You pay 25% after Tier
2*** deductible
MetroWest onsite pharmacy
You pay $20 co-pay
You pay $20 co-pay
You pay 0% after Tier
2*** deductible
Participating
pharmacy
You pay $45 co-pay
You pay $50 co-pay
You pay 45% after Tier
2*** deductible
Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription
drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies
are part of the formulary.
{00014391.DOCX-}
62
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
*It is not necessary to meet the medical plan deductible before receiving prescription drug benefits. Prescription co-pays and
co-insurance apply to the medical out-of-pocket maximum.
**Certain preventive medications are available at the co-pay/co-insurance level prior to the satisfaction of the deductible. For
a complete listing of these medications, contact CVS/Caremark at 877-906-3807. Non-preventive prescription costs apply to
the medical plan deductible and out-of-pocket maximum.
***The Tier 2 custom network deductible is $1300 per individual/$2600 family maximum. Please see the Medical Benefit
Program overview, available at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees for more
information.
Rx Benefit: PPO & EPO Plan – Cypress Fairbanks Union Only
Rx VII
Rx VIII
Annual Rx Deductible
None
$25
Generic
You pay $5 co-pay
You pay $10 co-pay after
deductible
Formulary – Benefit Based
You pay 20% ($75 maximum)
NA
Formulary
You pay 35% ($75 maximum)
You pay $30 co-pay after
deductible
Non-Formulary
You pay 50% ($125 maximum)
You pay $45 co-pay after
deductible
Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription
drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies
are part of the formulary.
If applicable, it may be necessary to meet the medical plan deductible before receiving prescription drug benefits. Prescription
co-pays and co-insurance apply to the medical out-of-pocket maximum.
If you request a brand-name drug when a generic is available, you’ll pay the generic co-pay or coinsurance, plus the cost difference between the brand-name and generic drug. This will occur even if
your doctor adds a “Dispense As Written” note on the prescription. You’ll pay any deductible amount,
co-pay or co-insurance at the participating pharmacy. As prescriptions for each family member are
filled, the participating pharmacy will track on the pharmaceutical carrier’s system when covered family
members meet their prescription deductible.
Most chain drugstores are participating pharmacies. For assistance in locating a participating pharmacy
near you, click on the Prescription Drugs link located on MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees or call the prescription drug carrier directly. You’ll need
your member number (included on your prescription drug ID card) and ZIP code.
FORMULARY DRUGS CAN SAVE YOU MONEY
This cost-saving feature allows your doctor to prescribe appropriate commonly used brand-name
medications, which are more cost effective than other brand-name medications that treat the same
condition. For a list of the brand-name drugs included on the formulary list, click on the Prescription
Drugs link in the My Benefit Links box or call the pharmaceutical carrier directly.
SAVE MONEY BY REQUESTING GENERIC DRUGS
Brand-name drugs often have generic counterparts. Generic drugs have the same active ingredients
as brand-name drugs and are subject to the same FDA standards for quality, strength and purity.
{00014391.DOCX-}
63
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Because generic drugs cost less to produce, it’s more cost effective to use the generic form. The
Prescription Drug Program pays higher benefits for generic drugs than for brand-name drugs. If you
request a brand-name drug when a generic equivalent is available, you’ll pay the generic co-pay or
co-insurance, plus the price difference between the brand-name and generic drug.
You should always discuss with your doctor or pharmacist whether a generic form of the prescribed
drug exists and is appropriate for you. Unless your doctor has specifically indicated “dispense as
written,” the pharmacist can make the generic substitution upon your request. You should consult
with your doctor regarding the medical implications, if any, of using a generic medication.
PROFILE: Tony and Sara
When Ryan was six months old, he caught an infection from one of the other children in his daycare
center. Sara received a prescription from his pediatrician and went to fill it at a participating
pharmacy. She was told that the total cost for Ryan’s medication was $70. After Sara showed her
medical ID card to the pharmacist, her prescription benefits were verified on the computer. Then
the pharmacist applied Sara’s prescription benefit to the total cost (see example below).
Here’s how the cost for Ryan’s medication was determined:
FOR RYAN’S FIRST PRESCRIPTION ...
Generic prescription drug cost
$70
THE COST FOR RYAN’S FIRST PRESCRIPTION IS . . .
Co-pay
Remaining cost
Under the Rx option, the cost for generic drugs
- $5 is a $5 co-pay. Sara pays this amount for Ryan’s
prescription
= $65 The plan picks up this cost.
After several months, Sara needs to fill another prescription for Ryan. Again, Sara shows her
medical ID card at the participating pharmacy. This time, Ryan’s doctor has prescribed a brandname medication that doesn’t have a generic equivalent but is included on the formulary list. The
cost of the brand-name drug is $125.
FOR RYAN’S SECOND PRESCRIPTION . . .
Brand-name prescription drug cost
$125
THE COST FOR RYAN’S SECOND PRESCRIPTION IS . . .
Co-pay
- $37.50 The co-pay for brand-name drugs on the
formulary list is 35% with a $30 minimum and
$100 maximum. The calculation is:
$125 x .35 = $37.50. Sara pays this amount for
Ryan’s prescription.
Remaining cost
{00014391.DOCX-}
= The plan picks up this cost.
$87.50
64
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
It Pays to Use Participating Pharmacies
When you use a participating pharmacy, you receive the highest level of benefits. You can also choose
to have your prescriptions filled at non-participating pharmacies; however, non-participating
pharmacies usually charge more than the contracted network rates for prescription drugs charged by
participating pharmacies.
These contracted network rates also apply to Health & Savings Plan participants who use participating
pharmacies — though you pay the full contracted price for the prescription until you meet your
medical deductible, you still are taking advantage of participating pharmacy discounts.
Using Non-Participating Pharmacies
With non-participating pharmacies, you pay the full cost of the prescription at the time of purchase. For
reimbursement, you’ll receive the contracted network cost for a 30-day supply, minus the appropriate
co-pay or co-insurance. You must complete a claim form to receive reimbursement from the
pharmaceutical carrier. Be sure to follow all directions on the claim form and attach original receipts.
You can get claim forms by clicking on the Prescription Drugs link in the My Benefit Links box.
How the Mail-Order Program Works
To save even more money, you can use the Mail-Order Program for long-term and maintenance
prescription drugs. It allows you to purchase up to a 90-day supply of generic or brand-name
medications, which are mailed directly to your home. You’ll get a larger supply of medications for less
money than using the Retail Prescription Drug Program.
Rx Benefit: General Tenet Options
Platinum or Gold Plans*
Health & Reimbursement Plan*
EPO Plan*
PPO Plan*
Blue Shield HMO Plan*
Bronze or Silver Plans**
Health & Savings Plan**
Generic
You pay $10 co-pay
You pay $10 co-pay after medical
deductible
Formulary
You pay 35% ($75 minimum, $200
maximum)
You pay 35% ($75 minimum, $200
maximum) after medical deductible
Non-Formulary
You pay 50% ($100 minimum, $300
maximum)
You pay 50% ($100 minimum, $300
maximum) after medical deductible
Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription
drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies
are part of the formulary.
*It is not necessary to meet the medical plan deductible before receiving prescription drug benefits. Prescription co-pays and
co-insurance apply to the medical out-of-pocket maximum.
**Certain preventive medications are available at the co-pay/co-insurance level prior to the satisfaction of the deductible. For
a complete listing of these medications, contact CVS/Caremark at 877-906-3807. Non-preventive prescription costs apply to
the medical plan deductible and out-of-pocket maximum.
{00014391.DOCX-}
65
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Rx Benefit: Harvard Plans – Saint Vincent MNA Union
Saint Vincent Harvard Co-Pay*
Saint Vincent Harvard PPO Select*
Generic
You pay $10 co-pay
You pay $20 co-pay
Formulary
You pay $25 co-pay
You pay $50 co-pay
Non-Formulary
You pay $50 co-pay
You pay $90 co-pay
Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription
drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies
are part of the formulary.
*It is not necessary to meet the medical plan deductible before receiving prescription drug benefits. Prescription co-pays and
co-insurance apply to the medical out-of-pocket maximum.
**Certain preventive medications are available at the co-pay/co-insurance level prior to the satisfaction of the deductible. For
a complete listing of these medications, contact CVS/Caremark at 877-906-3807. Non-preventive prescription costs apply to
the medical plan deductible and out-of-pocket maximum.
Rx Benefit: Harvard Plans—MetroWest MNA Union
Generic
Formulary
NonFormulary
MetroWest Harvard
PPO Select*
MetroWest Harvard
PPO Plus*
MetroWest Harvard
Advantage with HSA**
MetroWest onsite pharmacy
You pay $0
You pay $0
You pay 0% after Tier
2*** deductible
Participating
pharmacy
You pay $20 co-pay
You pay $20 co-pay
You pay 10% after Tier
2*** deductible
MetroWest onsite pharmacy
You pay $40 co-pay
You pay $40 co-pay
You pay 0% after Tier
2*** deductible
Participating
pharmacy
You pay $50 co-pay
You pay $50 co-pay
You pay 25% after Tier
2*** deductible
MetroWest onsite pharmacy
You pay $40 co-pay
You pay $40 co-pay
You pay 0% after Tier
2*** deductible
Participating
pharmacy
You pay $90 co-pay
You pay $100 co-pay
You pay 45% after Tier
2*** deductible
Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription
drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies
are part of the formulary.
*It is not necessary to meet the medical plan deductible before receiving prescription drug benefits. Prescription co-pays and
co-insurance apply to the medical out-of-pocket maximum.
**Certain preventive medications are available at the co-pay/co-insurance level prior to the satisfaction of the deductible. For
a complete listing of these medications, contact CVS/Caremark at 877-906-3807. Non-preventive prescription costs apply to
the medical plan deductible and out-of-pocket maximum.
*** The Tier 2 custom network deductible is $1300 per individual/$2600 family maximum. Please see the Medical Benefit
Program overview, available at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees, for more
information.
{00014391.DOCX-}
66
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Rx Benefit: PPO & EPO Plan – Cypress Fairbanks Union Only
Rx VII
Rx VIII
Generic
You pay $0
You pay $25 co-pay
Formulary – Benefit Based
You pay 20% ($150 maximum)
NA
Formulary
You pay 35% ($150 maximum)
You pay $63 co-pay
Non-Formulary
You pay 50% ($250 maximum)
You pay $100 co-pay
Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription
drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies
are part of the formulary.
It is not necessary to meet the medical plan deductible before receiving prescription drug benefits. Prescription co-pays and
co-insurance apply to the medical out-of-pocket maximum.
PROFILE: Tony and Sara
Tony has been diagnosed with high cholesterol. In addition to eating right and exercise, Tony’s
doctor has told him that he will need medication over the long term to control his cholesterol level
and has prescribed a brand-name drug that is on the formulary list.
FOR TONY’S PRESCRIPTION . . .
Brand-Name
prescription drug
$472.50
The retail price for Tony’s prescription is $175 for a 30-day
supply, compared to the Mail Order price of $157.50. A 90 day
Mail Order supply, before insurance applies, costs $472.50.
THE COST FOR TONY’S PRESCRIPTION IS . . .
Mail Order Calculation:
The co-pay for brand-name drugs on the formulary list is 35%
with a $75 minimum and $200 maximum. The calculation is:
$472.50 x .35 = $165.38.
Retail Calculation:
Tony’s cost
-$165.38
Had Tony chosen to fill the prescription at retail each month the
co-pay would have been 35% with $30 minimum / $100
maximum. The calculation is: $175 x .35 = $61.25 x 3 months =
$183.75.
My using the mail order service Tony saves $18.37 over the
course of 3 months / $73.48 over 12 months.
Remaining cost
=$307.12
The plan picks up this cost.
Please Be Aware . . .
The pharmaceutical carrier may require that some medications be dispensed through the MailOrder Program. If your medication falls into that category, the pharmaceutical carrier will contact
you.
It takes approximately two to three weeks from the time you send in your order form to receive your
prescription drugs in the mail. Order forms for the Mail-Order Program can be obtained by contacting
{00014391.DOCX-}
67
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
the pharmaceutical carrier. Additional forms can be obtained by clicking on the Prescription Drugs link
in the My Benefit Links box.
If your prescription indicates refills, the mail-order pharmacy will send you a reorder form with your
initial prescription and each subsequent refill. You can then order your refill by mail or you can call the
pharmaceutical carrier. You can also process your refill by clicking on the Prescription Drugs link in the
My Benefit Links box to access the pharmaceutical carrier’s website. Online orders are usually
processed within 7–10 days.
Purchasing Diabetic Supplies Through the Mail-Order Program
If you or a covered family member is diabetic, you can purchase over-the-counter diabetic
supplies,*including lancets and test strips, through the Mail-Order Program. Keep the following in mind
when purchasing these supplies:
Prescriptions Are
Required
Your physician needs to write a prescription for over-the-counter diabetic
supplies. (Please note that the pharmaceutical carrier always requires a
prescription, even if you live in a state where prescriptions aren’t required for
over-the-counter diabetic supplies.)
Prescriptions
Need to State the
Quantity and the
Number of Refills
Your doctor needs to indicate the quantity (90-day maximum) and the number
of refills allowed (if any) on your prescription. If your doctor doesn’t state the
quantity, the pharmacy will send the minimum order, which is one box. Please
note that the manufacturers don’t package lancets and test strips in equal
numbers.
A Co-pay or Coinsurance Is
Required for Each
Order
Co-pays or co-insurance for over-the-counter diabetic supplies are at the
brand-name formulary and non-formulary level. For example, with the Rx VIII
option, you will pay $63 per order for formulary or $100 per order for nonformulary (either new prescriptions or refill). Lancets and test strips are
considered separate orders; therefore, when ordering both, your total
payment with the Rx VIII option will be $126 for formulary and $200 for nonformulary (two times the formulary or non-formulary cost for each).
It Takes
Approximately 2 3 Weeks to Fill
Mail-Order
Prescriptions
Therefore, be sure you take this timing into consideration when mailing in
your order. If you need an immediate supply, you can purchase a 30-day
supply through the Retail Prescription Drug Program at any participating
pharmacy. Please note that the Retail Prescription Drug Program also requires
a prescription from your doctor, and you’ll be required to satisfy applicable
deductibles if you haven’t already. So be sure to get two prescriptions from
your doctor.
Refills Are Easy
If your prescription includes refills, you’ll receive a refill order slip with your
initial order, and with each subsequent order, until all refills have been sent ―
then you can expect to receive a renewal reminder once a new prescription is
needed. Refills can be ordered over the telephone, by mailing in your refill
order slip or online by clicking on the Prescription Drugs link in the My Benefit
Links box to access the pharmaceutical carrier’s website.
Please note: To cut down on paperwork, members with open home delivery
refills and a history of requesting refills online or by phone will not receive
order forms, business and customer reply envelopes or refill slips in their
{00014391.DOCX-}
68
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
home delivery packages. However, they will continue to receive renewal
reminders.
*
Subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies are part of the
formulary. If they aren’t, have your physician contact the pharmaceutical carrier to see if one of the formulary supply
options will work for you.
PROFILE: Randall
Randall has diabetes and manages his costs carefully. He takes advantage of ordering over-thecounter diabetic supplies through the Mail-Order Program. He knows he needs separate
prescriptions for his lancets and test strips — and that each of those orders requires separate copay. That’s why he makes sure his doctor writes prescriptions for formulary supplies. Under Rx VIII,
Randall pays a total of $126 for formulary lancets and test strips ($63 per order) instead of $200 for
non-formulary supplies.
Pre-Packaged Prescription Drugs
Certain prescription drugs are pre-packaged in supplies greater than the 30-day benefit normally filled
at retail pharmacies. Some drugs are pre-packaged in two-, three-, four- and six-month supplies and
the quantities cannot be cut back.
For pre-packaged drugs filled at retail pharmacies:
 1- to 30-day supplies will be one co-pay (or appropriate percentage of the total package),
 31- to 60-day supplies will be two co-pays (or appropriate percentage of the total package),
 61- to 90-day supplies will be three co-pays (or appropriate percentage of the total package),
 91- to 120-day supplies will be four co-pays (or appropriate percentage of the total package) and so
on.
For pre-packaged drugs filled through mail-order:
 91-day or greater supplies will never be charged more than the 90-day co-pay.
Specialty Pharmacy
The specialty pharmacy is designed to help you meet the particular needs and challenges of using
certain medications, many of which require injection or special handling.
If you are using a specialty pharmacy medication, you will be eligible to receive additional services
when you fill your specialty prescriptions with the specialty pharmacy. These additional services
include:
 Support and guidance from nurses and pharmacists who are trained in these medications, their
side effects and the conditions they treat
 Expedited delivery of all your specialty prescription medications
 Supplemental supplies, such as needles and syringes that are required to administer the
medication, at no additional charge
 Scheduling of refills and coordination of services with home care providers, case managers and
doctors or other health care professionals
{00014391.DOCX-}
69
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Days of Therapy Through the Specialty Pharmacy
Medications will be dispensed for up to a 90-day supply when appropriate. Certain medications
dispensed through the specialty pharmacy may only be available for up to a 30-day supply based on
dosing, safety, frequent change in therapy, or need to minimize waste for that particular drug. There
are other classes of medications that may be limited to a smaller quantity (up to a 30-day supply) early
in your treatment to allow for potential changes in dose. Once therapy has been stabilized, you will be
offered up to a 90-day supply. For example:
 Hemophilia drugs will always be limited to a maximum of a 30-day supply.
 Erythroid stimulants (Epogen®, Aranesp®) and agents for rheumatoid arthritis (Enbrel®, Humira®) will
be limited to a maximum of a 30-day supply early in treatment.
For those medications that are only limited early in therapy, a pharmacist will contact you regarding
your past history with the medication to determine whether a larger supply is appropriate for you.
Your co-pay will also be automatically adjusted for any medication that has a limited-day supply and
you will not be responsible for a full 90-day co-pay.
If you have any questions regarding specialty pharmacy medications, please call the specialty pharmacy
directly.
Some Medications Require Authorization or Review
The pharmaceutical carrier requires a prior authorization or coverage review for certain medications.
This applies both to new prescriptions and to continue coverage on certain medications.
Traditional Prior Authorization (TPA)
The following medications require prior authorization to ensure appropriate coverage decisions (e.g.,
patient diagnosis, what the prescribed drug is being used for, recommended dosage, how long the
medication is to be used, possible drug interactions and other safety concerns):














Alzheimer’s Therapy
Androgens & Anabolic Steroids
Anti-Narcoleptic Agents (Nuvigil, Provigil)
Antiviral Agents - Incivek, Victrelis, Ribavirin
Cancer Therapy – Oncology agents
Dermatologicals (Isotretinoin)
Dermatologicals (Retin A/Tazorac)
Dermatologicals / Misc. (Regranex gel)
Dermatologicals / Misc. (Solodyn)
Erythroid Stimulants
Growth Hormones
Immune Globulins (IVIG)
Interferons
Miscellaneous Specialty Hormones: (Interleukins / Misc. (Arcalyst/Ilaris); Acthar Gel, Kuvan,
Sensipar, Somavert, Zavesca, Cerezyme, Vpriv)
 Multiple Sclerosis Therapy
 Myeloid Stimulants and Hemostatics
 Neurological Agents/Misc. (Xenazine)
{00014391.DOCX-}
70
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------










Ophthalmic Agents - Retisert
Parkinson's Therapy (Apokyn)
PNH Agents (Soliris)
Psoriasis Therapy (Stelara, Amevive)
Pulmonary Agents – Berinert/Cinryze/Kalbitor
Pulmonary Agents/Misc. (Pulmozyme)
Pulmonary Agents/Misc. (Xolair)
Pulmonary Arterial Hypertension (All Agents)
Rheumatological Agents (such as Enbrel, Humira, Simponi, Cimzia, etc.)
RSV Agents – Synagis/Respigam
The list of medications requiring prior authorization is subject to change.
Your doctor should contact the pharmaceutical carrier before issuing a prescription to you. A Managed
Prior Authorization pharmacist will discuss the necessary drug criteria with your doctor before issuing
the authorization.
If you don’t receive authorization before picking up your prescription at the pharmacy, your pharmacist
will receive a message from the pharmaceutical carrier indicating that prior authorization is necessary
and instruct him or her to contact the pharmaceutical carrier’s managed prior authorization service.
This could result in a delay in receiving your medication.
Step with Prior Authorization
The pharmaceutical carrier automatically tracks each prescription and monitors the standard maximum
dosage and quantities for certain types of drugs. They also review other medications you have taken in
the past, your age and other patient factors. If your doctor has prescribed a medication in excess of the
quantity usually allowed or the usual dose of medication over time, or in cases when evidence of prior
therapy in a step approach is not found, your doctor will need to obtain authorization from the
pharmaceutical carrier.
Examples of medications that require authorization and/or quantity limits:













Anti-Convulsant Agents (Topamax and Zonegran)
Atypical Antipsychotics (Abilify)
CNS Stimulants (such as Ritalin, Metadate, Adderall)
Gout Therapy (example, Uloric)
Antiinfluenza Agents
Osteoporosis Therapy (Forteo)
Anti-Emetics
Anti-Fungal Agents
Hypnotic/ Sleep agents (such as Zolpidem)
Migraine Therapy (such as Imitrex, Maxalt, Relpax)
Ophthalmic Agents - Retisert
Pain Management (Celebrex, Stadol, Toradol)
Proton Pump Inhibitors (such as Omeprazole, Nexium, lansoprazole)
Preferred Drug Step Therapy
In some cases you must first try a less expensive drug before a more expensive drug will be covered.
The following categories of medications/conditions require Step Therapy:
{00014391.DOCX-}
71







Angiotensin Receptor Blockers (ARBs)
Depression Therapy (SSRI)
Hypnotic Medications
Intranasal Steroids
Migraine (Triptan)
Osteoporosis - Bisphosphonates
Proton Pump Inhibitors
Retrospective Drug Utilization Review
The pharmaceutical carrier conducts a Retrospective Drug Utilization Review to identify prescribing,
dispensing and consumption patterns that do not meet the established clinical practice guidelines.
Physicians may be notified about clinical considerations to safeguard patients and manage plan
expenses. In some cases, physicians may initiate changes in therapy.
What’s Not Covered by the Prescription Drug Program?
Ineligible Expenses from A to Z
Some prescription drugs and services aren’t available through the Prescription Drug Program. Ineligible
expenses include, but aren’t limited to:
















ADMINISTERING DRUGS: Charges for the administration or injection of any drug
BIRTH CONTROL DEVICES: Contraceptive devices, jellies, creams, foams, injections and implants
BLOOD PRODUCTS: Immunization agents, biologicals, blood and blood plasma
ERECTILE DYSFUNCTION DRUGS: Viagra, Cialis, Levitra, Caverject and Muse
EXPERIMENTAL MEDICATIONS: Experimental or investigational drugs (see "Experimental or
Investigational Services" in the Medical Program SPD section for more information)
FERTILITY MEDICATIONS: Drugs used to treat infertility
HAIR GROWTH MEDICATION: Drugs used to stimulate hair growth
INPATIENT MEDICATIONS: Medication that is to be taken by or administered to you or a covered
family member while a patient is in a licensed hospital, rest home, sanitarium, extended care
facility, skilled nursing facility, convalescent hospital, nursing home or similar institution that has
the ability to dispense medications on its premises
NON-SEDATING ANTIHISTAMINES
NOT MEDICALLY NECESSARY: Any prescription drug, service, medication or supply that is not
medically necessary
OVER-THE-COUNTER DRUGS AND SUPPLIES: Any medication or supply that doesn’t require a
prescription, except over-the-counter diabetic supplies
REFILLS: Refills that are dispensed more than one year from the date of the doctor’s original order
or that are in excess of the number of refills specified by the doctor
SMOKING-CESSATION DRUGS: Over-the-counter smoking cessation medications – Coverage
provided if over 18
THERAPEUTIC DEVICES: Therapeutic devices or appliances, except blood testing machines
VITAMINS: Over-the-counter vitamins, except prenatal vitamins
WEIGHT GAIN OR LOSS MEDICATIONS: Anorexients or obesity drugs
{00014391.DOCX-}
72
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
 WORK-RELATED INJURY MEDICATION: Medication for a work-related injury or illness that is
covered under Workers’ Compensation, or for which no charge is made
For information regarding eligible prescription drugs, please contact the pharmaceutical carrier.
How to File a Claim
Whether you need to file a claim depends on whether you go through the Retail Prescription Drug
Program or the Mail-Order Program and whether you use a participating or non-participating
pharmacy. In some situations, you may be required to file a claim. This section outlines the procedures
for both programs.
Retail Prescription Drug Program
Claim forms aren’t required when you use your medical ID card (or prescription drug card if a separate
one is sent) to purchase prescription drugs at participating pharmacies. Simply show your ID card and
pay the required deductible, co-pay or co-insurance at the time of purchase. Claim forms will be
required, however, if you must purchase prescription drugs before you receive your prescription ID
card or you fill a prescription at a non-participating pharmacy after you receive your prescription ID
card. You can obtain claim forms by clicking on the Prescription Drugs link in the My Benefit Links box
or by calling the pharmaceutical carrier.
Send the completed claim form to:
Claims must be filed within 12 months after you incur the expense.
Mail-Order Program
With this program, you need to use an order form supplied by the pharmaceutical carrier to buy
prescription drugs through the mail. You can obtain claim forms by clicking on the Prescription Drugs
link in the My Benefit Links box or by calling the pharmaceutical carrier.
Send the completed order form to:
Claims Review and Detailed Description of Claims Process
If you disagree with the pharmaceutical carrier’s decision regarding a claim, you can have your claim
reviewed as described in the Other Information section of the TEBP SPD. The Other Information section
also describes the claims appeal process in detail.
{00014391.DOCX-}
73
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
When You’re Covered by Another Prescription Drug Plan (Coordination of
Benefits)
The Prescription Drug Program is subject to the Coordination of Benefits provisions as set forth in the
Medical Benefit Program SPD section.
Helpful Information about the
Tenet Prescription Drug Program
You can learn additional information about the Prescription Drug Program offered under the TEBP by
reviewing the other sections of this online SPD. THE COMPLETE SPD INCLUDES INFORMATION ON
ELIGIBILITY AND ENROLLMENT, PROCEDURES FOR APPEALING CLAIM DENIALS, QUALIFIED MEDICAL
CHILD SUPPORT ORDERS, AUTHORITY TO AMEND AND TERMINATE THE TEBP AND ALL OF THE
BENEFIT PROGRAMS (INCLUDING THIS PRESCRIPTION DRUG PROGRAM), COBRA CONTINUATION
RIGHTS AND YOUR RIGHTS UNDER THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
(HIPAA).
Here’s a list of some quick facts about the Prescription Drug Program you may need to know:
EMPLOYER AND PLAN
SPONSOR
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, TX 75202-2703
469-893-2000
PLAN ADMINISTRATOR
Tenet Benefits Administration Committee
1445 Ross Avenue, Suite 1400
Dallas, TX 75202-2703
469-893-2000
CLAIMS ADMINISTRATOR
AGENT FOR SERVICE OF
LEGAL PROCESS
CVS Caremark
P.O. Box 6590
Lee’s Summit, MO 64064-6590
1-877-906-3807
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, TX 75202-2703
469-893-2000
Legal process may also be served on the Plan Administrator.
PRESCRIPTION DRUG
PROGRAM EFFECTIVE DATE
The Prescription Drug Program is a component program in the
TEBP, which was originally effective as of October 1, 1977 and was
restated January 1, 2015. The Prescription Drug Program became
a component program in the TEBP effective as of January 1, 2003.
EMPLOYER IDENTIFICATION
NUMBER
95-2557091
PLAN NUMBER
515
{00014391.DOCX-}
74
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
PLAN YEAR
January 1 through December 31
TYPE OF PLAN
Welfare benefit plan offering prescription drug benefits. See the
Other Information section of the TEBP SPD for more information.
Funding of Benefits
Your benefits under the Prescription Drug Program are funded by your co-pay and co-insurance
amounts and by premiums paid by you and by Tenet.
Tax Consequences of Participation in the Prescription Drug Program
In general, you may pay for your premiums in the Prescription Drug Program on a pre-tax basis by
reducing your salary. However, premiums for coverage for a domestic partner (or for any dependent
who does not qualify as your federal tax dependent) will be paid on an after-tax basis, unless your
domestic partner also qualifies as your federal tax dependent (determined without regard to IRC
sections 152(b) (1), (b) (2), and (d) (1) (B), which contain certain exceptions to the definition of
dependent and a gross income limitation). The test for determining whether your domestic partner
qualifies as your federal tax dependent may be different than the test for determining dependent
status under the plan. You should consult with your tax advisor to determine if your domestic partner
qualifies as your federal tax dependent. In addition, if you are a highly compensated employee, there
may be certain circumstances in which you are not eligible to exclude from gross income all or a
portion of the premiums or benefits paid under the Prescription Drug Program. Neither the Plan
Administrator nor your employer can guarantee that the benefits provided to you under the
Prescription Drug Program will be excludable from your gross income for federal and state tax
purposes. For more information on the tax consequences of participating in the Prescription Drug
Program, please see your tax advisor.
Your Rights Under ERISA and HIPAA
For a statement explaining your rights under the Employee Retirement Income Security Act of 1974
(ERISA) and HIPAA, see the Other Information section of the TEBP SPD.
Glossary
Benefit Eligible
Generally, you are a "benefit eligible" employee with respect to the Prescription Drug Benefit Program
if you are enrolled in a Tenet Medical Benefit Program option.
Co-pay or Co-insurance
This is the portion of the prescription costs you’re responsible for paying — under the Prescription Drug
Program, a co-pay is a flat fee and co-insurance is a percentage of the cost of the drug.
Deductible
The deductible is the amount you need to pay each calendar year before the Prescription Drug Program
begins to cover eligible retail prescription expenses.
Formulary
{00014391.DOCX-}
75
--------------------------------------------------------------- PRESCRIPTION DRUG SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
A key feature of the Prescription Drug Program, a “formulary” is a list of commonly prescribed
medications — both generic and brand name — that have been found to be clinically effective, as well
as cost effective. By asking your doctor to prescribe formulary medications when appropriate, you can
help keep your out-of-pocket costs lower while maintaining high-quality care.
{00014391.DOCX-}
76
Dental Summary Plan Description
About This Summary Plan Description (SPD)
The Tenet Dental Benefit Program is a component program in the Tenet Employee Benefit Plan (TEBP),
a comprehensive welfare benefits program intended to qualify as a cafeteria plan within the meaning
of Internal Revenue Code (IRC) section 125.
This document summarizes key provisions of the Comprehensive Dental Plan option and the Preventive
Dental Plan option offered under the Tenet Dental Benefit Program and serves as part of the summary
plan description (SPD) for the TEBP. You can obtain more information about the Dental Benefit
Program, the TEBP and the other component programs offered under the TEBP by reviewing the
complete SPD for the TEBP. If there is any discrepancy between the TEBP SPD (including this Tenet
Dental Benefit Program section) and the official plan documents for the TEBP, the official plan
documents will control. For more information on obtaining the official plan documents, see the Other
Information section of the TEBP SPD.
Plan Highlights
Under the Tenet Benefit Program, your plan options may vary by location:
Enhanced Comprehensive Dental Plan
Comprehensive Dental Plan
Preventive Dental Plan
High Option Plan (St. Vincent MNA)
Low Option Plan (St. Vincent MNA)
Comprehensive Dental Plan (MetroWest MNA)
Basic Dental Plan (MetroWest MNA)
Each plan offers different levels of cost and coverage, so it’s a good idea to review your options
carefully before making your decision. Regardless of the plan you choose, you’ll have access to a handy
cost-saving feature, the DELTA DENTAL Preferred Provider Organization (PPO). Visit a dentist in the PPO
network to maximize your savings. If you can’t find a DELTA DENTAL PPO dentist, DELTA DENTAL
Premier dentists offer the next best opportunity to save, unlike a non-network dentist.
Who You Can Cover
Benefit eligible employees and their eligible dependents are eligible to enroll in any of the available
(per facility location) Dental Benefit Program options. Please see the Eligibility and Enrollment section
of the TEBP SPD and the definition of "Benefit Eligible" in the Glossary below for more information on
eligibility requirements.
{00014391.DOCX-}
77
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Three Dental Coverage Options
Enhanced
Comprehensive Plan
The Enhanced Comprehensive Plan option provides coverage for a wide
range of services — including preventive, basic and major restorative
services, and orthodontia for all covered individuals (dependent child
coverage ends at age 26 or later if disabled prior to age 26—see Eligibility
and Enrollment for more information). Under this option, you can see any
dental provider. Choosing a DELTA DENTAL PPO or Premier dentist,
however, can save you money. You also have an annual deductible, which is
a fee you must pay before the plan starts paying benefits. For this option,
the maximum Annual Plan Year Benefits (excluding orthodontic benefits)
the Plan will pay is $1,500 per covered person. There is a lifetime maximum
of $1,500 per covered person for all orthodontics.
Comprehensive
Dental Plan1
The Comprehensive Plan option provides coverage for a wide range of
services — including preventive, basic and major restorative services, and
orthodontia for covered dependent children to age 19. Under this option,
you can see any dental provider. Choosing a DELTA DENTAL PPO or Premier
dentist, however, can save you money. You also have an annual deductible,
which is a fee you must pay before the plan starts paying benefits. For this
option, the maximum Annual Plan Year Benefits (excluding orthodontic
benefits) the Plan will pay is $1200 per covered person. There is a lifetime
maximum of $1,000 per covered person for all orthodontics.
Preventive Dental
Plan
Under the Preventive Dental Plan option, you can see any dental provider.
Choosing a DELTA DENTAL PPO or Premier dentist, however, can save you
money. What’s more, there’s no deductible or annual benefit limit for
preventive care, so covered dental procedures received from a PPO or
Premier dentist are free!
However, unlike the Comprehensive Dental Plan, the Preventive Dental
Plan may not offer reimbursement for basic or major restorative services
(e.g., fillings, oral surgery, or bridges) or orthodontia.
1
For MNA union employees at the Saint Vincent facility, this option is referred to as the High Option
Plan.
2
For MNA union employees as the Saint Vincent facility, this option is referred to as the Low Option
Plan. For MNA union employees at the MetroWest facility, this option is referred to as the Basic Dental
Plan.
Please Note: You or your provider must file a claim to receive reimbursement from the Enhanced
Comprehensive, Comprehensive, or Preventive Dental Plan options.
Cost of Coverage
You and Tenet share in the cost of the Dental Benefit Program. Your contribution amount depends on
the specific dental care plan you select and the family members you choose to enroll.
{00014391.DOCX-}
78
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Your contributions for your coverage and for coverage for your dependents (including your spouse and
legal same-sex spouse) are typically deducted from your paychecks on a before-tax basis. Before-tax
dollars come out of your pay before federal income and Social Security taxes are withheld - and in most
states, before state and local taxes are withheld. This gives your contributions a special tax advantage
and lowers the actual cost to you. However, your contributions for Domestic Partner coverage (and for
coverage for any other dependent who is not your federal tax dependent) will be deducted from your
paychecks on an after-tax basis unless your Domestic Partner qualifies as your federal tax dependent
within the meaning of IRC section 152 (determined without regard to IRC sections 152(b)(1), (b)(2), and
(d)(1)(B)). For more information in determining whether your Domestic Partner qualifies as your
federal tax dependent, contact your tax advisor.
Your contributions are subject to review and Tenet reserves the right to change your contribution
amount from time to time.
You can obtain current contribution rates by calling the MyBenefits Customer Support Center at 1-877468-3638 or accessing your personal enrollment information from MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees.
How to Enroll
1. Enroll online at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees or call the MyBenefits Customer Support Center at 1-877-468-3638.
2. Complete an enrollment transaction within the applicable deadline (generally, 31 days of the
date you first become eligible for coverage under the Tenet Medical Benefit Program—see the
Life Events section of this SPD for more specific information). If you do not enroll within the
applicable deadline, you will need to wait to make your benefit elections until the next Annual
Enrollment period or the date you incur a change of family status or HIPAA special enrollment
event entitling you to a mid-year enrollment. For more information on change of family status
and HIPAA special enrollment events, see the Life Events section of the TEBP SPD.
Each year during Annual Enrollment, you have the opportunity to review, change, or cancel your
healthcare coverage. All changes made during the Annual Enrollment period will take effect on January
1 of the following calendar year.
Important
If you wish to change your benefit elections following your marriage, birth or adoption of a child, or
other family status change or HIPAA special enrollment event, you must complete your enrollment
transaction online at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees or call the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days of
the event and request your change. Otherwise, you will need to wait until the next Annual
Enrollment period to change your elections.
Changing Your Coverage
Please refer to the Life Events section of the TEBP SPD for more information on making coverage
changes outside of an Annual Enrollment period.
How the Three Options Compare
To give you more detail on how the two options measure up, here are brief comparison charts:
{00014391.DOCX-}
79
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Enhanced Comprehensive, Comprehensive, and Preventive Plans
(for All Eligible Employees Except Saint Vincent and MetroWest MNA Union Employees)
Enhanced
Comprehensive Dental
Plan
Choice of
Dentist
Annual
Deductible
Covered
Diagnostic &
Preventive
Services*
Preventive Dental Plan
Your choice of dentist
Your choice of dentist
Your choice of dentist
Choosing a DELTA
DENTAL Preferred
Provider Organization
(PPO) or Premier
dentist can result in
lower out-of-pocket
costs
Choosing a DELTA
DENTAL Preferred
Provider Organization
(PPO) or Premier
dentist can result in
lower out-of-pocket
costs
Choosing a DELTA
DENTAL Preferred
Provider Organization
(PPO) or Premier
dentist means you
receive 100%
reimbursement
$25 In-Network annual $25 In-Network annual
deductible per person
deductible per person
(waived for In(waived for In-Network
Network preventive
preventive and
and diagnostic
diagnostic services)
services)
$50 out-of-network
$50 out-of-network
annual deductible per
annual deductible per
person
person
Both in- and out-ofnetwork annual
Both in- and out-ofnetwork annual
deductibles combined
deductibles combined
will not exceed $50
will not exceed $50
Plan pays 100% for InNetwork services (the
In-Network deductible
is waived for InNetwork diagnostic
and preventive
services) and 100%
(after the $50
deductible) of the
Reasonable and
Customary (R&C)
charge for out-ofnetwork services
You pay 0% for InNetwork services. For
out-of-network
services, you pay the
$50 deductible plus
{00014391.DOCX-}
Comprehensive Dental
Plan
Plan pays 100% for innetwork services (the
In-Network deductible
is waived for InNetwork diagnostic and
preventive services)
and 100% (after the
$50 deductible) of the
Reasonable and
Customary (R&C)
charge for out-ofnetwork services
You pay 0% for InNetwork services. For
out-of-network
services, you pay the
$50 deductible plus any
amount over the R&C
charge
80
 No annual deductible
Plan pays 100% for InNetwork services and
100% of the R&C
charge for out-ofnetwork services
You pay 0% for InNetwork services and
any amount over the
R&C charge for out-ofnetwork services
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Enhanced Comprehensive, Comprehensive, and Preventive Plans
(for All Eligible Employees Except Saint Vincent and MetroWest MNA Union Employees)
Enhanced
Comprehensive Dental
Plan
Comprehensive Dental
Plan
Preventive Dental Plan
any amount over the
R&C charge
Covered Basic
Services*
Covered
Major
Services*
Orthodontia
Benefits*
Lifetime
Maximum
Surgical
Implants
Annual Plan
Benefits
Plan pays 80% of InNetwork charges and
80% of R&C out-ofnetwork charges after
deductible
Plan pays 80% of InNetwork charges and
80% of R&C out-ofnetwork charges after
deductible
You pay the rest
You pay the rest
Plan pays 50% of InNetwork charges and
R&C out-of-network
charges
Plan pays 50% of InNetwork charges and
R&C out-of-network
charges
You pay the rest
You pay the rest
$1,500 per covered
individual (dependent
children to age 26 or
later if disabled prior
to age 26)
$1,000 per covered
dependent child under
age 19
Plan pays 50% of InNetwork and 50% of
the R&C charge for
out-of-network
charges after
deductible and up to
the lifetime maximum
Plan pays 50% of InNetwork and 50% of
the R&C charge for outof-network charges
after deductible and up
to the lifetime
maximum
 Not covered
 Not covered
 Implant Supported
Prosthetics Covered
 Implant Supported
Prosthetics Covered
 $1,500 per person
each year
 $1,200 per person each
year
 Not covered
 Not covered
 Not covered
 Not covered
 No annual maximum
* Out-of-network services are subject to Reasonable and Customary (R&C) reimbursement limits.
{00014391.DOCX-}
81
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
MetroWest MNA Union Comprehensive and Preventive Dental Plans
Choice of
Dentist
Annual
Deductible
Comprehensive Dental Plan
Basic Dental Plan
Your choice of dentist
Your choice of dentist
Choosing a DELTA DENTAL Preferred
Provider Organization (PPO) or Premier
dentist can result in lower out-of-pocket
costs
Choosing a DELTA DENTAL
Preferred Provider Organization
(PPO) or Premier dentist can
result in lower out-of-pocket
costs
$25 In-Network and out-of network
annual deductible per person
$25 In-Network and out-of
network annual deductible per
person
 $75 In-Network and out-of-network
annual deductible per family
Deductibles waived for In-Network
diagnostic preventive services
 $75 In-Network and out-ofnetwork annual deductible per
family
 Deductibles waived for InNetwork diagnostic and
preventive services
Covered
Diagnostic and
Preventive
Services*
Covered Basic
Services*
Covered Major
Services*
Plan pays 100% for In-Network charges
and 100% of the R&C charge for out-ofnetwork services. You pay the rest.
In-Network diagnostic and preventive
services are not subject to the annual
deductible
Plan pays 80% of In-Network charges
and 80% of the R&C charge for out-ofnetwork charges after deductible
Plan pays 100% for In-Network
services and 100% of the R&C
charge for out-of-network
services. You pay the rest.
In-Network diagnostic and
preventive services are not
subject to the annual deductible
You pay the rest
 Plan pays 80% of In-Network
charges and 80% of the R&C
charge for out-of-network
charges after deductible
Plan pays 50% of In-Network charges
and 50% of the R&C charge for out-ofnetwork charges after deductible
 Not covered
You pay the rest
Orthodontia
Benefits*
 $1,000 per covered dependent child
under age 19
Lifetime
Maximum
 Plan pays 50% of In-Network and 50%
of the R&C charge for out-of-network
charges after deductible and up to the
lifetime maximum
Implants
Plan pays 50% of In-Network charges
and 50% of the R&C charge for out-ofnetwork charges after deductible
{00014391.DOCX-}
82
 Not covered
 Not covered
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
MetroWest MNA Union Comprehensive and Preventive Dental Plans
Comprehensive Dental Plan
Basic Dental Plan
 You pay the rest
Annual Plan
Benefits
$1,200 per person each year
 $750 per person each year
* Out-of-network services are subject to Reasonable and Customary (R&C) reimbursement limits.
Saint Vincent MNA Union High and Low Dental Plans
Choice of
Dentist
Annual
Deductible
High Dental Plan
Low Dental Plan
Your choice of dentist
Your choice of dentist
Choosing a DELTA DENTAL Preferred
Provider Organization (PPO) or Premier
dentist can result in lower out-of-pocket
costs
Choosing a DELTA DENTAL
Preferred Provider Organization
(PPO) or Premier dentist can
result in lower out-of-pocket
costs
$25 In-Network and out-of network
annual deductible per person
$25 In-Network and out-of
network annual deductible per
person
 $75 In-Network and out-of-network
annual deductible per family
Deductibles waived for In-Network
diagnostic and preventive services
 $75 In-Network and out-ofnetwork annual deductible per
family
 Deductibles waived for InNetwork diagnostic and
preventive services
Covered
Diagnostic and
Preventive
Services*
Covered Basic
Services*
Covered Major
Services*
Plan pays 100% for In-Network charges
and 100% of the R&C charge for out-ofnetwork services. You pay the rest.
In-Network diagnostic and preventive
services are not subject to the annual
deductible
Plan pays 80% of In-Network charges
and 80% of the R&C charge for out-ofnetwork charges after deductible
In-Network diagnostic and
preventive services are not
subject to the annual deductible
You pay the rest
 Plan pays 80% of In-Network
charges and 80% of the R&C
charge for out-of-network
charges after deductible
Plan pays 50% of In-Network charges
and 50% of the R&C charge for out-ofnetwork charges after deductible
 Not covered
You pay the rest
{00014391.DOCX-}
Plan pays 100% for In-Network
services and 100% of the R&C
charge for out-of-network
services. You pay the rest.
83
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Saint Vincent MNA Union High and Low Dental Plans
High Dental Plan
Orthodontia
Benefits*
Lifetime
Maximum
Implants
Low Dental Plan
 $1,000 per covered dependent child
under age 19
 Plan pays 50% of In-Network and 50%
of the R&C charge for out-of-network
charges up to the lifetime maximum
Plan pays 50% of In-Network charges
and 50% of the R&C charge for out-ofnetwork charges after deductible
 Not covered
 Not covered.
You pay the rest
Annual Plan
Benefits
$1,200 per person each year
 $750 per person each year
* Out-of-network services may be subject to Reasonable and Customary (R&C) reimbursement limits.
For more information on the terms used in the charts above, see the “Glossary.”
How the Enhanced Comprehensive and Comprehensive
Dental Plan Works
With the Enhanced Comprehensive Dental Plan and Comprehensive Dental Plan, you have:
 The freedom to see any dental provider,
 Lower deductible and contracted rates when you use DELTA DENTAL PPO or DELTA DENTAL
Premier dentists, and
 Coverage for most types of preventive, basic and major services after you meet an annual
deductible.
Save Money by Using PPO Dentists
Under either dental program option, you are charged reduced fees when you use DELTA DENTAL’s
Preferred Provider Organization (PPO) dentists. PPO dentists are providers that agree to be part of a
network that provides services at contracted rates, which are generally lower than the cost of care
outside the network. Visit a dentist in the PPO network to maximize your savings. If you can’t find a
DELTA DENTAL PPO dentist, DELTA DENTAL Premier dentists offer the next best opportunity to save,
unlike a non-network dentist.
To obtain a directory of local PPO or Premier dentists, please contact Delta Dental at 1-855-643-8516
for a referral to a local PPO or Premier dentist or look up the information at www.DeltaDentalins.com.
Eligible Expenses Under the Dental Program Options
Both plan options provide coverage for “eligible expenses” ― that is, treatments, procedures, supplies
and services that are:
{00014391.DOCX-}
84
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Covered under the plan and provided by a licensed dental care provider, and
Necessary (see “Necessary Services” in the Glossary)
Each dental option offered under the Tenet Dental Benefit Program has its own specific provisions
regarding eligible and ineligible expenses, which will be covered in each dental option section.
Please Be Aware . . .
The fact that a treatment, plan or charge has been ordered by your dentist or has been determined
by DELTA DENTAL to be Reasonable and Customary (R&C) doesn’t necessarily mean that the
expense is covered by the plan. Be sure to verify that the services you’re receiving are considered
eligible expenses by the Tenet Dental Benefit Program.
You can do so by reading this plan summary or by calling DELTA DENTAL directly.
PROFILE: Maria
Meet Maria. She’s single and in her mid-20s. Over the years, Maria has had a fair amount of dental
work done. Maria expects that she will need a new filling or to have an old one replaced in the year
ahead, so she chooses the Enhanced Comprehensive Dental Plan. That way, if she uses an innetwork provider, all she needs to do is meet her annual deductible and cover 20% of the charge
for basic dental services and 50% of the charge for covered major services.
A Look at the Basics
Annual Deductible
Under both the Enhanced Comprehensive and the Comprehensive Dental Plan, you’ve got an annual
deductible — the amount you need to pay before the plan begins paying benefits. Under both options,
the individual annual deductible for in-network services is $25 — this means that every dependent
covered under the plan must meet the $25 individual deductible before plan benefits are paid (except
with regard to benefits for covered for in-network PPO and Premier diagnostic and preventive services,
which are not subject to the deductible). This is a combined deductible for basic, major and orthodontic
services.
Both options also have a separate annual deductible for out-of-network services of $50. Both in- and
out-of-network deductibles combined will not exceed $50 per covered person. For example, if you use
in-network services first, you must meet a $25 deductible. Later in the year, if you use out-of-network
services, you will only have to pay an additional $25 toward the $50 out-of-network deductible.
Note: Deductible amounts and types differ for the MetroWest and Saint Vincent MNA union options.
Please see the charts above.
Calendar Year Maximum
There’s a limit to the benefits that the plan pays each year for each person enrolled in the plan. This
limit is called the calendar year maximum (or the Annual Plan Benefit), and it amounts to $1,500 per
year for each covered person under the Enhanced Comprehensive Plan and $1,200 per year for each
covered person under the Comprehensive Plan. Once the plan’s benefit payments reach the calendar
year maximum for a particular family member, the plan pays no further benefits for that individual for
the rest of the calendar year.
Note: Calendar year maximums differ for the MetroWest and Saint Vincent MNA union options.
Please see the charts above.
{00014391.DOCX-}
85
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Lifetime Maximum Orthodontia Benefit
The Enhanced Comprehensive Plan pays a lifetime maximum of up to $1,500 in orthodontia benefits
for each covered individual (dependent children to age 26 only or later if disabled prior to age 26—see
Eligibility and Enrollment for more information). The Comprehensive plan pays a lifetime
maximum of up to $1,000 in orthodontia benefits for each covered dependent child under age
19.
Upon plan eligibility, to determine any coverage for work in progress, contact DELTA DENTAL directly at
1-855-643-8516
Note: Orthodontia lifetime maximums, benefits, and benefit conditions differ for the MetroWest and
Saint Vincent MNA union options. Please see the charts above.
Pre-Treatment Estimate of Benefits
A pre-treatment estimate of benefits is a voluntary procedure under which DELTA DENTAL will
estimate the amount of benefits payable to you for a proposed service. To obtain a pre-treatment
estimate, you may ask your provider to file a claim form showing the services to be provided to you.
Claim forms for pre-treatment estimates should be sent to:
Delta Dental Insurance Company
P.O. Box 1809
Alpharetta, GA 30023-1809
1-855-643-8516
Please Note: Pre-treatment estimates are not a guarantee of payment. Benefits will be processed
according to the terms of the Dental Benefit Program when the service is actually performed. Pretreatment estimates may not take into account Deductibles and other benefits paid prior to the
services being rendered, so please keep your Deductible and plan year maximum in mind when
reviewing pre-treatment estimates.
PROFILE: Maria
Maria has just learned that she needs a crown.
Step 1: To obtain an idea of the amount she will be charged, , Maria requests that her dentist file a
pre-treatment estimate of benefits with DELTA DENTAL, outlining:
The recommended course of treatment,
Any expected dental services,
X-rays that support the recommended procedure, and
Estimated costs.
Step 2: DELTA DENTAL will provide Maria with an estimate of benefits for her course of treatment.
What the Enhanced Comprehensive and
Comprehensive Dental Plans Cover
Eligible Expenses from A to Z
In this section, covered services are alphabetized under three categories of care: Diagnostic and
Preventive, Basic, and Major.
{00014391.DOCX-}
86
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Diagnostic and Preventive Services
The Enhanced Comprehensive and Comprehensive Dental Plans pay 100% of eligible expenses for the
In-Network (PPO and Premier) diagnostic and preventive care services listed below. (If the diagnostic
or preventive care services listed below are provided out-of-network, the Enhanced Comprehensive
and Comprehensive Dental Plans will pay 100% (after deductible, if applicable—please see the charts
above) of the R&C charge, and you are responsible for the rest.) Neither the Enhanced Comprehensive
Dental Plan nor the Comprehensive Plan provide any coverage for diagnostic or preventive care
services not listed below.
Fluoride Treatment
One topical fluoride treatment once every calendar year for children under
age 18 (or under age 19 for MetroWest MNA Union Comprehensive Plan
and Saint Vincent MNA Union High Plan)
Oral Exams
Two exams per calendar year
Sealants
For permanent first and second molars for children under age 14, one
application every three calendar years
Teeth Cleaning
Prophylaxis--two sessions per calendar year (the sessions are combined
with Periodontal Maintenance, a Basic Benefit), including minor scaling and
polishing when necessary (note that scaling and polishing are usually not
considered necessary for children under age 18)
X-Rays (bitewing)
Two sets of X-rays per calendar year. For MetroWest MNA Union
Comprehensive Plan and Saint Vincent MNA Union High Plan, once per
calendar year.
X-Rays (full mouth)
Once every three calendar years, including panoramic survey (maxillary and
mandibular), . For MetroWest MNA Union Comprehensive Plan and Saint
Vincent MNA Union High Plan, once every 60 months.
If you are a MetroWest or Saint Vincent MNA Union Employee . . .
The MetroWest Comprehensive Option and Saint Vincent High Option also provide benefits for
Screenings, Panoramic X-ray, Pulp Vitality Test, and Space Maintainers. Please contact the Plan
Administrator or access MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees for more information.
PROFILE: Maria
To increase her chances of catching dental problems before they become serious, Maria makes sure
she has her teeth cleaned twice a year and that her dental X-rays are up to date. Maria’s eligible
expenses for these services are covered at 100% by the Enhanced Comprehensive Plan, provided
she uses a PPO or Premier dentist).
Basic Services
After the annual deductible has been met, the Enhanced Comprehensive and the Comprehensive
Dental Plans pay 80% of eligible expenses for the In-Network basic services listed below. (If the basic
services listed below are provided out-of-network, the Enhanced Comprehensive and Comprehensive
{00014391.DOCX-}
87
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Dental Plans will pay 80% (after deductible) of the R&C charge, and you are responsible for the rest.)
Neither the Enhanced Comprehensive Plan nor the Comprehensive Dental Plan provide any coverage
for basic services not listed below.
Service
Comprehensive Dental Plan Benefits (for all eligible employees except
MetroWest and Saint Vincent MNA union employees)
Local anesthesia, when necessary and billed as part of the dental procedure, and
general anesthesia or intravenous sedation only when it is:
Anesthesia
 Provided for a covered oral surgery and select endodontic and periodontal
surgeries, and
 Billed as part of the surgery
Diagnostic
Tests
 X-rays for diagnostic purposes (other than the bitewing and full-mouth X-rays
that are covered with limited frequency under Preventive Care)
 Study models
 Microscopic examination of oral tissue
Endodontics
(dental
specialty
focusing on
diseases of the
tooth pulp)
 Root canal therapy on any tooth, including:
• X-rays and cultures,
• Extirpation (removal of pulp and filling one or more canals), and
• Apicoectomy (root amputation)
 Apexification (treatment to stimulate closure of an incompletely formed root)
 Pulp capping (covering an exposed pulp with medicine or cement) when
billed as part of a restorative service)
 Pulpotomy (removal of part of the tooth pulp)
 Remineralization/recalcification (treatment using calcium hydroxide or similar
materials before a temporary restoration is placed)
Follow-Up
Consultation
Follow-up consultation with specialist after a general dentist performs diagnostic
procedures
Habit
Appliance
Appliance to prevent teeth from grinding
Includes postoperative care. Depending on your situation, general anesthesia
may be authorized for a covered service.
Oral Surgery
{00014391.DOCX-}
 Incision and drainage of abscess
 Removal of:
• Erupted tooth,
• Tooth impacted in soft tissue (simple/uncomplicated extraction),
• Tooth impacted in bone,
• Foreign body from soft tissue or bone,
• Necrotic bone for osteomyelitis or bone abscess (sequestrectomy),
• Residual root,
• Oral tissue for examination purposes,
• Gum tissue to help expose the tooth as it erupts,
• Odontogenic cyst or tumor,
• Hardened salivary deposits (sialithotomy), and
• Tooth fragment or foreign body from maxillary sinus (maxillary
sinusotomy).
 Gingival reconstructions, including:
• Removal of a spur or bony growth on a bone or root of a tooth (exostosis),
• Removal of hyperplastic gum tissue, per arch, and
88
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
• Removal of gum tissue surrounding the tooth.
 Alveolar reconstructions (reconstructions of the jaw area where teeth are
formed), including:
• Alveolectomy, and
• Alveoplasty with ridge extension.
 Osseous surgery, including osseous graft (adding bone to correct periodontal
defect)
 Free soft-tissue graft (adding gum tissue to correct severe gum recession)
 Closure of salivary fistula; dilation of salivary duct
 Closure of oral fistula of maxillary sinus
 Transplantation of tooth or tooth bud
 Frenectomy/frenulectomy (procedure to correct the malformation of tissue
connecting the inner lip to the gum area)
 Hemisection (surgical division of a tooth for the purpose of removing all or
part of a tooth)
 Condylectomy of temporomandibular joint
Periodontics
(dental
specialty
focusing on
tissues and
structures
surrounding
and supporting
the teeth)
 Periodontal Maintenance (two sessions per calendar year – frequency
combined with regular Prophylaxis)
 Emergency periodontic treatment
 Correction of occlusion
 Scaling and root planing
The plan covers up to a maximum of four quadrants of scaling and root planing
each calendar year (i.e. scaling and root planing is covered for UR, UL, LL, or LR
each once in a calendar year in any combination).
 Gingivectomy (removing gum tissue) or gingivoplasty (reshaping gum tissue
to create or improve its function)
 Gingival flap procedure (includes root planing)
Repair
Repair of crowns, inlays, onlays, space maintainers, bridges and dentures,
including recementations
 Fillings made with amalgam (silver), plastic, silicate cement, composite or
equivalent material.
Restorations
(fillings and
temporary
crowns)
(Certain restorative materials may be considered cosmetic, depending on which
tooth is being restored; as a result, plan benefits will be limited to the least costly
material that produces a professionally satisfactory result, as determined by
DELTA DENTAL.)
 Temporary crowns made with stainless steel (permanent crowns are major
services)
The following types of maintainers are covered by the plan and include
adjustments within six months of initial placement of the maintainer:
Space
Maintainers
Unscheduled
Office Visits
{00014391.DOCX-}
• Fixed (band type) maintainer,
• Removable (acrylic and round wire clasp) maintainer, and
• Removable, fixed or cemented inhibiting appliance to correct for
thumbsucking
Visits after regular office hours and emergency visits, including diagnostic services
and treatment of pain, abscesses and infections
89
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Basic Services Provided Under the MetroWest MNA Union Comprehensive Plan
and the Saint Vincent MNA Union High Dental Plan
The MetroWest MNA Union Comprehensive Dental Plan and Saint Vincent MNA Union High Dental
Plan provide benefits for the following basic services:













Fillings
Emergency Care to Relieve Plan
Periapical X-rays
Root Canal Therapy/Endodontics
Osseous Surgery
Periodontal Scaling and Root Planing
Denture Adjustments and Repairs
Oral Surgery—including simple extractions
Endodontic and Periodontal Surgery
General Anesthesia and IV Sedation
Injection of Therapeutic Drugs
Surgical Extractions of Impacted Teeth
Repairs to Crowns and Inlays
Please contact the Plan Administrator or access MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees for more information.
Major Services
After the annual deductible has been met, both the Enhanced Comprehensive Plan and the
Comprehensive Plan options pay 50% of eligible expenses for the covered In-Network major services
listed below. (If the major services listed below are provided out-of-network, the Enhanced
Comprehensive and Comprehensive Dental Plans will pay 50% (after deductible) of the R&C charge,
and you are responsible for the rest.) Neither the Enhanced Comprehensive nor the Comprehensive
Dental Plan provide any coverage for major services that are not listed below.
Service
Orthodontia
Comprehensive Plan Benefits (for all eligible employees except MetroWest
and Saint Vincent MNA union employees)
Under the Enhanced Comprehensive Plan, benefits for orthodontia services
are limited to $1,500 per covered individual (dependent child coverage ends
at age 26 or later if disabled prior to age 26). (Note: retention appliances to
stabilize teeth are covered only when in conjunction with orthodontic
treatment covered under this plan).
Under the Comprehensive Plan, benefits for orthodontia services are limited
to $1,000 per covered person up to age 19 (retention appliances to stabilize
teeth are covered only when in conjunction with orthodontic treatment
covered under this plan)
{00014391.DOCX-}
90
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Prosthodontic appliances include:
Prosthodontics
(dental specialty
that uses
prosthetics —
primarily bridges
and dentures — to
replace missing
teeth)
 Dentures (full and partial), including all necessary adjustments. Denture
expenses may also include:
• Stayplate (temporary replacement until the permanent denture is
ready for installation),
• Denture relining or rebasing (either in the dentist’s office or at a
laboratory),
• Tissue conditioning, one treatment per denture, and
• Bridges.
 Pontics (artificial teeth for bridges and dentures)
 Implant supported prosthetics (1 per 60 consecutive months if
unserviceable and cannot be repaired)
Replacement of
Crowns, Gold
Restorations,
Bridges, Dentures
and Pontics
A crown, gold restoration, bridge, denture or pontic must be at least five
years old before the plan covers its replacement as a major service.
 Permanent crowns (temporary crowns made with stainless steel are
covered as a basic service)
 Inlays and onlays
 Posts
Please note:
Restorations
 Restorations made partially or entirely with gold are covered only if
another material cannot provide a professionally satisfactory result and
the restoration is intended to be a treatment for decay or injury or to
support a bridge or denture. If gold restorations are covered, the benefit
for full or partial gold restorations is limited to the benefit for restorations
made with nonprecious metal. In other words, the cost of gold in excess
of the cost of a nonprecious metal is not covered by the plan.
 Certain restorative materials may be considered cosmetic, depending on
which tooth is being restored; as a result, plan benefits will be based on
the least costly material that will produce a professionally satisfactory
result. For example, the benefit for porcelain on a molar will be limited to
a less costly, non-cosmetic material.
Major Services Provided Under the MetroWest MNA Union Comprehensive Dental Plan and the
Saint Vincent MNA Union High Dental Plan
The MetroWest MNA Union Comprehensive Dental Plan and Saint Vincent MNA Union High Dental
Plan provide benefits for the following major services:
 Crowns replacement every 5 years)
 Dentures (replacement every 5 years and/or repair)
 Bridges (replacement every 5 years
 Inlays (replacement every 5 years) and Onlays (replacement every 5 years)
{00014391.DOCX-}
91
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
 Implants—Surgical and Non-Surgical (1 per 60 consecutive months if unserviceable and
cannot be repaired—see MyTenet.com for Tenet colleagues and HealthyatTenet.com for
Conifer employees or Plan Administrator for additional information)
 Relining/Rebasing (covered if more than 6 months after installation)
Please be aware . . .
Coverage for some services may be limited for a period of time or excluded entirely. Please contact
DELTA DENTAL at 1-855-643-8516 prior to the date of your service to determine if such limitations
or exclusions exist. In some cases, benefits paid for certain restorative materials may be limited to
the cost of a less costly material.
How the Preventive Dental Plan Works
With the Preventive Dental Plan, you have:
The freedom to receive preventive care services from any licensed dentist,
No annual deductible to pay — the plan pays benefits from the very first dollar,
Contracted rates when you use DELTA DENTAL PPO and Premier dentists*, and
No benefit dollar maximum.
*
If you use a dentist who is not in the DELTA DENTAL PPO or Premier network, you will be
responsible for charges above the R&C limit.
What the Preventive Dental Plan Covers
Eligible Expenses from A to Z
Diagnostic and Preventive Services
Diagnostic Tests
 Bitewing X-rays, two sets each calendar year (one set for MetroWest
MNA Union Basic Plan and Saint Vincent MNA Union Low Option)
 Full-mouth X-rays, once every three calendar years (60 months, for
MetroWest MNA Union Basic Plan and Saint Vincent MNA Union Low
Option), including panoramic survey (maxillary and mandibular)
Scheduled Visits and
Exams
 Two oral examinations each calendar year
 Two cleanings each calendar year, including minor scaling (but
excluding periodontal scaling) and polishing of teeth
 One topical fluoride treatment every calendar year for children under
age 18 (under age 19, for MetroWest MNA Union Basic Plan and Saint
Vincent Union Low Plan)
The Preventive Dental Plan offers no reimbursement for basic or restorative services (e.g., fillings,
oral surgery, bridges or orthodontia). The MetroWest MNA Union Basic Plan and Saint Vincent Union
Low Plan also provide benefits for the following preventive services: Screenings, Panoramic X-rays,
Pulp Vitality, Sealants for dependent children under age 19 (limited to posterior tooth only, two
sealants per child, once per tooth in 60 month), and Space Maintainers.
{00014391.DOCX-}
92
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
What’s Not Covered by the Dental Options?
Ineligible Expenses from A to Z
Annual Deductible
Expenses used to satisfy your annual deductible
Automobile
Insurance Policies
Expenses for which benefits are paid or payable under the mandatory part
of any automobile insurance policy written to comply with a "no fault"
insurance law or uninsured motorist law
Bite Registration
Bite registrations; precision or semi-precision attachments; splinting
Bridge or Denture
Replacement
In Dental Benefit Program options that cover bridge or denture
replacement, replacement of a bridge or denture within 5 years following
the date of its original installation or which can be made useable according
to accepted dental standards
Charges Submitted
by Photocopy
Charges submitted for payment using a photocopy of an original bill (unless
the plan is the secondary payor)
Claim Filing or
Finance Charges
Charges for completion of claim forms or finance charges
Claims Over 12
Months Old
Claims filed more than 12 months from the date the expense was incurred
Cosmetic Dentistry
Any dental service rendered for cosmetic purposes, unless it is required to
repair a tooth that was damaged as the result of an accidental injury that
occurred while covered under the plan. For example, certain materials used
for fillings, crowns, and pontics (porcelain and composite materials) are
usually considered to be cosmetic when used behind the second molar.
Facings on molars and pontics (artificial teeth) are always considered
cosmetic.
Covered Under
Medical Plan
Expenses covered under any other Tenet-sponsored medical plan, including
hospital expenses and expenses related to inpatient oral surgery
Drug Injections
Therapeutic drug injections
Duplicate Services
Duplicate dental appliances or prosthodontic appliances; duplicate X-rays
Education/Training
Expenses related to education or training, including oral hygiene instruction
Excess Charges
Expenses Exceeding
Approved Course of
Treatment
{00014391.DOCX-}
A charge for a service that exceeds the usual charge made by the dentist for
the same service when there is no insurance
If more than one course of treatment (service, treatment, material or
appliance) can reasonably be used and DELTA DENTAL approves the least
costly course of treatment, the plan does not cover any charge in excess of
the expenses related to the approved course of treatment.
93
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Experimental
Treatment
Treatment or procedures considered to be experimental or investigational
Fragmented Charges
Fragmented or unbundled billing (individual charge) for a service, supply,
etc. that is normally billed as part of a procedure
GovernmentRelated Services
Any dental service furnished by or for a government of any country, unless
payment for the service is required by law. Any dental service that is
provided by any governmental law or plan, excluding Medicaid-affiliated
state plans, unless the governmental law or plan provides benefits that are
in excess of benefits provided in any private or nongovernmental program
Illegal Acts
Dental conditions resulting from the commission of or the attempt to
commit an illegal act
Illegal Charges
Charges prohibited by law
Incomplete Work
Expenses for a course of treatment that began while coverage was in effect
but not completed, including orthodontics, (except as outlined under
"Extending Your Dental Coverage" in the Eligibility and Enrollment section
of this SPD)
Ineligible Individual
Expenses incurred for ineligible employees or dependents, regardless of
whether they have been enrolled in a dental plan and whether payroll
deductions have occurred
Expenses related to jaw joint problems, including:
Jaw Joint Treatment
Temporomandibular joint (TMJ) dysfunction,
Craniomandibular disorders,
Orthognathic conditions, and
Other conditions of the joint linking the jawbone and skull, including the
interconnecting muscles, nerves and tissue.
Lost or Stolen
Appliances
Replacement of lost or stolen appliances
Maximum Benefit
Reached
Expenses incurred after the plan has paid maximum benefits for a specific
service or individual
Medical or Hospital
Services
Services that are deemed to be medical services or services and supplies
received from a hospital
Missed
Appointment
Expenses resulting from a missed appointment
Mouth Guards
Mouth guards for athletic use
Myofunctional
Therapy
Expenses associated with myo-occulsion therapy
No Coverage
Expenses incurred while coverage was not in effect. However, coverage
may be extended for certain procedures that begin before coverage
terminates (see "Extending Your Dental Coverage" in the Eligibility and
{00014391.DOCX-}
94
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Enrollment section of this SPD for additional information). Please contact
the Plan Administrator or visit MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees for more information.
No Obligation to Pay
Expenses that you aren’t legally obligated to pay
No Services
Provided
Charges for which no services were provided
Nuclear Radiation
Dental conditions resulting from nontherapeutic release of nuclear
radiation
Prescription Drugs
Drugs or medications prescribed by your dentist (refer to the Prescription
Drug Program section of this SPD for prescription drug benefit information)
Pulp Vitality Tests
Expenses associated with determining the health of the pulp tissue, except
as otherwise provided under the terms of a specific Dental Benefit Program
option. Note: To the extent permitted, only one pulp vitality test will be
covered for any date of service.
Reasonable and
Customary Limits
Any dental service or expense that does not comply with an applicable
reasonable and customary allowance, as determined by DELTA DENTAL (see
the “Glossary”)
Restorations/
Appliances Used for
Alteration
Restorations or appliances used to alter vertical dimension, restore
occlusion or splint or correct attrition or abrasion
Self-Inflicted Injury
Dental expenses incurred as the result of a non-accidental self-inflicted
injury or attempted suicide, regardless of state of mind
Self-Treatment
Supplies
Plaque control, take-home fluoride or over-the-counter dental supplies
Services Not
Meeting Standards
Dental services that do not meet common dental standards
Services Provided by
Relative
Services provided by a close relative of the covered person (parent, spouse,
child, sibling, grandparent, in-law)
Stress Breakers
Simple stress breakers for prosthodontia care
Surgical Implants
Surgical implants of any type (except as provided otherwise with respect to
the Saint Vincent and MetroWest MNA Unions Plans and implant supported
prosthetics in the Enhanced Comprehensive and Comprehensive Plans)
Temporary Services
Temporary services when billed separately
Third-Party
Responsibility
Expenses for which another person or organization is responsible — if
DELTA DENTAL pays more than it should have, it has the right to recover
any excess amount paid, including the cash value of services provided, from
one or more of the following:
You or your dependent,
The dental provider,
Insurance companies, and
Other responsible persons or organizations.
{00014391.DOCX-}
95
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Unlicensed Provider
Any dental service not furnished by a licensed dentist or a licensed dental
hygienist under the direction of a licensed dentist
Unnecessary
Services
Any dental service that is not necessary as determined by DELTA DENTAL
(see “Necessary Services” in the “Glossary”)
Veneers
Veneers of porcelain or acrylic materials on crowns or pontics on or
replacing the upper and lower first, second and third molars
War and Crime
Dental conditions resulting from war or any act of war, declared or
undeclared, or from active military duty with the armed services of any
country
Work-Related
Conditions
Any dental service in connection with a work-related injury or disease
Workers'
Compensation
Any sickness covered under any workers' compensation or similar law
Note: Notwithstanding the foregoing, in certain circumstances, for reasons such as overall cost savings
or medical treatment efficiency, the Dental Benefit Program may, in the sole discretion of the Plan
Administrator, provide benefits for services that would otherwise not be eligible expenses. The fact
that the Dental Benefit Program does so in any particular case shall not in any way be deemed to
require the Dental Benefit Program to do so in other similar cases.
How to File a Claim
What You Need to Do
To file a claim for dental care expenses:
Obtain a claim form using the Dental link in the My Benefit Links box on MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer employees. Your dentist will usually file the claim for
you. Your dentist should attach an original bill that includes:






Your name and Social Security number,
Dentist’s name and tax ID number,
Patient’s name,
Date of service,
Amount of charge, and
Amount you paid (if any).
Photocopied bills will be accepted only when the Tenet Dental Benefit Program is the secondary payor.
Submit the form to DELTA DENTAL:
DELTA DENTAL
P.O. Box 1809
Alpharetta, GA 30023-1809
1-855-643-8516
File your claim as soon as possible. Claims must be filed within 12 months after you incur the expense.
If your claim is filed more than 12 months after the expense is incurred, the expense will not be
covered.
{00014391.DOCX-}
96
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
DELTA DENTAL processes claims on behalf of the Tenet Dental Benefit Program and has the fiduciary
discretion and authority to interpret the provisions of the Dental Benefit Program, establish eligibility
and benefit levels, and determine all claims and appeals.
Explanation of Benefits (EOB)
Each time a claim is submitted, you’ll receive an Explanation of Benefits (EOB) from DELTA DENTAL. The
EOB explains how the benefit payment was determined or gives the reason that a claim was denied.
Sometimes an EOB is sent because the claims administrator is requesting additional information
necessary to process a claim.
Claims Review
If you disagree with DELTA DENTAL’s decision regarding a claim for benefits, you can have your claim
reviewed as described in the Other Information section of the TEBP SPD. The Other Information section
describes the claims review process in detail.
When You’re Covered by Another Dental Plan (Coordination of Benefits)
If you or a family member is covered under both the Tenet Dental Benefit Program and another group
dental plan, the plans work together to pay covered expenses. Under this process, called Coordination
of Benefits (COB), the plan covering you as an employee pays first and is called the “primary plan,” and
the plan covering you as a dependent pays second and is called the “secondary plan.”
Which Plan Pays First?
Here’s how to determine which plan is primary (pays first) when you or a covered dependent has other
group dental care coverage:
If you’re covered by the Tenet Dental
Benefit Program as an active
employee and another plan as a
retiree . . .
The Tenet Dental Benefit Program pays first
If the condition is
automobile-related . . .
Dental coverage under automobile insurance is always
primary
If your other coverage does not
include Coordination of Benefits . . .
Plans without a COB feature are always primary. The Tenet
Dental Benefit Program would be secondary
If your other plan states it will pay no
benefits at all if you have other
coverage . . .
That plan is primary. The Tenet Dental Benefit Program
will be secondary
If your other plan claims to always be
the secondary payor . . .
The Tenet Dental Benefit Program will be secondary.
However, the Tenet Dental Benefit Program will be
primary to secondary payor plans offered by Tenet
If you’re also covered under a
government plan . . .
Coverage under a government plan is always primary
(unless otherwise required by law)
If your dependent children are
covered under both parents’
plans . . .
The plan of the parent whose birthday falls earlier in the
year is primary; if both parents have the same birthday,
the plan that has covered the child longer is primary. For
{00014391.DOCX-}
97
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
an eligible child of divorced or separated parents, the
primary plan would be determined in the following order:
1. As ruled by the court through a separation agreement,
divorce settlement, Qualified Medical Child Support
Order, etc. (a copy of the court ruling will be required
when submitting claims for your dependent child).
2. The plan of the parent with legal custody. In the case of
joint custody, the plan of the parent with whom the
child spends the majority of his or her time.
3. The plan of the spouse of the parent with legal custody.
4. The plan of the parent without custody.
If payment of the claim cannot be
determined by the above rules or the
plans do not agree . . .
The plan that has covered the individual for the longer
period of time is the primary plan, and the plan that has
covered the individual for the shorter period of time is the
secondary plan
How Benefits Are Determined
Here’s how the Tenet Dental Plan determines benefits when it’s the secondary plan:
First: DELTA DENTAL determines the benefit amount that would have been paid if there were no
other group coverage.
Next: The amount the primary plan actually pays is subtracted. If the benefits paid by the primary
plan are less than the benefit amount determined under the Tenet plan, then DELTA DENTAL would
pay the difference.
To help you see how these rules apply to an actual claim, here’s an example:
Assumptions:
The eligible expense for a covered service is $100.
The Tenet Dental Benefit Program is secondary coverage.
The Tenet Dental Benefit Program would pay 80% ($80) if there were no other group coverage.
The primary plan pays 60%.
If . . .
If you used an In-Network
provider . . .
Then . . .
Then the primary plan pays:
$ 60 (60% of $100)
The Tenet Dental Benefit Program
pays:
$ 20 (difference between what
primary plan paid and what the
Tenet Dental Benefit Program
would have paid)
Total benefit paid:
$ 80
Once the primary plan is determined, here’s what you need to do:
 If the Tenet Dental Benefit Program is primary, you must first file a claim with DELTA DENTAL,
which determines benefits payable with no consideration of what the secondary plan may or may
not pay.
 If the Tenet Dental Benefit Program is secondary, you must file with the primary plan first. Then,
when you’ve received an Explanation of Benefits (EOB) statement from the other plan, you can file
the claim, including a photocopy of the EOB and the bill, with DELTA DENTAL.
{00014391.DOCX-}
98
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
If the Tenet Dental Benefit Program is Secondary
When the Tenet Dental Benefit Program is the secondary plan, it covers the amount up to, but not
beyond, what it would pay if it were your only source of benefits.
Note that in the example above, if the primary plan had paid 80% of the $100 eligible expense, the
Tenet Dental Benefit Program would not pay an additional benefit.
Remember that you’re always responsible for paying the portion of an expense, if any, that’s not
eligible under this plan. Remember, too, that the other plan’s definition of “eligible expense” may be
different from the Tenet Dental Benefit Program’s definition, so benefit calculations may be a little
more complicated than shown in the example above.
Annual Update of COB Information
Coordination of Benefits (COB) information is updated on a rolling calendar year for each employee.
When DELTA DENTAL receives the first dependent claim, it will obtain COB information:
 From the claim, if it’s filed with a completed claim form, or
 By pending the claim and sending you a COB questionnaire
When you receive the questionnaire, you may complete the form and return it to DELTA DENTAL or you
can phone in the COB information to DELTA DENTAL directly. When possible, eligible-dependent data
also will be updated when this information is received. Your claim will be held pending DELTA DENTAL’s
receipt of the COB information from you.
Coordinating COBRA Coverage with That of Another Plan
If you or a family member is also covered under another employer’s COBRA coverage, the COBRA
coverage will be primary for services subject to the exclusionary waiting period under the
Comprehensive Dental Plan. In all other situations, the Tenet Dental Benefit Program will be primary.
If you or your family member continues Tenet dental coverage under COBRA and then becomes
covered under another employer’s plan, the Tenet Dental Benefit Program will be primary only for preexisting conditions and/or services subject to exclusionary waiting periods under the other plan; no
other conditions will be covered (either on a primary or secondary basis) by the Tenet Dental Benefit
Program.
Helpful Information about the
Tenet Dental Benefit Program
You can learn additional information about the Dental Benefit Program offered under the TEBP by
reviewing the other sections of this SPD at MyTenet.com for Tenet colleagues and HealthyatTenet.com
for Conifer employees. The complete SPD includes information on eligibility and enrollment,
procedures for appealing claim denials, qualified medical child support orders, authority to amend
and terminate the TEBP and all of the benefit programs (including the Dental Benefit Program),
COBRA continuation rights, and your rights under the Health Insurance Portability and Accountability
Act (HIPAA).
Here’s a list of some quick facts you may need to know:
Employer and Plan
Sponsor
{00014391.DOCX-}
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
99
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Plan Administrator
Tenet Benefits Administration Committee
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
DELTA DENTAL
P.O. Box 1809
Claims Administrator
Alpharetta, GA 30023-1809
1-855-643-8516
Agent for Service of
Legal Process
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
Legal Process may also be served on the Plan Administrator.
Dental Program
Effective Date
The Dental Benefit Program is a component program in the TEBP, which
was originally effective as of October 1, 1977. The TEBP was amended and
restated effective as of January 1, 2015.
Employer
Identification
Number
95-2557091
Plan Number
515
Plan Year
January 1 through December 31.
Type of Plan
Self-insured welfare benefit plan offering dental benefits. See the Other
Information section for more information.
Funding of Benefits
Benefits under the Dental Benefit Program are funded by the premiums paid by you and by Tenet. The
amount of your premium for dental coverage under the Tenet Dental Benefit Program will be
determined by the Plan Administrator and may depend on the option and level of coverage you have
selected for yourself and your dependents. Your premium amount may be changed at any time. If your
premium amount is changed, you will be given written notice in advance of the change. Premium
information was provided to you during the annual enrollment period or your initial enrollment period
Tax Consequences of Participation in the Dental Benefit Program
In general, you may pay for your premiums in your selected Dental Benefit Program option on a pre-tax
basis by reducing your salary. However, premiums for coverage for a domestic partner (or for any
dependent who does not qualify as your federal tax dependent) will be paid on an after-tax basis,
unless your domestic partner also qualifies as your federal tax dependent (determined without regard
to IRC sections 152(b) (1), (b) (2), and (d) (1) (B), which contain certain exceptions to the definition of
dependent and a gross income limitation). The test for determining whether your domestic partner
qualifies as your federal tax dependent may be different than the test for determining dependent
status under the plan. You should consult with your tax advisor to determine if your domestic partner
qualifies as your federal tax dependent. In addition, if you are a highly compensated employee, there
{00014391.DOCX-}
100
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
may be certain circumstances in which you are not be eligible to exclude all or a portion of the
premiums or benefits paid under the Dental Benefit Program from your gross income. Neither the Plan
Administrator nor your employer can guarantee that the benefits provided to you under the Dental
Benefit Program will be excludable from your gross income for federal and state tax purposes. For
more information on the tax consequences of participating in the Dental Benefit Program, please see
your tax advisor.
Your Rights Under ERISA and HIPAA
For a statement explaining your rights under the Employee Retirement Income Security Act of 1974
(ERISA) and HIPAA, see the Other Information section of this SPD.
Glossary
Annual Deductible (or deductible)
The amount of eligible expenses you pay each calendar year before certain benefits are payable under
the Comprehensive Dental Plan
Benefit Eligible
Generally, you’re eligible to participate in the Tenet Dental Benefit Program if you are classified by
Tenet as a full-time or part-time 1 employee (other than a Tenet Physician Resource (TPR) employee).
(Determination of full-time or part-time 1 status is based on anticipated scheduled hours and is not
impacted by the fact that you may, on occasion, work more or less than your anticipated scheduled
hours.) If you meet this eligibility requirement, you’re considered “benefit eligible.”
Calendar Year Maximum
The maximum limit that the Comprehensive Dental Plan pays for each person enrolled in the plan over
a calendar year.
Co-insurance
The percentage you pay for basic and major covered services under the Comprehensive Dental Plan
(for example, if your plan pays 80% after the deductible for a basic service by a PPO dentist, then you
pay 20%, which is your co-insurance).
In-Network
A DELTA DENTAL PPO or Premier Provider.
Lifetime Maximum Orthodontia Benefit
The maximum that the Comprehensive Dental Plan pays for orthodontia benefits for each covered
person.
Necessary Services
“Necessary” means that the course of treatment (i.e., service, treatment, material or device) was
necessary and appropriate for maintaining the primary function of teeth and supporting tissue. If two
or more courses of treatment can be used for any one situation, “necessary” will mean the least costly
course of treatment that produces a professionally satisfactory result, as determined by DELTA
DENTAL.
Preferred Provider Organization (PPO) Dentists
{00014391.DOCX-}
101
------------------------------------------------------------------------ DENTAL SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
PPO dentists are licensed dental care providers who agree to be part of a network that provides
services at negotiated rates, which are generally lower than the cost of care outside the network.
Premier Provider
A licensed dental care provider who agrees to be part of DELTA DENTAL’s premier network.
Reasonable and Customary (R&C) Charges
The amount customarily charged by providers of similar services or supplies in the same geographic
area. Reasonable and Customary (R&C) charges apply to out-of-network services only.
Please note: R&C charges are based on the overall cost of the procedure, not on the individual
components involved in the procedure. As a result, related charges that are split out and billed
separately won’t be eligible for reimbursement.
{00014391.DOCX-}
102
Employee Assistance Program
Summary Plan Description
About This Summary Plan Description (SPD)
The Employee Assistance Program (EAP), managed by GuidanceResources, is a component in the Tenet
Employee Benefit Plan (TEBP). The TEBP is a comprehensive welfare benefits plan intended to qualify
as a cafeteria plan within the meaning of Internal Revenue Code (IRC) section 125.
This document summarizes key provisions of the EAP and serves as part of the summary plan
description (SPD) for the TEBP. You can obtain more information about the EAP and the other
programs offered through the TEBP by reviewing the complete SPD for the TEBP. If there is any
discrepancy between the TEBP SPD and the official plan documents for the TEBP, the official plan
documents will control. For more information on obtaining the official plan documents, see the Other
Information section of the TEBP SPD.
Plan Highlights
When it comes to your well-being, Tenet believes in taking a whole-health approach. Because we feel
it’s important to be healthy in mind, body and spirit, we offer services to help you take good care of
yourself physically and emotionally.
The EAP is a professional counseling service offering confidential help for day-to-day concerns or
difficult times. Services include telephone consultation, online resources, face-to-face counseling, and
referral services. All employees may use the EAP services at no cost to the employees or their
household members.
Quick Facts
EAP
Who’s
Covered
 You and your household members, regardless of whether you are covered
under the Tenet Medical Program or whether you are classified as a Full Time,
Part-Time 1, or Part-Time 2 Employee.
Cost of
Coverage
 No cost.
When
Coverage
Begins
When
Coverage
Ends
{00014391.DOCX-}
 On your first day of employment.
 You do not need to enroll in the Tenet Medical Program for you or your
household members to receive EAP benefits.
 Coverage for you and your household members end on the last day of the
month of the last pay period during which you are terminated.
103
------------------------------------------------------ EMPLOYEE ASSISTANCE PROGRAM SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------
How the Employee Assistance Program Works
When you or a covered family member needs help, just follow these simple steps to access your
benefits under the EAP:
How the EAP Works
Call the EAP’s toll-free telephone number at 1-844-416-1158 or visit the EAP website at
www.guidanceresources.com (Web-ID: TENET). Under the EAP, you and/or your household members
may be entitled to up to five, free face-to-face assessment sessions per issue.
What the EAP Covers
Through telephone and online resources, face to face counseling, and referral services, the EAP can
confidentially help you and your family members with a variety of needs, including:
 Legal Questions or Concerns – Personal injury, wills, financial issues, bankruptcy, tax questions,
housing, real estate, landlord/tenant disputes, family law, e.g., divorce, custody, child support
 Marital or Family Conflicts
 Childcare Concerns – Referrals to daycare centers, daycare homes, nannies and au pairs;
information on how to choose a childcare provider and how to evaluate the care that your child
receives; adoption; summer camps, special needs; prenatal classes; preschools/nursery schools
 Senior Care - Living arrangements, from retirement communities and adult homes to nursing
homes, home care agencies, support groups, elder law, e.g. wills, durable power of attorney,
advance directives
 Financial Problems – Debt consolidation, budgeting strategies, managing debt/credit, spending
habits
 Work – Balancing work and life, working overtime, workplace conflict, working with others
 Alcohol or Drug Problems – Online assessment, access to an Alcohol Specialty team, treatment
 Stress, emotions, and much more.
In addition, EAP can provide:
Immediate Help during a Crisis
Get quick and effective intervention when your emotional needs reach a critical point.
Referrals to Local Resources
Find sources in your community for information and assistance on a wide range of topics.
What the EAP Pays
All benefits provided to you or your household members under the EAP are fully paid by Tenet.
How to File a Claim
Because benefits under the EAP are only provided by an EAP network counselor, no claim forms are
required. If you would like additional information regarding the claims appeal process, please see the
Other Information section of this SPD.
{00014391.DOCX-}
104
------------------------------------------------------ EMPLOYEE ASSISTANCE PROGRAM SUMMARY PLAN DESCRIPTION, 2017 -----------------------------------------------
Helpful Information about the Employee Assistance
Program
You can learn additional information about the EAP by visiting the GuidanceResources website at
www.guidanceresources.com (Web-ID: TENET). You may also view the other sections of this SPD,
which contain information on participating employers in the TEBP, eligibility and enrollment,
procedures for appealing claim denials, qualified medical child support orders, authority to amend
and terminate the TEBP and all of the benefit programs, COBRA continuation rights and your rights
under the Health Insurance Portability and Accountability Act (HIPAA).
Here’s a list of some facts you may need to know about the Employee Assistance Program:
Employee Assistance Program
Employer and Plan
Sponsor
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
Plan Administrator
Tenet Benefits Administration Committee
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
Agent for Service of
Legal Process
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
Legal process may also be served on the Plan Administrator.
Plan Effective Date
The EAP is a component programs in the TEBP, which was originally
effective as of October 1, 1977. The TEBP was amended and restated
effective January 1, 2015.
Employer Identification
Number
95-2557091
Plan Number
515
Plan Year
January 1 to December 31
Type of Plan
Self-insured welfare benefit plan offering confidential counseling
services. See Other Information section of the TEBP SPD for more
information.
Funding of Benefits
Benefits under the EAP are funded by Tenet.
Your Rights Under ERISA and HIPAA
For a statement explaining your rights under the Employee Retirement Income Security Act of 1974
(ERISA) and HIPAA, see the Other Information section of the TEBP SPD.
{00014391.DOCX-}
105
Vision Summary Plan Description
About This Summary Plan Description (SPD)
The Tenet Vision Benefit Program is a component program in the Tenet Employee Benefit Plan (TEBP).
The TEBP is a comprehensive welfare benefits program intended to qualify as a cafeteria plan within
the meaning of Internal Revenue Code (IRC) section 125.
This document summarizes key provisions of the Tenet Vision Benefit Program and serves as part of the
summary plan description (SPD) for the TEBP. You can obtain more information about the Tenet Vision
Benefit Program, the TEBP and the other component programs offered under the TEBP by reviewing
the complete SPD for the TEBP. If there is any discrepancy between this online SPD and the official plan
documents for the TEBP, the official plan documents will govern. For more information on obtaining
the official plan documents, see the Other Information section of the T6EBP SPD.
Plan Highlights
The Tenet Vision Benefit Program which is administered by VSP allows you to obtain benefits for vision
care by visiting either an in-network (VSP) or out-of-network (non-VSP) provider. :
 Receive the maximum benefit amount under the plan
In-Network
(a VSP provider)
 Pay a co-pay for each eye exam, as well as for lenses, frames and
medically necessary contacts
 There are no claim forms to file
 Receive a lower benefit level
Out-Of-Network
(any non-VSP provider)
 Pay the entire bill at the time you receive service
 Submit a claim to VSP, including necessary documentation and
details regarding service received
 Expenses are reimbursed by the plan according to a fixed
schedule
Introduction to the Vision Benefit Program
This section of the SPD includes:
 Quick Facts: Who You Can Cover, Cost of Coverage, When Coverage Begins, and When Coverage
Ends
 The factors that impact your cost of coverage
 Instructions and timeframes for enrolling yourself and your eligible dependents in the Vision
Benefit Program
 When you can make coverage changes under the Vision Benefit Program
{00014391.DOCX-}
106
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Quick Facts
Who You Can Cover
 Benefit eligible Employee and eligible dependents
 You pay the full cost of vision coverage. (Premium information is
provided to you during enrollment)
Cost of Coverage
When Coverage
Begins
 Generally, you pay for coverage for yourself and your dependents,
including a legal, same-sex spouse, through pre-tax payroll deductions.
However, coverage for a domestic partner* cannot be paid on a pre-tax
basis unless the domestic partner qualifies as your federal tax
dependent within the meaning of Internal Revenue Code (IRC) section
152 (determined without regard to IRC sections 152(b)(1), (b)(2), and
(d)(1)(B)). In addition, coverage for any other dependent who does not
qualify as your federal tax dependent cannot be paid on a pre-tax basis.
 On the 31st day after you begin employment in a full-time or part-time
benefit eligible position, provided you’ve enrolled. For an explanation of
benefit eligible employees, see the definition of “Benefit Eligible” in the
Glossary below and the Eligibility and Enrollment section of this TEBP
SPD.
 When coverage ends is dependent on various factors. Please refer to
the Eligibility and Enrollment section of this TEBP SPD for detailed
information on when coverage for you and your dependents ends.
When Coverage
Ends
 In some circumstances, you or your dependents may be eligible to
continue your vision coverage under the Consolidated Omnibus Budget
Reconciliation Act (COBRA) of 1985, as amended. For more information
on COBRA coverage, please see the Other Information section of this
TEBP SPD.
*Children of your domestic partner may not be covered under the Tenet Vision Benefit Program unless
they meet the criteria for eligible dependent children. Please refer to the Eligibility and Enrollment
section of this TEBP SPD for eligibility information.
Cost of Coverage
You pay the full cost of vision coverage. (Premium information is provided to you during enrollment)
Your contributions for your coverage and for coverage for your dependents (including your spouse and
legal same-sex spouse) are typically deducted from your paychecks on a before-tax basis. Before-tax
dollars come out of your pay before federal income and Social Security taxes are withheld - and in most
states, before state and local taxes are withheld. This gives your contributions a special tax advantage
and lowers the actual cost to you. However, your contributions for Domestic Partner coverage (and for
coverage for any other dependent who is not your federal tax dependent) will be deducted from your
paychecks on an after-tax basis unless your Domestic Partner qualifies as your federal tax dependent
within the meaning of IRC section 152 (determined without regard to IRC sections 152(b)(1), (b)(2), and
(d)(1)(B)). For more information determining whether your Domestic Partner qualifies as your federal
tax Dependent, contact your tax advisor.
Your contributions are subject to review and Tenet reserves the right to change your contribution
amount from time to time.
{00014391.DOCX-}
107
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
You can obtain current contribution rates by calling the MyBenefits Customer Support Center at 1-877468-3638 or accessing your personal enrollment information from MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees.
How to Enroll
1. Enroll online at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees
or call the MyBenefits Customer Support Center at 1-877-468-3638.
2. Complete an enrollment transaction within 31 days of the date you first become eligible for
coverage under the Tenet Medical Benefit Program. If you do not enroll within 31 days, you will
need to wait to make your benefit elections until the next Annual Enrollment period or the date
you incur a change of family status or HIPAA special enrollment event entitling you to a mid-year
enrollment. For more information on change of family status and HIPAA special enrollment events,
see the Life Events section of the TEBP SPD.
Each year during Annual Enrollment, you have the opportunity to review, change, or cancel your
healthcare coverage. All changes made during the Annual Enrollment period will take effect on January
1 of the following calendar year.
Important
If you wish to change your benefit elections following your marriage, birth or adoption of a child, or
other family status change or HIPAA special enrollment event, you must complete your enrollment
transaction online at MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees or call the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days of
the event and request your change. Otherwise, you will need to wait until the next Annual
Enrollment period to change your elections.
Changing Your Coverage
Please refer to the Life Events section of the TEBP SPD for more information on making coverage
changes outside of an Annual Enrollment period.
How the Tenet Vision Benefit Program Works
With the Tenet Vision Benefit Program, you:
 Have the freedom to see any vision care provider,
 Get the best value when you use an in-network doctor, and
 Receive coverage for many types of eye care, including eye exams, lenses, frames and contact
lenses.
Using a Network Doctor
To find one of the 43,000 eye care professionals in the nationwide network, log on to MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer employees and click the Vision link, or call VSP’s
Member Services at 1-800-877-7195 for a list of network doctors.
{00014391.DOCX-}
108
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Tell the doctor’s office you’re covered by VSP and provide:
When You Call a Network
Doctor to Make an
Appointment . . .
 Your name and date of birth,
 The name of the group that provides your VSP coverage (Tenet
Healthcare), and
 The covered member’s VSP identification number.
PROFILE: Charlotte and Her Daughter, Emily
Meet Charlotte and her daughter, 16-year-old Emily. Like her mother, Emily is nearsighted and has
to rely on corrective lenses to see clearly. Because Emily is now learning to drive, getting quality
vision care has become a priority for her. Through the Tenet Vision Benefit Program, Charlotte and
her daughter can see a VSP network doctor and simply pay $10 co-pay for an eye exam and $15 copay for lenses. Frames are covered up to the $170 allowance after the lens co-pay because they
select the frames from their VSP provider.
And remember, there are no claim forms to file when you use a VSP network doctor. VSP pays your
doctor for covered services and materials. Any co-pays and other costs not covered by your VSP plan at
the time of your visit are your responsibility.
Using an Out-of-Network Provider
You can choose to visit any doctor or eye care center to receive care. When seeing an out-of-network
provider, you’ll pay the full cost for services and you’ll need to submit a claim for reimbursement. See
“How to File a Claim” for more information.
What the Vision Plan Covers Benefit Summary Chart
Benefit/
Frequency
Examination
(one per
calendar year)
Tenet Facilities
(Except Saint Vincent's/
MetroWest MNA union)
In-Network Out-ofDoctor
Network
Provider
Saint Vincent's/
MetroWest MNA Union
High Option
In-Network Out-ofDoctor
Network
Provider
Saint Vincent's/
MetroWest MNA Union
Low Option
In-Network Out-ofDoctor
Network
Provider
Exam
covered in
full after a
$10 co-pay
Reimbursed
up to $50
Exam
covered in
full after a
$10 co-pay
Reimbursed
up to $34
Exam
covered in
full after a
$10 co-pay
Reimbursed
up to $34
Lenses
covered in
full after a
$15 co-pay
Reimbursed
up to:
$50 for single
vision
$75 for lined
bifocal
$100 for
lined trifocal
$125 for
lenticular
Lenses
covered in
full after $15
co-pay
Reimbursed
up to:
$32 for single
vision
$46 for lined
bifocal
$57 for lined
trifocal
$90 for
lenticular
Lenses
covered in
full after $25
co-pay
Reimbursed
up to:
$32 for single
vision
$46 for lined
bifocal
$57 for lined
trifocal
$90 for
lenticular
Lenses
(once per
calendar year)
Single vision
Lined bifocal
Lined trifocal
Lenticular
Polycarbonate
lenses for
{00014391.DOCX-}
109
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Benefit/
Frequency
Tenet Facilities
(Except Saint Vincent's/
MetroWest MNA union)
In-Network Out-ofDoctor
Network
Provider
Saint Vincent's/
MetroWest MNA Union
High Option
In-Network Out-ofDoctor
Network
Provider
Saint Vincent's/
MetroWest MNA Union
Low Option
In-Network Out-ofDoctor
Network
Provider
Polycarbonate
lenses for
dependent
children not
covered
Polycarbonate
lenses for
dependent
children not
covered
Polycarbonate
lenses for
dependent
children not
covered
dependent
children
Frames
(once every
other calendar
year for Tenet
and Saint
Vincent's/
MetroWest
MNA Union
Low Option
and once per
calendar year
for Saint
Vincent's/
MetroWest
MNA Union
High Option)
Frames
covered up
to $170
allowance
(after $15 copay), plus a
20% discount
on any
amounts
exceeding
the retail
frame
allowance
Frames
reimbursed
up to $70
Frames
covered up
to $175
allowance
(after $15 copay), plus a
20% discount
on any
amounts
exceeding
the retail
frame
allowance
Frames
reimbursed
up to $78
Frames
covered up
to $100
allowance
(after $25 copay), plus a
20% discount
on any
amounts
exceeding
the retail
frame
allowance
Frames
reimbursed
up to $47
OR
$25 co-pay
for contact
lenses exam
Contacts
(once per
calendar year)
Elective
contacts:
Covered up
to $150
allowance in
lieu of frames
and lenses
Medically
necessary
contacts: $15
co-pay
Laser Eye
Surgery*
{00014391.DOCX-}
Average of
15% off the
regular price
or 5% off the
promotional
Elective
contacts:
Reimbursed
up to $150 in
lieu of
frames and
lenses
Medically
necessary
contacts:
Reimbursed
up to $210
Not covered
$25 co-pay
for contact
lenses exam
Elective
contacts:
Covered up
to $150
allowance in
lieu of
frames and
lenses
Medically
necessary
contacts:
$15 co-pay
Average of
15% off the
regular price
or 5% off the
promotional
110
Elective
contacts:
Reimbursed
up to $150 in
lieu of
frames and
lenses
Medically
necessary
contacts:
Reimbursed
up to $210
Not covered
$25 co-pay
for contact
lenses exam
Elective
contacts:
Covered up
to $100
allowance in
lieu of
frames and
lenses
Medically
necessary
contacts:
$25 co-pay
Average of
15% off the
regular price
or 5% off the
promotional
Elective
contacts:
Reimbursed
up to $100 in
lieu of
frames and
lenses
Medically
necessary
contacts:
Reimbursed
up to $210
Not covered
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Benefit/
Frequency
Tenet Facilities
(Except Saint Vincent's/
MetroWest MNA union)
In-Network Out-ofDoctor
Network
Provider
Saint Vincent's/
MetroWest MNA Union
High Option
In-Network Out-ofDoctor
Network
Provider
Saint Vincent's/
MetroWest MNA Union
Low Option
In-Network Out-ofDoctor
Network
Provider
price;
discounts
available
from
contracted
facilities.
price;
discounts
available
from
contracted
facilities.
price;
discounts
available
from
contracted
facilities.
The
maximum fee
a member
will pay is:
The
maximum
fee a
member will
pay is:
The
maximum
fee a
member will
pay is:
$1,500 per
eye for PRK
$1,800 per
eye for LASIK
$2,300 per
eye for
Custom
LASIK
$1,500 per
eye for PRK
$1,800 per
eye for LASIK
$2,300 per
eye for
Custom
LASIK
$1,500 per
eye for PRK
$1,800 per
eye for LASIK
$2,300 per
eye for
Custom LASIK
* VSP has arranged for members to receive PRK, LASIK and Custom LASIK at a discounted fee by
participating laser centers, which could add up to hundreds of dollars in savings. Discounts vary by
location, but will average 15% off of the contracted laser center's usual and customary price.
Additionally, if the participating laser center is offering a temporary price reduction, VSP members
will receive 5% off of the promotional price.
Eligible Expenses from A to Z
When you use a VSP network doctor, the following services and items are provided:
Contact Lenses
An allowance is applied to the cost of your contacts. The contact lens exam
(fitting and evaluation) is covered after a $25 copay. This exam is in addition to
your vision exam to ensure the proper fit of contacts. Medically necessary
contacts required for certain conditions are covered in full after a $25 copay
when specific benefit criteria are satisfied and when prescribed by a doctor.
Frames
A wide variety of frames are available that are fully covered by VSP. If you
choose a frame over your allowance of $170, you’ll be responsible for paying
any overages. However, you will get 20% off any out-of-pocket costs.
Laser Eye
Surgery
VSP has arranged for members to receive PRK, LASIK and Custom LASIK at a
discounted fee from participating laser centers. (See the Benefit Summary
{00014391.DOCX-}
111
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Chart above for more information.) Please see your VSP provider for referral to
a participating Laser Vision Correction facility and surgeon.
Lenses
Your VSP provider will order the proper lenses and will also verify the accuracy
of the finished lenses. See the Benefit Summary Chart above for a description
of your co-pay when obtaining lenses from a VSP provider.
Vision Exam
The exam includes a complete analysis of visual functions, including the
prescription of glasses [or contact lenses] when necessary.
PROFILE: Charlotte
Because Charlotte has worn eyeglasses since the age of 5, it’s no surprise that she’s intrigued by the
prospect of having LASIK surgery. While Charlotte has heard some positive things about this
procedure, she feels it’s important to get more details before making any decisions. Being a smart
consumer, she makes an appointment with her VSP network doctor to determine if she is a
candidate for laser surgery. Her VSP network doctor will then refer her to a contracted surgery
center to make an appointment
What’s Not Covered
by the Tenet Vision Benefit Program?
Ineligible Expenses from A to Z
Anisokonic Lenses or
Tomography
Does not cover anisokonic lenses or tomography.
Experimental, Developmental
or Investigational Services or
Supplies
Does not cover charges for services or supplies generally
considered experimental, developmental or investigational.
Lenses (extra charges)
Does not cover extra charges for tinted, oversized, photosensitive
or antireflective lenses.
Lenses (provided by someone
other than ophthalmologist,
optometrist or optician)
Does not cover lenses provided by someone other than a licensed
ophthalmologist, optometrist or optician, except for disposable
contact lenses dispensed by a pharmacist that are otherwise
covered under the plan.
Medical or Surgical
Treatment
Does not cover medical or surgical treatment.
Missed Appointments
Does not cover charges for missed appointments.
Out-of-Network Claims Over
Six Months Old
Does not cover out-of-network claims that are filed more than six
months from the date the expense was incurred.
Replacement of Broken or
Lost Lenses or Frames
Does not cover charges for replacement of broken or lost lenses or
frames.
Services or Supplies (covered
by another plan)
Does not cover services or supplies covered by any other health
plan.
{00014391.DOCX-}
112
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Services or Supplies (covered
by workers’ compensation or
similar laws)
Does not cover services or supplies payable under workers’
compensation or similar laws, or drugs or any other medication.
Services or Supplies (for
which you’re not obligated to
pay)
Does not cover services or supplies for which you’re not obligated
to pay or for which no charge would be made in the absence of
vision coverage.
Services or Supplies (not
prescribed by optometrist or
ophthalmologist)
Does not cover services or supplies not prescribed by a licensed
optometrist or ophthalmologist or lenses that don’t require a
prescription.
Special or Unusual Treatment
Does not cover special or unusual treatment, such as orthoptics,
vision training or subnormal-vision aids.
Vision Examinations (for
work-related conditions)
Does not cover vision examinations or any materials furnished for
any condition, disease, ailment or injury arising out of or in the
course of employment.
Vision Examinations and
Supplies Ordered (before or
after patient is covered)
Does not cover vision examinations performed and lenses and
frames ordered before the patient is covered under the program
or after termination of coverage.
How to File a Claim
What You Need to Do
If you use a VSP provider, you don’t need to do a thing! There are no claim forms to file. VSP will pay
your doctor directly for services and materials covered by VSP.
If you use an out-of-network provider, you’ll pay the entire bill at the time you receive service and then
submit a claim to VSP. The claim form is available by accessing MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees and following the link for “Vision Benefit.”
Claims must be filed within 365 days after you’ve incurred the expense. Submit your documentation to:
VSP
P.O. Box 385018
Birmingham, AL 35238-5018
Claims Review and Appeal Process
If you disagree with VSP’s decision regarding a claim for benefits, you can have your claim reviewed as
described in the Other Information section of this SPD site. The Other Information section describes the
claims review process in detail.
Helpful Information about the Vision Benefit Program
You can learn additional information about the Tenet Vision Benefit Program offered under the TEBP
by reviewing the other sections of this TEBP SPD. The complete SPD includes information about
eligibility and enrollment, procedures for appealing claim denials, qualified medical child support
orders, authority to amend and terminate the TEBP and all of the benefit programs (including the
Tenet Vision Benefit Program), COBRA continuation rights and your rights under the Health Insurance
Portability and Accountability Act (HIPAA).
{00014391.DOCX-}
113
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
Here’s a list of some quick facts you may need to know:
Employer and Plan
Sponsor
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
Plan Administrator
Tenet Benefits Administration Committee
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
Claims Administrator
VSP
P.O. Box 997105
Sacramento, CA 95899-7105
1-800-877-7195
Agent for Service of Legal
Process
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
Legal process may also be served on the Plan Administrator.
Vision Program Effective
Date
The Tenet Vision Benefit Program is a component program in the
TEBP, which was originally effective as of October 1, 1977. The TEBP
was amended and restated effective as of January 1, 2015.
Employer Identification
Number
95-2557091
Plan Number
515
Plan Year
January 1 through December 31
Type of Plan
Insured welfare benefit plan offering vision benefits. See the Other
Information of the TEBP section for more information.
Funding of Benefits
Benefits under the Tenet Vision Benefit Program are fully insured by VSP. You are required to pay
premiums for your vision benefit coverage by making employee contributions under the TEBP. The
amount of your premium for vision coverage will be determined by the Plan Administrator and may
depend on the level of coverage you have selected for yourself and your dependents. Your premium
amount may be changed at any time. If your premium amount is changed, you will be given written
notice in advance of the change. Premium information was provided to you during the annual
enrollment period or on your initial eligibility period.
Tax Consequences of Participation in the Tenet Vision Benefit Program
In general, you may pay for your premiums in the Tenet Vision Benefit Program on a pre-tax basis.
However, premiums for coverage for a domestic partner (or for any dependent who does not qualify as
your federal tax dependent) will be paid on an after-tax basis, unless your domestic partner also
{00014391.DOCX-}
114
------------------------------------------------------------------------- VISION SUMMARY PLAN DESCRIPTION, 2017 ------------------------------------------------------------------
qualifies as your federal tax dependent (determined without regard to IRC sections 152(b) (1), (b) (2),
and (d)(1)(B), which contain certain exceptions to the definition of dependent and a gross income
limitation). The test for determining whether your domestic partner qualifies as your federal tax
dependent may be different than the test for determining dependent status under the plan. You should
consult with your tax advisor to determine if your domestic partner qualifies as your federal tax
dependent. In addition, if you are a highly compensated employee, there may be certain circumstances
in which you are not eligible to exclude from gross income all or a portion of the premiums or benefits
paid under the Tenet Vision Benefit Program. Neither the Plan Administrator nor your employer can
guarantee that the benefits provided to you under the Tenet Vision Benefit Program will be excludable
from your gross income for federal and state tax purposes. For more information on the tax
consequences of participating in the Tenet Vision Benefit Program, please see your tax advisor.
Your Rights Under ERISA and HIPAA
For a statement explaining your rights under the Employee Retirement Income Security Act of 1974
(ERISA) and HIPAA, see the Other Information section of this TEBP SPD.
Glossary
Benefit Eligible
Generally, you’re eligible to participate in the Tenet Vision Benefit Program if you are classified by
Tenet as a full-time or part-time 1 employee (other than a Tenet Physician Resource (TPR) employee).
(Determination of full-time or part-time 1 status is based on anticipated scheduled hours and is not
impacted by the fact that you may, on occasion, work more or less than your scheduled hours.) If you
meet either of this eligibility requirement, you’re considered “benefit eligible.”
Co-pay
A co-pay is a flat fee that you pay at the time you receive the service from a network doctor. For
example, you pay a $10 co-pay when you get an eye exam from a VSP network doctor.
Medically Necessary Contacts
The plan pays for visually necessary contact lenses if prior authorization is obtained.
Network Doctor
A network doctor is an eye care professional who has contracted with VSP to provide services to VSP
members.
{00014391.DOCX-}
115
Life Events
About This Information
This document serves as part of the summary plan description (SPD) for the Tenet Employee Benefit
Plan (TEBP), a comprehensive welfare benefits plan intended to qualify as a cafeteria plan within the
meaning of Internal Revenue Code (IRC) section 125. This document explains what you need to know
and do about your employee benefits coverage when circumstances in your life change.
You can obtain more information about the component programs offered under the TEBP by reviewing
the complete SPD for the TEBP. If there is any discrepancy between the TEBP SPD and the official plan
documents for the TEBP, the official plan documents will govern. For more information on obtaining
the official plan documents, see the Other Information section of the TEBP SPD.
Note: Certain Tenet facilities and subsidiaries maintain their own SPD summarizing benefits under
the Tenet Employee Benefit Plan.
If You’re Getting Married
Making a Benefit Change?
If you’re making any benefit changes due to your marriage, please access MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer employees and go to My Benefits or call the
MyBenefits Customer Support Center at 1-877-468-3638 within 31 days of the date of your marriage.
Notification prior to the marriage date will not be accepted. You must provide notification of your Life
Event change by the deadline or you won’t be able to change your benefits.
What You Need to
Know About . . .
What You Need to Do . . .

You can enroll yourself and/or your spouse. You can change your
level of coverage (e.g., from employee coverage to employee and
spouse coverage). You can also cancel coverage for yourself, or enroll
or cancel coverage for your children, but only if the change is
consistent with the life event.

If you declined coverage before, but want to elect it now, you need to
enroll yourself for coverage to cover your spouse and/or children.

You can change your Medical Benefit Plan option. (Your Prescription
Drug Program option will automatically change to the option
associated with your selected Medical Benefit Program option.)

Your spouse and any newly-acquired household members can
participate in the EAP.

You can enroll or cancel your enrollment in the Dental or Vision
Programs. You can also enroll your spouse or dependent children in
the Dental or Vision Programs.
Health Care Coverage






Medical
Employee Assistance
Program (EAP)
Prescription Drug
Dental
Vision
Health
Reimbursement
Account
{00014391.DOCX-}
116
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If you enroll in either the Gold or Health & Reimbursement Plan
option under the Medical Benefit Program, you will be automatically
enrolled in the Health Reimbursement Account Program. If you drop
coverage in the Medical Benefit Program or switch from the Gold or
Health & Reimbursement Plan option to a Medical Benefit Program
option other than the Gold or Health & Reimbursement Plan, your
participation in the Health Reimbursement Account Program will
terminate, and you will forfeit any remaining account balance in such
program.

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program, and you have an HSA, you can
increase, decrease or stop your current HSA contributions. Any
increase in the amount of your HSA contributions cannot exceed the
maximum HSA contribution established by the Internal Revenue
Service (IRS) for your level of coverage (i.e. employee-only coverage
or family coverage).

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program, you have an HSA, and you change
your Medical Benefit Program coverage level from employee-only to
family coverage, then you may increase your HSA contribution to the
maximum allowed for family coverage, prorated by the number of
months remaining in the year. Note: Under the IRS’s “last-month
rule,” if you have family coverage on the first day of last month of
your taxable year, (December 1 for most taxpayers), you will be
considered to have family coverage for the entire year, allowing you
to contribute up to the HSA family maximum for the entire year in
which you get married, without proration. However, to take
advantage of this rule, you must remain eligible for the HSA family
maximum for the entire next year.
Health Savings Account
(HSA)
Note: If you don’t have an HSA, you may open an account at any time (if
you participate in a high deductible health plan). However, to receive
company contributions, you must open an HSA within 31 days of your
benefits effective date. Changes to your HSA can be made at any time.
You do not need to make a change within 31 days of a Life Event. Joint
HSAs are not permitted.

If you’re currently enrolled, you can increase your contributions. You
may also decrease or stop your HCSA contributions, but only if such
change is consistent with the life event.

If you’re not currently enrolled, you can elect participation.

If you’re currently enrolled, you can increase, decrease or stop your
DDCSA contributions, as long as such change is consistent with the life
event.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
{00014391.DOCX-}
117
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If you’re not currently enrolled and you’ll be gaining eligible children
who require care because your spouse works or is looking for work,
you can elect participation.

To change your beneficiary designation access MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer employees and
go to My Benefits or call the MyBenefits Customer Support Center at
1-877-468-3638. Your beneficiary designation will not automatically
change as a result of your marriage.

You can enroll for coverage or increase your coverage, but you may
need to show Evidence of Insurability (EOI). You may also drop
coverage.

You can enroll your spouse for coverage, provided you’re enrolled in
Supplemental Employee Life Insurance or are electing coverage.

Your spouse’s coverage can’t exceed 100% of your coverage amount
for Supplemental Employee Life.

You can enroll your new children, in addition to other eligible children
who aren’t covered, provided you’re enrolled in Supplemental
Employee Life Insurance or are electing coverage and the change is
consistent with the life event. Child coverage can’t exceed 100% of
your coverage amount for Supplemental Employee Life.

You may also drop coverage.
Supplemental Accidental
Death and
Dismemberment (AD&D)

You can enroll for coverage or increase coverage, or you can drop
coverage, provided the change is consistent with the life event.
Spouse AD&D

You can enroll your spouse for coverage.

You can enroll your children, and add new children. You can also drop
coverage. Any change must be consistent with the life event.
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.
Accident Insurance

You can enroll yourself or your spouse for coverage.

You can enroll yourself or your spouse for coverage. If you enroll,
your children are automatically enrolled (at 25% of your benefit
level).

To enroll in Critical Illness Insurance, you (or your spouse) must have
comprehensive medical coverage.
Basic Life and Basic
Accidental Death and
Dismemberment (AD&D)
Supplemental Employee
Life Insurance
Spouse Life Insurance
Child Life Insurance
Child AD&D
Critical Illness Insurance
{00014391.DOCX-}
118
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Business Travel Accident
Insurance
Changing Beneficiaries

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

To change your beneficiary designation for life, AD&D, or business
travel accident insurance, access MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877468-3638. Your beneficiary designation will not automatically change
as a result of your marriage.
What is EOI?
Evidence of Insurability (EOI) refers to a questionnaire required for certain coverage.
What is Marriage?
Marriage refers to a legal marriage, including a same-sex marriage and a common law marriage if
common law marriages are recognized in the jurisdiction where the employee resides.
Things to Consider
Whose Benefits
Coverage Best Meets
Your Needs?

Compare the Tenet benefit plans to the coverage offered by your
spouse’s employer to see which plans offer the benefits best suited to
your needs.

If you change your last name or address, you’ll need to submit a change
of address through your local Tenet Human Resources department.
You’ll also need to contact your local Social Security Administration
office to update your personal information. A new name also means a
new driver’s license, so be sure to contact your local Department of
Motor Vehicles.

If you’re currently enrolled: If you expect your dependent care
expenses to go up, you may want to increase your Dependent Day Care
Spending Account (DDCSA) contribution amount. If your spouse isn’t
working or actively looking for work, your dependent care expenses will
not be eligible for reimbursement after the date of your marriage.

If you’re not currently enrolled: You can elect participation provided
you are gaining eligible dependents who will require care. If your
spouse isn’t working or actively looking for work, you won’t be allowed
to enroll.
Are You Changing Your
Name?
Will You Have Higher
Dependent Care
Expenses?
Refer to the Spending Accounts section for more information.
Are You Increasing or
Decreasing Your HSA
Contributions?
{00014391.DOCX-}

Remember, it is your responsibility to monitor your HSA contributions
and make sure they fall within the parameters established by the IRS
for your selected level of Silver or Health & Savings Plan coverage.
119
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
If You’re Getting a Divorce,
Legal Separation or Annulment
Making a Benefit Change?
If you’re making any benefit changes due to divorce, legal separation or annulment, please access
MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days from the
date the event becomes final. Legal documentation of your divorce, legal separation or annulment is
required. Notification prior to the date of your divorce, legal separation, or annulment will not be
accepted. Be sure to provide notification of your Life Event change by the deadline or you won’t be
able to change your benefits. This means you will have to continue paying for the coverage, even after
your spouse loses it!
What You Need to
Know About . . .
What You Need to Do . . .

You need to cancel your spouse’s health care coverage. Your spouse will
be eligible to elect to continue health care coverage under COBRA. (Your
spouses’ EAP coverage will automatically continue for the COBRA period;
no COBRA election is necessary for EAP.) You must notify MyBenefits by:

Health Care Coverage







Medical
Employee
Assistance
Program (EAP)

If you’re losing coverage under your spouse’s health care plans, you can
enroll yourself and any other eligible dependents in the Tenet health
care plans. You need to enroll yourself for coverage to cover your
dependents. You must enroll within 31 days of the date you lose
coverage under your spouse’s plan. If you enroll in either the Gold or
Health & Reimbursement Plan option under the Medical Benefit
Program, you will automatically be enrolled in the Health
Reimbursement Account Program.

If your child(ren) will now have health care coverage provided by your
spouse, you may cancel coverage under Tenet’s plans.

You can change your Medical Benefit Program option. If you switch from
the Gold or Health & Reimbursement Plan option to a Medical Benefit
Program option other than the Gold or Health & Reimbursement Plan,
your participation in the Health Reimbursement Account Program will
automatically end and you will forfeit any remaining balance.

If you change your Silver or Health & Savings Plan coverage level from
family coverage to employee-only coverage, you must decrease your
HSA contributions to the maximum permitted by the IRS for employeeonly coverage, prorated by the number of months remaining in the
taxable year. You can also stop HSA contributions.
Dental
Vision
Health Savings
Account (HSA)
{00014391.DOCX-}
Calling the MyBenefits Customer Support Center at 1-877-468-3638.
Refer to the Other Information section for more information on COBRA.
Prescription Drug
Health
Reimbursement
Account
Accessing MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees and going to My
Benefits, or
120
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If you have other dependents covered under your Silver or Health &
Savings Plan Medical Program option (who will remain covered after the
divorce, legal separation, or annulment), you may continue to make
contributions up to the IRS HSA family coverage annual contribution
limit.
Note: If you don’t have an HSA, you may open an account at any time (if you
participate in a high deductible health plan). However, to receive company
contributions, you must open an HSA within 31 days of your benefits
effective date. Changes to your HSA can be made at any time. You do not
need to make a change within 31 days of a Life Event. Joint HSAs are not
permitted.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)
Supplemental
Employee Life
Insurance
 If you’re currently enrolled, you can decrease or stop your HCSA
contributions. You can also increase your contributions, as long as such
increase is consistent with the divorce, legal separation, or annulment.
 If you’re not currently enrolled, you can elect participation, as long as
such election is consistent with the life event (if, for example, you lose
health coverage under your spouse’s plan).

If you’re currently enrolled, you can increase, decrease or stop your
DDCSA contributions, as long as such change is consistent with the life
event.

If you’re not currently enrolled, you can enroll for coverage provided you
have eligible dependents requiring care.

You may change your beneficiary designation by accessing MyTenet.com
for Tenet colleagues and HealthyatTenet.com for Conifer employees and
going to My Benefits or by calling the MyBenefits Customer Support
Center at 1-877-468-3638.

You can enroll for coverage or increase coverage, as long as such change
is consistent with the life event (if, for example, you lose life insurance
coverage under your spouse’s plan), but you’ll need to show Evidence of
Insurability (EOI).

You must cancel your spouse’s coverage. Your spouse may be eligible to
convert his or her coverage to an individual policy with the life insurance
carrier. See the Life/AD&D SPD section for more information.

You can enroll any child(ren) for Child Life coverage, provided you’re
enrolled in Supplemental Employee Life Insurance or are electing
coverage. Your child’s coverage can’t exceed 100% for your coverage
amount for Supplemental Employee Life Insurance. You may also
decrease or cancel your child’s coverage. Any change you make must be
consistent with the life event.

You can enroll for coverage or increase coverage, provided the change is
consistent with the life event.
Spouse Life Insurance
Child Life Insurance
Supplemental
Accidental Death and
{00014391.DOCX-}
121
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Dismemberment
(AD&D)

You must cancel your spouse’s coverage.

You can enroll any children. You can also decrease or cancel your child’s
AD&D coverage, provided the change is consistent with the divorce, legal
separation or annulment (if, for example, your child will have coverage
under your spouse’s plan).
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.
Accident Insurance

You must cancel your spouse’s coverage.
Critical Illness
Insurance

You must cancel your spouse’s coverage.
Business Travel
Accident Insurance

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1 employee.

To change your beneficiary designation for life, AD&D, or business travel
accident insurance, access MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees and go to My Benefits or call
the MyBenefits Customer Support Center at 1-877-468-3638. Your
beneficiary designation will not automatically change as a result of the
divorce, legal separation, or annulment.
Spouse AD&D
Child AD&D
Changing
Beneficiaries
Things
to Consider

Review your divorce decree to see if a Qualified Medical Child Support
Order (QMCSO) has been issued. A QMCSO requires that one parent be
responsible for maintaining health care coverage for your children. If
you’re required to provide health care coverage, be sure to enroll your
children in the Tenet health care plans within 31 days of your divorce or
issuance of the QMCSO (if they aren’t already enrolled). If your child
becomes newly eligible due to a QMCSO, see the section “If Your Child
Becomes Eligible for Coverage” for other benefit changes that will be
permitted.

Your spouse’s health care (excluding EAP coverage), life insurance and
AD&D coverage end automatically on the date of your divorce, legal
separation or annulment. (Your spouse may choose to continue his or
her health coverage under COBRA. EAP coverage automatically
continues under COBRA.) However, you must notify MyBenefits within
31 days of the event to stop the payroll deductions for the coverage.
Who Is Responsible for
Providing Health Care
Coverage to Your
Children?
When Does Your
Spouse’s Coverage
End?
{00014391.DOCX-}
122
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
Payroll deductions taken before you notify MyBenefits are not
refunded.

If you change your last name or address, you’ll need to submit these
changes through your local HR department. You’ll also need to contact
your local Social Security Administration to update your personal
information. A new name also means a new driver’s license, so be sure
to contact your local Department of Motor Vehicles.

If you’re not currently participating in the Dependent Day Care
Spending Account (DDCSA): You may elect to enroll.

If you’re currently participating in the DDCSA: If you expect your
dependent care expenses to go up, you may want to increase your
DDCSA contribution amount; if you expect your expenses to go down,
you may want to decrease your contribution amount or stop your
contributions.

If you lose legal custody, you may not be eligible to continue your
participation in the DDCSA. See the “Spending Accounts” section of the
TEBP for more information.
Are You Having
Difficulty Coping with
Your Situation?

Trained EAP counselors are available to help you sort through your
feelings. For a free consultation, call GuidanceResources at 1-844-4161158.
Are You Increasing or
Decreasing Your HSA
Contributions?

Remember, it is your responsibility to monitor your HSA contributions
and make sure they fall within the parameters established by the IRS
for your selected level of Silver or Health & Savings Plan coverage.
Are You Changing Your
Name?
Will You Have Higher
Dependent Day Care
Expenses … or Lower?
Are You Losing Legal
Custody of a Child?
If You’re Reconciling with Your Spouse
After Legal Separation
Making a Benefit Change?
If you’re making any benefit changes due to your reconciliation after legal separation, please access
MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days of the date
of your reconciliation. Notification prior to the reconciliation date will not be accepted. You must
provide notification of your Life Event change by the deadline or you won’t be able to change your
benefits!
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage



Medical
Employee
Assistance Program
(EAP)
{00014391.DOCX-}
You can enroll or cancel coverage for yourself, add your spouse
and/or enroll or cancel coverage for your children. You can change
your level of coverage (e.g., from employee coverage to employee
and spouse coverage). If you declined coverage before, but want to
elect it now, you need to enroll yourself for coverage to cover your
spouse and/or children. All changes must be consistent with the life
123
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .




Prescription Drug
Dental
Vision
Health
Reimbursement
Account
What You Need to Do . . .
event. (For example, you may only cancel coverage for yourself and
your children if you will be covered under your spouse’s plan.)

If you enroll in either the Gold or Health & Reimbursement Plan
option under the Medical Benefit Program, you will be automatically
enrolled in the Health Reimbursement Account Program. If you drop
coverage in the Medical Benefit Program or switch your Medical
Benefit Program coverage from the Gold or Health &
Reimbursement Plan option to an option other than the Gold or
Health or Reimbursement Plan , your participation in the Health
Reimbursement Account Program will terminate, and you will forfeit
any remaining account balance in such program.

If you are enrolled in either the Silver or Health & Savings Plan
option under the Medical Benefit Program, and you have an HSA,
you can increase, decrease or stop your current HSA contributions.
Any increase in the amount of your HSA contributions cannot exceed
the maximum HSA contribution established by the Internal Revenue
Service (IRS) for your level of coverage (i.e. employee-only coverage
or family coverage).

If you are enrolled in either the Silver or Health & Savings Plan
option under the Medical Benefit Program, you have an HSA, and
you change your Medical Benefit Program coverage level from
employee-only to family coverage, then you may increase your HSA
contribution to the maximum allowed for family coverage, prorated
by the number of months remaining in the year. Note: Under the
IRS’s “last-month rule,” if you have family coverage on the first day
of last month of your taxable year, (December 1 for most taxpayers),
you will be considered to have family coverage for the entire year,
allowing you to contribute up to the HSA family maximum for the
entire year in which you and your spouse reconcile, without
proration. However, to take advantage of this rule, you must remain
eligible for the HSA family maximum for the entire next year.
Health Savings Account
(HSA)
Note: If you don’t have an HSA, you may open an account at any time.
However, to receive company contributions, you must open an HSA
within 31 days of your benefits effective date. Changes to your HSA can
be made at any time. You do not need to make a change within 31 days
of a Life Event. Joint HSAs are not permitted.

If you’re currently enrolled, you can increase or decrease your HCSA
contributions, as long as your change is consistent with the life
event.

If you’re not currently enrolled, you can elect participation.

If you’re currently enrolled, you can increase or decrease your
DDCSA contributions, as long as your change is consistent with the
life event.

If you’re currently enrolled but you will no longer be needing care
(because your spouse does not work), you may terminate your
coverage.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
{00014391.DOCX-}
124
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If you’re not currently enrolled and you’ll be gaining children who
require care because your spouse works or is looking for work, you
can elect participation.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)

To change your beneficiary designation access MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer employees
and go to My Benefits or call the MyBenefits Customer Support
Center at 1-877-468-3638.
Supplemental
Employee Life
Insurance

You can enroll for coverage or increase your coverage, but you may
need to show Evidence of Insurability (EOI). You may also drop
coverage.

You can enroll your spouse for coverage, provided you’re enrolled in
Supplemental Employee Life Insurance or are electing coverage, but
you may need to show Evidence of Insurability (EOI).

Your spouse’s coverage can’t exceed 100% of your coverage amount
for Supplemental Employee Life.

You can enroll your new children, in addition to other eligible
children who aren’t covered, provided you’re enrolled in
Supplemental Employee Life Insurance or are electing coverage, and
the change is consistent with the life event. Child coverage can’t
exceed 100% of your coverage amount for Supplemental Employee
Life.

You may also drop coverage.

You can enroll for coverage or increase coverage, or you can drop
coverage, provided the change is consistent with the life event.

You can enroll your spouse for coverage.

You can enroll your new children, as well as other eligible children.
You also can drop coverage. Any change must be consistent with
the life event.
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.
Accident Insurance

You can enroll your spouse for coverage.

You can enroll your spouse for coverage if your spouse has
comprehensive medical coverage.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.
Spouse Life Insurance
Child Life Insurance
Supplemental
Accidental Death and
Dismemberment
(AD&D)
Spouse AD&D
Child AD&D
Critical Illness Insurance
Business Travel
Accident Insurance
{00014391.DOCX-}
125
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

Changing Beneficiaries
To change your beneficiary designation for life, AD&D, or Business
Travel Accident insurance, access MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877468-3638.
Things to Consider
Whose Benefits Coverage
Best Meets Your Needs?
Will You Have Higher
Dependent Day Care
Expenses?

Compare the Tenet benefit plans to the coverage offered by your
spouse’s employer to see which plans offer the benefits best suited
to your needs.

If you’re currently enrolled: If you expect your dependent care
expenses to go up, you may want to increase your Dependent Day
Care Spending Account (DDCSA) contribution amount. If your
spouse isn’t working or actively looking for work, your dependent
care expenses will not be eligible for reimbursement after the date
of your reconciliation.

If you’re not currently enrolled: You can elect participation
provided you are gaining eligible dependents who will require care.
If your spouse isn’t working or actively looking for work, you won’t
be allowed to enroll.
Refer to the Spending Accounts section for more information.
Are You Increasing or
Decreasing Your HSA
Contributions?

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health &
Savings Plan coverage.
If You’re Starting or Ending a Domestic Partnership
What is a Domestic Partner?
Tenet’s criteria for determining domestic partnership status (for purposes of determining eligibility for
certain Tenet benefit programs) is set forth on Tenet’s “Domestic Partner Affidavit” form, available at
MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees or from your Plan
Administrator. Please see the Eligibility and Enrollment section of this SPD for more information on the
criteria for domestic partner status. Any insured benefit program may have separate criteria for
determining domestic partnership status (or may not cover domestic partners at all). If you have any
questions regarding whether your domestic partner qualifies as a domestic partner for purposes of
determining eligibility for and benefits under Tenet’s benefit programs, please contact the Plan
Administrator.
{00014391.DOCX-}
126
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
If You’re Starting a Domestic Partnership
No Mid-Year Enrollment Allowed
If you acquire a new domestic partner mid-year, you must wait until the next annual enrollment period
to enroll your domestic partner into the group medical, vision, dental, prescription drug, health
spending account, life and/or AD&D plans, unless your domestic partner qualifies as your federal tax
dependent within the meaning of IRC section 152 (determined without regard to IRC sections 152(b)(1)
and (b)(2), which contain certain inapplicable exceptions to the definition of dependent, and IRC
section 152(d)(1)(B), which contains a gross income limitation). If your new domestic partner is your
federal tax dependent, you may make the changes to your plans as described below within 31 days of
the date you begin your domestic partnership. You must provide notification of your new domestic
partnership by the deadline, or else you won’t be able to make any changes to your plans.
What You Need to
Know About . . .
What You Need to Do . . .

If your new domestic partner does not qualify as your federal tax
dependent, no changes are allowed. You may only enroll your new
domestic partner or make changes to your coverage during the next
annual enrollment period or the occurrence of another life event.

If your new domestic partner qualifies as your federal tax
dependent, you can enroll or cancel coverage for yourself, add your
domestic partner and/or enroll or cancel coverage for your
children. You can change your level of coverage (e.g., from
employee coverage to employee and domestic partner coverage). If
you declined coverage before, but want to elect it now, you need to
enroll yourself for coverage to cover your domestic partner and/or
children. All changes must be consistent with the life event. (For
example, you may only cancel coverage for yourself and your
children if you will be covered under your domestic partner’s plan.)

If you enroll in either the Gold or Health & Reimbursement Plan
option under the Medical Benefit Program, you will be
automatically enrolled in the Health Reimbursement Account
Program. If you drop Medical Benefit Program coverage or switch
your Medical Benefit Program coverage from the Gold or Health &
Reimbursement Plan option to an option other than the Gold or
Health & Reimbursement Plan, your participation in the Health
Reimbursement Account Program will terminate, and you will
forfeit any remaining account balance in such program.

No changes necessary. Your domestic partner will automatically be
covered if he or she is a member of your household, regardless of
whether he or she qualifies as your federal tax dependent.

If you are enrolled in either the Silver or Health & Savings Plan
option under the Medical Benefit Program, and you have an HSA,
you can increase, decrease or stop your current HSA contributions.
Any increase in the amount of your HSA contributions cannot
exceed the maximum HSA contribution established by the IRS for
Health Care Coverage





Medical
Dental
Prescription Drug
Vision
Health
Reimbursement
Account
Employee Assistance
Program (EAP)
Health Savings Account
(HSA)
{00014391.DOCX-}
127
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
your level of coverage (i.e. employee-only coverage or family
coverage).

If you are enrolled in either the Silver or Health & Savings Plan
option under the Medical Benefit Program, you have an HSA, and
you change your Medical Benefit Program coverage level from
employee-only to family coverage, then you may increase your HSA
contribution to the maximum allowed for family coverage, prorated
by the number of months remaining in the year.
Note: Under the IRS’s “last-month rule,” if you have family coverage
on the first day of last month of your taxable year, (December 1 for
most taxpayers), you will be considered to have family coverage for
the entire year, allowing you to contribute up to the HSA family
maximum for the entire year in which you’ve acquired the new
domestic partner, without proration. However, to take advantage
of this rule, you must remain eligible for the HSA family maximum
for the entire next year.

If you don’t have an HSA, in order to receive company contributions
and make personal contributions, you must open an HSA within 31
days of your benefits effective date.
Note: You will only be allowed to change your Silver or Health &
Savings Plan coverage level from employee to family if your new
domestic partner qualifies as your federal tax dependent as described
above. In addition, you will only be able to use your HSA to receive
reimbursement for health care expenses incurred by your domestic
partner if your domestic partner qualifies as your federal tax
dependent.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
{00014391.DOCX-}

If your new domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If you’re currently enrolled and your new domestic partner qualifies
as your federal tax dependent, you can increase or decrease your
HCSA contributions, as long as your change is consistent with the
life event.

If you’re not currently enrolled and your new domestic partner
qualifies as your federal tax dependent, you can elect participation.

If your new domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If you’re currently enrolled and your new domestic partner qualifies
as your federal tax dependent, you can increase or decrease your
DDCSA contributions. You can also enroll if you’ll be gaining eligible
children who require care. All changes must be consistent with the
life change.
128
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)
Supplemental Employee
Life Insurance
What You Need to Do . . .

To change your beneficiary designation access MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer employees
and go to My Benefits or call the MyBenefits Customer Support
Center at 1-877-468-3638.

If your new domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If your new domestic partner qualifies as your federal tax
dependent, you can enroll for coverage or increase your coverage,
but you may need to show EOI. You may also drop coverage. Any
change made must be consistent with the life event.

If your new domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If your new domestic partner qualifies as your federal tax
dependent, you can enroll your domestic partner for coverage,
provided you’re enrolled in Supplemental Employee Life Insurance
or are electing coverage and your domestic partner meets the
eligibility requirements for coverage, but you may need to show
EOI.

Your domestic partner’s coverage can’t exceed 100% of your
coverage amount for Supplemental Employee Life.

You can enroll your new children, in addition to other eligible
children who aren’t covered, provided you’re enrolled in
Supplemental Employee Life Insurance or are electing coverage.
Child coverage can’t exceed 100% of your coverage amount for
Supplemental Employee Life.


You may also drop coverage.

If your new domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If your new domestic partner qualifies as your federal tax
dependent, you can enroll for coverage or increase coverage, or
you can decrease or drop coverage, provided the change is
consistent with the life event.

If your new domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If your new domestic partner qualifies as your federal tax
dependent, you can enroll your domestic partner for coverage.
Spouse Life Insurance
Child Life Insurance
Supplemental Accidental
Death and
Dismemberment
(AD&D)
Spouse AD&D
{00014391.DOCX-}
All changes must be consistent with the life event.
129
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

You can enroll your new children, as well as other eligible children.
You also can drop coverage.

Any change must be consistent with the life event.
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.

If your new domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If your new domestic partner qualifies as your federal tax
dependent, you can enroll your domestic partner for coverage.

You can enroll your domestic partner for coverage if your domestic
partner has comprehensive medical coverage and qualifies as your
federal tax dependent.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

To change your beneficiary designation for life, AD&D, or business
travel accident insurance, access MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877468-3638. You can change your beneficiary designation at any time,
even if you cannot change your election.

It is your responsibility to inform Tenet (by checking the box on the
Domestic Partner Affidavit) whether your domestic partner qualifies
as your federal tax dependent within the meaning of IRC section
152 (determined without regard to IRC sections 152(b)(1) and
(b)(2), which contain certain inapplicable exceptions to the
definition of dependent, and IRC section 152(d)(1)(B), which
contains a gross income limitation). For assistance in determining
whether your domestic partner qualifies as your federal tax
dependent, please consult with your tax advisor.

You will be required to provide a signed Domestic Partnership
Affidavit within 31 days of enrollment. Enrollment will not be
effective until the documentation is received and approved.
Coverage for your domestic partner will be retroactive to his or her
enrollment date.
Child AD&D
Accident Insurance
Critical Illness Insurance
Business Travel Accident
Insurance
Changing Beneficiaries
Things to Consider
Is Your Domestic Partner
Your Federal Tax
Dependent?
Will Documentation Be
Required?
{00014391.DOCX-}
130
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------

You may be able to enroll a domestic partner who is losing other
health coverage into Tenet’s medical and prescription drug
programs, regardless of whether the domestic partner qualifies as
your federal tax dependent.

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health &
Savings Plan coverage.
Is Your Domestic Partner
Losing Other Coverage?
Are You Increasing or
Decreasing Your HSA
Contributions?
If You’re Ending a Domestic Partnership
Making a Benefit Change?
If you’re making any benefit changes due to the end of your domestic partnership, please access
MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days from the
date domestic partnership ends. Notification prior to the effective date will not be accepted. Be sure
to provide notification of your Life Event change or you won’t be able to change your benefits. This
means you will have to continue paying for the coverage, even after your domestic partner loses
coverage. If this notification is not provided within 31 days, you won’t be able to terminate your
domestic partner’s coverage until the next annual enrollment period or life event.
What You Need to
Know About . . .
What You Need to Do . . .

You need to cancel your domestic partner’s health care coverage
which includes the Medical, Dental and Vision Programs. You must
notify MyBenefits by:

Health Care Coverage



Medical



Prescription Drug

Dental
Employee Assistance
Program (EAP)
Vision
Health
Reimbursement
Account
{00014391.DOCX-}
Accessing MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees and going to the My
Benefits section, or
Calling the MyBenefits Customer Support Center at 1-877-4683638.

If you’re losing coverage under your domestic partner’s health care
plans, you can enroll yourself and any other eligible dependents in the
Tenet health care plans within 31 days of the date you lose coverage
under your domestic partner’s plan. You need to enroll yourself for
coverage to cover your dependents.

If your domestic partner qualified as your federal tax dependent
(within the meaning of IRC section 152, determined without regard to
IRC sections 152(b)(1), (b)(2), and (d)(1)(B)), you may change your
medical plan option or make any other changes consistent with the
life event.

If your domestic partner did not qualify as your federal tax
dependent, you may only change your medical plan election from
employee plus domestic partner to employee-only coverage.
131
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
Health Savings Account
(HSA)
Health Care Spending
Account (HCSA)
What You Need to Do . . .

You may cancel coverage for your children if they no longer qualify as
your dependents or if they are enrolling in a group health plan
sponsored by your former domestic partner's employer.

If you change your Silver or Health & Savings Plan coverage level from
family coverage to employee-only coverage, you must decrease your
HSA contributions to the maximum permitted by the IRS for
employee-only coverage, prorated by the number of months
remaining in the taxable year. You can also stop HSA contributions.

If you have other dependents covered under your Silver or Health &
Savings Plan Medical Program option (who will remain covered after
the dissolution of the domestic partnership), you may continue to
make contributions up to the IRS HSA family coverage annual
contribution limit.

If your domestic partner did not qualify as your federal tax
dependent, then no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If your domestic partner qualified as your federal tax dependent, then
you may increase or decrease your contributions, as long as the
change is consistent with the life event.

If your domestic partner did not qualify as your federal tax
dependent, then no changes are allowed until the next annual
enrollment period or the occurrence of another life event.

If your domestic partner qualified as your federal tax dependent, then
you may increase or decrease your contributions, as long as the
change is consistent with the life event (For example, you may
increase your contributions if your domestic partner will no longer be
providing care for your eligible children while you work).

If your domestic partner qualified as your federal tax dependent and
you are not enrolled, you may enroll if you have eligible children
requiring care and the change is consistent with the life event.

To change your beneficiary designation access MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer employees and
go to My Benefits or call the MyBenefits Customer Support Center at
1-877-468-3638.

If your domestic partner did not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualified as your federal tax dependent, you
can enroll for coverage or increase your coverage, but you may need
to show EOI. You may also drop coverage. All changes must be
consistent with the life event.
Dependent Day Care
Spending Account
(DDCSA)
Basic Life and Basic
Accidental Death and
Dismemberment (AD&D)
Supplemental Employee
Life Insurance
{00014391.DOCX-}
132
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

You must cancel your domestic partner’s coverage. Your domestic
partner may be able to convert his or her coverage to an individual
policy with the life insurance carrier.

You can enroll your new children, in addition to other eligible children
who aren’t covered, provided you’re enrolled in Supplemental
Employee Life Insurance or are electing coverage. Child coverage
can’t exceed 100% of your coverage amount for Supplemental
Employee Life.


You may also drop coverage.

Supplemental Accidental
Death and
Dismemberment (AD&D)
If your domestic partner did not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualified as your federal tax dependent, you
can enroll for coverage or increase coverage, or you can decrease or
drop coverage, provided the change is consistent with the life event.
Spouse AD&D

You must cancel your domestic partner’s coverage.

You can enroll your new children, as well as other eligible children.
You also can drop coverage.

Any change must be consistent with the life event.
Disability Plan

No changes allowed.
Accident Insurance

You must cancel your domestic partner’s coverage.
Critical Illness Insurance

You must cancel your domestic partner’s coverage.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

No changes allowed.

To change your beneficiary designation for life, AD&D, or business
travel accident insurance, access MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877468-3638.
Spouse Life Insurance
Child Life Insurance
Child AD&D
Business Travel Accident
Insurance
Long-Term Care
Insurance
Changing Beneficiaries
All changes must be consistent with the life event.
Things to Consider
Does Anyone Need To
Be Informed?
{00014391.DOCX-}

Access MyTenet.com for Tenet colleagues and HealthyatTenet.com for
Conifer employees and go to My Benefits or call the MyBenefits
Customer Support Center at 1-877-468-3638 within 31 days of the end
133
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
of your domestic partnership. If this notification is not provided within
31 days, you won’t be able to terminate your domestic partner’s
coverage until the next annual enrollment period or life event.
Are You Having
Difficulty Coping with
Your Situation?

Trained EAP counselors are available to help you sort through your
feelings. For a free consultation, call GuidanceResources at 1-844-4161158.
Are You Entering Into a
New Domestic
Partnership?

You may not file a new “Affidavit of Domestic Partnership” with Tenet
until six months after the termination of your prior domestic
partnership.
Are You Increasing or
Decreasing Your HSA
Contributions?

Remember, it is your responsibility to monitor your HSA contributions
and make sure they fall within the parameters established by the IRS
for your selected level of Silver or Health & Savings Plan coverage.
If Your Domestic Partner Gains Coverage
Under Another Employer Plan
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage




Medical
If your domestic partner does not qualify as your federal tax
dependent, you may cancel your domestic partner’s coverage under
the Medical, Dental, Prescription Drug, and Vision Programs. You
should cancel the coverage within 31 days of the event.



Vision
If your domestic partner qualifies as your federal tax dependent, you
can enroll or cancel coverage for yourself, and/or enroll or cancel
coverage for your children. You can change your level of coverage
(e.g., from employee and domestic partner coverage to employee).
All changes must be consistent with the life event.

If you enroll in either the Gold or Health & Reimbursement Plan
option under the Medical Benefit Program, you will be automatically
enrolled in the Health Reimbursement Account Program. If you drop
coverage in the Medical Benefit Program or switch your Medical
Benefit Program coverage from the Gold or Health & Reimbursement
Plan option to an option other than the Gold or Health &
Reimbursement Plan, your participation in the Health Reimbursement
Account Program will terminate, and you will forfeit any remaining
account balance in such program.

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program, and you have an HSA, you can
increase, decrease or stop your current HSA contributions. Any
increase in the amount of your HSA contributions cannot exceed the
maximum HSA contribution established by the IRS for your level of
coverage (i.e. employee-only coverage or family coverage).

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program, you have an HSA, and you
change your Medical Benefit Program coverage level from employeeonly to family coverage, then you may increase your HSA contribution
to the maximum allowed for family coverage, prorated by the

Dental
Prescription Drug
Program
Health
Reimbursement
Account
EAP
Health Savings
Account (HSA)
{00014391.DOCX-}
134
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
number of months remaining in the year. Note: Under the IRS’s “lastmonth rule,” if you have family coverage on the first day of last
month of your taxable year, (December 1 for most taxpayers), you
will be considered to have family coverage for the entire year,
allowing you to contribute up to the HSA family maximum for the
entire year in which you’ve acquired the new domestic partner,
without proration. However, to take advantage of this rule, you must
remain eligible for the HSA family maximum for the entire next year.

If you don’t have an HSA, in order to receive company contributions
and make personal contributions, you must open an HSA within 31
days of your benefits effective date.
Note: You will only be allowed to change your Silver or Health & Savings
Plan coverage level from employee to family if your domestic partner
qualifies as your federal tax dependent as described above (or if you have
other dependents enrolling). In addition, you will only be able to use your
HSA to receive reimbursement for health care expenses incurred by your
domestic partner if your domestic partner qualifies as your federal tax
dependent.

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If you’re currently enrolled and your domestic partner qualifies as
your federal tax dependent, you can increase or decrease your HCSA
contributions, as long as your change is consistent with the life event.

If you’re not currently enrolled and your domestic partner qualifies as
your federal tax dependent, you can elect participation, as long as the
election is consistent with the life event.

Dependent Day Care
Spending Account
(DDCSA)
If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If you’re currently enrolled and your domestic partner qualifies as
your federal tax dependent, you can increase or decrease your DDCSA
contributions. You can also enroll if you’ll be gaining eligible children
who require care. All changes must be consistent with the life
change.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)

Not applicable.

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualifies as your federal tax dependent, you
can enroll for coverage or increase your coverage, but you may need
Health Care Spending
Account (HCSA)
Supplemental
Employee Life
Insurance
{00014391.DOCX-}
135
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
to show EOI. You may also drop coverage. Any change made must be
consistent with the life event.

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualifies as your federal tax dependent, you
may drop your domestic partner's coverage, provided the change is
consistent with the life event.

Your domestic partner’s coverage can’t exceed 100% of your
coverage amount for Supplemental Employee Life.

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualifies as your federal tax dependent, you
may drop coverage, provided the change is consistent with the life
event.

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualifies as your federal tax dependent, you
can enroll for coverage or increase coverage, or you can decrease or
drop coverage, provided the change is consistent with the life event.

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualifies as your federal tax dependent, you
can cancel coverage, as long as the change is consistent with the life
event.

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualifies as your federal tax dependent, you
may drop coverage, provided the change is consistent with the life
event.
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.
Spouse Life Insurance
Child Life Insurance
Supplemental
Accidental Death and
Dismemberment
(AD&D)
Spouse AD&D
Child AD&D
{00014391.DOCX-}
136
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
Accident Insurance
Critical Illness
Insurance
Business Travel
Accident Insurance
What You Need to Do . . .

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualifies as your federal tax dependent, you
can cancel coverage, as long as the change is consistent with the life
event.

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If your domestic partner qualifies as your federal tax dependent, you
can cancel coverage, as long as the change is consistent with the life
event.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

To change your beneficiary designation for life, AD&D, or business
travel accident insurance, access MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877468-3638. You can change your beneficiary designation at any time,
even if you cannot change your election.
Changing Beneficiaries
Things to Consider
Does Anyone Need To
Be Informed?
Access MyTenet.com for Tenet colleagues and HealthyatTenet.com for
Conifer employees and go to My Benefits or call the MyBenefits Customer
Support Center at 1-877-468-3638 within 31 days of your domestic partner
gaining coverage under another employer plan. If this notification is not
provided within 31 days, you won’t be able to terminate your domestic
partner’s coverage until the next annual enrollment period or life event.
If Your Domestic Partner Loses Other
Health Plan Coverage
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage



Medical
Dental
{00014391.DOCX-}
If your domestic partner previously declined coverage under the
Medical Program, Dental Program, or Vision Program due to coverage
under another employer plan, you may enroll your domestic partner
(and yourself, if you are not currently enrolled) in coverage within 31
days after the loss of such other coverage.
137
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

Prescription Drug
Program



Vision
You can also change your level of Medical, Dental, or Vision coverage
(e.g., from employee coverage to employee and domestic partner
coverage). If you declined coverage before, but want to elect it now,
you need to enroll yourself for coverage to cover your domestic
partner. All changes must be consistent with the life event.

If you enroll in the either Gold or Health & Reimbursement Plan
option under the Medical Benefit Program, you will be automatically
enrolled in the Health Reimbursement Account Program. If you
switch your Medical Benefit Program coverage from the Gold or
Health & Reimbursement Plan option to an option other than the
Gold or Health & Reimbursement Plan, your participation in the
Health Reimbursement Account Program will terminate, and you will
forfeit any remaining account balance in such program.

The Medical Benefit Program option in which you and your domestic
partner enroll, if any, will determine your Prescription Benefit
Program option.

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program, and you have an HSA, you can
increase, decrease or stop your current HSA contributions. Any
increase in the amount of your HSA contributions cannot exceed the
maximum HSA contribution established by the IRS for your level of
coverage (i.e. employee-only coverage or family coverage).

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program, you have an HSA, and you
change your Medical Benefit Program coverage level from employeeonly to family coverage, then you may increase your HSA contribution
to the maximum allowed for family coverage, prorated by the
number of months remaining in the year. Note: Under the IRS’s “lastmonth rule,” if you have family coverage on the first day of last
month of your taxable year, (December 1 for most taxpayers), you
will be considered to have family coverage for the entire year,
allowing you to contribute up to the HSA family maximum for the
entire year in which you’ve acquired the new domestic partner,
without proration. However, to take advantage of this rule, you must
remain eligible for the HSA family maximum for the entire next year.

If you don’t have an HSA, in order to receive company contributions
and make personal contributions, you must open an HSA within 31
days of your benefits effective date.
Health
Reimbursement
Account
Health Savings
Account (HSA)
Note: You will only be able to use your HSA to receive reimbursement for
health care expenses incurred by your domestic partner if your domestic
partner qualifies as your federal tax dependent.
Health Care Spending
Account (HCSA)
{00014391.DOCX-}

If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.
138
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If you’re currently enrolled and your domestic partner qualifies as
your federal tax dependent, you can increase or decrease your HCSA
contributions, as long as your change is consistent with the life event.

If you’re not currently enrolled and your domestic partner qualifies as
your federal tax dependent, you can elect participation.

Dependent Day Care
Spending Account
(DDCSA)
If your domestic partner does not qualify as your federal tax
dependent, no changes are allowed until the next annual enrollment
period or the occurrence of another life event.

If you’re currently enrolled and your domestic partner qualifies as
your federal tax dependent, you can increase or decrease your DDCSA
contributions. You can also enroll if you’ll be gaining eligible children
who require care. All changes must be consistent with the life
change.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)

Not applicable.

You can enroll for coverage or increase your coverage, but you may
need to show EOI. All changes must be consistent with the life event.

You can enroll your domestic partner for coverage, provided you’re
enrolled in Supplemental Employee Life Insurance or are electing
coverage and your domestic partner meets the eligibility
requirements for coverage, but you may need to show EOI.

Your domestic partner’s coverage can’t exceed 100% of your
coverage amount for Supplemental Employee Life.

You can enroll your new children, in addition to other eligible children
who aren’t covered, provided you’re enrolled in Supplemental
Employee Life Insurance or are electing coverage. Child coverage
can’t exceed 100% of your coverage amount for Supplemental
Employee Life.


You may also drop coverage.
Supplemental
Accidental Death and
Dismemberment
(AD&D)

You can enroll for coverage or increase coverage, or you can decrease
or drop coverage, provided the change is consistent with the life
event.
Spouse AD&D

You can enroll your domestic partner for coverage.
Supplemental
Employee Life
Insurance
Spouse Life Insurance
Child Life Insurance
{00014391.DOCX-}
All changes must be consistent with the life event.
139
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

You can enroll your new children, as well as other eligible children.
You also can drop coverage. All changes must be consistent with the
life event.
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.
Accident Insurance

You can enroll your domestic partner for coverage.

You can enroll your spouse for coverage. To enroll in Critical Illness
Insurance, your domestic partner must have comprehensive medical
coverage.

No changes necessary. Your domestic partner will automatically be
covered as soon as he or she meets the eligibility requirements,
regardless of whether he or she qualifies as your federal tax
dependent.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

To change your beneficiary designation for life, AD&D, or business
travel accident insurance, access MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877468-3638. You can change your beneficiary designation at any time,
even if you cannot change your election.

It is your responsibility to inform Tenet (by checking the box on the
Domestic Partner Affidavit) whether your domestic partner qualifies
as your federal tax dependent within the meaning of IRC section 152
(determined without regard to IRC sections 152(b)(1) and (b)(2),
which contain certain inapplicable exceptions to the definition of
dependent, and IRC section 152(d)(1)(B), which contains a gross
income limitation). For assistance in determining whether your
domestic partner qualifies as your federal tax dependent, please
consult with your tax advisor.

You will be required to provide a signed Domestic Partnership
Affidavit within 31 days of enrollment. Enrollment will not be
effective until the documentation is received and approved.
Coverage for your domestic partner will be retroactive to his or her
enrollment date.
Child AD&D
Critical Illness
Insurance
Employee Assistance
Program (EAP)
Business Travel
Accident Insurance
Changing Beneficiaries
Things to Consider
Is your domestic
partner your federal
tax dependent?
Will documentation be
required?
{00014391.DOCX-}
140
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
Are you increasing or
decreasing your HSA
contributions?

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health &
Savings Plan coverage.
If You’re Having a Baby or Adopting a Child
Making a Benefit Change?
If you’re making any benefit changes due to gaining a child, please access MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer employees and go to My Benefits, or call the
MyBenefits Customer Support Center at 1-877-468-3638 within 31 days of the date of your baby’s
birth or adoption. Notification prior to the date of birth or adoption will not be accepted. To be sure
that your baby is covered, you must provide notification of your Life Event change by the deadline. If
you don’t provide notification within 31 days, you won’t be able to change your benefits.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage

You can enroll yourself, your new child, and your spouse for coverage.
You can change to a higher tier of coverage (e.g., from employee and
spouse to employee and family). You can also enroll any other eligible
dependents, as long as the enrollment is consistent with the life
event.

You can change your Medical Benefit Program option, Dental
Program and Vision Program. (Your Prescription Drug Program
options will automatically change to the option associated with your
selected Medical Benefit Program option.)
Vision

Health
Reimbursement
Account
If you declined coverage before but want to elect it now, you need to
enroll yourself for coverage to cover your dependents.

Your new child will automatically be covered in the EAP. No
enrollment is necessary.

If you enroll in either the Gold or Health & Reimbursement Plan
option under the Medical Benefit Program, you will be automatically
enrolled in the Health Reimbursement Account Program. If you
switch your Medical Benefit Program coverage from the Gold or
Health & Reimbursement Plan option to an option other than the
Gold or Health & Reimbursement Plan, your participation in the
Health Reimbursement Account Program will terminate, and you will
forfeit any remaining account balance in such program.

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program and you have an HSA, you can
increase, decrease or stop your current HSA contributions, subject to
the limitations set by the IRS for your selected level of coverage.


Medical




Prescription Drug
Employee
Assistance Program
(EAP)
Dental
Health Savings
Account (HSA)
{00014391.DOCX-}
141
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If you change your Medical Benefit Program coverage level from
employee-only to family coverage, then you may increase your HSA
contribution to the maximum allowed for family coverage, prorated
by the number of months remaining in the year. Note: Under the
IRS’s “last-month rule,” if you have family coverage on the first day of
the last month of your taxable year, (December 1 for most taxpayers),
you will be considered to have family coverage for the entire year,
allowing you to contribute up to the HSA family maximum for the
entire year in which your child is born or adopted, without proration.
However, to take advantage of this rule, you must remain eligible for
the HSA family maximum for the entire next year.

If you don’t have an HSA, in order to receive company contributions
and make personal contributions, you must open an HSA within 31
days of your benefits effective date.

If you’re currently enrolled, you can increase, decrease or stop your
HCSA contributions, as long as the change is consistent with the life
event.

If you’re not currently enrolled, you can elect participation.

If you’re currently enrolled, you can increase, decrease or stop your
DDCSA contributions, as long as the change is consistent with the life
event.

If you’re not currently enrolled and are single or your spouse works or
is actively looking for work, you can elect participation.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)

To change your beneficiary designation access MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer employees and
go to My Benefits or call the MyBenefits Customer Support Center at
1-877-468-3638.
Supplemental
Employee Life
Insurance

You can enroll for coverage or increase coverage, but you may need
to show Evidence of Insurability (EOI). You can also drop coverage.
All changes must be consistent with the life event.
Spouse Life Insurance

No changes allowed.

You can enroll your new child, as well as any other eligible children,
provided you’re enrolled in Supplemental Employee Life Insurance or
are electing coverage and the change is consistent with the life event.
Your child’s coverage can’t exceed 100% of your coverage amount for
Supplemental Employee Life.

You can enroll for coverage or increase or decrease coverage, but
only if the change is consistent with the life event.

No changes allowed
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
Child Life Insurance
Supplemental
Accidental Death and
Dismemberment
(AD&D)
Spouse AD&D
{00014391.DOCX-}
142
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Child AD&D

You can enroll your new child, as well as any other eligible children,
provided the change is consistent with the life event.
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.

You may enroll yourself and/or your new child for coverage or you
may increase coverage, provided the change is consistent with the life
event.

You may enroll, if you are enrolled in a comprehensive medical plan.
If you enroll (or if you are already enrolled), your child will
automatically be enrolled at 25% of your coverage level.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

To change your beneficiary designation for life, AD&D, or business
travel accident insurance, please access MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer employees and go to
My Benefits or call the MyBenefits Customer Support Center at 1877-468-3638.

Under the Family and Medical Leave Act (FMLA), you may be eligible
to take a leave of absence for up to 12 weeks to care for your child
after his or her birth or adoption.

To apply for FMLA, contact your local Human Resource department.
For more information, please see “If You Take a Leave of Absence.”

Check to see if your medical plan offers a prenatal program. If so,
you’ll want to enroll in it right away, so you can take advantage of the
information and services it has to offer.

If you or your spouse or domestic partner plans to take time off after
the birth or adoption, you’ll want to obtain more information about
the Family and Medical Leave Act (FMLA). You may also want to get
more information about other applicable leaves of absence offered by
your spouse’s or domestic partner’s company. You’ll also need to
consider the impact these leaves may have on your company
benefits.

If you and your spouse or domestic partner work at separate
companies and have medical coverage through your respective
employers, you’ll want to compare your coverage to see which plan
offers the well-baby care and other child-friendly benefits best suited
Accident Insurance
Critical Illness
Insurance
Business Travel
Accident Insurance
Changing Beneficiaries
Family and Medical
Leave
Things to Consider
Need Help During Your
Pregnancy?
Are You or Your
Spouse or Domestic
Partner Planning to
Take Time Off After
the Birth or Adoption?
Whose Medical Plan
Will Cover the Baby?
{00014391.DOCX-}
143
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------


Keep Tenet’s Dependent Day Care Spending Account (DDCSA) in
mind. The DDCSA allows you to set aside tax-free dollars to pay for
certain eligible dependent care expenses so you and, if you’re
married, your spouse can work. If you’re not currently enrolled in the
DDCSA, you can enroll in the plan during the 31 days following the
birth or placement for adoption.

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health &
Savings Plan coverage.
Will You Need
Dependent Care for
Your Child?
Are You Increasing or
Decreasing Your HSA
Contributions?
to your needs. The Medical Benefit Program options each offer innetwork preventive care, paid at 100% with no deductible. This
preventive care includes well-child visits and immunizations and
routine physical exams for children.
If you and your spouse or domestic partner both work for Tenet, keep
in mind that each of you can cover different children; however, each
child can be covered only once.
If Your Child Loses Eligibility for Coverage
Making a Benefit Change?
If you’re making any benefit changes because you child is no longer eligible for coverage under the
Tenet benefit plans, for example as a consequence of attaining age 26, please call the MyBenefits
Customer Support Center at 1-877-468-3638 within 31 days of the date your child loses eligibility for
coverage. You must provide notification of this Life Event change by the deadline or you won’t be able
to change your benefits!
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage



You need to cancel your child’s health care coverage. Your child may be
eligible to elect to continue health care coverage under COBRA.

Your child may keep EAP coverage past turning age 26 as long as he or
she remains a member of your household.

You must notify MyBenefits by:




Medical
Employee
Assistance Program
(EAP)
Prescription Drug

Dental

Vision
Health
Reimbursement
Account
Calling the MyBenefits Customer Support Center at 1-877-4683638.
Refer to the Other Information section of this SPD for more information on
COBRA.

{00014391.DOCX-}
Accessing MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees and going to My
Benefits, or
You can change your medical program option or drop your own
coverage, as long as the change is consistent with your child’s loss of
coverage. If you enroll in either the Gold or Health & Reimbursement
Plan option, you will be automatically enrolled in the Health
144
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Reimbursement Account Program. If you drop coverage in the Medical
Benefit Program, or switch from the Gold or Health & Reimbursement
Plan option to an option other than the Gold or Health &
Reimbursement Plan, your participation in the Health Reimbursement
Account Program will terminate, and you will forfeit any remaining
account balance in such program.

If your child loses coverage in the Silver or Health & Savings Plan option
under the Medical Benefit Program and you change your Medical
Benefit Program coverage level from family coverage to employee-only
coverage, you must decrease your HSA contributions to the maximum
permitted by the IRS for employee-only coverage, prorated by the
number of months remaining in the taxable year. You can also increase
(subject to IRS maximums) or stop HSA contributions.

If you have other dependents covered under your Silver or Health &
Savings Plan Medical Program option, you may continue to make
contributions up to the IRS HSA family coverage annual contribution
limit.
Health Care Spending
Account (HCSA)

If you’re currently enrolled, you can decrease or stop your HCSA
contributions.
Dependent Day Care
Spending Account
(DDCSA)

If you’re currently enrolled, you can increase, decrease or stop your
DDCSA contributions, as long as such change is consistent with the life
event.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)

Not applicable.
Supplemental
Employee Life
Insurance

No change allowed.
Spouse Life Insurance

No change allowed.
Child Life Insurance

You must cancel your child’s coverage.
Supplemental
Accidental Death and
Dismemberment
(AD&D)

No change allowed.
Spouse AD&D

No change allowed.
Child AD&D

You must cancel your child’s coverage.
Disability Plan

No changes allowed.
Health Savings
Account (HSA)
{00014391.DOCX-}
145
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Long-Term Care
Insurance

No changes allowed.
Accident Insurance

No changes allowed.
Critical Illness
Insurance

No changes allowed. Any ineligible covered dependent will be
automatically dropped.
Business Travel
Accident Insurance

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1 employee.
If You or Your Dependent Becomes Entitled to
Medicare
Making a Benefit Change?
If you’re making any benefit changes because you or your dependent have become entitled to
Medicare, please call the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days of
Medicare entitlement. You must provide notification of this Life Event change by the deadline or you
won’t be able to change your benefits!
What is Medicare?
Medicare is a government-provided health insurance program available for those age 65 years and
older, certain disabled individuals under age 65 and those with End-Stage Renal Disease (permanent
kidney failure treated with dialysis or a transplant). In general, you or your dependent will become
eligible for Medicare when you attain age 65 or earlier if you have certain disabilities or end-stage renal
disease. You will become entitled to Medicare when you enroll in either Medicare Part A or Part B.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage

If you become entitled to Medicare: You may continue your
current Tenet health care coverage or you may drop your Tenet
coverage if you feel Medicare is sufficient for you. If you drop Tenet
coverage for yourself, you must also drop coverage for any covered
spouse or children. Your dependents may be eligible to continue
coverage under COBRA. Refer to the Other Information section for
more information on COBRA.

If your federal tax dependent (within the meaning of IRC section
152, without regard to IRC sections 152(b)(1), (b)(2), and (d)(1)(B))
becomes entitled to Medicare: You may drop health care coverage
for your dependent only.

If your dependent who is not a federal tax dependent becomes
entitled to Medicare: No other changes are allowed.

EAP coverage will continue, regardless of Medicare entitlement.


Medical




Prescription Drug
Employee Assistance
Program (EAP)
Dental
Vision
Health
Reimbursement
Account
{00014391.DOCX-}
146
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If you become entitled to Medicare, you will no longer be eligible to
make HSA contributions. You must notify MyBenefits by calling the
MyBenefits Customer Support Center at 1-877-468-3638.

If your dependent becomes entitled to Medicare, you are enrolled
in either the Silver or Health & Savings Plan Medical Benefit
Program option at the family coverage level, and you have no other
dependents enrolled in such option, you must decrease your HSA
contributions to the maximum permitted by the IRS for the
employee-only coverage level (even if your dependent remains
covered).

If you or your federal tax dependent (within the meaning of IRC
section 152 (determined without regard to section 152(b)(1),
(b)(2), and (d)(1)(B)) becomes eligible for Medicare: If you’re
currently enrolled, you can decrease or stop your HCSA
contributions. You can also increase your contributions or enroll in
the HCSA, as long as the change is consistent with the life event.

If your dependent who is not your federal tax dependent becomes
entitled to Medicare: No changes allowed.
Dependent Care
Spending Account
(DDCSA)

No changes allowed.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)

Not applicable.
Supplemental Employee
Life Insurance

No changes allowed.
Spouse Life Insurance

No changes allowed.
Child Life Insurance

No changes allowed.
Supplemental Accidental
Death and
Dismemberment
Insurance (AD&D

No changes allowed.
Spouse AD&D

No changes allowed.
Child AD&D

No changes allowed.
Disability Plan

No changes allowed.
Health Savings Account
(HSA)
Health Care Spending
Account (HCSA)
{00014391.DOCX-}
147
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Long-Term Care
Insurance

No changes allowed.
Accident Insurance

No changes allowed.
Critical Illness Insurance

No changes allowed.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

If your dependents are losing health care coverage, they can
continue health care coverage under COBRA for up to 36 months.
(Note: EAP coverage will automatically continue for the COBRA
period. No election is necessary.) If they elect COBRA, they will
have the same coverage, but will be responsible for paying the full
cost of coverage plus an administrative fee. Refer to the Other
Information section for more information on COBRA.

The Tenet plan generally pays primary to Medicare, so if you are
covered by both the Tenet plan and Medicare, your medical
expenses would be paid first by the Tenet plan. In the unlikely event
that Medicare provided better coverage, Medicare would make up
any difference. In certain circumstances of end stage renal disease,
Medicare will pay primary.

If you dropped your Tenet coverage, Medicare would provide your
health coverage.

When you become eligible for Medicare, you must decide whether
you wish to continue your prescription drug coverage under a Tenet
plan or whether you wish to enroll in a Medicare plan. To help you
make this decision, you will receive a notice of creditable or noncreditable coverage. See the Other Information section of this TEBP
SPD for more information and a copy of this notice.

To elect drug coverage under the Tenet Employee Benefit Plan
(TEBP) you must also elect a Tenet Medical Plan option.
Business Travel Accident
Insurance
Things to Consider
What Health Care
Options Do Your
Dependents Have if
They Lose Coverage
Under Tenet’s Plans?
What Happens When
You or Your Spouse
Becomes Entitled to
Medicare?
What About
Prescription Drug
Coverage?
If You Lose Coverage Under Another Health Plan
What Does It Mean to Lose Coverage?
If you previously declined coverage under a Tenet health plan because you were covered under
another health plan and you lose your other coverage for any of the reasons listed below, you may
{00014391.DOCX-}
148
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
enroll yourself and your dependents in a Tenet health plan within 31 days of your loss of other plan
coverage. Examples of loss of other health plan coverage include:
 You lose health plan coverage under your spouse’s health plan due to divorce, legal separation,
death of your spouse, or your spouse’s termination of employment or reduction in hours.
 You lose coverage as a dependent under another health plan due to divorce, legal separation,
cessation of dependent status, death, or termination of employment or reduction in hours.
 You lose coverage offered through an HMO or other arrangement because you no longer reside,
live, or work in the service area (and no other benefit package is available to you).
 You lose coverage because the plan no longer offers benefits to a class of individuals including you.
(For example, the plan is amended to drop dependent coverage.)
 Employer contributions toward your coverage (either as a dependent or as an employee) are
terminated (assuming your coverage is not COBRA coverage).
 If your other coverage is COBRA continuation coverage, you exhaust your maximum period of
COBRA coverage.
A “loss of coverage” does not include a loss due to failure to pay premiums or termination of coverage
for cause (such as a fraudulent claim).
What You Need to Know About . . .
What You Need to Do . . .

You and your eligible dependents can enroll for health
care coverage under the Medical Benefit Program, the
Dental Benefit Program, and/or the Vision Benefit
Program. If you and/or your eligible dependents enroll
in the Medical Benefit Program, you will automatically
be enrolled in the Prescription Drug option associated
with your selected Medical Benefit Program coverage
option.

You do not need to enroll in the EAP. You were
automatically covered in the EAP upon your initial
eligibility.

If you enroll in either the Gold or Health &
Reimbursement Plan option under the Medical Benefit
Program, you will be automatically enrolled in the
Health Reimbursement Account Program.

If you are enrolling in either the Silver or Health &
Savings Plan Medical Benefit Program option, you must
open your HSA within 31 days of your benefits effective
date, in order to receive company contributions and
make personal contributions for you and your
spouse/child/family.

You can enroll for HCSA or increase participation.

You can enroll for DDCSA participation or increase
participation, if you have eligible dependents requiring
care. You may also stop participation.
Health Care Coverage


Medical




Prescription Drug
Employee Assistance Program
(EAP)
Dental
Vision
Health Reimbursement Account
Program
Health Savings Account (HSA)
Health Care Spending Account (HCSA)
Dependent Day Care Spending
Account (DDCSA)
{00014391.DOCX-}
149
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to Know About . . .
What You Need to Do . . .
Basic Life and Basic Accidental Death
and Dismemberment (AD&D)

Not applicable.

You can enroll or increase coverage, provided the
change is consistent with the life event. EOI may be
required.

You can enroll your spouse or domestic partner for
coverage, provided you have elected Supplemental
Employee Life Insurance for yourself and the change is
consistent with the life event. Your spouse’s or
domestic partner’s coverage can’t exceed 100% of your
coverage amount for Supplemental Employee Life. EOI
may be required.

You can enroll your child(ren) for coverage, provided
you have elected Supplemental Life Insurance for
yourself and the change is consistent with the life
event. Your child’s coverage can’t exceed 100% of your
coverage amount for Supplemental Employee Life.

You can enroll or increase coverage, provided the
change is consistent with the life event.

Not applicable. You are covered for accidents which
occur while travelling on company business as a fulltime or part-time 1 employee.

You can enroll your spouse or domestic partner for
coverage, provided the change is consistent with the
life event.

You can enroll your child(ren) for coverage, provided
the change is consistent with the life event.
Disability Plan

No changes allowed.
Long-Term Care Insurance

No changes allowed.
Accident Insurance

You can enroll for coverage.

You can enroll for coverage if you are enrolled in a
comprehensive medical plan.

To name a beneficiary for life, AD&D, or business travel
accident insurance, please access MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer
employees and go to My Benefits or call the MyBenefits
Customer Support Center at 1-877-468-3638.
Supplemental Employee Life Insurance
Spouse Life Insurance
Child Life Insurance
Supplemental Accidental Death and
Dismemberment (AD&D)
Business Travel Accident Insurance
Spouse AD&D
Child AD&D
Critical Illness Insurance
Naming Beneficiaries
{00014391.DOCX-}
150
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
Things to Consider
Should You Elect
COBRA Under the
Other Health Plan or
Enroll in a Tenet
Health Plan?
You should weigh the costs and benefits of Tenet health plan coverage
against COBRA continuation coverage offered under the health plan from
which you lost coverage (assuming you are eligible for COBRA). If you elect
COBRA continuation coverage under the other health plan, you will not be
able to enroll in a Tenet health plan until annual enrollment or you exhaust
your COBRA coverage. (You will not be able to enroll in a Tenet health plan
until the next annual enrollment period if your COBRA coverage ends early
due to failure to pay premiums or for cause, such as a false claim.)
Are You Opening an
HSA?
Remember, it is your responsibility to monitor your HSA contributions and
make sure they fall within the parameters established by the IRS for your
selected level of Silver or Health & Savings Plan coverage.
If Your Dependent Loses Coverage Under Another
Health Plan
Making a Benefit Change?
If your eligible dependent loses other health plan coverage, you can make changes to your health care
coverage. (See “If You Lose Coverage Under Another Health Plan” above for a description of loss of
other health coverage.) Please access MyTenet.com for Tenet colleagues and HealthyatTenet.com for
Conifer employees and go to My Benefits or call the MyBenefits Customer Support Center at 1-877468-3638 within 31 days of the date your dependent loses other health coverage. Be sure to submit
changes by the deadline or you won’t be able to change your benefits! ).
Note: This section does not apply to dependents who are domestic partners. Please see “If Your
Domestic Partner Loses Other Health Plan Coverage" above.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage

You can enroll yourself and any eligible dependents losing other health
plan coverage in coverage under any of the Tenet health plan options
for which you and the enrolling dependents are eligible. You cannot
decrease your coverage election (i.e. from family coverage to
employee-only coverage).

You can change your Medical Benefit Program option, Dental Program
and Vision Program. (Your Prescription Drug Program options will
automatically change to the option associated with your selected
Medical Benefit Program option.)
Vision

Health
Reimbursement
Account
If you declined coverage before but want to elect it now, you need to
enroll yourself for coverage to cover your dependent.

Your eligible dependent was automatically covered in the EAP upon
your initial eligibility. No enrollment is necessary.

If you enroll in either the Gold or Health & Reimbursement Plan option
under the Medical Benefit Program, you will be automatically enrolled
in the Health Reimbursement Account Program. If you switch your


Medical




Prescription Drug
Employee
Assistance Program
(EAP)
Dental
{00014391.DOCX-}
151
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Medical Benefit Program coverage from the Gold or Health &
Reimbursement Plan option to an option other than the Gold or Health
& Reimbursement Plan, your participation in the Health Reimbursement
Account Program will terminate, and you will forfeit any remaining
account balance in such program.

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program and you have an HSA, you can
increase, decrease or stop your current HSA contributions, subject to
the limitations set by the IRS for your selected level of coverage.

If you are enrolled in either the Silver or Health & Savings Plan option
under the Medical Benefit Program, you have an HSA, and you change
your Medical Benefit Program coverage level from employee-only to
family coverage, then you may increase your HSA contribution to the
maximum allowed for family coverage, prorated by the number of
months remaining in the year. Note: Under the IRS’s “last-month rule,”
if you have family coverage on the first day of last month of your
taxable year, (December 1 for most taxpayers), you will be considered
to have family coverage for the entire year, allowing you to contribute
up to the HSA family maximum for the entire year in which your
dependent lost other health coverage, without proration. However, to
take advantage of this rule, you must remain eligible for the HSA family
maximum for the entire next year.

If you don’t have an HSA, in order to receive company contributions and
make personal contributions, you must open an HSA within 31 days of
your benefits effective date.

If your dependent losing other health plan coverage qualifies as your
federal tax dependent within the meaning of IRC section 152
(determined without regard to IRC sections 152(b)(1), (b)(2), and
(d)(1)(B)), you can enroll in the HCSA or increase your HCSA
contribution if you are already enrolled.

If your dependent losing other health plan coverage does not qualify as
your federal tax dependent, no change is allowed.

If your dependent losing other health plan coverage qualifies as your
federal tax dependent, you can enroll in the DDCSA provided you have
eligible dependents requiring care. If you are already enrolled in the
DDCSA, you can increase your contributions.

If your dependent losing other health plan coverage does not qualify as
your federal tax dependent, no change is allowed.

Not applicable.
Health Savings
Account (HSA)
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)
{00014391.DOCX-}
152
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Supplemental
Employee Life
Insurance

You can enroll for coverage or increase coverage, but you may need to
show Evidence of Insurability (EOI). Any change must be consistent
with the life event

If your dependent losing other coverage is your spouse, you may enroll
your spouse or domestic partner for coverage, as long as you are
enrolled or are electing coverage and the change is consistent with the
life event. Your spouse’s coverage can’t exceed 100% of your coverage
amount for Supplemental Employee Life. EOI may be required.

If your dependent losing other coverage is your child, you can enroll
your child, provided you’re enrolled in Supplemental Employee Life
Insurance or are electing coverage. Your child’s coverage can’t exceed
100% of your coverage amount for Supplemental Employee Life.

You can enroll for coverage or increase or decrease coverage, but only if
the change is consistent with the life event.

If your dependent losing other coverage is your spouse, you can enroll
for coverage or increase or decrease coverage, but only if the change is
consistent with the life event.

If your dependent losing other coverage is your child, you can enroll
your child.
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.

You can elect coverage for your spouse or child, provided the election is
consistent with the life event.

You can elect coverage for your spouse or child. To enroll in Critical
Illness Insurance, the spouse or child must have comprehensive medical
coverage.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1 employee.
Spouse Life Insurance
Child Life Insurance
Supplemental
Accidental Death and
Dismemberment
(AD&D)
Spouse AD&D
Child AD&D
Accident Insurance
Critical Illness
Insurance
Business Travel
Accident Insurance
Things to Consider
If You’re Transferring to Another Facility
Making a Benefit Change?
{00014391.DOCX-}
153
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
If your transfer changes your health care plan eligibility, you can make changes to your health care
coverage. Please access MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer
employees and go to My Benefits or call the MyBenefits Customer Support Center at 1-877-468-3638
within 31 days of your transfer. Be sure to submit changes by the deadline or you won’t be able to
change your benefits!
What You Need to Know
About . . .
What You Need to Do . . .
Health Care Coverage

If you gain or lose options as a result of your transfer (for
example, move into or out of the EPO service area): You may
add, drop or change coverage in the Medical Benefit Program,
Dental Benefit Program, and Vision Benefit Program for you
and your enrolled dependents.

If your transfer results in a cost of coverage increase: You may
add, drop or change coverage in the Medical Benefit Program,
the Dental Benefit Program, and the Vision Benefit Program.

Your Prescription Drug coverage will be determined by the
Medical Benefit Program option in which you are enrolled, if
any.

Your coverage under the EAP will not be impacted by your
transfer to another facility.

If you enroll in either the Gold or Health & Reimbursement
Plan option under the Medical Benefit Program, you will be
automatically enrolled in the Health Reimbursement Account
Program. If you drop coverage in the Medical Benefit Program
or switch your Medical Benefit Program coverage from the
Gold or Health & Reimbursement Plan option to an option
other than the Gold or Health & Reimbursement Plan, your
participation in the Health Reimbursement Account Program
will terminate, and you will forfeit any remaining account
balance in such program.

If you are enrolled in either the Silver or Health & Savings Plan
medical program option, you may increase (up to the
maximum permitted by the IRS), decrease or stop your current
HSA contributions.

If you are enrolling in either the Silver or Health & Savings Plan
option, you must open your HSA within 31 days of your
benefits effective date, in order to receive company
contributions and make personal contributions for you and
your spouse/child/family.

If you make changes to your medical, dental or vision coverage
as a result of your transfer that affect your health care
expenses, you can increase, decrease or stop your HCSA
contributions, as long as such HCSA election change is


Medical




Prescription Drug
Employee Assistance
Program (EAP)
Dental
Vision
Health Reimbursement
Account
Health Savings Account (HSA)
Health Care Spending
Account (HCSA)
{00014391.DOCX-}
154
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to Know
About . . .
What You Need to Do . . .
consistent with the change to your health care expenses. You
may also elect participation.

If your transfer affects your dependent care expenses, you can
increase, decrease or stop your DDCSA contributions, as long
as your election change is consistent with the life event. You
may also elect participation.

Not applicable.

You can make changes to your insured life and AD&D policies
only if your transfer impacts your eligibility for or options
under those programs. Please see the Life/AD&D SPD section
for more information.

Accident and Critical Illness
Insurance
You can make changes only if your transfer impacts your
eligibility for or options under those programs.

To enroll in Critical Illness Insurance, you must have
comprehensive medical coverage.
Disability

No changes allowed.

Not applicable. You are covered for accidents which occur
while travelling on company business as a full-time or parttime 1 employee.

No changes allowed.

Make sure you complete the paperwork required by your
facility. If your address changes, update your personal
information by contacting your local Human Resource
department.
Dependent Day Care
Spending Account (DDCSA)
Basic Life and Basic
Accidental Death and
Dismemberment (AD&D)
Employee Supplemental Life,
Spouse Life, Child Life,
Employee Supplemental
Accidental Death and
Dismemberment (AD&D),
Spouse AD&D, and Child
AD&D
Business Travel Accident
Insurance
Long-Term Care Insurance
Personnel Records
{00014391.DOCX-}
155
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
Things to Consider

If you’re being transferred to a new facility, go to MyTenet.com
for Tenet colleagues and HealthyatTenet.com for Conifer
employees and go to My Benefits or call the MyBenefits
Customer Support Center at 1-877-468-3638 to find out which
medical program options are offered in your new area.

The Employee Assistance Program is an excellent resource for
finding services and support in your new location. The EAP can
provide information and referrals for child care, elder care,
support groups, classes and a variety of other services.

Medical care: For an up-to-date directory of providers in your
new area, go to MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1877-468-3638.

Dental care: If you’re enrolled in the Dental Benefit Program,
find network dentists convenient to your new location by calling
DELTA DENTAL at 1-855-643-8516 or log on to their Web site via
My Benefits at MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees.

Prescription drugs: If you’re enrolled in the Prescription Drug
Program, contact CVS/Caremark at 1-877-906-3807 to locate a
participating pharmacy near you or log on to their Web site via
My Benefits at MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees.

Vision care: If you’re enrolled in the Vision Plan, contact the VSP
Information Line at 1-800-877-7195 or log on to the VSP Web
site via My Benefits at MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees to get a list of VSP
doctors in your new area.

If you’re being transferred to a new facility and the transfer
involves a change in your employment status (going from fulltime to part-time or vice versa), be sure to read “If Your
Employment Status Changes” below.

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health
& Savings Plan coverage.
Are You Transferring to a
New Facility?
Need Help Finding
Resources and Services in
Your New Area?
Need Help Finding Network
Providers in Your New
Area?
Is Your Employment Status
Changing?
Are You Opening an HSA or
Increasing or Decreasing
Your HSA Contributions?
If You’re Transferring Into or Out of a
Collective Bargaining Unit Position
{00014391.DOCX-}
156
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Into Collective Bargaining Unit:

You can enroll yourself, spouse and previously enrolled children
into the Medical, Dental, and Vision Program options provided by
the collective bargaining unit. (Plan option availability will depend
on the terms of the applicable collective bargaining agreement.)


You cannot enroll any new dependents.
Employee Assistance
Program (EAP)

Your EAP coverage will not be impacted.
Prescription Drug
Out of Collective Bargaining Unit:
Dental

You can enroll yourself, spouse and previously enrolled children
into the Medical, Dental, and Vision Program options available
outside the collective bargaining unit. (Your Prescription Drug
Program options will automatically change to the option
associated with your selected Medical Benefit Program option.)


You cannot enroll any new dependents.

Your EAP coverage will not be impacted.

If you are enrolled in either the Silver or Health & Savings Plan
medical program option, you may increase (up to the maximum
permitted by the IRS), decrease or stop your current HSA
contributions.

If you are enrolling in either the Silver or Health & Savings Plan
medical program option, you must open your HSA within 31 days
of your benefits effective date, in order to receive company
Health Care Coverage






Medical
Vision
Health Reimbursement
Account (HRA)
Health Savings Account
(HSA)
{00014391.DOCX-}
Your Prescription Drug option will be determined by the Medical
Benefit Program option you select. If you enroll in either the Gold
or Health & Reimbursement Plan option under the Medical
Benefit Program, you will be automatically enrolled in the Health
Reimbursement Account Program. If you drop coverage in the
Medical Benefit Program or switch your Medical Benefit Program
coverage from the Gold or Health & Reimbursement option to an
option other than the Gold or Health & Reimbursement Plan ,
your participation in the Health Reimbursement Account Program
will terminate, and you will forfeit any remaining account balance
in such program.
Your Prescription Drug option will be determined by the Medical
Benefit Program option you select. If you enroll in either the Gold
or Health & Reimbursement Plan option under the Medical
Benefit Program, you will be automatically enrolled in the Health
Reimbursement Account Program. If you drop coverage in the
Medical Benefit Program or switch your Medical Benefit Program
coverage from the Gold or Health & Reimbursement Plan option
to an option other than the Gold or Health & Reimbursement
Plan, your participation in the Health Reimbursement Account
Program will terminate, and you will forfeit any remaining
account balance in such program.
157
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
contributions and make personal contributions for you and your
spouse/child/family.

If you make changes to your medical, dental or vision coverage as
a result of your transfer that affect your health care expenses,
you can increase, decrease or stop your HCSA contributions, as
long as such HCSA election change is consistent with the change
to your health care expenses. You may also elect participation.

If your transfer affects your dependent care expenses, you can
increase, decrease or stop your DDCSA contributions, as long as
your election change is consistent with the life event. You may
also elect participation.

Not applicable.

You can make changes to your insured life and AD&D policies only
if your transfer impacts your eligibility for or options under those
programs. Please see the Life/AD&D SPD section for more
information.

Accident and Critical
Illness Insurance
You can make changes only if your transfer impacts your eligibility
for or options under those programs.

To enroll in Critical Illness Insurance, you must have
comprehensive medical coverage.
Long-Term Care Insurance

No changes allowed.

No changes allowed, unless the terms of the collective bargaining
provide otherwise.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

Make sure you complete the paperwork required by your facility.
If your address changes, update your personal information by
contacting your local Human Resource department.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
Basic Life and Basic
Accidental Death and
Dismemberment (AD&D)
Employee Supplemental
Life, Spouse Life, Child
Life, Employee
Supplemental Accidental
Death and
Dismemberment (AD&D),
Spouse AD&D, and Child
AD&D
Disability
Business Travel Accident
Insurance
Personnel Records
If Your Employment Status Changes
You could have a change in your employment status for many reasons, including cutting back on or
increasing the hours you work, moving to a new position, changing from a position classified by Tenet
{00014391.DOCX-}
158
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
as full-time to a part-time 1 or part-time 2 position (or vice versa) or becoming newly eligible for
benefits.
All of these changes can affect your benefit coverage. Find out what happens when:
 You’re no longer eligible for coverage because you switch from a position classified by Tenet as fulltime or part-time 1 to a position classified by Tenet as part-time 2
 You're no longer eligible for coverage because you cease to be an ACA Full-Time Employee,
 You gain eligibility for coverage, or
 You change from part-time 1 status to full-time (or vice versa).
Before you switch jobs or change your status, understand how your benefits may be affected.
If You Switch from a Position Classified by Tenet as Full-Time or Part-Time 1 to
a Position Classified as Part-Time 2, or if You Cease to be an ACA Full-Time
Employee
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage

Coverage in the Vision Benefit Program and the Dental Benefit
Program will terminate effective as of the last day of the month
concurrent with or following the last of the pay period in which the
switch occurred.

Your coverage in the Medical Benefit Program and the Prescription
Drug Benefit Program will terminate as of the date specified in
Tenet's ACA Compliance Full-Time Employee Determination Policy
attached as Appendix 1 to this SPD.

Your coverage under the Health Reimbursement Account Program
will terminate as of the date your Medical Benefit Program
coverage terminates, and any amounts remaining in your Health
Reimbursement Account will be forfeited.

You and your family members may be eligible to elect to continue
health care coverage under COBRA. Refer to the Other Information
section for more information on COBRA.

Your coverage under the EAP will not be impacted.

If you’re currently enrolled in either the Silver or Health & Savings
Plan medical plan option, your HSA eligibility ends on the last day of
the month that you’re no longer enrolled in such option. You may
continue to use the remaining amounts in your HSA account to pay
for eligible expenses, but you will not be able to make any further
contributions.

You can incur eligible expenses for reimbursement up to the last
day of the month in which the last pay period ends based on the
effective date of your switch to a part-time 2 position. Expenses


Medical




Prescription Drug
Employee Assistance
Program (EAP)
Dental
Vision
Health
Reimbursement
Account
Health Savings Account
(HSA)
Health Care Spending
Account (HCSA)
{00014391.DOCX-}
159
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
incurred before this date can be submitted for reimbursement
through March 31 of the next year.

You can continue your HCSA participation under COBRA until the
end of the calendar year, provided you have unreimbursed funds
remaining in your HCSA account when your eligibility ends. Refer to
the Other Information section for more information on COBRA.

Provided you have funds remaining in your account, you may
continue to submit expenses for reimbursement through the end of
the calendar year.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)


Your coverage ends.
Supplemental Employee
Life Insurance


Your coverage ends.
Coverage for your spouse or domestic partner ends.
Spouse Life Insurance


Coverage for your children ends.
Child Life Insurance



Your Business Travel Accident Insurance coverage will end on your
last day of employment. There are no conversion privileges to an
individual policy for this insurance.


Coverage ends.
Coverage for your spouse or domestic partner ends.
Spouse AD&D


Coverage for your children ends.
Child AD&D


Disability Plan

Coverage ends. No conversion allowed.
Dependent Day Care
Spending Account
(DDCSA)
Business Travel Accident
Insurance
Supplemental Accidental
Death and
Dismemberment
(AD&D)
{00014391.DOCX-}
You may be eligible to convert your coverage to an individual policy.
You may be eligible to convert your coverage to an individual policy.
Your spouse or domestic partner may be eligible to convert his or
her coverage to an individual policy.
Your child(ren) may be eligible to convert coverage to an individual
policy.
You may be eligible to convert your coverage to an individual policy.
Your spouse or domestic partner may be eligible to convert his or
her coverage to an individual policy.
Your child(ren) may be eligible to convert coverage to an individual
policy.
160
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Long-Term Care
Insurance


Coverage ends.
Accident Insurance


Coverage ends.
Critical Illness Insurance


Coverage ends.
You may be eligible to convert your coverage to an individual policy.
You may be eligible to convert your coverage to an individual policy.
You may be eligible to convert your coverage to an individual policy.
Things to Consider
Are You Losing Your
Health Care Coverage
(You’re No Longer Eligible
for Coverage)?
Are You Opening an HSA
or Increasing or
Decreasing Your HSA
Contributions?

If you’re married or in a domestic partnership and losing health
care coverage due to your change in employment status, be sure
to find out which benefit plans are offered by your spouse’s or
domestic partner’s employer.

If you’re losing health care coverage and don’t have other
coverage available to you, you may be eligible to continue your
current health care coverage under COBRA for up to 18 months.
You’ll have the same coverage, but you’ll be responsible for
paying the full cost of coverage plus an administrative fee. Refer
to the Other Information section for more information on COBRA.

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health &
Savings Plan coverage.
If You Change from Part-Time 2 Status to Full-Time or Part-Time 1
If you gain eligibility due to a switch from a position classified by Tenet as Part-time 2 to a position
classified by Tenet as Part-time 1 or Full-Time, coverage will take effect on the 31st day after you gain
benefits eligibility, provided you timely complete enrollment.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage



Medical


Prescription Drug
Employee Assistance
Program (EAP)
Dental
{00014391.DOCX-}
You and your eligible dependents can enroll for health care
coverage. If you and/or your eligible dependents enroll in the
Medical Benefit Program, you will automatically be enrolled in the
Prescription Drug option associated with your selected Medical
Benefit Program coverage option. If you enroll in either the Gold
or Health & Reimbursement option under the Medical Benefit
Program, you will automatically be enrolled in the Health
Reimbursement Account.
161
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .


What You Need to Do . . .

You and your household members will remain covered under the
EAP.

If you are enrolling in either the Silver or Health & Savings Plan
medical program option, you must open your HSA within 31 days
of your benefits effective date, in order to receive company
contributions and make personal contributions for you and your
spouse/child/family.
Health Care Spending
Account (HCSA)

You can enroll for HCSA participation.
Dependent Day Care
Spending Account
(DDCSA)

You can enroll for DDCSA participation, if you have eligible
dependents requiring care.

If you are classified as Full-Time, you will be enrolled in Basic Life
and Basic Accidental Death and Dismemberment.


Your coverage will begin within 31 days of becoming eligible.

You can enroll for coverage. EOI may be required.

You can enroll your spouse or domestic partner for coverage,
provided you have elected Supplemental Employee Life Insurance
for yourself. Your spouse’s or domestic partner’s coverage can’t
exceed 100% of your coverage amount for Supplemental
Employee Life. EOI may be required.

You can enroll your child(ren) for coverage, provided you have
elected Supplemental Life Insurance for yourself. Your child’s
coverage can’t exceed 100% of your coverage amount for
Supplemental Employee Life.

You can enroll for coverage.
Business Travel Accident
Insurance

You are covered for accidents which occur while travelling on
company business as a full-time or part-time 1 employee.
Spouse AD&D

You can enroll your spouse or domestic partner for coverage.
Child AD&D

You can enroll your child(ren) for coverage.
Vision
Health
Reimbursement
Account
Health Savings Account
(HSA)
Basic Life and Basic
Accidental Death and
Dismemberment (AD&D)
Supplemental Employee
Life Insurance
Spouse Life Insurance
Child Life Insurance
Supplemental Accidental
Death and
Dismemberment (AD&D)
{00014391.DOCX-}
Employees classified as Part-Time 1 are not eligible.
162
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

You can enroll for coverage. Eligibility for the Disability Plan for
part-time 1 employees covered by a collective bargaining
agreement (i.e. union) will depend on the terms of the agreement.
Long-Term Care
Insurance

You can enroll for coverage, provided you are a full-time employee.
Accident Insurance

You can enroll yourself and your dependents for coverage.

You can enroll for coverage if you are enrolled in a comprehensive
medical plan.

To name a beneficiary for life, AD&D, or business travel accident
insurance, please access MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees and go to My Benefits
or call the MyBenefits Customer Support Center at 1-877-4683638.
Disability Plan
Critical Illness Insurance
Naming Beneficiaries
If You Change from Part-Time 1 Status to Full-Time (or Vice Versa)
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage

If you change from part-time 1 status to full-time: If your cost of
coverage or eligibility for coverage are affected, you may change
plan options, drop coverage for some or all of your dependents or
waive coverage, as long as any change you make is consistent with
the change to cost of coverage or eligibility for coverage. If you are
continuing coverage, your payroll deductions for health care
premiums will change to the full-time premium rate. You will
automatically be enrolled in the Prescription Drug option associated
with your elected Medical Benefit Program option, if any. If you
enroll in either the Gold or Health & Reimbursement Plan option
under the Medical Benefit Program, you will automatically be
enrolled in the Health Reimbursement Account Program. If you
switch your Medical Benefit Program coverage from the Gold or
Health & Reimbursement Plan option to an option other than the
Gold or Health & Reimbursement Plan, your participation in the
Health Reimbursement Account Program will terminate and you
will forfeit any remaining balance in your account.

If you change from full-time to part-time 1 status: If your cost of
coverage or eligibility for coverage are affected, you may change
plan options, drop coverage for some or all of your dependents or
waive coverage, as long as any change you make is consistent with
the change to cost of coverage or eligibility for coverage. If you are
continuing coverage, your payroll deductions for health care
premiums will change to the part-time premium rate. You will


Medical




Prescription Drug
Employee Assistance
Program (EAP)
Dental
Vision
Health
Reimbursement
Account
{00014391.DOCX-}
163
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
automatically be enrolled in the Prescription Drug option associated
with your elected Medical Benefit Program option, if any. If you
enroll in either the Gold or Health & Reimbursement Plan option
under the Medical Benefit Program, you will automatically be
enrolled in the Health Reimbursement Account. If you switch your
Medical Benefit Program coverage from the Gold or Health &
Reimbursement Plan option to an option other than Gold or Health
& Reimbursement Plan, your participation in the Health
Reimbursement Account Program will terminate and you will forfeit
any remaining balance in your account.
Health Savings Account
(HSA)

Your coverage under the EAP will not change.

If you are covered under either the Silver or Health & Savings Plan
medical program option and have you have an HSA, you may
increase (subject to the maximum set by the IRS for your selected
level of coverage), decrease, or stop contributions.

If you are enrolling in either the Silver or Health & Savings Plan
option under the Medical Benefit Program, you must open your
HSA within 31 days of your benefits effective date, in order to
receive company contributions and make personal contributions for
you and your spouse/child/family.

If your cost of coverage or eligibility for coverage is affected, you
may enroll or increase or decrease contributions, as long as the
change is consistent with the change to your cost of coverage or
eligibility for coverage.

If your employment change affects your dependent care
arrangements, you can elect participation, increase, decrease or
stop your DDCSA contributions, as long as the change is consistent
with the life event.

If you change from part-time 1 status to full-time: You
automatically become enrolled in Basic Life and Basic AD&D.

If you change from full-time to part-time 1 status: You will no
longer be eligible for Basic Life and Basic AD&D coverage. You may
be able to convert your Basic Life coverage to an individual policy
with the insurance carrier.

No changes allowed. Your coverage will be recalculated based on
your new salary.

No changes allowed. Your spouse’s or domestic partner’s coverage
amount will be decreased only if the current coverage amount is in
excess of 100% of your Supplemental Employee Life Insurance
amount.

No changes allowed. Your child’s coverage amount will be
decreased only if the current coverage amount is in excess of 100%
of your Supplemental Employee Life Insurance amount.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)
Supplemental Employee
Life Insurance
Spouse Life Insurance
Child Life Insurance
{00014391.DOCX-}
164
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------

No changes allowed. Your coverage will be recalculated based on
your new salary.
Business Travel Accident
Insurance

You are covered for accidents which occur while travelling on
company business as a full-time or part-time 1 employee.
Spouse AD&D

No changes allowed.
Child AD&D

No changes allowed.

You may continue or elect coverage, as long as the change is
consistent with the life event. Note: Part-time 1 employees subject
to a collective bargaining agreement may not be eligible for the
Disability Plan. Please check the terms of your collective bargaining
agreement.

Long-Term Care
Insurance
If you change from part-time 1 status to full-time: You can enroll
for coverage.

If you change from full-time to part-time 1 status: You will no
longer be eligible for Long-Term Care Insurance coverage.
Accident Insurance

No changes allowed.
Critical Illness Insurance

No changes allowed.

If you gain eligibility for life and AD&D insurance, you will need to
name a beneficiary. Please access MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer employees and go
to My Benefits, or call the MyBenefits Customer Support Center at
1-877-468-3638.
Supplemental AD&D
Disability Plan
Naming Beneficiaries
Things to Consider
Are You Opening an HSA
or Increasing or
Decreasing Your HSA
Contributions?

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health
& Savings Plan coverage.
If You Want to Enroll in a Marketplace Plan
Under certain circumstances, you may be allowed to revoke your coverage (and your dependents'
coverage) in the Medical Benefit Program so that you may enroll in a health plan offered under the
Health Insurance Marketplace. You may revoke Medical Benefit Program coverage for yourself and
your dependents if:
 There is a reasonable expectation that your hours will be reduced below 30 hours per week
(regardless of whether the reduction will result in a loss of eligibility for Medical Benefit Program
coverage) and you express an intent to enroll yourself and your Dependents who will cease Medical
Benefit Program coverage due to the revocation in a plan offered under the Health Insurance
Marketplace, with the new coverage becoming effective no later than the first day of the second
month following the date Medical Benefit Program was revoked; or
{00014391.DOCX-}
165
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
 You express an intention to enroll yourself and any of your Dependents who will cease Medical
Benefit Program coverage due to the revocation in a plan offered under the Health Insurance
Marketplace during annual enrollment for the Marketplace or a Marketplace special enrollment
period, with the new coverage becoming effective no later than the day immediately following the
last day of your Medical Benefit Program coverage.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage


Medical




Prescription Drug

If you meet the requirements described above, you may revoke
your Medical Benefit Program coverage. Your associated
Prescription Drug and Health Care Reimbursement Account
coverage will also terminate.

In some limited circumstances, you and your covered dependents
may also be eligible to for COBRA continuation rights. Please see
the Other Information section of this SPD for more information.

Your coverage (and your dependents’ coverage, if any) under the
EAP, Vision Program, and Dental Program will not change.

If you’re currently enrolled in either the Silver or Health & Savings
Plan medical plan option, your HSA eligibility ends on the last day of
the month that you’re no longer enrolled in such option. You may
continue to use the remaining amounts in your HSA account to pay
for eligible expenses, but you will not be able to make any further
contributions.
Health Care Spending
Account (HCSA)

No changes are permitted.
Dependent Day Care
Spending Account
(DDCSA)

No changes are permitted.
Basic Life, Basic
Accidental Death and
Dismemberment
(AD&D), Supplemental
Life Insurance and
Supplemental AD&D

No change to your coverage.
Business Travel Accident
Insurance

No changes are permitted.
Spouse Life Insurance
and Spouse AD&D

No change to coverage.
Employee Assistance
Program (EAP)
Dental
Vision
Health
Reimbursement
Account
Health Savings Account
(HSA)
{00014391.DOCX-}
166
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Child Life Insurance and
Child AD&D

No change to coverage.
Disability Plan (LTD
Portion Only)

No change to coverage.
Accident Insurance

No change to coverage.
Critical Illness Insurance

No change to coverage.
Long-Term Care
Insurance

No change to coverage.

Visit www.healthcare.gov.
Things to Consider
Are you interested in
learning more about
your Health Insurance
Marketplace options?
If You’re Leaving Tenet
Your coverage under the Tenet benefit plans ends on the date specified in the Eligibility and Enrollment
section of this SPD. In some cases, however, you may be able to continue coverage. It’s important to
review the following information to be sure you have the coverage you need.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage


Medical




Prescription Drug

You and your covered dependents may be eligible to continue
coverage under COBRA for a period of up to 18 months. COBRA
information will be sent to you after you leave the company. You’ll
have 60 days from the date you were notified of your COBRA rights
to elect COBRA coverage. See the Other Information section for
more information on COBRA.

Your coverage (and your dependents’ coverage) under the EAP will
automatically be extended until the end of the COBRA period. No
election is necessary. See the EAP section of the TEBP SPD for more
information.

If you’re currently enrolled in either the Silver or Health & Savings
Plan medical plan option, your HSA eligibility ends on the last day of
the month that you’re no longer enrolled in such option. You may
Employee Assistance
Program (EAP)
Dental
Vision
Health
Reimbursement
Account
Health Savings Account
(HSA)
{00014391.DOCX-}
167
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
continue to use the remaining amounts in your HSA account to pay
for eligible expenses, but you will not be able to make any further
contributions.

If you continue your Silver or Health & Savings Plan coverage under
the Medical Benefit Program through COBRA, contact your HSA
provider about the possibility of continuing HSA contributions on an
after-tax basis.

You can incur eligible expenses for reimbursement only up to your
last day of work, also known as your “termination date.” Expenses
incurred before this date can be submitted for reimbursement
through March 31 of the next year.

You can continue your HCSA participation under COBRA until the
end of the calendar year, provided you have unreimbursed funds
remaining in your HCSA account on your termination date. You
must pay the full cost of this coverage with after-tax dollars, and
you must also pay a 2% administrative fee. See the Other
Information section for more information on COBRA.

Your participation will end on December 31 of the current calendar
year, regardless of the date you leave Tenet. You can continue to be
reimbursed for eligible dependent care expenses incurred during
the entire calendar year, up to the amount you actually contributed
to your DDCSA prior to your last day worked. You have until March
31 of the next year to submit claims for reimbursement.


Your coverage will end on your last day of employment.

Your Business Travel Accident Insurance coverage will end on your
last day of employment. There are no conversion privileges to an
individual policy for this insurance.

Your spouse’s or domestic partner’s coverage will end on your last
day of employment.
Spouse Life Insurance
and Spouse AD&D

Your spouse or domestic partner’s life insurance coverage may be
eligible to be converted to an individual policy. The life insurance
carrier will mail your spouse or domestic partner conversion
information after you terminate.
Child Life Insurance and
Child AD&D

Your child’s coverage will end on your last day of employment.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
Basic Life, Basic
Accidental Death and
Dismemberment
(AD&D), Supplemental
Life Insurance and
Supplemental AD&D
Business Travel Accident
Insurance
{00014391.DOCX-}
You may be able to convert your life insurance coverage to an
individual policy. The life insurance carrier will mail you conversion
information after you terminate.
168
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

Your child’s life insurance coverage may be eligible to be converted
to an individual policy. The life insurance carrier will mail your child
conversion information after you terminate.

Your coverage will end on your last day of employment. You may
elect to convert this coverage to an individual policy — provided
you’re not currently disabled — by contacting Unum at 1-888-8522232.

Your coverage will end on your last day of employment. You may
elect to convert this coverage to an individual policy.

Your coverage will end on your last day of employment. You may
elect to convert this coverage to an individual policy.

Your coverage will end on your last day of employment. You may
elect to convert this coverage to an individual policy by contacting
Unum at 1-800-852-2232.

Be sure to check with your new employer to see when your health
care benefits take effect. If there’s a lapse, you and your
dependents may be eligible to elect COBRA continuation coverage
until your benefits start.

If you move to a new location after leaving Tenet, be sure to update
your address by contacting the Human Resource department of the
Tenet facility where you last worked.
Disability Plan (LTD
Portion Only)
Accident Insurance
Critical Illness Insurance
Long-Term Care
Insurance
Things to Consider
When Do Your Benefits
Start with Your New
Employer?
Are You Moving To A
New Location?
If You’re Reinstated Within 30 Days
If you leave Tenet and are reinstated within 30 days, your prior health care benefits (medical, dental
and vision) are reinstated for you and your dependents. You must re-elect any life, accidental death
and dismemberment, disability and/or long-term care coverage. Depending on your circumstances, you
may be able to make Health Care and Dependent Day Care Spending Account changes.
Making a Benefit Change?
If you’re making any benefit changes or electing coverage upon being reinstated, please access
MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days of your
reinstatement. Be sure to submit elections by the deadline or you won’t be able to change or
participate in certain benefits!
{00014391.DOCX-}
169
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage


Medical




Prescription Drug
Employee Assistance
Program (EAP)


You and your dependents are reinstated to your prior coverage.

If you were previously enrolled in either the Silver or Health &
Savings Plan medical plan option, you resume your HSA
contributions the first of the month following your reinstatement
date. You may also increase (subject to the IRS limitations for your
elected coverage), decrease, or stop coverage.

If you were previously enrolled, you continue participation at your
prior HCSA contribution rate.

If you were previously enrolled, you continue participation at your
prior DDCSA contribution rate. You also may increase, decrease or
stop contributions, if the circumstances of your reinstatement
have affected your child care requirements.

If you were not previously enrolled, you can elect participation, if
the circumstances of your reinstatement have affected your child
care requirements.

You will be enrolled in Basic Life and Basic Accidental Death and
Dismemberment.

If you previously completed the 30 day waiting period, your
coverage will begin immediately.

You can enroll for coverage. No Evidence of Insurability (EOI) is
required up to $750,000 of coverage.

You can enroll your spouse for coverage, provided you’re enrolled
in Supplemental Employee Life Insurance or are electing coverage.
(EOI) may be required.

Your spouse’s coverage can’t exceed 100% of your coverage
amount for Supplemental Employee Life.

You can enroll your eligible children, provided you’re enrolled in
Supplemental Employee Life Insurance or are electing coverage.
Dental
If your prior medical coverage is not available, you may elect new
medical coverage only.
Vision
Health
Reimbursement
Account
Health Savings Account
(HSA)
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
Basic Life and Basic
Accidental Death and
Dismemberment (AD&D)
Supplemental Employee
Life Insurance
Spouse Life Insurance
Child Life Insurance
{00014391.DOCX-}
170
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
Child coverage can’t exceed 100% of your coverage amount for
Supplemental Employee Life.
Supplemental Accidental
Death and
Dismemberment (AD&D)

You can enroll for coverage.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.
Spouse AD&D

You can enroll your spouse or domestic partner for coverage.
Child AD&D

You can enroll your eligible children for coverage.

You can enroll for coverage, if eligible. (Eligibility for a part-time 1
union employee is subject to the terms of the applicable collective
bargaining agreement.)
Long-Term Care
Insurance

If you’re a full-time employee, you can enroll for coverage. No
Evidence of Insurability (EOI) is required.
Accident Insurance

You can enroll for coverage.
Critical Illness Insurance

You can enroll for coverage.
Business Travel Accident
Insurance
Disability Plan
If You Take a Leave of Absence
Tenet understands that there are times when you may need to take time off from your job to see to
important personal needs or commitments. To help you take the time you need, Tenet offers the
following types of leaves of absence:
 Family and medical leave (FMLA),
 General/Personal/Medical non-FMLA/extended leave, and
 Military leave
If you haven’t satisfied the 30-day benefit eligibility period and you take a personal or extended leave
of absence, any employment time you had with Tenet prior to your leave will count toward satisfying
the benefit eligibility period upon your return. Your coverage will begin once you have returned to
work.
In all cases, if you elect to suspend or cancel your health care coverage while you’re on a leave, you
won’t be given the opportunity to continue them under COBRA. (In some circumstances, you may be
entitled to COBRA, however, if you decide not to return to work after your leave ends. See the
“Other Information” section of the TEBP for more information.
Making a Benefit Change?
If you’re making any benefit changes due to a leave of absence, please contact the MyBenefits
Customer Support Center at 1-877-468-3638 within 31 days of beginning your leave. You must provide
notification of your leave by the deadline or you won’t be able to change your benefits.
{00014391.DOCX-}
171
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
For Billing and Payment Questions During a Leave of Absence
If you are making benefit payments during a leave of absence and have questions, please contact the
MyBenefits Customer Support Center at 1-877-468-3638.
Family and Medical Leave
When Are You Entitled to FMLA Leave?
If you are approved for FMLA, you are entitled to up to 12 weeks of leave:
 Following the birth of a child and to care for the child within one year of birth;
 Following the placement of a child with you for adoption or foster care and to care for the child
within one year of the placement;
 To care for your spouse, child, or parent who has a serious health condition;
 If you have a serious health condition that makes you unable to perform the essential functions of
your job; or
 Because of a qualifying exigency arising out of the fact that your son, daughter, spouse, or parent is
a covered military member on covered active duty.
You are entitled to up to 26 weeks of FMLA Leave:
 To care for your son, daughter, spouse, parent, or next of kin who is a covered service member and
who has a serious injury or illness.
You are only entitled to FMLA leave if you have worked for Tenet for 12 months (and at least 1,250
hours within the past 12 months). Please contact your local HR representative for more information.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage

You can continue your health care coverage at active employee rates
during your FMLA leave (up to a maximum period of 12 weeks or 26
weeks if your FMLA is to care for your spouse, son, daughter, parent, or
next of kin who is a covered service member and who has a serious
injury or illness). If your leave extends beyond the maximum FMLA
period (12 weeks or 26 weeks, if applicable), your rates will change. You
can make changes to your health care coverage again at that time.

You can drop some or all of your dependents, or you can suspend
coverage entirely during your leave. When you return to active status,
you’ll need to reenroll for coverage no later than 31 days from the date
you return to work if you would like your coverage reinstated. You and
your dependents will be able to re-enroll in the same health care plans
you had prior to your leave.

Your EAP coverage will continue at no cost to you during your FMLA
leave.

If you maintain coverage in either the Silver or Health & Savings Plan
medical program option, you can increase (subject to the IRS maximum


Medical




Prescription Drug
Employee
Assistance Program
(EAP)
Dental
Vision
Health
Reimbursement
Account
Health Savings
Account (HSA)
{00014391.DOCX-}
172
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
for your elected level of coverage), decrease or stop your HSA
contributions.
Health Care Spending
Account (HCSA)

If you suspend your Silver or Health & Savings Plan coverage, you will no
longer be eligible to make HSA contributions as of the last day of the
month in which your coverage is suspended. You may continue to use
the remaining amounts in your HSA account to pay for eligible
expenses.

You can continue participation during your leave by paying your
contributions on an after-tax basis. Please consult with the Plan
Administrator to determine a payment schedule.

You can suspend participation during your leave. You’ll have the
opportunity to re-enroll, provided you do so within 31 days of returning
to work. If you suspend participation, you won’t be reimbursed for any
expenses incurred during your leave. When you re-enroll, your
remaining contributions are divided evenly among your pay periods
through the rest of the year.

You can decrease or continue participation during your leave. You must
pay your contributions on an after-tax basis. Contact your local Human
Resource department within 31days of your leave date to arrange for
payment.

However, your DDCSA can only reimburse dependent care expenses
incurred while you’re working. If your child continues in dependent care
during your family leave of absence, those expenses can’t be
reimbursed from the DDCSA. If you contribute to your DDCSA during
your leave, the amount must be applied to dependent care expenses
incurred during the part of the year when you are working.

You can suspend participation during your leave. When you return to
active status, you can reinstate your contributions back to the annual
amount you were contributing prior to your leave or increase them to a
higher amount if your provider charges are increased. When you reenroll, your remaining contributions are divided evenly among your pay
periods through the rest of the year.

Your coverage continues during your leave.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If you cancel your coverage
or if your coverage terminates due to nonpayment of premiums, you
must re-enroll upon your return to active status in order to obtain
coverage again. You’ll be allowed to re-enroll at your prior election
without showing Evidence of Insurability (EOI).
Dependent Day Care
Spending Account
(DDCSA)
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)
Supplemental
Employee Life
Insurance and
Supplemental AD&D
{00014391.DOCX-}
173
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If you suspend Supplemental Life for yourself you must also suspend
Spouse and Child Life. If your Supplemental Life coverage terminates
due to failure to pay Supplemental Life premiums, Spouse and Child Life
coverage will also terminate.

You can continue coverage during your leave. If you’re continuing
Spouse Life Insurance, you must also continue Supplemental Employee
Life Insurance. Contact the MyBenefits Customer Support Center at 1877-468-3638 to arrange for premium payments. (Coverage will
terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If you cancel coverage or if
coverage has terminated for any reason, your spouse or domestic
partner is eligible upon your return to re-enroll at the coverage level
elected prior to taking your leave without providing EOI. You’ll also
need to reinstate your Supplemental Employee Life Insurance for
Spouse Life coverage to take effect.

If you cancel, your spouse may be able to convert coverage to an
individual policy.

You can continue coverage during your leave. If you’re continuing Child
Life Insurance, you must also continue Supplemental Employee Life
Insurance. Contact the MyBenefits Customer Support Center at 1-877468-3638 to arrange for premium payments. (Coverage will terminate
for nonpayment of premiums.)
Child Life Insurance
and Child AD&D

You can cancel coverage during your leave. If you cancel coverage or if
coverage has terminated for any reason, your child is eligible upon your
return to re-enroll at the coverage level elected prior to taking your
leave without providing EOI. You’ll also need to reinstate your
Supplemental Employee Life Insurance for Child Life coverage to take
effect. If you cancel, your child may be able to convert coverage to an
individual policy.
Business Travel
Accident Insurance

Your coverage will be suspended until you return from leave.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If your coverage has been
canceled or terminated, when you return, you can re-enroll at the
coverage level you elected prior to taking your leave. You must re-enroll
in order to obtain coverage again.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If you cancel coverage or if
coverage has terminated due to nonpayment of premiums, you must
re-enroll upon your return to active status in order to obtain coverage
again. You’ll be allowed to re-enroll at your prior level provided without
providing EOI. If your leave is longer than six months, you won’t be able
Spouse Life Insurance
and Spouse AD&D
Disability Plan
Long-Term Care
Insurance
{00014391.DOCX-}
174
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
to re-enroll until the next annual enrollment period and you will be
subject to EOI approval. If you don’t return from leave, you won’t have
the opportunity to convert your long-term care coverage to an
individual policy.
Accident Insurance
Critical Illness
Insurance

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If your coverage has been
canceled or terminated, when you return to active status, you’ll be
allowed to re-enroll to your prior election. You must re-enroll in order
to obtain coverage again.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If your coverage has been
canceled or terminated, when you return to active status, you’ll be
allowed to re-enroll to your prior election (if you have comprehensive
medical coverage). You must re-enroll in order to obtain coverage
again.
Things to Consider

Will your leave extend
beyond the maximum
FMLA period?
While you are on FMLA leave, your health coverage premiums will
remain at the active employee rate. However, if your leave of
absence extends beyond the maximum FMLA period available to
you, then your coverage premiums will increase to the leave of
absence rates (100% of both the employee and employer portion of
the premium).
General/Personal/Medical non-FMLA/extended leave
All personal or extended leaves of absence must be approved by Tenet.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage

You can continue coverage for you and/or your dependents up to 12
months by paying leave of absence rates administered by MyBenefits
Customer Support Center during your approved leave.

You can drop some or all of your dependents, or you can suspend
coverage entirely during your leave. Contact the MyBenefits Customer
Support Center at 1-877-468-3638 to let them know you’re suspending
coverage. When you return to active status, you’ll need to re-enroll for


Medical

Prescription Drug
Employee
Assistance Program
(EAP)
{00014391.DOCX-}
175
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .



What You Need to Do . . .
coverage no later than 31 days from the date you return to work if you
would like your coverage reinstated. You and your dependents will be
able to re-enroll in the same health care plans you had prior to your
leave.
Dental
Vision
Health
Reimbursement
Account
Health Savings Account
(HSA)
Health Care Spending
Account (HCSA)

If you are enrolled in either the Gold or Health & Reimbursement
option under the Medical Benefit Program and you choose to suspend
your coverage during your leave, your HRA Account will be frozen
during the period of your leave, and you may not obtain
reimbursement from your HRA Account for any expenses incurred
during the period of your leave. If you re-enroll in the Gold or Health
& Reimbursement Medical Benefit Program option upon your return,
your HRA Account will be reinstated.

Your EAP coverage will automatically extend during your approved
leave of absence at no cost to you.

If you maintain coverage in either the Silver or Health & Savings Plan
medical program option, you can increase (up the maximum
established by the IRS for your selected level of coverage), decrease or
stop your HSA contributions.

If you suspend your Silver or Health & Savings Plan coverage, you will
no longer be eligible to make HSA contributions as of the last day of
the month in which your coverage is suspended. You may continue to
use the remaining amounts in your HSA account to pay for eligible
expenses.

You can continue participation during your leave by paying your
contributions on an after-tax basis. Please consult with the Plan
Administrator to determine a payment schedule.

You can suspend participation during your leave. You’ll have the
opportunity to re-enroll, provided you do so within 31 days of
returning to work. If you suspend participation, you won’t be
reimbursed for any expenses incurred during your leave. When you reenroll, your remaining contributions are divided evenly among your
pay periods through the rest of the year.

You can decrease or continue participation during your leave. You
must pay your contributions on an after-tax basis.

However, your DDCSA can only reimburse dependent care expenses
incurred while you’re working. If your child continues in dependent
care during your family leave of absence, those expenses can’t be
reimbursed from the DDCSA. If you contribute to your DDCSA during
your leave, the amount must be applied to dependent care expenses
incurred during the part of the year when you are working.

You can suspend participation during your leave. When you return to
active status, you can reinstate your contributions back to the annual
Dependent Day Care
Spending Account
(DDCSA)
{00014391.DOCX-}
176
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
amount you were contributing prior to your leave or increase them to
a higher amount if your provider charges are increased. When you reenroll, your remaining contributions are divided evenly among your
pay periods through the rest of the year.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)
Supplemental
Employee Life
Insurance and
Supplemental AD&D


You can continue coverage during your leave for up to 12 months.

You can continue coverage during your leave. Contact the
MyBenefits Customer Support Center at 1-877-468-3638 to arrange for
premium payments. (Coverage will terminate for nonpayment of
premiums.)

You can cancel coverage during your leave. If coverage has been
canceled or terminated, when you return to active status, you can reelect the coverage level you elected prior to taking your leave. EOI will
be required. You must re-enroll in order to begin receiving coverage
again.

If you suspend Supplemental Life for yourself you must also suspend
Spouse and Child Life.

You can continue coverage during your leave. If you’re continuing
Spouse Life Insurance, you must also continue Supplemental Employee
Life Insurance. Contact the MyBenefits Customer Support Center at 1877-468-3638 to arrange for premium payments. (Coverage will
terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If coverage has been
canceled or terminated, when you return, your spouse or domestic
partner is eligible to re-enroll at the coverage level elected prior to
taking your leave. You’ll also need to reinstate your Supplemental
Employee Life Insurance for Spouse Life coverage to take effect. EOI
will be required. Your spouse or domestic partner must re-enroll in
order to begin receiving coverage again.

If you cancel, your spouse may be able to convert coverage to an
individual policy.

You can continue participation during your leave. If you’re continuing
Child Life Insurance, you must also continue Supplemental Employee
Life Insurance. Contact the MyBenefits Customer Support Center at 1877-468-3638 to arrange for premium payments. (Coverage will
terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If coverage has been
canceled or terminated, when you return, you can re-enroll your
children for coverage at their prior level(s). Your child must be reenrolled in order to begin receiving coverage again. EOI will be
required.
Spouse Life Insurance
and Spouse AD&D
Child Life Insurance and
Child AD&D
{00014391.DOCX-}
If you choose not to continue your coverage during your leave, upon
return to active status your coverage will be reinstated.
177
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
Business Travel
Accident Insurance
Disability Plan
Accident Insurance
Critical Illness Insurance
Long-Term Care
Insurance
What You Need to Do . . .

If you cancel, your child may be able to convert coverage to an
individual policy.

Your coverage will be suspended until you return from leave.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If your coverage has been
canceled or terminated, when you return, you can re-enroll at the
coverage level you elected prior to taking your leave. You must reenroll in order to obtain coverage again.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If your coverage has been
canceled or terminated, when you return to active status, you’ll be
allowed to re-enroll to your prior election. You must re-enroll in order
to obtain coverage again.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If your coverage has been
canceled or terminated, when you return to active status, you’ll be
allowed to re-enroll to your prior election (as long as you have
comprehensive medical coverage). You must re-enroll in order to
obtain coverage again.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If your coverage has been
canceled or terminated, when you return to active status, you’ll be
allowed to re-enroll to your prior election. EOI will be required. If your
leave is longer than six months, you won’t be able to re-enroll until the
next annual enrollment period and you will be subject to EOI approval.
If you don’t return from leave, you won’t have the opportunity to
convert your long-term care coverage to an individual policy.
Military Leave
What is Military Leave?
Military Leave means service within the “uniformed services,” as such term is defined in the Uniformed
Services Employment and Reemployment Rights Act of 1994, as amended (USERRA). It includes
{00014391.DOCX-}
178
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
voluntary or involuntary duty in the Army, Navy, Marine Corps, Air Force, Coast Guard, and Public
Health Service commissioned corps, as well as the reserve components of each of those services. It
also includes federal training or service in the Army National Guard and the Air National Guard. Finally,
certain disaster response work (and authorized training for such work) may be considered “uniformed
service.” Please see the Department of Labor’s website (www.dol.gov) or contact your Plan
Administrator for more information on USERRA.
What You Need to
Know About . . .
What You Need to Do . . .
Health Care Coverage

You can continue your health care coverage at active employee rates
for up to 90 days. After 90 days, you may continue coverage at leave
of absence rates (100% of both the employer and employee portion
of the premium) for up to nine months from the initial date of the
leave and then at COBRA rates (102% of both the employer and
employee portion of the premium) for up to 24 months from the
initial date of the leave. Leave payments are required and will be
administered through the MyBenefits Customer Support Center.

You can drop some or all of your dependents, or you can suspend
coverage entirely during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to let them know you’re
suspending coverage. When you return to active status, you’ll need to
re-enroll for coverage no later than 31 days from the date you return
to work if you would like your coverage reinstated. You and your
dependents will be able to re-enroll in the health care plans.

EAP coverage will automatically extend (at no cost to you) during your
military service for a period of up to 24 months from the date your
military leave begins.

If you maintain coverage in either the Silver or Health & Savings Plan
medical plan option, you can increase (up to the maximum
established by the IRS for your level of coverage), decrease or stop
your HSA contributions.

If you suspend your Silver or Health & Savings Plan coverage, you will
no longer be eligible to make HSA contributions as of the last day of
the month in which your coverage is suspended. You may continue to
use the remaining amounts in your HSA account to pay for eligible
expenses.

You can continue participation while on leave by paying your
contributions on an after-tax basis. You can’t change the amount of
your contribution, unless you drop health care coverage for you or a
dependent, in which case you can decrease your contributions.

You can suspend participation while you’re on leave. You’ll have the
opportunity to re-enroll, provided you do so within 31 days of
returning to work. If you suspend participation, you won’t be
reimbursed for any expenses incurred during your leave. When you


Medical




Prescription Drug
Employee Assistance
Program (EAP)
Dental
Vision
Health
Reimbursement
Account
Health Savings Account
(HSA)
Health Care Spending
Account (HCSA)
{00014391.DOCX-}
179
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
re-enroll, your remaining contributions are divided evenly among
your pay periods through the rest of the year.

You can decrease or continue participation during your leave. You
must pay your contributions on an after-tax basis.

Dependent Day Care
Spending Account
(DDCSA)
Keep in mind that your DDCSA can only reimburse dependent
expenses incurred while you and your spouse are working.

You can suspend participation during your leave. When you return to
active status, you can reinstate your contributions back to the annual
amount you were contributing prior to your leave or increase them to
a higher amount if your provider charges are increased. When you reenroll, your remaining contributions are divided evenly among your
pay periods through the rest of the year.
Basic Life and Basic
Accidental Death and
Dismemberment (AD&D)

You can continue coverage during your leave.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If you cancel your
coverage or if your coverage terminates due to nonpayment of
premiums, you must re-enroll upon your return to active status in
order to obtain coverage again. You’ll be allowed to re-enroll at your
prior election without showing EOI.

If you suspend Supplemental Life for yourself you must also suspend
Spouse and Child Life.

You can continue coverage during your leave. If you’re continuing
Spouse Life Insurance, you must also continue Supplemental
Employee Life Insurance. Contact the MyBenefits Customer Support
Center at 1-877-468-3638 to arrange for premium payments.
(Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If your coverage is
canceled or terminated, when you return, your spouse or domestic
partner is eligible to re-enroll at the coverage level elected prior to
taking your leave without showing EOI. You’ll also need to reinstate
your Supplemental Employee Life Insurance for Spouse Life coverage
to take effect. Your spouse or domestic partner must re-enroll in
order to begin receiving coverage again.

If you cancel, your spouse may be able to convert coverage to an
individual policy.
Supplemental Employee
Life Insurance and
Supplemental AD&D
Spouse Life Insurance
and Spouse AD&D
{00014391.DOCX-}
180
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
Child Life Insurance and
Child AD&D
Business Travel Accident
Insurance
Disability Plan
Accident Insurance
Critical Illness Insurance
Long-Term Care
Insurance
{00014391.DOCX-}
What You Need to Do . . .

You can continue coverage during your leave. If you’re continuing
Child Life Insurance, you must also continue Supplemental Employee
Life Insurance. Contact the MyBenefits Customer Support Center at 1877-468-3638 to arrange for premium payments. (Coverage will
terminate for nonpayment of premiums.)

You can cancel Child AD&D coverage during your leave. If coverage is
canceled or terminated, when you return, you can re-enroll your
children for coverage at their prior level(s) without showing EOI. Your
child must be re-enrolled in order to begin receiving coverage again.
You’ll need to reinstate your Supplemental Employee Life Insurance
before Child Life coverage takes effect.

If you cancel, your child may be able to convert coverage to an
individual policy.

Your coverage will be suspended until you return from leave.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel participation while you’re on leave. If your coverage is
canceled or terminated, when you return, you can re-enroll at the
coverage level you elected prior to taking your leave.You must reenroll in order to obtain coverage again.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If coverage is canceled or
terminated, when you return to active status, you’ll be allowed to reenroll to your prior election. You must re-enroll in order to obtain
coverage again.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If coverage is canceled or
terminated, when you return to active status, you’ll be allowed to reenroll to your prior election (if you have comprehensive medical
coverage). You must re-enroll in order to obtain coverage again.

You can continue coverage during your leave. Contact the MyBenefits
Customer Support Center at 1-877-468-3638 to arrange for premium
payments. (Coverage will terminate for nonpayment of premiums.)

You can cancel coverage during your leave. If coverage is canceled or
terminated, when you return to active status, you may re-enroll at
181
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
your prior level without showing EOI. If your leave is longer than six
months, you won’t be able to re-enroll until the next annual
enrollment period and you will be subject to EOI approval. If you
don’t return from leave, you won’t have the opportunity to convert
your long-term care coverage to an individual policy.
Things to Consider

If you take a leave of absence and you’re electing to continue eligible
coverage, you’ll need to pay for this coverage by each payment due
date. If you do not pay your bill on time, all coverage will be
dropped.

Remember, a family and medical leave can be taken only up to a
maximum period of 12 or 26 weeks, as applicable (see “Family and
Medical Leave” above for more information. If you arrange for
additional leave, your rates will change to the leave of absence rates.
You can make changes to your health care coverage again at that
time.
Are You Feeling
Overwhelmed with
Your Caregiving
Responsibilities During
Your Family and
Medical Leave?

If you’re taking a family and medical leave to care for a loved one
and you’re feeling overwhelmed, the Employee Assistance Program
(EAP) can assist you. Contact GuidanceResources at 1-844-416-1158
and speak with a counselor, who can help you through this difficult
time.
How Long Can
Coverage Continue
During a Leave of
Absence (Other Than
an FMLA Leave)?

For personal leave, your coverage can continue up to 12 months.
When coverage ends after 12 months, you can continue eligible
health care coverages by electing COBRA for up to an additional 18
months. For military leave, your coverage can continue for up to 24
months from the date of your leave.

Even if your coverage under Tenet benefit programs continues
during military service, many benefit programs do not offer coverage
for injuries, illnesses, or conditions that result from military service.
See the individual SPD sections for each benefit program for more
information.

If you are planning to take an FMLA, personal, or military leave,
please contacting Human Resources as soon as possible to obtain
approval for your leave and work out payment issues for any
benefits you wish to and are permitted to continue during your
leave.

If the need for your FMLA leave is foreseeable, you must provide
Tenet with at least 30 days’ notice prior to taking your FMLA leave.
Are You Planning to
Continue Your Tenet
Coverage During a
Leave of Absence?
How Long Is Your
Family and Medical
Leave Expected to Last?
Will Injuries, Illnesses,
or Conditions Resulting
from Military Service
Be Covered?
Are There
Documentation
Requirements?
{00014391.DOCX-}
182
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
Are You Increasing or
Decreasing Your HSA
Contributions?

You must notify Tenet Human Resources of your intent to take
military leave as allowed by USERRA as far in advance as is
reasonable under the circumstances.

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health &
Savings Plan coverage.
If You Pass Away
Some coverages may continue after your death and others will end. Your family should be sure to
review the following information carefully.
Helping Your Loved Ones Cope with Your Passing
Free confidential counseling services are provided by the Employee Assistance Program (EAP). For a
free consultation, your family members may contact GuidanceResources at 1-844-416-1158.
What Your Family Needs
to Know About . . .
Health Care Coverage


Medical




Prescription Drug
What Your Family Needs to Do . . .

Employee Assistance
Program (EAP)
Dental

Vision
Health Reimbursement
Account


If your spouse is the designated beneficiary of your HSA, it will
be treated as your spouse’s HSA after your death. (Your
spouse’s ability to make further contributions to the HSA will
depend on whether your spouse is an eligible person as
determined by rules established by the IRS. Please consult your
tax advisor for more information.)

If your spouse is not the designated beneficiary of your HSA,
upon your death, the HSA will stop being an HSA and the fair
market value of the account will be taxable to the beneficiary in
the year of your death.
Health Savings Account
(HSA)
{00014391.DOCX-}
Health care coverage for your covered dependents will end on
the date of your death. If you participated in the Health
Reimbursement Account, your dependents can submit for
reimbursement any expenses incurred up to the date of your
death. Any amounts remaining in your account after the
deadline for submission of reimbursement claims will be
forfeited.
Your covered dependents may be eligible to continue health care
coverage under COBRA for a period of up to 36 months. COBRA
information will be sent to them within 44 days of the date of
your death. They’ll have 60 days from the date of your death or
the date they were notified of their COBRA rights, whichever is
later, to elect COBRA coverage. Refer to the Other Information
section for more information on COBRA.
Your dependents’ coverage under the EAP will continue
automatically for the duration of the COBRA period. No election
is necessary.
183
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What Your Family Needs
to Know About . . .
What Your Family Needs to Do . . .

If your estate is the beneficiary of your HSA, the value of the HSA
will be included on your final income tax return.

HCSA participation will end on the date of your death. Your
dependents can submit for reimbursement of eligible expenses
incurred only up to your date of death. Any amounts remaining
in your account after the deadline for submission of
reimbursement claims will be forfeited.

DDCSA participation will end on the date of your death. Your
dependents cannot continue DDCSA participation under COBRA.
Your dependents can continue to be reimbursed for eligible
dependent care expenses incurred during the entire calendar
year, up to the amount you actually contributed to your DDCSA.


Coverage will end on your date of death.

Death claim processing will be handled through The Hartford.
Correspondence to your beneficiary will be sent directly from
The Hartford.

Your spouse’s or domestic partner’s life insurance coverage will
end on your date of death. Your spouse or domestic partner may
be able to convert his or her coverage to an individual policy. The
life insurance carrier will mail conversion information to your
spouse or domestic partner.

Your child’s life insurance coverage will end on your date of
death. His or her coverage may be able to be converted to an
individual policy. The life insurance carrier will mail conversion
information to your child.
Disability Plan

Coverage will end on your date of death.
Accident Insurance

Coverage will end on your date of death.

Coverage will end on your date of death. It may be possible for
your spouse's coverage under the Critical Illness Program, if any,
to be converted to an individual policy. Child coverage may not
be converted.

Coverage will end on your date of death.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account (DDCSA)
Basic Life, Personal
Accident Death and
Dismemberment (AD&D),
Supplemental Employee
Life Insurance,
Supplemental AD&D
Business Travel Accident
Insurance
Spouse Life Insurance and
Spouse AD&D
Child Life Insurance and
Child AD&D
Critical Illness Insurance
Long-Term Care Insurance
{00014391.DOCX-}
Death claim processing will be handled through Unum.
Correspondence to your beneficiary will be sent directly from
Unum.
184
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What Your Family Needs
to Know About . . .
What Your Family Needs to Do . . .
Things to Consider

Your spouse or domestic partner may want to consider obtaining
coverage under his or her employer’s health care plan. Since
there’s a specific window of time in which your spouse or
domestic partner will be able to elect employer-provided
coverage as a result of losing Tenet coverage, he or she should
explore this option as soon as possible.

If no other coverage is available, your dependents may be
eligible to elect to continue coverage under COBRA. Refer to the
Other Information section for more information on COBRA.

If your family moves to a new location after your death, they
should be sure to contact the facility where you last worked, to
update their address. This will help guarantee that they continue
to receive beneficiary information, as well as any pertinent
health care information (if they’ve elected COBRA continuation
coverage).
Do Your Dependents
Currently Have Tenet
Health Care Coverage?
Would Your Family Move
as a Result of Your Death?
If You Experience the Loss of a Loved One
Coping with a Loss? The EAP is Here to Help
The Employee Assistance Program (EAP) can help you obtain support and counseling should you or
your family needs professional, confidential assistance in coping with your loss. For a free consultation,
contact GuidanceResources at 1-844-416-1158.
Making a Benefit Change?
If you’re making any benefit changes due to loss of a spouse, domestic partner or child, please access
MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees and go to My
Benefits or call the MyBenefits Customer Support Center at 1-877-468-3638 within 31 days from the
date of your loved one’s passing. You must provide notification by the deadline or you won’t be able
to change your benefits.
What You Need to
Know About . . .
Health Care Coverage

Medical
{00014391.DOCX-}
What You Need to Do . . .

If your spouse dies: You must notify the MyBenefits Customer
Support Center of the death no later than 31 days from the date of
death. If currently covered under the Tenet health care plans, you
must cancel your spouse’s coverage. You can add or drop eligible
children or change plan options. If you are not currently covered
185
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .

Employee
Assistance
Program (EAP)




Prescription Drug
What You Need to Do . . .
under the Tenet health care plans, you’ll have 31 days from the date
of death to enroll yourself and any eligible children. You must enroll
yourself for coverage to cover your dependents.

If your domestic partner dies: You must notify the MyBenefits
Customer Support Center of the death no later than 31 days from the
date of the death. If currently covered under the Tenet health care
plans, you must cancel your domestic partner’s coverage. If your
domestic partner qualified as your federal tax dependent (within the
meaning of IRC section 152, determined without regard to sections
152(b)(1) and (b)(2), which contain certain inapplicable exceptions to
the definition of dependent, and section 152(d)(1)(B), which contains
a gross income limitation), you may change your health plan options
or enroll any other dependents. If you or your dependents are not
covered under Tenet’s health plans and you lose coverage under
another health plan as a result of your domestic partner’s death, you
may enroll yourself and any of your dependents who have lost other
coverage.

If your child dies: You must notify the MyBenefits Customer Support
Center of the death no later than 31 days from the date of death. If
currently covered under the Tenet health care plans, you must cancel
your child’s coverage.

If you enroll in the Medical Benefit Program or switch Medical Benefit
Program options, you will automatically be enrolled in the
Prescription Drug option associated with your elected Medical Benefit
Program option. If you enroll in either the Gold or Health &
Reimbursement Plan option under the Medical Benefit Program, you
will automatically be enrolled in the Health Reimbursement Account
Program. If you were previously enrolled in the Gold or Health &
Reimbursement Plan option under the Medical Benefit Program and
you switch to an option other than the Gold or Health &
Reimbursement Plan (or if you drop Medical Benefit Program
coverage altogether), your participation in the Health Reimbursement
Account will terminate and you will forfeit any remaining balance in
your account.

There is no change to your EAP coverage as a result of the death of
your loved.

If as a result of the death of your loved one, you change your Silver or
Health & Savings Plan coverage level from family coverage to
employee-only coverage, you must decrease your HSA contributions
to the maximum permitted by the IRS for employee-only coverage,
prorated by the number of months remaining in the taxable year.
You can also stop (or increase, subject to the limits established by the
IRS) HSA contributions.
If you have other dependents covered under either the Silver or
Health & Savings Plan Medical Program option, you may continue to
Dental
Vision
Health
Reimbursement
Account
Health Savings
Account (HSA)

{00014391.DOCX-}
186
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .
make contributions up to the IRS HSA family coverage annual
contribution limit.

If your spouse dies: If you’re currently enrolled in the HCSA, you can
elect to increase, decrease or stop the amount you’re currently
contributing to this account, provided it’s within 31 days of the date
of your spouse’s death. If you’re not currently enrolled in the HCSA,
you can enroll. Any election change must be consistent with the life
event.

If your domestic partner dies: No changes allowed, unless your
domestic partner qualified as your federal tax dependent with the
meaning of IRC section 152 (determined without regard to IRC
sections 152(b)(1), (b)(2), and (d)(1)(B)), in which case you can make
the same changes as described in the prior paragraph regarding death
of a spouse.

If your child dies: If you’re currently enrolled, you’ll have 31 days
from the date of death to decrease the amount you’re currently
contributing to your HCSA or stop contributions.

If your spouse dies: If you’re currently enrolled in the DDCSA, you can
elect to increase, decrease or stop the amount you’re currently
contributing to this account, provided it’s within 31 days of the date
of your spouse’s or domestic partner’s death and the change
corresponds to the life event. If you’re not currently enrolled in the
DDCSA, you can enroll, provided you have eligible dependents
needing care.

If your domestic partner dies: No change is allowed, unless your
domestic partner qualified as your federal tax dependent with the
meaning of IRC section 152 (determined without regard to IRC
sections 152(b)(1), (b)(2), and (d)(1)(B)), in which case you can make
the same changes as described in the prior paragraph regarding death
of a spouse.

If your child dies: If you’re currently enrolled, you’ll have 31 days
from the date of death to decrease the amount you’re currently
contributing to your DDCSA or stop contributions.
Basic Life and Basic
Accidental Death and
Dismemberment
(AD&D)

To change your beneficiary designation access MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer employees and
go to My Benefits or call the MyBenefits Customer Support Center at
1-877-468-3638.
Supplemental
Employee Life and
Supplemental
Accidental Death and
Dismemberment
(AD&D)

If your spouse or domestic partner dies: You’ll have 31 days from the
date of death to enroll for coverage or increase coverage. You may
need to show Evidence of Insurability (EOI) before Supplemental
Employee Life Insurance coverage takes effect.

If your child dies: No change is allowed.
Health Care Spending
Account (HCSA)
Dependent Day Care
Spending Account
(DDCSA)
{00014391.DOCX-}
187
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
What You Need to
Know About . . .
What You Need to Do . . .

If your spouse or domestic partner dies, you must cancel his or her
coverage.

Death claim processing will be handled through Unum.

If your spouse or domestic partner dies: You’ll have 31 days from the
date of death to enroll for coverage or add children. You must be
enrolled in Supplemental Employee Life Insurance to elect Child Life
coverage.

If your child dies: You must cancel your child’s coverage. However, if
you have other children enrolled in the plan, your coverage for these
dependents will remain active.

Death claim processing will be handled through Unum.
Disability Plan

No changes allowed.
Long-Term Care
Insurance

No changes allowed.

If your spouse, domestic partner or child dies, you must cancel his or
her coverage.

If your spouse, child, or domestic partner dies, you must cancel his or
her coverage.

Not applicable. You are covered for accidents which occur while
travelling on company business as a full-time or part-time 1
employee.

To change your beneficiary designation for life, AD&D, or business
travel accident insurance, please access MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer employees and go to
My Benefits or call the MyBenefits Customer Support Center at 1-877468-3638.
Spouse Life Insurance
and Spouse AD&D
Child Life Insurance
and Child AD&D
Accident Insurance
Critical Illness
Insurance
Business Travel
Accident Insurance
Changing Beneficiaries
Things to Consider

If you’re already enrolled in the Dependent Day Care Spending
Account (DDCSA) and you expect to have additional dependent
care expenses, you may want to increase your contribution
amount; if you expect to have lower expenses, you may want to
decrease your contribution amount.

If you have a beneficiary designation on file listing your deceased
dependent as a beneficiary, you should complete a new
beneficiary form as soon as possible by accessing MyTenet.com
for Tenet colleagues and HealthyatTenet.com for Conifer
Will You Have Higher
Dependent Care Expenses
or Lower?
Do You Need to Update
Your Beneficiary File?
{00014391.DOCX-}
188
--------------------------------------------------------------------- LIFE EVENTS SUMMARY PLAN DESCRIPTION, 2017 ---------------------------------------------------------------
employees and go to My Benefits or by calling the MyBenefits
Customer Support Center at 1-877-468-3638.

If you need to take additional time off to cope with your loss,
contact your local Human Resource department to obtain a copy
of Tenet’s bereavement policy. Also inquire about how taking a
leave may affect your benefit coverage.

Trained EAP counselors are available to help you sort through
your feelings. For a free consultation, contact GuidanceResources
at 1-844-416-1158.

Due to federal law, if you lose coverage under your domestic
partner’s health plan because of his or her death, you may not be
eligible for COBRA coverage. See “If You Lose Coverage Under
Another Health Plan” above for information on how you may be
able to enroll in a Tenet health plan.

Remember, it is your responsibility to monitor your HSA
contributions and make sure they fall within the parameters
established by the IRS for your selected level of Silver or Health &
Savings Plan coverage.
Need to Take Some Time
Off to Grieve and Heal?
Are You Having Difficulty
Coping with Your Loss?
Losing Coverage Under
Your Domestic Partner’s
Health Plan?
Are You Opening an HSA
or Increasing or
Decreasing Your HSA
Contributions?
{00014391.DOCX-}
189
Other Information Summary Plan Description
About This Summary Plan Description (SPD)
This section of the SPD gives you general information about the Tenet Employee Benefit Plan
(TEBP), a comprehensive welfare benefits plan, and the benefit programs offered under the
TEBP, including:
 Details on the claims process,
 A description of your rights under the Consolidated Omnibus Budget Reconciliation Act (COBRA)
and the Health Insurance Portability and Accountability Act (HIPAA), and
 Information about your protection under the Employee Retirement Income Security Act (ERISA).
Benefits Claims Review and Appeals Procedures
Claims for benefits or reimbursement under the TEBP and its benefit programs will be submitted and
processed in accordance with the claims procedures set forth in this “Benefits Claims Review and
Appeals Procedures” section, unless otherwise stated. Any reference to the “Claims Administrator” in
this “Benefits Claims Review and Appeals Procedures” section means the Claims Administrator for the
benefit program (or, with regard to benefit programs that offer multiple options, the benefit program
option) under which a claim is being filed. Any reference to “plan” in this “Benefits Claims Review and
Appeals Procedures” section means the TEBP and the benefit program under which a claim is being
filed.
Claims for benefits must be filed by the deadline set forth in the applicable SPD section for the benefit
program under which the claim is being filed. If no deadline is specified, claims must be filed no later
than 12 months after the date the expense is incurred.
The Plan Administrator may modify or change the claims procedures at any time. You may request
updated claims procedures from the Plan Administrator at no charge.
Medical, Dental, and Health Care Spending Account Claims
The following claims procedures apply only to claims for benefits in the medical, dental, and Health
Care Spending Account (HCSA) benefit programs (the “health claims”) administered by Blue Cross Blue
Shield of Texas, CIGNA, DELTA DENTAL, DMC Care, Health Plans, Inc. (HPI), and Allegian. For a
description of the claims procedures for the medical benefit program options administered by Fallon
(i.e. Fallon Select and Fallon Direct) and Blue Shield (i.e. Blue Shield HMO), please see the separate SPD
documents or Schedule of Benefits for these options, available at MyTenet.com for Tenet colleagues
and HealthyatTenet.com for Conifer employees.
Types of Claims
Health claims for benefits under the medical, dental, and HCSA programs should be filed with the
appropriate Claims Administrator for each benefit program (or benefit program option) in accordance
with the procedures and time periods described under the “How to File a Claim” heading in the SPD
section for each of these benefit programs. (If no such deadline for submission of claims is specified,
claims must be filed no later than 12 months after the date the expense is incurred.) (For the address
{00014391.DOCX-}
190
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
of a specific Claims Administrator, please see the SPD section for the benefit program at issue.) Your
claim for benefits under one of these programs will be characterized as one of the following types of
claims:
Urgent Care Claims
Urgent care claims are pre-service claims where any delay in treatment could jeopardize your health,
life or ability to regain maximum function, or in the opinion of a physician with knowledge of your
medical condition, subject you to severe pain that cannot be adequately managed without the care or
treatment that is the subject of the claim. Your claim will be treated as an urgent care claim if the
physician treating you advises the Claims Administrator that the claim meets the criteria for an Urgent
care claim as defined above. Urgent care claims may be filed in writing or by telephone.
Pre-Service Claims
Pre-service claims are claims that are conditioned on obtaining approval prior to obtaining care. For
example, you are required to have all scheduled hospital stays pre-certified under the Tenet Employee
Benefit Plan. Your request for pre-certification is considered to be a pre-service claim.
Post-Service Claims
Post-service claims are any claims that are not pre-service claims or urgent care claims.
Concurrent Claims
Concurrent claims are any claims that involve an ongoing course of treatment. Typically, concurrent
claims will be handled as either a pre-service claim or urgent care claim, depending on the
circumstances.
It is important to know what type of claim you have because the appeal procedures and deadlines vary
depending on the type of claim involved. These time deadlines are summarized below and described
in detail following the chart.
Applicable Time
Limits
Plan Provides Notice
of Initial Benefits
Decision
Urgent Care Claims
Pre-Service Claims
Post-Service Claims
 72 hours after
receiving the initial
claim, if it was proper
and complete
 15 days after
receiving the initial
claim
 30 days after
receiving the initial
claim
 30 days if special
circumstances
require an
extension and you
are notified in
advance
 45 days if special
circumstances
require an
extension and you
are notified in
advance
 24 hours in the case
of a concurrent claim
if you request to
extend the treatment
at least 24 hours
before it would
otherwise end
{00014391.DOCX-}
In the case of a
concurrent claim, you
will be notified in
advance of any
reduction or
termination of
treatment so you
191
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Applicable Time
Limits
Urgent Care Claims
Pre-Service Claims
Post-Service Claims
may appeal the
decision.
Deadline for
Requesting Internal
Appeal
180 days after receiving
notice of initial decision
180 days after
receiving notice of
initial decision
180 days after
receiving notice of
initial decision
Plan Notice of
Decision on Internal
Appeal
72 hours after receiving
your request
30 days after
receiving your
request
60 days after receiving
your request for an
appeal
Deadline for
Requesting External
Review (for
applicable Medical
Benefit Program or
Prescription Drug
Benefit Program
claims only)
Four months after
receiving decision on
internal appeal
Four months after
receiving decision on
internal appeal
Four months after
receiving decision on
internal appeal
Six business days after
receiving the request for
External Review
Six business days
after receiving the
request for External
Review
Six business days after
receiving the request
for External Review
Notice of Preliminary
Expedited External
Review Eligibility
Immediately upon
receipt of a qualifying
request for expedited
External Review
Immediately upon
receipt of a qualifying
request for expedited
External Review
Immediately upon
receipt of a qualifying
request for expedited
External Review
Notice of External
Review Decision
45 days after reviewer’s
receipt of a qualifying
request for External
Review
45 days after
reviewer’s receipt of
a qualifying request
for External Review
45 days after
reviewer’s receipt of a
qualifying request for
External Review
Notice of Preliminary
External Review
Eligibility
{00014391.DOCX-}
192
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Applicable Time
Limits
Urgent Care Claims
Pre-Service Claims
Post-Service Claims
Notice of Expedited
External Review
Decision
72 hours after
reviewer’s receipt of a
qualifying request for
expedited External
Review
72 hours after
reviewer’s receipt of
a qualifying request
for expedited
External Review
72 hours after
reviewer’s receipt of a
qualifying request for
expedited External
Review
Request for
Voluntary BAC
Review
Four months after
receiving denial of claim
upon internal appeal or,
if you have requested
External Review, 60
days after denial of
claim upon External
Review
Four months after
receiving denial of
claim upon internal
appeal or, if you have
requested External
Review, 60 days after
denial of claim upon
External Review
Four months after
receiving denial of
claim upon internal
appeal or, if you have
requested External
Review, 60 days after
denial of claim upon
External Review
72 hours after receiving
your request for
voluntary BAC Review
60 days after
receiving your
request for voluntary
BAC Review
60 days after receiving
your request for
Voluntary BAC Review
Plan Notice of
Decision on
Voluntary BAC
Review
Detailed Description of Claims Process: Initial Benefits Decision and Internal
Appeal
Time Limits for the Initial Benefits Decision
If you file a claim, an initial benefits decision on your claim will be provided to you within the following
time periods, based on the type of claim:
Urgent care claim — no later than 72 hours after the claim is filed
Your urgent care claim will be reviewed by the Claims Administrator. The Claims Administrator will
provide you with its initial benefits decision on your urgent care claim as soon as possible taking into
account your medical condition, but not longer than 72 hours after the claim is received. If the urgent
care claim is a concurrent claim (i.e., involves approval to extend a current course of treatment), the
decision will be provided at least 24 hours before plan coverage would otherwise end, as long as your
request is made at least 24 hours before your treatment would otherwise end. (If you do not make
your claim at least 24 hours before coverage would otherwise end, the 72-hour rule will apply). Notice
may be by telephone or in person followed by written or electronic notification.
If additional information is required to process your urgent care claim, you will be notified of the
information necessary as soon as possible, but not later than 24 hours after your claim is filed, and you
will be given at least 48 hours to provide the information. The Claims Administrator will provide you
with its initial benefits decision within 48 hours after the end of the additional time period (or after
receipt of the information, if earlier).
If your claim names a specific claimant, medical condition and service or supply for which approval is
requested, and is submitted to a plan representative responsible for handling benefit matters, but
otherwise fails to follow the plan’s procedures for filing pre-service urgent care claims, you will be
{00014391.DOCX-}
193
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
notified of the failure within 24 hours and of the proper procedures to be followed. The notice may be
oral unless you request written notification.
Pre-service claim — no later than 15 days after the claim is filed
Your pre-service claim will be reviewed by the Claims Administrator. The Claims Administrator will
provide you with its initial benefits decision on your pre-service claim within a reasonable period of
time appropriate to the medical circumstances, but not later than 15 days after the claim is received.
The 15-day period may be extended up to an additional 15 days due to circumstances outside the
plan’s control. In that case, you will be notified of the need for the extension before the end of the
initial 15-day period. If additional information is necessary to process your claim, you will be advised of
the specific information necessary and given 45 days to provide such information, and the Claims
Administrator’s deadline for providing you with its initial benefits decision will be tolled from the date
the Claims Administrator sent you the notice requesting additional information until the earlier of (1)
the date the Claims Administrator receives the requested information, or (2) the expiration of the 45day period given to you to provide the requested information. If you fail to provide the additional
information within the 45-day period, the initial benefits decision will be made without regard to this
information.
If your claim names a specific claimant, medical condition and service or supply for which approval is
requested, and is submitted to a plan representative responsible for handling benefit matters, but
otherwise fails to follow the plan’s procedures for filing pre-service claims, you will be notified of the
failure within five days and of the proper procedures to be followed. The notice may be oral unless you
request written notification.
If the claim is a concurrent claim (i.e., seeks approval to seek an ongoing course of treatment), the
decision will be provided in sufficient time to permit you to appeal the decision and obtain a decision
on appeal before plan coverage would otherwise end.
Post-service claim — no later than 30 days after the claim is filed
Your post-service claim will be reviewed by the Claims Administrator. The Claims Administrator will
provide you with its initial benefits decision on your post-service claim within a reasonable period of
time, but not later than 30 days after the claim is received. The 30-day period may be extended up to
an additional 15 days due to circumstances outside the plan’s control. In that case, you will be notified
of the need for the extension before the end of the initial 30-day period. If additional information is
necessary to process your claim, you will be advised of the specific information necessary and given 45
days to provide that information, and the Claims Administrator’s deadline for providing you with notice
of its initial benefits decision will be tolled from the date the Claims Administrator sends the notice of
extension until the earlier of (1) the date the Claims Administrator receives the additional information,
or (2) the expiration of the 45-day period given to you to provide the requested information. If you fail
to provide the additional information within the 45-day period, the initial benefits decision will be
made without regard to this information.
Notice of a Denial of Initial Benefit Claim
A denial of your benefit claim includes (i) a denial, reduction, or termination of your benefit, (ii) the
benefit program’s failure to provide or make a payment (in whole or in part) for a benefit, or (iii) a
cancellation or discontinuance of a benefit that has a retroactive effect.
If your claim for a benefit is denied in whole or in part, the Claims Administrator will notify you of the
denial within the time limits described above. The notice will either be in the form of an Explanation of
Benefits (EOB) statement or a letter and will include, to the extent required by law, the following
information: (i) information sufficient to identify the claim involved, including the date or dates of
service, the health care provider, and the claim amount (if applicable), (ii) the specific reasons for the
denial, including the denial code and its meaning and a description of any standard relied upon to deny
{00014391.DOCX-}
194
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
the claim, (iii) references to the specific plan provisions on which the denial is based, (iv) a description
of any additional material or information necessary for you to perfect your claim and an explanation of
why such material or information is necessary, (v) a statement that, upon request and free of charge,
you will be provided reasonable access to and copies of all documents, records and other information
relevant to your claim for benefits, (vi) a description of the plan’s review procedures and the time
limits applicable to such procedures, including a statement of your right to bring a civil action under
section 502(a) of ERISA or, in the case of a medical (or prescription drug) claim only, to request an
external review following an adverse decision on appeal, and (vii) a statement regarding the availability
of any applicable office of health insurance consumer assistance or ombudsman established to help
claimants with plan claims and appeals and external reviews, including contact information. For urgent
care claims, the notice will include a description of the expedited appeal review process applicable to
your claim and such notice may be provided by telephone, provided that a written or electronic
notification is given to you no later than three days after the oral notification. A notice of a denial of
your benefit claim will also, to the extent applicable, contain the information described in “Special
Rules Regarding Claims.”
Internal Appeal
If your initial claim for benefits is denied, you have the right to request an appeal of this denial (i.e., an
“internal appeal” or “appeal"). The appeal of your benefit claim will be conducted by the Claims
Administrator. You have up to 180 days after you receive notice of a denial of your claim to request the
Claims Administrator to reconsider your claim (unless a later date is permitted by the Claims
Administrator for the benefit program or benefit program option at issue). Requests for internal appeal
must be made in writing (or orally, but only if your claim is an urgent care claim), and you should
provide your name, the patient’s name, the date of service and the amount of the charge. See “Special
Rules Regarding Claims.”
Time Limits for Internal Appeal of Claims and Notice Requirements
The Claims Administrator will provide you with notice of its decision on your request for internal appeal
within the following time periods: (i) 72 hours after receiving such request, in the case of an urgent
care claim, (ii) 30 days after receiving such request, in the case of a pre-service claim, and (iii) 60 days
after receiving such request, in the case of a post-service claim.
If your claim is denied in whole or in part, the notice of denial of your claim upon first-stage review will
include, to the extent required by law, the following information: (i) information sufficient to identify
the claim involved, including the date or dates of service, the health care provider, and the claim
amount (if applicable), (ii) the specific reasons for the denial, including the denial code and its meaning
and a description of any standard relied upon to deny the claim, (iii) references to the specific plan
provisions on which the decision is based, (iv) a statement that, upon request and free of charge, you
will be provided reasonable access to and copies of all documents, records and other information
relevant to your claim for benefits, (v) a statement describing the plan’s voluntary BAC appeal
procedures and voluntary binding arbitration procedures (and a statement of your right to obtain
information about that procedure), (vi) in the case of a medical (or prescription drug) claim only, a
statement of your right to file a request for an external review (including information on how to file a
request for an external review and the time limits that apply),(vii) a statement regarding your right to
bring a civil action under section 502(a) of ERISA, (viii) a statement regarding the availability of any
applicable office of health insurance consumer assistance or ombudsman established to help claimants
with plan claims and appeals and external reviews (to the extent applicable), including contract
information. The notice will also, to the extent applicable, contain the information described in Special
Rules Regarding Claims.
{00014391.DOCX-}
195
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Special Rules Regarding Claims
During the initial claim determination and the internal appeal, you have the right to review your claim
file, and you may submit written comments, documents, records and other information with respect to
your claim, regardless of whether or not such information was considered during the initial or a prior
level of review. You will be provided, free of charge, with any new or additional evidence that the BAC
or Claims Administrator (as appropriate, see the chart under “Delegation of Authority” below)
considered or generated in connection with the claim as soon as possible so that you have an
opportunity to respond before the date the decision is required on your appeal. Similarly, your appeal
cannot be denied based on a new or additional rationale until you have been provided with the
rationale, free of charge. This must be done as soon as possible so that you have an opportunity to
respond before the date the decision is required on your appeal. In addition, the plan must continue to
provide coverage for a Concurrent Claim (to the extent such continued coverage is required by
Department of Labor regulation 29 C.F.R. 2560.503-1(f)(2)(ii)) until your appeal has been decided.
You will be notified of your right to request the diagnostic and treatment codes (and their meanings) in
all notices of medical and prescription drug benefit claim denials, and such information will be provided
to you upon request. A request for a diagnostic and/or treatment code will not be considered, in itself,
to be a request for an internal appeal or External Review.
Also, during internal appeal, the reviewer will be a different individual than the prior reviewer utilized
during the initial determination of your claim (and will not be a subordinate of the prior reviewer). The
reviewer will fully and fairly review your claim, taking into account any additional information you
submit, and will not give deference to any prior benefits decision. No decisions regarding hiring,
compensation, termination, promotion, or other similar matters with respect to the reviewer will be
based on the likelihood that the reviewer will support a denial of benefits.
If your request for internal appeal is based in whole or part on medical judgment, the reviewer will
consult with a health care professional who has the appropriate training and experience in the field of
medicine involved in the medical judgment, and who is not the same person consulted in the prior
determination of your claim. If an internal rule, guideline, protocol or other similar criterion was relied
upon in deciding your claim, any notice of denial will include a statement that a description of such rule
will be provided to you free of charge upon written request. If any denial is based on medical necessity,
experimental treatment or similar exclusion, the notice will include a statement that an explanation of
the scientific or clinical judgment that formed the basis for the decision, applying the terms of the plan
to your medical condition, will be provided to you free of charge upon written request. Finally, if an
expert was consulted in connection with your benefits determination, you will be given the identity of
such individual upon written request.
External Review
Request for External Review
If you claim for benefits under the Medical Benefit Program (or Prescription Drug Benefit Program) is
denied in whole or in part upon internal appeal, you may file a request (“Request”) for a review by an
independent decision-maker (an “External Review”) within four months after the day you receive such
denial on or the day your claim is deemed denied on internal appeal (a “Denial”). (Note: If your denied
claim is for benefits under the Dental Benefit Program or the Health Care Spending Account Program,
please see "Voluntary BAC Review" below.) Your Request should be submitted to the Claims
Administrator for the benefit program or benefit program option at issue. The four-month deadline
may be modified as illustrated in the following examples: If the day you receive the Denial notice is
October 30, because there is no February 30, the Request must be filed by March 1. If the filing
deadline would fall on a Saturday, Sunday, or federal holiday, the deadline is extended to the next day
that is not a Saturday, Sunday, or federal holiday.
{00014391.DOCX-}
196
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Preliminary Eligibility Determination
Within five business days after receiving the Request, the Claims Administrator must determine
whether:
 You had coverage under the plan at the relevant time;
 The Denial is not related to ineligibility under the plan;
 You have completed the required steps of the internal claims appeal process as described in this
“Benefits Claims Review and Appeals Procedures” section (or you have been deemed to complete
the required steps of the internal review process because of the Plan’s failure to meet the
requirements set forth above (with the exception of minor errors attributable to good cause or
matters beyond the Plan's control); and
 You have provided all information and forms required to process an External Review.
If the Claims Administrator determines that you have not met any of these four requirements, your
Request is ineligible for an External Review.
Within one business day after making these determinations, the Claims Administrator will provide you
a written notice of its determination. If your Request is complete but does not meet the requirements
for an External Review, the notice will include the reasons the Request is ineligible as well as contact
information for the Employee Benefits Security Administration. If your Request is not complete, the
notice will describe the information or materials needed to complete the Request. Your deadline for
completing the Request is the end of the 4-month period described under “Request for External
Review” above or, if later, 48 hours after you received the notice that the Request was incomplete.
External Review
If your Request qualifies for External Review, it will be assigned to one of the qualified independent
reviewers with which the Claims Administrator has a contract (“Reviewers”). Within five business days
after assigning your Request to the Reviewer, the Claims Administrator must provide the Reviewer the
documents and information that were considered in making the Denial.
The Reviewer will give you written notice of the acceptance of your Request for External Review. The
notice will include a statement that you have ten business days to submit additional written
information. The Reviewer must consider this information in its review. (The Reviewer also may agree
to consider additional information submitted after ten business days.) Within one business day after
receiving additional information from you, the Reviewer must forward the information to the Claims
Administrator. The Claims Administrator may reconsider the Denial based on this additional
information. If the Claims Administrator decides to reverse its Denial and provide coverage or
payment, it must provide written notice to you and to the Reviewer within one business day after
making the decision. The Reviewer will terminate the External Review if it receives this notice.
Unless the Claims Administrator reverses its decision, the Reviewer will review all of the information
and documents that you submit by the deadline. In reaching its decision, the Reviewer will make its
own independent decision of the claim and will not be bound by any decisions or conclusions reached
during the benefit program’s internal claim and appeal process.
In addition to the documents and information provided by you and the Claims Administrator, the
Reviewer will consider the following information or documents if they are available and the Reviewer
considers them appropriate:
 Your medical records;
 Your attending health care professional’s recommendation;
{00014391.DOCX-}
197
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
 Reports from appropriate health care professionals and other documents submitted by the plan,
you, or your treating provider;
 The terms of the plan unless the terms are inconsistent with applicable law;
 Appropriate practice guidelines, which must include applicable evidence-based standards;
 Any applicable clinical review criteria developed and used by the Claims Administrator, unless the
criteria are inconsistent with the terms of the plan or with applicable law; and
 The opinion of the Reviewer’s clinical reviewer(s) after considering the information described
above to the extent the information or documents are available and the clinical reviewer(s)
consider them appropriate.
The Reviewer will provide written notice of its decision to you and the plan within 45 days after the
Reviewer receives your Request. The notice will contain:
 A general description of the reason for the Request and information that identifies the claim,
including the date or dates of service, the health care provider, the claim amount (if applicable),
the diagnosis code and its meaning, the treatment code and its meaning, and the reason for the
previous denial;
 The date the Reviewer received the Request and the date of its decision;
 References to the evidence or documents (including the specific coverage provisions and evidencebased standards) considered in reaching its decision;
 A discussion of the principal reason(s) for its decision, including the rationale for its decision and
any evidence-based standards that were relied on in making its decision;
 A statement that the determination is binding except to the extent that other remedies may be
available under state or federal law to you or the plan;
 A statement that review by a judge may be available to you; and
 Current contact information, including phone number, for any office of health insurance consumer
assistance or ombudsman.
The Reviewer will maintain records of all claims and notices associated with the External Review
process for six years and make these records available for examination by you, the plan, or a state or
federal oversight agency upon request (except where disclosure would violate state or federal privacy
laws).
Expedited External Review
You may file a Request for an expedited (faster) External Review in certain circumstances involving
emergency services or where a longer review period could put you in jeopardy. Specifically, you may
file this type of request if you receive:
 A Denial that involves a medical condition for which the time allowed for completion of an
expedited appeal under the plan’s internal appeal process would seriously jeopardize your life or
health, or would jeopardize your ability to regain maximum function, and you have filed a request
for an expedited internal appeal with the Claims Administrator; or
 A Denial if you have a medical condition where the time allowed for completion of a standard
External Review would seriously jeopardize your life or health, or would jeopardize your ability to
regain maximum function; or
 A Denial that concerns an admission, availability of care, continued stay, or a health care item or
service for a condition for which you received emergency services if you have not been discharged
from the facility.
{00014391.DOCX-}
198
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
The processing of your Request will be substantially the same as described above for other Requests,
with the following exceptions:
 The decision and notice of eligibility on the Preliminary Review will be made immediately upon the
Claim Administrator’s receipt of your request; and
 If the Request is eligible for External Review, the Claims Administrator will transmit required
information and documents to the Reviewer electronically, by telephone or facsimile, or any other
fast, available method; and
 The Reviewer will provide you and the Claims Administrator notice of its decision as quickly as your
medical condition or circumstances require, but in no event more than 72 hours after the Reviewer
receives the request for an expedited External Review. If the Reviewer’s notice is not provided in
writing, within 48 hours after the date of providing that notice, the Reviewer will provide written
confirmation of the decision to you and the Claims Administrator.
Voluntary BAC Review
Request for Voluntary Review
If your claim is denied on internal appeal or External Review (if you have requested External Review),
you may choose to file a request for Voluntary BAC Review. Your request for Voluntary BAC Review
should be made no later than four months after you receive the notice of denial on internal review, or,
if you have requested External Review, 60 days after the date you receive notice of denial upon
External Review.
Requests for Voluntary BAC Review should be submitted to the Tenet Benefits Administration
Committee (BAC), which is the Plan Administrator for the TEBP. Requests for Voluntary BAC Review
must be made in writing (or orally, but only if your claim is an urgent care claim), and you should
provide your name, the patient’s name, the date of service, the amount of the charge, a detailed
explanation of the reason you are appealing the claim, and any supporting documentation you have
regarding your claim or argument for payment. You may not request Voluntary BAC Review unless you
have completed the applicable internal appeals process.
Time Limits for Voluntary BAC Review and Notice of Decision
The BAC will provide you with a notice of its decision upon Voluntary BAC Review within: (i) 72 hours
after receiving the request, in the case of an urgent care claim, or (ii) 60 days after receiving your
request, in the case of a pre-service claim or post-service claim.
If your claim is denied in whole or in part upon voluntary BAC Review, the notice of denial will include a
discussion of the decision to deny the claim on Voluntary BAC Review and a statement of any other
dispute resolution rights you may have, such as voluntary mediation or arbitration, or the right to file
suit under federal law.
Prescription Drug Claims
The following claims procedures apply to claims for prescription drug benefits under the Medical
Benefit Program in the TEBP.
Types of Claims
You have the right to appeal all decisions regarding claims for prescription drug benefits, including but
not limited to co-payments decisions, plan exclusions, plan limits, and drugs not covered. The Claims
Administrator classifies claims for prescription drug benefits into two types: administrative reviews
and appeals and clinical reviews and appeals.
{00014391.DOCX-}
199
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Administrative Reviews and Appeals
These are benefit coverage decisions that are strictly based on your plan’s benefit design (plan rules)
without clinical criteria or the need to obtain information from the prescriber. Administrative reviews
and appeals include appeals of decisions regarding the following:




Cost share (including co-pays and deductibles)
Pharmacy network (participating or nonparticipating)
Plan exclusions (for certain categories of drugs, such as cosmetic, fertility, etc.)
Plan limitations (such as maximum days’ supply, maximum refill limits, and limits based on age or
gender)
Clinical Reviews and Appeals
These are benefit coverage decisions that are based on your plan’s conditions of coverage and require
additional information to be obtained from the prescriber. Clinical reviews and appeals include appeals
of decisions regarding the following:
 Coverage programs (Prior Authorization, Smart Rules, Quantity Per Dispensing Event)
 Closed formulary (Rx SelectionsTM)
 Incentive co-pays (formulary incentives, generic incentives)
Review and Appeals Process
Initial Benefit Determination
A claim for benefits prescription drug benefits should be filed in accordance with the procedures and
time periods set forth under the “How to File a Claim” section of the Prescription Drug SPD. (If no time
period is specified, claims must be filed no later than 12 months after the date the expense was
incurred).
The administrative review process begins when you or your representative submits a request for
benefit coverage in writing. The Claims Administrator will review this request and either approve or
deny coverage in writing based on the plan’s parameters (i.e., initial benefit determination). If your
claim is denied, you will receive a written notification of the Claims Administrator’s decision within the
time periods set forth in the “Medical, Dental, and Health Care Spending Account Claims” section
above for initial determinations of urgent care claims, pre-service claims, and post-service claims. The
notice will contain the information described under the “Notice of a Denial of Initial Benefit Claim”
subsection of the “Medical, Dental, and Health Care Spending Account Claims” section above.
The clinical reviews process, including coverage authorization and formulary reviews, begins when you
or your representative submits a request for benefit coverage in writing or when your physician
requests a coverage review by phone or fax. The Claims Administrator will review this request and
either approve or deny coverage in writing based on the plan’s parameters (i.e., initial benefit
determination). If your claim is denied, you will receive a written notification of the Claims
Administrator’s decision within the time periods set forth in the “Medical, Dental, and Health Care
Spending Account Claims” section above for initial determinations of urgent care claims, pre-service
claims, and post-service claims. The notice will contain the information described under the “Notice of
Denial of Initial Benefit Claim” subsection of the “Medical, Dental, and Health Care Spending Account
Claims” section above. Direct claims occur when you have paid for a prescription and then submit a
claim for reimbursement. A rejected direct claim or a partially paid direct claim is considered a claim
denial.
If your claim is an urgent care claim (as such term is defined under the “Medical, Dental, and Health
Care Spending Account Claims” section above, an initial benefit determination will be rendered to you
(in the manner described in such section) within 72 hours of receipt of the request.
{00014391.DOCX-}
200
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Appealing Claim Denials
In appealing a denial of your claim for prescription drug benefits, you (and the Claims Administrator)
will have all of the rights and responsibilities set forth in the claims procedures for the Medical, Dental,
and Health Care Spending Account Programs (including the rights under “Special Rules Regarding
Claims”), except as modified below. There are two levels of internal appeals (called "First Stage
Review" and "Final Review") for Prescription Drug Program claims.
First-Stage Review
You have up to 180 days after you receive notice of a denial of your claim to request the Claims
Administrator to reconsider your claim (i.e., file a request for first-stage review). Requests for firststage review must be made in writing (or orally, but only if your claim is an urgent care claim), and you
should provide your name, the patient’s name, the date of service and the amount of the charge. See
the “Special Rules Regarding Claims” under the “Medical, Dental, and Health Care Spending Account
Claims” section above.
If your claim is an administrative appeal, it will be reviewed and evaluated by a dedicated appeals unit
of the Claims Administrator to determine if the drug use meets the coverage conditions specified or
intended by the plan. If approval is granted, benefits are authorized for the proposed drug therapy. If,
however, the drug coverage is denied, you will be notified of the denial in accordance with the
procedures, and notice requirements set forth in “Time Limits for Internal Appeal of Claims and Notice
Requirements” under the “Medical, Dental, and Health Care Spending Account Claims” section above,
except that the deadline for receiving a notice of denial of a pre-service claim will be 15 days instead of
30 days, and a post-service claim will be 30 days instead of 60 days.
If your claim is a clinical appeal, it will be reviewed and evaluated by the appeals committee established
by the Claims Administrator to determine if the drug use meets the coverage conditions specified or
intended by the plan. This committee consists of two clinical pharmacists and a physician. If approval is
granted, benefits are authorized for the proposed drug therapy. If the drug coverage is denied, you will
be notified of the denial in accordance with the time limits, procedures, and notice requirements set
forth in “Time Limits for Internal Appeal of Claims and Notice Requirements” under the “Medical,
Dental, and Health Care Spending Account Claims” section above, except that the deadline for receiving
a notice of denial of a pre-service claim will be 15 days instead of 30 days, and a post-service claim will
be 30 days instead of 60 days.
Final Review
If your Prescription Drug Program claim is denied on First-Stage Review, you may request a Final
Review of your claim from the Claims Administrator. You must request Final Review within 180 days of
receiving the notice of denial of your claim upon First-Stage Review. Your request should be made in
accordance with the process for requesting a First-Stage Review (as described in "First-Stage Review"
above.), and the Final Review of your claim will follow the process described in "First-Stage Review"
above. If your claim is denied upon First-Stage Review, you will receive a notice of denial of your claim
within 72 hours after receipt of your request for Final Review in the case of an urgent care claim, 15
days after receipt of your request for Final Review in the case of a pre-service claim, and 30 days after
receipt of your request for Final Review in the case of a post-service claim. The notice of denial will
contain the information described in "Time Limits for Internal Appeal of Claims and Notice
Requirements" under the “Medical, Dental, and Health Care Spending Account Claims “section above.
External Review
If your claim is denied on internal appeal, you may request an External Review (as described under
"Medical, Dental, and Health Care Spending Account Claims").
{00014391.DOCX-}
201
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Voluntary BAC Review
If your claim is denied on internal appeal or External Review (if you have requested and received
External Review), you may request a Voluntary BAC Review in accordance with the procedures
described in “Voluntary BAC Review” under the “Medical, Dental, and Health Care Spending Account
Claims” section above. If your claim is denied on Voluntary BAC Review, you will be notified of the
denial in accordance with the time limits, procedures, and notice requirements set forth in “Time Limits
for Voluntary BAC Review and Notice of Denial” under the “Medical, Dental, and Health Care Spending
Account Claims” section above.
Vision
A claim for benefits under the Tenet Vision Benefit Program should be submitted in accordance with
the procedures set out in Tenet Vision Benefit Program SPD section. If your claim for benefits under the
program is denied in whole or in part, you may request a review in writing from the Claims
Administrator within 180 days following receipt of the denial. Claims for vision benefits will be treated
like post-service health claims as described above under the “Medical, Dental, and Health Care
Spending Account Claims” section, except as modified below. You have the same rights and
responsibilities (including the rights set forth in “Special Rules Regarding Claims”), and the same
notification procedures (except the right to diagnostic and treatment codes) and timelines will apply.
If your claim for benefits is denied on internal appeal, you may file suit under federal law as described
in “Exhaustion of Claims” below.
EAP
Typically, you will not need to submit a claim in order to receive benefits under the EAP. However, if
you have been denied a benefit or service under the EAP which you believe you are entitled, you may
file a claim with the person or organization delegated responsibility for rendering an initial claims
decision for such program, as set forth in the “Delegation of Authority” chart below and in accordance
with the terms of the SPD section for the EAP. If your claim for benefits is denied in whole or part, you
will receive a notice of that denial within the time frames and containing the applicable information
specified in “Detailed Description of Claims Process: Initial Benefits Decision and Internal Appeal” under
the Medical, Dental, and Health Care Spending Account claims review procedures. You will also have
the right to appeal a denial of your claim, in accordance with the time frames and procedures set forth
in “Detailed Description of Claims Process: Initial Benefits Decision and Internal Appeal.” Denied claims
under the EAP are not eligible for external review or voluntary BAC review.
Short-Term Disability, Long-Term Disability, Long-Term Care, Life/AD&D,
and Dependent Day Care Spending Account Claims
For information on the claims review procedures for the short-term disability, long-term disability,
long-term care, life/AD&D, and dependent day care spending account benefit programs, please see the
individual SPD sections for those benefit programs.
Exhaustion of Claims
You cannot bring any legal action against the plan, Plan Administrator, or Claims Administrator for any
reason unless you first complete all non-voluntary steps in the appeal process as described in this
“Benefits Claims Review and Appeals Procedure” section. (However, you may be treated as having
completed all these steps with respect to a health claim or a prescription drug claim if the plan fails to
{00014391.DOCX-}
202
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
comply with its obligations at any point in the claims and appeal process, unless the plan’s failure to
comply is de minimis, non-prejudicial, attributable to good cause or matters beyond the plan’s control,
in the context of an ongoing, good-faith exchange of information, and not reflective of a pattern or
practice of non-compliance.) Note: You do not have to complete External Review or Voluntary BAC
Review before bringing a legal action. After completing the claims and appeals process, if you want to
bring such a legal action you must do so within one year of the date you are notified of the final
decision on your appeal or, if you have requested and received External Review or Voluntary BAC
Review, one year after the date you are notified of the final decision upon External Review or Voluntary
BAC Review, or you lose any rights to bring such an action.
Authorized Representative
An authorized representative may act on your behalf in pursuing a benefit claim under any benefit
program offered through the TEBP. (Any references to “you” in the description of claims review
procedures under the TEBP shall be interpreted to mean “you or your authorized representative.”) An
authorized representative means a person you authorize, in writing, to act on your behalf. The benefit
program will also recognize a court order giving a person authority to submit claims on your behalf. The
Plan or Claims Administrator may determine reasonable procedures for determining whether an
individual has been authorized to act on your behalf. However, in case of a medical claim involving
urgent care, a health care professional with knowledge of your condition may always act as your
authorized representative.
Delegation of Authority
In some cases, the Tenet Benefits Administration Committee (BAC) has delegated its discretionary
authority and responsibility as Plan Administrator for determining benefits and claims under the TEBP
(and the benefit programs and benefit program options) to a Claims Administrator. If such delegation
of authority has occurred, the Claims Administrator for the benefit program or benefit program option
at issue has the discretionary authority, in processing claims and appeals, to interpret the provisions of
the TEBP and the benefit program and to interpret the facts and circumstances of claims for benefits.
No benefits will be paid under the TEBP and/or the benefit program at issue unless the BAC or Claims
Administrator, as applicable, decides in its sole discretion that the claimant is entitled to the benefits
(or the benefits are required to be paid as a result of an external review (see “External Review” above),
lawsuit, or binding arbitration (see “Binding Arbitration” below)). Any decision made by the BAC or
Claims Administrator, as applicable, upon internal appeal is conclusive and binding, unless you file a
permissible request for External Review (see “External Review” above), request a Voluntary BAC
Review after completion of the internal appeal process, file suit under ERISA upon denial of your claim
on final appeal, or request binding arbitration as described below.
The chart below depicts the person or entity with responsibility for deciding each type of claim under
the TEBP:
Benefit
Program
Medical
{00014391.DOCX-}
Claim
Type
Initial Benefit
Determination
Internal
Appeal
External
Review
Voluntary
BAC Review
Urgent Care
Claims
Claims
Administrator
Claims
Administrator
Independent
Reviewer
BAC
Pre-Service
Claims
Claims
Administrator
Claims
Administrator
Independent
Reviewer
BAC
203
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Benefit
Program
EAP
Dental
Prescription
Drug
Vision
Program
Health Care
Spending
Account
Dependent
Day Care
Spending
Short-Term
Account
Disability
Claim
Type
Initial Benefit
Determination
Internal
Appeal
External
Review
Voluntary
BAC Review
Post-Service
Claims
Claims
Administrator
Claims
Administrator
Independent
Reviewer
BAC
All Claims
Claims
Administrator
Claims
Administrator
N/A
N/A
Urgent Care
Claims
Claims
Administrator
Claims
Administrator
N/A
BAC
Pre-Service
Claims
Claims
Administrator
Claims
Administrator
N/A
BAC
Post-Service
Claims
Claims
Administrator
Claims
Administrator
N/A
BAC
Urgent Care
Claims
Claims
Administrator
Claims
Administrator
Independent
Reviewer
BAC
Claims
Administrator
Claims
Administrator
(Both FirstStage and Final
Review)
Independent
Reviewer
BAC
Post-Service
Claims
Claims
Administrator
Claims
Administrator
(Both FirstStage and Final
Stage)
Independent
Reviewer
BAC
All Claims
Claims
Administrator
Claims
Administrator
N/A
BAC
All Claims
Claims
Administrator
Claims
Administrator
N/A
BAC
All Claims
Claims
Administrator
Claims
Administrator
N/A
BAC
All Claims
Claims
Administrator
Claims
Administrator
N/A
N/A
Claims
Administrator
Claims
Administrator
Claims
Administrator
Claims
Administrator
Claims
Administrator
Claims
Administrator
N/A
N/A
N/A
N/A
N/A
N/A
Pre-Service
Claims
Long-Term
Disability
All Claims
Life / AD&D
All Claims
Business
Travel
All Claims
A claim for benefits that is to be reviewed by the BAC (as depicted on the preceding chart) should be
submitted to the BAC at the following address:
{00014391.DOCX-}
204
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Tenet Healthcare Corporation
c/o Benefits Administration Committee
Attn: Health and Welfare Benefits Department
1445 Ross Avenue, Ste. 1400
Dallas, Texas 75202
A claim for benefits that is to be reviewed by the Claims Administrator (as depicted on the preceding
chart) should be submitted to the appropriate Claims Administrator for the benefit program or benefit
program option as set forth in the individual SPD section for that benefit program. A Request for an
External Review should be submitted to the Claims Administrator for the benefit program or benefit
program option at issue.
Binding Arbitration
If your claim for benefits under the medical, dental, prescription drug, Health Care Spending Account or
Dependent Day Care Spending Account benefit programs is denied in final review, you may elect
between submitting the claim to binding arbitration or filing a case in federal district court. (Your claim
for benefits under any other benefit programs offered by the TEBP is not eligible for binding
arbitration.) You may choose to submit your claim to binding arbitration, but you will not be forced to
do so. A decision as to whether to submit your claim to binding arbitration will not affect your rights to
any other benefits under the TEBP. However, once you elect binding arbitration, the decision is final
and you will not have the right to bring a lawsuit in court.
 The TEBP will waive any right it may have to assert that you failed to exhaust your administrative
remedies if you do not elect to submit a benefits dispute to binding arbitration, provided that the
benefits dispute has been processed through first-stage and final review.
 Any statute of limitations or other timeliness defense the TEBP may raise will be tolled during the
time binding arbitration is pending.
 Binding arbitration is available only after the final-review stage of the claims procedures described
above. If your claim is eligible for External Review, you may submit your claim for binding
arbitration before, after, concurrently with, or in lieu of, a request for External Review, as long as
binding arbitration is requested within the deadline set forth in “How Binding Arbitration Works”
below.
 Upon written request, you will be provided sufficient information about the claim to make an
informed judgment about whether to submit your claim to binding arbitration.
 You will not be required to pay any fees or costs associated with the binding arbitration offered
under the TEBP. However, if you choose to be represented by an attorney during the binding
arbitration process, you will be responsible for your attorney’s fees. The arbitrator, as part of his or
her award, may provide for the payment of such attorney’s fees.
How Binding Arbitration Works
1. You may request binding arbitration if your claim is still not resolved to your satisfaction after all
required levels of review have been completed. Your request for binding arbitration should be
submitted in writing to the Plan Administrator within one year of your last appeal denial (excluding
a denial on External Review). This means that you may contest the denial of your claim only by
submitting the matter to arbitration within this deadline. In this event, you and the Plan
Administrator will select an arbitrator from a list of names supplied by the American Arbitration
Association (AAA), in accordance with the Association’s selection procedures, and the arbitration
{00014391.DOCX-}
205
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
will be conducted in accordance with the Association’s commercial arbitration rules and
procedures.
2. The arbitration will be held in a major metropolitan area (closest to your place of employment),
unless you and the Plan Administrator agree to another site. The arbitrator’s authority will be
limited to the affirmation or reversal of the Plan Administrator’s (or Claim Administrator’s) denial
of the claim, based on whether the claim was denied arbitrarily or capriciously. The arbitrator does
not have the power to alter, add to or subtract from any provision of the plan or Trust agreement,
and can’t interfere with the proper exercise of the Plan Administrator’s discretion. In addition, the
arbitrator does not have the authority to award extra-contractual, compensatory or consequential
damages.
3. Except as otherwise required by applicable law and as provided in paragraph 4 below, the
arbitrator’s decision will be final and binding between you and the Plan Administrator, if warranted
by the evidence and if reasonably based on applicable law and the provisions of the plan or Trust
agreement, and may be filed with any court of competent jurisdiction. The arbitrator’s decision will
not serve as a precedent for any other claim unless the decision has been confirmed by a court of
competent jurisdiction.
4. If your claim is eligible for External Review, you may request External Review either before or after
receiving the arbitrator’s decision, provided that the period for requesting External Review (four
months after the denial of your claim on final review, not the denial of your claim on binding
arbitration) has not expired. If your claim is eligible for both External Review and binding
arbitration, and you request both External Review and binding arbitration within the time periods
and in accordance with the procedures set forth in this SPD, then (i) the decision of the Reviewer
upon External Review will control if received subsequent to the decision of the arbitrator, and (ii)
the decision of the arbitrator will control if received subsequent to the decision of the Reviewer
upon External Review.
Keep in mind that this binding arbitration option applies only to the Tenet medical, prescription drug,
dental, HCSA and DCSA benefit programs. These binding arbitration procedures do not apply to Tenet’s
vision, AD&D, long-term disability, short-term disability, or long-term care benefit programs. Nor do
they apply to fully insured managed care plans, to benefits covered by another plan or to requests to
change the plan to accommodate a special need.
COBRA — Continuing Your Health Care Coverage
COBRA, the Consolidated Omnibus Budget Reconciliation Act, gives you and your eligible dependents
the option to continue your health care coverage (medical, which includes prescription drug and health
reimbursement account coverage (if applicable), vision; dental; EAP, and the Health Care Spending
Account) temporarily after it would otherwise end under normal plan provisions. COBRA coverage isn’t
free — you pay the full cost of the coverage you choose, plus an administrative charge.
What Is
COBRA
Coverage?
{00014391.DOCX-}
COBRA coverage is health care coverage that continues temporarily after you or
your eligible dependent loses coverage under the plan’s regular terms. COBRA
coverage is entirely optional.
206
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Who May
Elect COBRA
Coverage?
You (a Tenet employee) and your eligible dependents are eligible to elect COBRA
coverage if you are “qualified beneficiaries” within the meaning of COBRA, and you
have lost health care coverage due to a “qualifying event.” Qualified beneficiaries
are participants and spouses and children of participants who were covered in the
health plan on the day before the qualifying event, or children of a participant born
or adopted during a participant's period of COBRA coverage. However, your
domestic partner is not eligible to elect COBRA coverage as a “qualified
beneficiary.” See below for a definition of “qualifying event.”
You can elect to continue your health care coverage (which includes coverage under
the Medical Program (including prescription drug coverage and Health
Reimbursement Account coverage, if applicable), the Vision Program, the Dental
Program, and, in some cases (see below), the Health Care Spending Account) under
COBRA. You’ll have the same health care plan options as you would if you hadn’t
lost coverage.
If Tenet’s active employee plans or options change while you’re covered under
COBRA, your coverage will change as well.
What is
Included in
COBRA
Coverage?
You may continue participation under COBRA in the Health Care Spending
Account (HCSA), but your HCSA participation will end at the end of the calendar
year in which you elected COBRA coverage. However, you will not be entitled to
COBRA continued coverage under the HCSA if, at the time of your qualifying event,
the maximum benefit you could receive under the HCSA for the remainder of the
plan year is less than the amount of COBRA premiums that would be required to
continue your coverage under the HCSA.
In lieu of COBRA coverage under the EAP, your EAP coverage will automatically be
extended from the date of a qualifying event (as described below) until the date
your COBRA coverage would have ended, had you been eligible for and elected
COBRA coverage under the EAP. Please see the Employee Assistance Program Care
section of the TEBP SPD for more information.
When Do You
Become
Eligible for
COBRA
Coverage?
COBRA is available to qualified beneficiaries who lose health plan coverage due to a
“qualifying event.” See “COBRA Qualifying Events.”
How Do You
Enroll in
COBRA
Coverage?
If you or your dependent has a qualifying event that is a divorce, legal separation, or
loss of dependent status, you or your dependent must call the MyBenefits
Customer Support Center toll free at 1-877-468-3638 within 60 days of the later of
the qualifying event or the loss of coverage. If you do not provide notification of a
qualifying event that is a divorce, legal separation, or loss of dependent status in a
timely manner, you may delay receipt of COBRA information or lose the right to
enroll for COBRA coverage altogether. If you leave Tenet or once you provide notice
of one of the qualifying events listed above, you’ll receive a COBRA Enrollment
Notice. You have 60 days from the later of the statement date or the date you lose
coverage to elect COBRA coverage. For more information on enrolling in COBRA
coverage, read the rest of this COBRA section.
{00014391.DOCX-}
207
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
How Much
Does COBRA
Coverage
Cost?
Generally, the COBRA coverage premium is 102% of the full premium the company
pays for employee coverage, paid on an after-tax basis. (In some cases, coverage
may cost 150% of the full premium. See “How Much You’ll Pay for COBRA
Coverage” for more information.) Because the company subsidizes employee and
dependent coverage for active employees, COBRA premiums based on the full
company premium will be much higher than what you might be used to paying.
However, in some situations, COBRA coverage may be a better option than buying
individual coverage on your own.
When Does
COBRA
Coverage
End?
In most cases, you can keep COBRA coverage for up to 18 months after your
qualifying event. See “COBRA Qualifying Events” for some exceptions to this rule.
Which Benefit
Program
Coverages are
Eligible for
COBRA
Coverage?
COBRA applies to the following benefit programs offered under the TEBP: the
Medical Program, which include prescription drugs coverage and the Health
Reimbursement Account (if applicable), the EAP, the Dental Program, the Vision
Program, and the Health Care Spending Account Program (HCSA). (Special rules
apply to COBRA coverage under the HCSA, as stated earlier). In lieu of COBRA
coverage under the EAP, your EAP coverage will automatically be extended from
the date of a qualifying event (as described below) until the date your COBRA
coverage would have ended, had you been eligible for and elected COBRA coverage
under the EAP.
COBRA Qualifying Events
You and your dependents (who are qualified beneficiaries) are eligible to elect COBRA coverage if you
lose health care coverage as a result of a qualifying event. Below is a description of the qualifying
events entitling you and your eligible dependents to COBRA coverage (if you lose health care coverage
as a result of experiencing one of these qualifying events), and the maximum amount of time you can
be covered under COBRA from the date of each qualifying event.
Qualifying Event
Maximum Period of COBRA Coverage from
Date of Qualifying Event
Your Tenet Employment Is Terminated (except
for gross misconduct)
18 months (or 29 months, in the case of
disability as described below)
Your Tenet Employment Is Terminated
Following an FMLA Family or Medical Leave of
Absence*
18 months (or 29 months, in the case of
disability as described below)
Your Hours Are Reduced to a Non-Eligible
Status
18 months (or 29 months, in the case of
disability as described below)
You Die (in this case, COBRA coverage is offered
to your eligible dependents)
36 months
You Are Divorced or Legally Separated (in this
case, COBRA coverage is offered to your eligible
dependents)
36 months
Your Dependent Child Loses Eligibility Under
Plan Rules
36 months
{00014391.DOCX-}
208
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
* Taking a family or medical leave under the Family and Medical Leave Act of 1993 (FMLA) is not a
qualifying event under COBRA. However, you’ll have a qualifying event on the last day of your
FMLA leave if all of the following apply:
 You and/or your dependent is covered under the plan on the day before the FMLA leave,
 You don’t return to employment with Tenet at the end of the FMLA leave, and
 You and/or your dependent would otherwise qualify for COBRA.
Please note that you’ll qualify for COBRA coverage whether or not you maintain your health care
coverage (including contributing to your HCSA) while on FMLA leave. Also note that even if you don’t
contribute to the HCSA while you’re on an FMLA leave, you’ll still be eligible to re-enroll for HCSA
when you return from your FMLA leave.
Maximum Coverage Period
It’s important to know that the maximum COBRA coverage period shown in the right-hand column
above begins on the day of the qualifying event, even if you don’t lose your coverage immediately after
that event.
If your dependent who is a qualified beneficiary experiences another qualifying event during the
COBRA continuation period, your dependent may be eligible to continue COBRA coverage for up to 36
months from the initial qualifying event. For example, if you and your dependent become eligible for
COBRA coverage due to your termination of employment and then you die during the COBRA
continuation period, your dependent will be able to extend COBRA continuation coverage until 36
months after your termination of employment. You or your dependent must call the MyBenefits
Customer Support Center toll free at 1-877-468-3638 within 60 days of the second qualifying event, or
this right to extend COBRA continuation coverage to 36 months after the initial qualifying event might
be lost.
In the case of a qualifying event that is a termination of employment, reduction of hours, or
termination following FMLA or medical leave, the 18-month COBRA continuation period may be
extended to 29 months if the qualified beneficiary (either you or your dependent) is determined to
have been disabled (within the meaning of Title II or Title XVI of the Social Security Act) at the time of
the qualifying event or within the first 60 days of COBRA coverage (or, in the case of your newborn or
recently adopted child, within 60 days of the child’s birth or placement for adoption). To receive the
extension in COBRA coverage, notice of the disability determination must be provided to the Plan
Administrator within 60 days after receiving the determination (or, if later, within 60 days after the
date of the qualifying event), but before the end of the initial 18-month COBRA continuation period.
The COBRA continuation period may be extended from 18 months to 29 months for all related qualified
beneficiaries.
Electing COBRA Coverage
COBRA coverage isn’t automatic — you and your dependents who are qualified beneficiaries will need
to elect it. The process you must follow to elect COBRA coverage depends on the circumstances of the
qualifying event. Here’s what happens.
{00014391.DOCX-}
209
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Qualifying Event
What Happens Next
How Long You Have to
Enroll
Your Employment
Ends, Your Hours
Are Reduced, You
Die, You Become
Entitled to
Medicare
Within 44 days after the later of the qualifying
event or the date you lose coverage due to the
qualifying event, you and/or your dependents will
receive a COBRA Enrollment Notice notifying you
and/or your dependents of your COBRA
eligibility.
You’ll have 60 days from
the statement date on the
notice or the benefit
termination date,
whichever is later.
Any Other
Qualifying Event
You and/or your dependents must call the
MyBenefits Customer Support Center within 60
days after the later of the qualifying event or the
date the qualified beneficiary would lose
coverage as a result of the qualifying event. If you
don’t notify us within the 60-day period, you
and your covered dependents will lose your
right to elect COBRA coverage. If you notify us of
the qualifying event within this 60-day period and
if you are eligible for COBRA coverage due to the
qualifying event, you will receive a COBRA
Enrollment Form within 14 days after the date
you notify the MyBenefits Customer Support
Center of the qualifying event.
Assuming you report the
qualifying event within 60
days, you’ll have 60 days
from the statement date
on the COBRA Enrollment
Notice or the benefit
termination date,
whichever is later, to
make elections.
Don’t Forget
After receiving the COBRA notification, you should call the MyBenefits Customer Support Center to
enroll within 60 days of the statement date on the COBRA Enrollment Notice (or, if later, the
benefit termination date).
If, while you are covered under COBRA, you have a child born or you adopt a child, that child is eligible
to be covered as a “qualified beneficiary” for the remaining period of COBRA coverage, provided you
call the MyBenefits Customer Support Center within 31 days of the birth or adoption. You may also,
during the period of your COBRA continuation coverage, enroll your spouse or other dependent in the
plan under the same terms as active employees are eligible to enroll a spouse or other dependent.
(However, your enrolled spouse or other dependent is not a “qualified beneficiary.”)
Please contact the MyBenefits Customer Support Center if you believe your COBRA notification has
been delayed.
COBRA Second-Election Period
The Trade Adjustment Act of 2002 amended COBRA to provide a second 60-day election period for
certain individuals who become eligible for trade adjustment assistance pursuant to the Trade Act of
1974 (a TAA-Eligible Individual). You may be eligible for TAA assistance if you lost your jobs as a result
of increased imports or shifts in production out of the United States. Specifically, if you did not elect
COBRA continuation coverage during the initial 60-day election period following your termination of
employment and that termination was a direct consequence of you becoming a TAA-Eligible Individual,
then you may elect COBRA continuation coverage during a second 60-day election period.
The second 60-day COBRA election period begins on the first day of the month in which you are
determined to be a TAA-Eligible individual, provided that this determination is made within six months
after your loss of health coverage (i.e., medical, including prescription drug and health reimbursement
{00014391.DOCX-}
210
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
account, if applicable, vision, dental, EAP, and Health Care Spending Account coverage) under the plan.
You may elect COBRA coverage for yourself and your eligible family members,) and any coverage
elected during the second-election period will begin with the first day of the second-election period
and not the date on which coverage lapsed.
You must call the MyBenefits Customer Support Center at 1-877-468-3638 prior to the expiration of
this second election period to notify us of your status as a TAA-eligible individual (and to provide us
with a copy of your TAA-eligibility certificate).
How Much You’ll Pay for COBRA Coverage
The amount you pay for COBRA coverage is based on the full premium the company pays for the
plan(s) and on the coverage levels you elect. You’ll also pay an additional amount to cover
administrative expenses, depending on your situation:
Your Situation
Total Monthly Amount You’ll Pay for COBRA Coverage
You or Your Covered Dependents
Are Not Disabled (or become
disabled after the first 60 days of
the COBRA continuation period)
Up to 102% of the full premium the company pays for the
plan(s) and coverage you elect.
You or Your Covered Dependents
Are Disabled Before or Within the
First 60 Days of the COBRA
Continuation Period
Up to 102% of the full premium the company pays for the
plan(s) and coverage you elect, for the first 18 months of
COBRA coverage.
After the first 18 months of COBRA coverage, up to 150% of
the full premium the company pays for the plan(s) and
coverage you elect, if the disabled qualified beneficiary elects
to continue COBRA coverage for an additional 11 months.*
* Coverage may continue for an additional 11 months after the initial 18-month period if you or
your dependent (who is a qualified beneficiary) is disabled before the qualifying event or within
the first 60 days of COBRA coverage. You must call the MyBenefits Customer Support Center
within 60 days of becoming disabled, as defined by Social Security (or, if later, within 60 days after
the date of the qualifying event), and prior to the expiration of the initial 18-month period. After
the first 18 months of COBRA coverage, the COBRA payment may increase to 150% of the full
premium for you and each related qualified beneficiary, if the disabled qualified beneficiary elects
to continue COBRA coverage.
You’ll pay these COBRA premiums on an after-tax basis.
Here are some dates and provisions to keep in mind when you elect COBRA coverage:
When You Need
to Elect
{00014391.DOCX-}
Generally, 60 days after the qualifying event or receipt of the notification,
whichever is later. (Remember, a loss of coverage due to certain qualifying
events requires you to notify the MyBenefits Customer Support Center of the
qualifying event. See above for more information.)
211
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
First payment (covering any back payments due): 45 days from the date of
your election — claims and/or reimbursement requests will not be paid until
your first payment has been received by:
When Premiums
Are Due
Tenet Healthcare
P.O. Box 1026
Carol Stream, IL 60132-1026
Each payment after the first: The first day of each month, with a 30-day grace
period.
When Coverage
Begins
As soon as your regular employee coverage ends, provided you elect coverage
by the election expiration date or the date of notification, whichever is later,
and assuming you pay your first premium by the due date.
What Happens if
a Payment Is Late
If your payment is not received by the end of the 30-day grace period, your
COBRA eligibility period ends immediately and cannot be reinstated.
Changing COBRA Coverage
If you’re eligible for COBRA coverage, you’ll be able to change medical vision, and dental options during
the Annual Enrollment period, just like the active Tenet employee population. (Your prescription drug
and health reimbursement account coverage will reflect your selected medical program option.) In
addition, you’ll be able to drop (or add) dependent coverage for medical (including prescription drug),
dental, and/or vision coverage during Annual Enrollment or when you experience a major life event.
See “When You Can Change Your Health Care Coverage Elections” in the Life Events of this SPD.
When COBRA Coverage Ends
Your or your covered dependent’s COBRA coverage will end on the earliest of the following dates:
 The expiration of your or your covered dependent’s maximum period of COBRA coverage. The
maximum period of COBRA coverage depends on the reason you or your covered dependent
became entitled to COBRA coverage (i.e., the qualifying event). See “Maximum Coverage Period”
for the maximum period of COBRA coverage applicable to each qualifying event.
 The date Tenet ceases to provide medical (including prescription drug and HRA Program), dental,
vision, and/or HCSA coverage, as applicable, to active employees.
 The date you or your covered dependent fails to make timely payment.
 The date you or your covered dependent first becomes covered under another group health plan
after electing COBRA coverage.
 With respect to qualified beneficiaries entitled to an 11-month extension of COBRA coverage due
to disability or the disability of a related qualified beneficiary, the first day of the month that begins
more than 30 days after a determination that the qualified beneficiary is no longer disabled (or, the
end of the initial 18-month COBRA period, if later).
 The date specified by the participant when calling the MyBenefits Customer Support Center
notifying Tenet of your or your covered dependent’s intent to stop participating.
 The date you or your covered dependent first becomes eligible for Medicare after electing COBRA
coverage. (This only applies to the COBRA beneficiary who has become eligible for Medicare.)
{00014391.DOCX-}
212
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
HIPAA Privacy Rules
Beginning April 14, 2003, HIPAA provides for certain privacy rights regarding the use and disclosure of
protected health information about you. For purposes of the HIPAA privacy provisions, the medical,
prescription drug, mental health care, dental, vision, Health Care Spending Account, long-term care,
and EAP benefit programs are covered health care components of the TEBP required to comply with
HIPAA.
To provide you with information regarding your privacy rights, the TEBP (or, if you are a participant in a
fully insured HMO or insurance arrangement, the HMO or insurer) is required to provide you with a
notice describing its privacy practices and other required information (a HIPAA Privacy Notice). A
revised HIPAA Privacy Notice was provided to plan participants in November, 2016. In addition, the
HIPAA Privacy Notice will be provided: (i) at the time of enrollment for new TEBP participants, and (ii)
when the notice is materially revised for all TEBP participants.
You may also obtain a copy of the HIPAA Privacy Notice any time by calling the MyBenefits Customer
Support Center at 1-877-468-3638 and on MyTenet.com for Tenet colleagues and HealthyatTenet.com
for Conifer employees. If you are a participant in a fully insured HMO or insurance arrangement, you
may obtain a copy of the applicable HIPAA Privacy Notice from the HMO or insurer.
Important Notice from Tenet about Your
Prescription Drug Coverage and Medicare
Notice of Creditable Coverage
Please read this notice carefully and keep it where you can find it. This notice has information about
your current prescription drug coverage with Tenet under the Tenet Medical Benefit Program options
and about your options under Medicare’s prescription drug coverage. This information can help you
decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should
compare the coverage available under Tenet’s Medical Plan options, including which drugs are covered
at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in
your area. Information about where you can get help to make decisions about your prescription drug
coverage is at the end of this notice.
There are two important things you need to know about the prescription drug coverage available under
Tenet’s Medical Benefit Program:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can
get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan
(like an HMO or PPO) that offers prescription drug coverage. All Medicare prescription drug plans
provide at least a standard level of coverage set by Medicare. Some plans may also offer more
coverage for a higher monthly premium.
2. Tenet has determined that the prescription drug coverage under the Tenet Medical Benefit
Programs option is, on average for all plan participants, expected to pay out at least as much as the
standard Medicare prescription drug coverage pays and is therefore considered Creditable
Coverage. Because the prescription drug coverage under Tenet’s Medical Benefit Program options
is Creditable Coverage, if you are covered under either Tenet’s Medical Benefit Program, you can
keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare
drug plan.
{00014391.DOCX-}
213
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
When Can You Join a Medicare Drug Plan?
You can join a Medicare drug plan when first become eligible for Medicare and each year from October
15 to December 7. However, if you lose your current creditable prescription drug coverage through no
fault of your own, you will also be eligible for a two-month Special Enrollment Period (SEP) to join a
Medicare drug plan.
What Happens to Your Current Coverage if You Decide to
Join a Medicare Drug Plan?
If you decide to join a Medicare drug plan, your coverage under the PPO or EPO options of the Tenet
Medical Benefit Program will be affected in the following ways. If you or a dependent join a Medicare
drug plan, the Tenet Medical Benefit Program plan will be the primary payor and the Medicare plan will
be the secondary payor. If you decide to enroll in a Medicare prescription drug plan and drop your
medical drug coverage under the Tenet Medical Benefit Program, neither you nor your dependent(s)
will be able to get this coverage back within the current enrollment period unless there is a life event. If
you were enrolled in a Tenet Medical Benefit Program that provided for Health Reimbursement
Account participation, your participation in the Health Reimbursement Account will terminate and any
remaining amounts in your account will be forfeited.
If you decide to join a Medicare drug plan, coverage under the Health & Savings Plan option of the
Tenet Medical Benefit Program will be affected in the following ways. If you or a dependent join a
Medicare drug plan, the Tenet Medical Benefit Program will be the primary payor and the Medicare
plan will be the secondary payor. If you join a Medicare drug plan, you will be prohibited from
contributing to the HSA for yourself or your dependent. If a dependent joins a Medicare drug plan, you
will be prohibited from making an HSA contribution for that dependent. If you decide to enroll in a
Medicare prescription drug plan and drop your medical and prescription drug coverage under the
Tenet Medical Program, neither you nor your dependent(s) will be able to get this coverage back within
the current enrollment period unless there is a life event.
When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?
You should also know that if you drop or lose your coverage under the Tenet Medical Benefit Program
and don’t join a Medicare drug plan within 63 continuous days after your Tenet coverage ends, you
may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 days or longer
without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the
Medicare base beneficiary premium per month for every month that you did not have that coverage.
For example, if you go 19 months without creditable coverage, your premium maybe at least 19%
higher than the Medicare base beneficiary premium. You’ll have to pay this higher premium (a penalty)
as long as you have Medicare coverage. In addition, you may have to wait until the following October
to join.
For More Information about This Notice or
Your Current Prescription Drug Coverage
For further information you may call the MyBenefits Customer Support Center toll free at
1-877-468-3638.
Note: You will receive this notice each year. You will also get this notice before the next period you can
join a Medicare drug plan, and if this coverage under the Tenet Medical Benefit Program changes. You
also may request a copy by contacting us.
{00014391.DOCX-}
214
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
For More Information about Your Options
Under Medicare Prescription Drug Coverage
More detailed information about Medicare plans that offer prescription drug coverage is in the
“Medicare & You” handbook. You’ll get a copy of the handbook every year in the mail from Medicare.
You may also be contacted directly by Medicare prescription drug plans. For more information about
Medicare prescription drug coverage:
 Visit www.medicare.gov,
 Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the
Medicare & You handbook for the telephone number) for personalized help, or
 Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for a Medicare prescription drug plan
is available. Information about this extra help is available from the Social Security Administration (SSA).
For more information about this extra help, visit SSA online at www.socialsecurity.gov or call them at 1800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug
plans, you may be required to provide a copy of this notice when you join to show whether or not
you have maintained creditable coverage and, therefore, whether or not you are required to pay a
higher premium (penalty).
Tenet Healthcare Corporation
Health and Welfare Benefits Department
1445 Ross Ave., Suite 1400
Dallas, Texas 75202
Phone Number: MyBenefits Customer Support Center, 1-877-468-3638
Date Notice Provided: November 30, 2016
{00014391.DOCX-}
215
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Your ERISA Rights
As a participant in the TEBP, you’re entitled to certain rights and protections under the Employee
Retirement Income Security Act of 1974 (ERISA). ERISA is a law that applies to certain kinds of
employer-sponsored benefit plans.
ERISA
Provides
That You’ll
Be Entitled
to . . .
 Receive information about your plan and benefits.
 Examine, without charge, at the Plan Administrator’s office and at other specified
locations, such as worksites and union halls, all documents governing the plan,
including insurance contracts and collective bargaining agreements and a copy of
the plan’s latest annual report (Form 5500 series) filed by the plan with the U.S.
Department of Labor and available at the Public Disclosure Room of the Employee
Benefits Security Administration.
 Obtain copies of all documents governing the operation of the plan, including
insurance contracts and collective bargaining agreements and copies of the latest
annual report (Form 5500 Series) and updated summary plan descriptions upon
written request to the Plan Administrator. The Plan Administrator may make a
reasonable charge for the copies.
 Receive a summary of the plan’s annual financial report. The Plan Administrator is
required by law to furnish each participant with a copy of this summary annual
report.
 Continue health care coverage for yourself, spouse or dependents if there is a loss
of coverage under the plan as a result of a qualifying event. You or your dependents
may have to pay for such coverage. Review this summary plan description and the
documents governing the plan on the rules governing your COBRA continuation
coverage rights.
In addition to creating rights for plan participants, ERISA imposes duties upon the people who are
responsible for the operation of the plan. The people who operate your plan, called “fiduciaries,” have
a duty to do so prudently and in the interest of you and other plan participants and beneficiaries.
Here are some of ERISA’s requirements:
 No one, including your employer, may fire you or otherwise discriminate against you in any way to
prevent you from obtaining a benefit as provided for in this plan or from exercising your rights
under ERISA.
 If your claim for benefits is denied in whole or in part, you have a right to know why this was done,
to obtain copies of documents relating to the decision without charge and to appeal any denial, all
within certain time schedules.
 Under ERISA, you can take steps to enforce your rights. For instance, if you request a copy of the
plan documents or latest annual report from the Plan Administrator and don’t receive them within
30 days, you may file suit in a federal court. In such a case, the court may require the Plan
Administrator to provide the materials and pay you up to $110 a day until you receive the
materials, unless the materials were not sent because of reasons beyond the control of the Plan
Administrator.
 If you have a claim for benefits that has been denied improperly or ignored in whole or in part, you
may file suit in a federal court unless you have consented to binding arbitration.
 If you disagree with the Plan Administrator’s decision or lack thereof concerning the qualified
status of a Medical Child Support Order (QMCSO), you may file suit in federal court.
{00014391.DOCX-}
216
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
 If plan fiduciaries misuse the plan’s money or if you’re discriminated against for asserting your
rights, you may seek assistance from the U.S. Department of Labor or you may file suit in a federal
court. The court will decide who should pay court costs and legal fees. If you’re successful, the
court may order the person you’ve sued to pay these costs and fees. If you lose, the court may
order you to pay these costs and fees — if, for example, it finds that your claim is frivolous.
If you have any questions about this plan, you should contact the Plan Administrator. If you have any
questions about this statement or your rights under ERISA, or if you need assistance in obtaining
documents from the Plan Administrator, you should contact the nearest area office of the Employee
Benefits Security Administration, U.S. Department of Labor, listed in the telephone directory, or the
Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S.
Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210. You may also obtain
certain publications about your rights and responsibilities under ERISA by calling the publications
hotline of the Employee Benefits Security Administration.
Special Requirements for Medical Plans Regarding
Maternity and Newborn Care
The Tenet Medical Benefit Program and the Prescription Drug Program 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).
Your Rights After a Mastectomy
If your Medical Benefit Program option provides benefits for a mastectomy, it will also provide benefits
for mastectomy-related services, including all stages of reconstruction and surgery to achieve
symmetry between the breasts, prostheses and complications resulting from a mastectomy, including
lymphedema. Call your medical plan carrier or the MyBenefits Customer Support Center toll free at
1-877-468-3638 for more information on coverage for mastectomies and mastectomy-related services
offered under your medical plan option, including any deductible or co-insurance limitations.
Qualified Medical Child Support Orders (QMCSOs)
A qualified medical child support order (QMCSO) is a judgment, decree or order issued by a court or
appropriate state agency that requires a child to be covered for medical benefits. Generally, a QMCSO
is issued as part of a paternity, divorce, or other child support settlement. If the TEBP receives a
medical child support order for your child that instructs a benefit program offered under the TEBP to
provide health care coverage to the child, the MyBenefits Customer Support Center will review the
order to determine if it meets the requirements for a QMCSO. If it determines that it does, your child
will be enrolled in the benefit program as your Dependent. You many obtain, without charge, a copy of
the procedures governing QMCSOs from the MyBenefits Customer Support Center.
Note: A National Medical Support Notice will be recognized as a QMCSO if it meets the
requirements of a QMCSO.
{00014391.DOCX-}
217
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
TEBP Nondiscrimination Notice
The TEBP complies with applicable federal civil rights law and does not discriminate on the basis of
race, color, national origin, age, disability, or sex. The TEBP does not exclude people or treat them
differently because of race, color, national origin, age, disability, or sex.
TEBP provides free aids and services to people with disabilities to communicate effectively with us,
such as:
 Qualified sign language interpreters
 Written information in other formats (large print, audio, accessible electronic formats, other
formats).
TEBP provides free language services to people whose primary language is not English, such as:
 Qualified interpreters;
 Information written in other languages.
If you need the above aids or services, contact the Benefits Department at (469) 893-2000 or 1445
Ross Avenue, Suite 1400, Dallas, Texas 75202 .
If you believe that the TEBP has failed to provide these services or discriminated in another way on the
basis of race, color, national origin, age, disability, or sex, you can file a written grievance with the
Benefits Department at 1445 Ross Avenue, Suite 1400, Dallas, Texas 75202. You can file a grievance in
person or by mail. If you need help filing a grievance, the Benefits Department is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office
for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and
Human Services, 200 Independence Avenue, SW., 509F, HHH Building, Washington, DC 20201, 1-800868-1019, 800-537-7697(TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Language Translation
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al
(469)-893-2000.
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 (469) 893-2000
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (469)
893-2000.
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. (469) 8932000 번으로 전화해 주십시오.
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika
nang walang bayad. Tumawag sa (469) 893-2000.
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.
Звоните (469) 893-2000.
‫االه تمام‬: ‫ ال ل غة ت تحدث ك نت إذا‬،‫ل ك ال م تاحة ال م ساعدة خدمات مجان ية ل غة ال عرب ية‬. ‫( ا س تدعاء‬469) 893-2000.
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (469) 8932000.
{00014391.DOCX-}
218
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.
Appelez le (469) 893-2000.
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod
numer (469) 893-2000.
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para (469)
893-2000.
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica
gratuiti. Chiamare il numero (469) 893-2000.
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur
Verfügung. Rufnummer: (469) 893-2000.
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。(469) 893-2000ま
で、お電話にてご連絡ください。
‫ت وجه‬: ‫ خدمات ک مک زب ان ف ار سی حرف اگ ر‬،‫ه س ت ند د س ترس در شما ب ه راي گان‬. (469) 893-2000 ‫ت ماس‬
‫ب گ يري د‬.
Nondiscrimination Grievance Procedure
It is the policy of the TEBP not to discriminate on the basis of race, color, national origin, sex, age or
disability. The TEBP has adopted an internal grievance procedure providing for prompt and equitable
resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42
U.S.C. 18116) and its implementing regulations at 45 CFR Part 92, issued by the U.S. Department of
Health and Human Services. The Tenet Benefits Department has been designated to coordinate the
efforts of the TEBP to comply with Section 1557 (the “Section 1557 Coordinator”). You may contact the
Benefits Department at (469) 893-2000 or 1445 Ross Avenue, Suite 1400, Dallas, Texas 75202.
Any person who believes someone has been subjected to discrimination on the basis of race, color,
national origin, sex, age, or disability may file a grievance under this procedure. It is against the law for
the TEBP to retaliate against anyone who opposes discrimination, files a grievance, or participates in
the investigation of a grievance.
Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date the person
filing the grievance becomes aware of the alleged discriminatory action. The complaint must be in
writing and contain the name and address of the person filing it. The complaint must state the problem
or action alleged to be discriminatory and the remedy or relief sought.
The Section 1557 Coordinator (or his/her designee) shall conduct an investigation of the complaint. The
investigation may be informal, but it will be thorough, affording all interested persons an opportunity
to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and
records of the TEBP relating to such grievances. To the extent possible, and in accordance with
applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality
of files and records relating to grievances and will share them only with those who have a need to
know.
The Section 1557 Coordinator will issue a written statement on the grievance, based on a
preponderance of the evidence, no later than 30 days after its filing, including a notice to the
complainant of his or her right to pursue further administrative or legal remedies. The person filing the
grievance may appeal the decision of the Section 1557 Coordinator by writing to the Senior Director of
Benefits, 1445 Ross Avenue, Suite 1400, Dallas Texas 75202, within 15 days of receiving the Section
{00014391.DOCX-}
219
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
1557 Coordinator’s decision. The Senior Director of Benefits shall issue a written decision in response
to the appeal no later than 30 days after its filing.
The availability and use of this grievance procedure does not prevent a person from pursuing other
legal or administrative remedies, including filing a complaint of discrimination electronically through
the Office for Civil Rights Complaint Portal, which is available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and
Human Services, 200 Independence Ave. SW, Room 509F, HHH Building, Washington, DC 20210.
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Such complaints must
be filed within 180 days of the date of the alleged discrimination.
The TEBP will make appropriate arrangements to ensure that individuals with disabilities and
individuals with limited English proficiency are provided auxiliary aids and services or language
assistance services, respectively, if needed to participate in the grievance process. Such arrangements
may include, but are not limited to, providing qualified interpreters, providing taped cassettes of
materials for individuals with low vision, or assuring a barrier-free location for the proceedings. The
Section 1557 Coordinator will be responsible for such arrangements.
Administrative Provisions
Official Plan Documents and Summary Plan Description
The official plan documents for the TEBP consist of the TEBP plan document (including all appendices to
the TEBP) and all benefit program documents, including benefit summaries, insurance policies and
contracts. In compliance with ERISA, this document, together with the other online SPD sections
comprise your SPD for the TEBP. Tenet has tried to write this SPD in clear, understandable and informal
language. However, you should refer to the official plan documents for more extensive information
about the benefits offered under the TEBP. As provided in the TEBP plan document, all or a portion of
this SPD (including, but not necessarily limited to, the subrogation and reimbursement provisions of
this SPD) may be incorporated into the official plan document.
Copies of these official plan documents are available for your examination online or at the office of the
Plan Administrator. (See below for the Plan Administrator’s address.) You can also obtain copies of the
official plan documents by making a written request to the Plan Administrator. If there is any
inconsistency between this SPD and the official plan documents, the official plan documents will
determine your benefits.
You can also find out more information about the TEBP and the benefit programs offered under the
TEBP by reviewing the complete online SPD sections for the TEBP. You may request a paper copy of this
SPD free of charge from the Plan Administrator.
Nothing in the official plan documents or this SPD shall be construed as a contract or guarantee of
employment.
Electronic Distribution of TEBP Materials
Consistent with efforts to “go green” and protect the environment, this SPD and certain other TEBP
materials and information will be provided to you online. The information that may be provided online
includes:
 Enrollment materials, which describe the benefits offered under the TEBP, the costs and your
enrollment options,
{00014391.DOCX-}
220
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
 Summaries of Material Modifications (“SMMs”), which describe any changes to the benefits
offered under the TEBP, and
 Provider Directories, which contain contact information for the network providers under the TEBP.
You may access these materials and information online at MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees where you will be prompted to create a user identification
number and password. Once you have created a user identification and password you may access
these documents at any time and view them or print them at your convenience. You may also obtain
paper copies of these documents upon request and free of charge by contacting the Plan Administrator
at the contact address and telephone number listed at the end of this section.
Plan Administrator Discretion
The Plan Administrator reserves complete fiduciary discretion and authority to resolve all questions
concerning the eligibility of any employee or dependent to participate in the plan or entitlement to
benefits under the plan. In addition, the Plan Administrator has fiduciary discretion and authority to:
 Interpret the meaning of any plan provision,
 Establish and apply standards and criteria for determining necessary and appropriate materials,
treatments and procedures, etc.,
 Decide on a participant’s entitlement to or application for benefits under the plan, and
 Decide all questions of law or fact relevant to these determinations.
In general, the Plan Administrator has sole and complete discretion to establish, maintain and
administer the plan, such as execute agreements, adopt and communicate reasonable rules and
regulations, and take any action it determines to be reasonable and necessary. Any decision or
interpretation of plan provisions made by the Plan Administrator (or any of its agents) or any finding of
law or fact in good faith will be final and binding on all affected parties.
The Plan Administrator may make exceptions to the coverage provisions of the TEBP when it deems
necessary and any such exception will not constitute binding precedent with respect to any other
coverage situation.
The Plan Administrator may have delegated all or some of its authority and responsibilities to any of its
agents. Please see the individual benefits sections of this SPD for more information.
Amendment and Termination of Coverage
While Tenet intends to continue offering the Tenet benefit plans indefinitely, it reserves the right to
amend or terminate any or all of its plans at any time for any reason without notice. In addition to the
company, the Tenet Benefits Administration Committee also has the right to adopt plan amendments
that either do not result in a material increase in Tenet’s costs or are required by law. Provisions
affecting potential benefits, such as annual maximum or lifetime plan benefits, are not guaranteed or
vested unless specifically stated in writing by the Plan Administrator.
For Medical Only
To the extent required by ERISA, in the case of any modification or change that constitutes a material
reduction in covered services or benefits, you will be given a summary of such modification or change
within 60 days after the adoption of such modification or change.
Source of Payment
Some benefit programs offered under the TEBP are funded by insurance contracts, and other benefit
programs are funded by contributions made by Tenet and participants in those programs. For
{00014391.DOCX-}
221
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
information on whether any specific benefit program is insured or self-funded, please see the section
of the SPD for the TEBP relating to that benefit program. With respect to benefit programs in the TEBP
that are self-funded (meaning they are paid solely from contributions made by Tenet and program
participants), the Plan Administrator may have designated, in accordance with administrative service
agreements, the authority to process and review claims to a Claims Administrator that is a health
insurance issuer. Although these health insurance issuers are responsible for the claims administration
of the benefit programs (as the designated Claims Administrator), they do not insure any benefits and
are not responsible for the financing of such benefit programs. All benefits for self-funded benefit
programs are paid out of the contributions made by Tenet and members of the plan, in accordance
with the schedule of contributions established by the Plan Administrator.
For more information on the Claims Administrator (or insurer, for an insured benefit program) for any
benefit program, please see the section of this SPD relating to that benefit program.
If You Receive Money from a Third Party
If you and/or a covered family member receives damages, a settlement or any other award,
reimbursement or recovery from a third party or any insurer (including uninsured/underinsured
motorists or other personal coverages) relating to any event, accident or other occurrence as a result of
which you received medical treatment paid for by a benefit program offered under the TEBP, you (or
your family member) must reimburse the plan for the amount of benefits paid by the plan, up to the
full amount collected from the third party or any insurer. For example, if you’re injured in a car accident
and receive medical benefits from a Tenet plan and later recover any amount from the other party or
from your own insurance policy, you’ll need to reimburse the plan from the amounts recovered by such
third party or insurer for the accident-related expenses.
Here’s what you need to know if that happens:
 The amount recovered from the third party or insurer will be first applied to reimburse the plan —
or offset future expenses or payments — even if your claim for damages against the third party has
not been paid in full or you are otherwise not fully compensated for your injuries or damages, and
even if the payment received is for damages other than medical expenses or personal injuries
covered by the plan.
 The plan isn’t obligated to reduce or discount its rights related to this reimbursement because of
any attorney fees you may have incurred to obtain your settlement, damages, proceeds, recovery
or award.
 If expenses are due to injuries or illnesses caused by someone else’s actions, you and/or your
covered family member must agree in writing to reimburse the plan on a “first dollar” priority basis
and grant it the rights described in this section before any benefits are paid. In other words, you
must agree that the plan is entitled to reimbursement in accordance with the terms of this section
before any plan benefit will be paid. Also, you’ll be required to provide the plan with an equitable
lien to the extent of benefits provided (or to hold the amounts recovered in constructive trust for
the plan to the extent of benefits provided). In other words, if you receive compensation from
someone else for injuries caused by that person, you must agree to reimburse the plan for any
benefits the plan paid you for those injuries. If you don’t sign a reimbursement agreement, benefits
won’t be paid. Even if benefits are mistakenly paid without a signed claim form or reimbursement
agreement, you’re still obligated to reimburse the plan in accordance with the terms of this
section.
 The Plan Administrator may request your reimbursement either by direct payment from you (from
amounts received by a third party) or by withholding future benefit payments, whether or not
they’re related to the injury or illness with respect to which you obtained your settlement or
{00014391.DOCX-}
222
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
recovery. In addition, when someone else is obligated to pay for your medical expenses, the plan
will automatically be subrogated (or substituted) in your or your family member’s rights of recovery
(to the extent of the plan’s prior payments and obligation to pay future benefits).
 These rights apply to all participants and their covered family members, as well as to their
beneficiaries, heirs, guardians, legal representatives, assignees and estates. By participating in the
plan, you and your dependents agree to sign any documents and instruments and take any legal
action that the plan considers necessary to protect its rights. You also agree not to take any actions
that could jeopardize the plan’s position or otherwise compromise its rights. Any violation of these
requirements automatically releases the plan from its obligation to pay benefits that might
otherwise be covered.
 The amount to which the plan is subrogated, or the amount to which the plan is entitled to
reimbursement, will not be limited or reduced because a third party is liable only in part, resources
or insurance of the third party is limited, you (or your dependent(s)) have not been fully
compensated (i.e., made whole), by the “double recovery” rule” or any other specific doctrine
reflecting unjust enrichment principles, to share in a pro rata allocation of your (or your
dependents') fees and/or costs (including attorney fees) incurred in pursuit of a claim (e.g.,
"common fund doctrine"), or because of any other reason.
 Finally, the plan has the right to take any action necessary and legal to enforce these rights,
including to join in any action brought by you against a third party or to bring an action against you
for equitable lien or constructive trust. If the plan has to take any legal action to enforce these
rights, it has the right to recover all of its costs and expenses in doing so (including attorney’s fees).
Assignment of Rights or Benefits
Except as provided elsewhere in this TEBP SPD or the Plan document, no participant, dependent, or
beneficiary may assign any rights or benefits provided under the Plan to a third party including, but not
necessarily limited to, a third party to whom such participant, dependent, or beneficiary may be liable
for medical treatment or services, unless such assignment is approved in writing by the Plan
Administrator in its discretion. Any assignment of rights or benefits that is not approved by the Plan
Administrator will not be recognized by the Plan.
Address Changes
You must keep the Plan Administrator informed of your current mailing address (which will also serve
as the current mailing address for your covered dependents). Contact your local Human Resource
department to update your address. If you fail to keep the Plan Administrator informed of your current
mailing address, amounts owed to you will be forfeited.
Helpful Information about the
Tenet Employee Benefit Plan
Below is a list of helpful information regarding the TEBP and the benefit programs offered under the
TEBP. For more information on any specific benefit program, please see the section of this SPD relating
to that benefit program.
Employer
Identification
Number
{00014391.DOCX-}
95-2557091
223
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Plan Name
Tenet Employee Benefit Plan
Plan Type
The TEBP is a comprehensive welfare benefits program offering a variety of
benefits through various component benefit programs. The TEBP is intended
to qualify as a cafeteria plan within the meaning of Internal Revenue Code
(IRC) section 125. The cafeteria plan feature of the TEBP allows participants to
select between salary reduction and benefits provided by certain of the
component programs offered under the TEBP, including medical, which
includes prescription drug and mental health care; dental; vision; and
dependent care and health care spending account benefits. Disability benefits
are offered on an after-tax basis through the cafeteria plan. Long-term care
and life/AD&D benefits are available on an after-tax basis outside the
cafeteria plan.
TEBP Plan Number
515
Plan Year
January 1 through December 31
Plan Sponsor
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, TX 75202-2703
469-893-2000
Participating
Employers and
Collective
Bargaining
Agreements
A complete list of the participating employers (i.e., divisions) that have
adopted the TEBP and certain benefit programs offered under the TEBP may
be obtained free of charge upon written request to the Plan Administrator
and is available for examination by you at the office of the Plan Administrator
during normal business hours.
In addition, certain labor organizations (“Unions”) may have negotiated
benefits under the TEBP with respect to employees covered by a collective
bargaining agreement (“CBA”) between the Union and Tenet Healthcare
(and/or any other participating employers who have adopted the TEBP). A
complete list of Unions who have adopted the TEBP may be obtained upon
written request to the Plan Administrator, and is available for examination by
participants and beneficiaries at the office of the Plan Administrator and
certain other locations.
Plan Administrator
Tenet Benefits Administration Committee
Attn: Health and Welfare Benefits Department
1445 Ross Avenue, Suite 1400
Dallas, TX 75202-2703
469-893-2000
Claims
Administrators for
the Benefit
Programs Offered
Under the TEBP
The Plan Administrator of the TEBP may have designated the authority to
process and administer the claims made under any benefit program to the
Claims Administrator for that benefit program. For more information on the
Claims Administrator for any specific benefit program, including the address
for filing claims, please see “Helpful Information” in the SPD section relating
to that benefit program.
{00014391.DOCX-}
224
-------------------------------------------------------------- OTHER INFORMATION SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Agent for Service of
Legal Process
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, TX 75202-2703
469-893-2000
Legal process may also be served on the Plan Administrator.
Plan Funding
Tax Consequences
of Participating in
the TEBP
The vision, long-term care, employee assistance and disability benefit
programs offered under the TEBP are insured programs, as are certain
localized Medical Benefit Program options available at specific facilities or
geographic localities (i.e. the Blue Shield option and New England plans). All
other Medical Benefit Program options are self-funded by your, and in some
cases, Tenet's contributions. The prescription drug, dental, HRA, and
spending accounts are also self-funded. For general information on the
funding of benefit programs offered under the TEBP, see “Source of
Payment” above. For information on the funding of any specific benefit
program offered under the TEBP, including the address of the insurer, if
applicable, see “Helpful Information” in the SPD section relating to that
benefit program.
Premiums for some benefits under the TEBP may be paid for on a pre-tax
basis, such as medical (which includes prescription drug), dental, and vision
benefits. (Note that medical (including prescription drug), dental, and vision
benefits for a domestic partner or the children of a domestic partner, may not
be paid for on a pre-tax basis unless such individual also qualifies as your
federal tax dependent under Internal Revenue Code section 152 (determined
without regard to Code sections 152(b)(1), (b)(2), and (d)(1)(B)) Likewise,
health care expenses incurred for a domestic partner or child of a domestic
partner cannot be reimbursed under the flexible spending account or the
health reimbursement account unless such individual qualifies as your federal
tax dependent).
Other benefits are available only on an after-tax basis, such as disability,
life/AD&D and long-term care benefits. Highly compensated individuals may
not be able to exclude all or a portion of the benefits or premiums paid under
a component program. Neither Tenet nor the Plan Administrator can
guarantee that benefits or premiums will be excludable from gross income for
federal or state tax purposes. Please consult your tax advisor for more
information on the tax consequences of participating in the TEBP.
{00014391.DOCX-}
225
Spending Accounts and Health
Reimbursement Account
Summary Plan Description
About This Summary Plan Description (SPD)
The Health Care Spending Account (HCSA), Dependent Day Care Spending Account (DDCSA), and Health
Reimbursement Account (HRA) Program are component programs in the Tenet Employee Benefit Plan
(TEBP). The TEBP is a comprehensive welfare benefits program intended to qualify as a cafeteria plan
within the meaning of Internal Revenue Code (IRC) section 125.
This document summarizes key provisions of the HCSA, the DDCSA, and the HRA Program and serves as
part of the summary plan description (SPD) for the TEBP. You can obtain more information about the
HCSA, DDCSA, the HRA Program, the TEBP and the other component programs offered under the TEBP
by reviewing the complete SPD for the TEBP. If there is any discrepancy between this online SPD and
the official plan documents for the TEBP, the official plan documents will control. For more information
on obtaining the official plan documents, see the Other Information section of the TEBP SPD.
Plan Highlights
Tenet’s health reimbursement and spending accounts help you save money by allowing you to pay for
eligible health care and/or dependent care expenses on a tax-free basis. Amounts your employer
contributes to your Health Reimbursement Account or you contribute to your health care or dependent
care spending accounts that are used to reimburse you for eligible expenses are not subject to federal
income tax, Social Security tax and, in some cases, state tax, as well. Tenet offers the Health
Reimbursement Account Program for individuals enrolled in either the Gold or Health &
Reimbursement Plan option under the Medical Benefit Program. Tenet also offers two kinds of
spending accounts. Below is a brief summary of the three account programs.
Health Care Spending
Account (HCSA)
Through the HCSA, you can be reimbursed for certain eligible
medical, dental and vision expenses not already paid through a
personal or employer-sponsored medical, prescription drug,
mental health care, dental or vision plan.
Dependent Day Care
Spending Account (DDCSA)
The DDCSA allows you to be reimbursed for certain eligible
dependent care expenses so that you — and your spouse, if you’re
married — can work.
{00014391.DOCX-}
226
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Health Reimbursement
Account (HRA)
Like the HCSA, the HRA Program allows you to be reimbursed for
certain eligible, medical, dental and vision expenses that are not
paid by your other health care coverage. However, your HRA
Account is funded entirely from employer contributions.
Participation in the HRA Program is limited to employees who have
enrolled in either the Gold or Health & Reimbursement Plan option
under the Medical Benefit Program.
Note: The HCSA and DDCSA are completely separate accounts. Contributions made to the HCSA cannot
be used to cover expenses eligible for reimbursement under the DDCSA and vice versa. Likewise, your
HRA Program account, if any, is completely separate from your HCSA or DDCSA accounts. If you
participate in both the HRA Program and the HCSA, you may not be reimbursed for the same expense
under both accounts. Expenses will be reimbursed first from your HCSA, and you will not receive any
reimbursement from your HRA Program account until your HCSA is exhausted.
Key Points About Spending Accounts
You Enroll Each Year
You must enroll in the spending accounts each year if you wish to
participate.
You Determine How
Much to Set Aside
When you enroll, you decide how much (up to the maximum amounts) to
set aside in each spending account, based on the amount of eligible
expenses you expect to incur during the calendar year (or the remainder
of the year, if you’re enrolling for the first time after January 1).
Deposits Are Made
on a Pre-Tax Basis
Deposits are made on a pre-tax basis through payroll deductions, and you
receive tax-free reimbursements for eligible expenses you incur
throughout the year.
As you incur eligible expenses during the calendar year:
You Pay Yourself Back
with Tax-Free Money
 For health care expenses — Use your HCSA debit card (available if you
make a minimum annual contribution of $150) to pay those expenses
immediately or file a claim to reimburse yourself with the tax-free
money from your HCSA.
 For dependent care expenses — File a claim to reimburse yourself
with the tax-free money from your DDCSA.
If You Participate in
the HCSA, You Cannot
Also Participate in a
Health Savings
Account (HSA)
The Internal Revenue Service (IRS) prohibits you from participating in an
HSA (such as the HSA offered in conjunction with the Health Savings Plan
option under the Tenet Medical Benefit Program) if you have other health
coverage, including coverage under the HCSA.
To receive the tax advantages with spending accounts, there are some rules you must follow. To make
sure you know and understand these rules about spending accounts ― and reap the advantages they
have to offer ― we encourage you to read this summary of the spending accounts, the entire SPD for
the TEBP and IRS Publications 502 and 503. You should discuss the Tenet spending accounts with your
tax advisor before deciding whether to participate.
{00014391.DOCX-}
227
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
PROFILE: Tracey
Meet Tracey and her two children, 8-year-old Robert and 5-year old Tiffany. Tracey is divorced, so
it’s important for her to make her paycheck go as far as possible. Because Tracey sometimes has to
work the night shift at the hospital, she needs to have a licensed dependent care provider come to
the house to be with her children in the evening. Also, it looks like Robert is going to need major
dental work this year ― and even though Tracey participates in the Comprehensive Dental Plan,
she knows they’ll need to pay for uncovered expenses. For these reasons, Tracey decides to
participate in both the DDCSA and the HCSA for the coming year.
Key Points About the Health Reimbursement Account (HRA) Program
If Eligible, You Are
Automatically
Enrolled
You are automatically enrolled in the HRA Program if you enroll in either
the Gold or Health & Reimbursement Plan option under the Medical
Benefit Program.
Contributions Are
Made by Your
Employer
Your account in the HRA Program is funded entirely by employer
contributions. Tenet will determine the amount, if any, to be contributed
to accounts under the HRA Program each year and the date of such
funding. You may view the contribution amount for the current plan year
on MyTenet.com for Tenet colleagues and HealthyatTenet.com for
Conifer employees.
Contributions Are
Tax-Free
You will not pay federal tax on the amounts that are contributed to your
account under the HRA Program.
As you incur eligible expenses, you can obtain reimbursement from the
You Pay Yourself Back HRA Program (up to the maximum amount in your account) for those
with Tax-Free Money expenses. You will not pay federal taxes on the amounts you receive from
the HRA Program as reimbursements for eligible expenses.
You Can Carryover
Unused Amounts
from Year-to-Year
As long as you remain eligible to participate in the HRA Program (by
continuing to participate in either the Gold or Health & Reimbursement
Plan under the Medical Benefit Plan), you may carryover to the next plan
year any unused amounts remaining in your account at the end of the
current plan year. There is no cap to the dollar amount that can be carried
over each year. If your eligibility to participate in the HRA Program ends
for any reason, any amounts remaining in your HRA Program will be
forfeited. (You will, however, have until March 31st of the next following
Plan Year to submit for reimbursement any expenses incurred prior to the
date your HRA Program ended.)
If You Participate in
the HRA Program,
You Cannot Also
Participate in a
Health Savings
Account (HSA)
The Internal Revenue Service (IRS) prohibits you from participating in an
HSA (such as the HSA offered in conjunction with the Silver or Health
Savings Plan options under the Tenet Medical Benefit Program) if you have
other health coverage, including coverage under the HRA Program. If you
switch from the Gold or Health & Reimbursement Plan under the Medical
Benefit Program to the Silver, Health & Savings Plan, or to any Medical
Benefit Program option other than the Gold or Health & Reimbursement
Plan, your participation in the HRA Program will automatically cease, and
you will forfeit any amounts remaining in your HRA Program account.
{00014391.DOCX-}
228
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Quick Facts
Health Care Spending
Account
Dependent Care
Spending Account
Health Reimbursement
Account Program
 Eligible family
 Dependent children
members, including
under the age of 13.
your spouse, your
 A spouse who is
children under the age
physically or mentally
of 26, and any other
incapable of caring for
person who qualifies
him/herself.
Who You Can
as your federal tax
Cover
dependent.* Expenses  A federal tax
(Whose
dependent* who is
for a domestic partner
expenses can
physically or mentally
cannot be reimbursed
be
incapable of caring for
unless your domestic
reimbursed)
him/herself.
partner qualifies as
your federal tax
See “Eligibility to
dependent. See
Participate” for more
“Health Care Expenses information.
for Dependents” for
more information.
 Same as for the HCSA
Program.
Minimum
Contribution
(per year)
 $0. Tenet determines the
amount it will contribute
each year, if any.
Maximum
Contribution
(per year)
When
Participation
Begins
{00014391.DOCX-}
 $130
 $130
 $2,550
 $5,000 (per
household)
 N/A. Tenet determines
the amount it will
contribute each year.
Note: If you are identified
You may view the
as a highly compensated
contribution amount for
employee, you may have a
the current plan year on
lower contribution
MyTenet.com for Tenet
maximum. Please contact
colleagues and
your Plan Administrator
HealthyatTenet.com for
for more information.
Conifer employees.
 On the 31st day after you begin employment in a
full-time or part-time benefit eligible position,
provided you’ve enrolled by the date indicated on
the enrollment website. See the Eligibility and
Enrollment section of the TEBP for more
information on determining your eligibility to
participate in the HCSA or the DDCSA.
229
 On the date your
coverage in either the
Gold or Health &
Reimbursement Plan
option under the Medical
Benefit Program takes
effect.
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
When
Participation
Ends
 When participation ends is dependent on the type
of spending account and other factors. Please refer
to the When Participation Ends… sections below for
each of the spending accounts. Additional
information is found in the Eligibility and
Enrollment section of this TEBP SPD.
 On the date you cease
participating in either the
Gold or Health &
Reimbursement Plan
option under the Medical
Benefit Program.
Federal tax dependent status is determined in accordance with the rules under Internal Revenue Code
section 152, without regard to IRC sections 152(b)(1) and (b)(2) (which contain certain inapplicable
exceptions to the definition of dependent) and section 152(d)(1)(B) (which contains a gross income
limitation).
How Your Contributions to the HCSA and the DDCSA
Programs Reduce Your Taxes and Maximize Money
Available to You
Contributing to a health or dependent day care flexible spending account is a good way to reduce your
tax liability and maximize the amount of your take-home pay available to you. Because you contribute
to these accounts with pre-tax payroll deductions, the amount of your income subject to federal, state
(if applicable) and Social Security taxes is reduced. This means you’ll generally pay less in taxes and get
more in your paycheck.
PROFILE: Tracey
Tracey earns $30,000 per year and elects to deposit $3,000 to the Dependent Care Spending Account
to pay for dependent care for her children, Robert and Tiffany. Here’s how participation can reduce
the amount of taxes she pays and how making contributions on a before-tax basis can make a
difference in Tracey’s paycheck:
With a Spending Account
Annual Base Salary
Reimbursement Account Deposits
Without a Spending Account
$ 30,000
–
Taxable Salary
$
3,000
$ 30,000
–
$ 27,000
$
0
$ 30,000
Federal Income Tax (Estimated)
–
$
5,400
–
$
6,000
Social Security (FICA) Tax (6.2%)
–
$2,065.50
–
$
2,295
After-Tax Expenses
–
$
–
$
3000
0
Take-Home Salary
$ 19,534
$ 18,705
Tax Savings
$ 828.50
$
In the above example, Tracey actually reduces her federal income and Social Security tax liability by
$828.50 per year by participating in the DDCSA. This means more money that is available to her.
{00014391.DOCX-}
230
0
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
How the Health Care Spending Account (HCSA) Works
You can use the HCSA to reimburse yourself for a number of health care expenses that you pay for outof-pocket.
Eligibility to Participate
For information on eligibility to participate in the HCSA, please see the Eligibility and Enrollment section
of this SPD site.
How Much You Can Set Aside Annually
Minimum Contribution
$130 for the year
Maximum Contribution
$2,550 for the year
Your entire annual election is available for reimbursement on the first day of your HCSA participation.
Health Care Expenses for Dependents
You can also use your HCSA to pay for health care expenses for any eligible dependents, as long as the
expenses submitted can’t be reimbursed by any other health care plan. “Eligible dependents” means:
 Your spouse
 Your children under the age of 26
 Any other person you can claim as your federal tax dependent (within the meaning of IRC section
152 (determined without regard to IRC sections 152(b)(1) and (b)(2), which contain certain
inapplicable exceptions to the definition of dependent, and section 152(d)(1)(B), which contains a
gross income limitation for a qualifying relative).
Please note that expenses for a domestic partner (or child of a domestic partner) are not eligible for
reimbursement unless your domestic partner (or child of a domestic partner) qualifies as your federal
tax dependent according to the rules listed above. For more information on determining dependent
status, please contact your tax advisor.
Note: If you participate in both the HCSA and the HRA Program, you may not obtain reimbursement
for the same expense under both accounts. Expenses will be reimbursed first from the HCSA. No
expenses will be reimbursed from the HRA Program until your HCSA is exhausted.
Estimating Your Health Care Expenses
To determine how much to set aside in the HCSA, first estimate the amount of eligible expenses you
expect to incur during your “HCSA participation period” — usually the calendar year for which you’re
enrolling and are making contributions. Note: If you have enrolled in either the Gold or Health &
Reimbursement Plan option under the Medical Benefit Program, you may want to consider your HRA
balance and potential contribution when determining how much money to set aside in the HCSA.
Please keep in mind, however, that Tenet may change the amount of its HRA contribution at any time.
{00014391.DOCX-}
231
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Please Be Aware . . .
Because everyone’s tax situation is different, we encourage you to discuss your participation in the
HCSA with your tax advisor before enrolling.
Consider:
HCSA Worksheet
Estimated Annual Expenses
Medical and dental deductibles
$
Co-pays or co-insurance amount for doctor visits
$
Insulin costs and Prescription drug co-pays or co-insurance
$
Orthodontia costs
$
Vision care co-pays, supplies (i.e., lens solution), laser eye surgery
and other amounts not covered by the plan
 Items not paid or only partially paid by your health care and
dental plans: Expenses above your health care or dental plan
limits, such as health care and dental expenses above
reasonable and customary (R&C) charge limits
 Other health care costs allowed by the IRS that aren’t
reimbursed by your health care or dental care plans (for a
complete list of eligible expenses, contact the MyBenefits
Customer Support Center at 1-877-468-3638)
Total Estimated Expenses for January 1 – December 31 (or HCSA
Participation Period if Enrolling Mid-Year)
$
$
$
$
HRA Balance, if any
Difference between Total Estimated Expenses and HRA Balance
Please Be Aware . . .
It’s important to estimate your expenses carefully and to set aside only the amount you will definitely
use, because your HCSA can reimburse only those expenses incurred during your HCSA participation
period. If you don’t incur enough eligible expenses by the end of the calendar year, you’ll forfeit any
unused money in your account. For more information on forfeitures, see “Forfeitures.”
What’s Eligible, What’s Not
To qualify for reimbursement through this account, the health care expense must:
Qualify as a
Reimbursable Health
care Expense
{00014391.DOCX-}
You may only obtain reimbursement for qualifying medical expenses (as
determined by the IRS). For a good reference guide on eligible expenses
under the plan, see IRS Publication 502.
Note: Current federal tax law does not allow premiums to be reimbursed
through the HCSA.
232
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Be Incurred by You,
Your Spouse, Your
Child under age 26, or
by an Individual Who
Qualifies as a
Dependent According
to the IRS
You may obtain reimbursement for expenses incurred by your federal tax
dependent. Since the IRS definition of a dependent differs from the
definition used in Tenet’s health plan, your dependent under Tenet’s health
plan may not qualify as a dependent for purposes of reimbursement under
the HCSA. You may be required to show proof of dependency before
receiving reimbursement from the HCSA.
The HCSA cannot reimburse you for any amount that is:
 Paid by any medical, prescription drug, mental health care, dental, vision
or other health care plan (in other words, you must be responsible for
paying the cost),
Be Paid by You
 Reimbursed through another spending account,
 Used as a medical deduction on your income tax return, or
 Used to pay premiums for any medical, prescription drug, mental health
care, dental, vision or other health care plan.
Be Incurred During
Your HCSA
Participation Period
Because participation in the HCSA is usually elected during annual
enrollment, your HCSA participation period is normally a calendar year
(January 1 through December 31). However, if you enroll after January 1,
your HCSA participation period begins on the participation effective date
shown on the enrollment website. Please refer to the Eligibility and
Enrollment section for more information on eligibility and mid-year
enrollments.
Examples of Eligible Health Care Expenses from A to Z
This list is not intended to be exhaustive. Please see IRS Publication 502 for more information.
Capital Expenses
The amounts you pay for special equipment installed in your home or for
improvements if their main purpose is medical care for you or your
dependent (e.g., installing railings and/or support bars and widening or
modifying hallways and interior doorways), reduced by the increase in value
of your property (if any).
Costs Related to
Medical Illness or
Condition
Expenses resulting from illness or medical condition, including acupuncture,
ambulance, braces, Braille reading materials (to the extent the cost of such
reading materials exceeds the cost for regular printed materials) and the
cost, maintenance, and training of a guide dog or other animal.
Deductibles
Medical, dental and vision plan deductibles, co-insurance and co-pays.
Doctor and Dentist
Fees
Fees for services provided by licensed physicians and dentists for the
diagnosis and treatment of diseases, illnesses and injuries affecting any
body part or function.
Hearing Care
Hearing care, such as hearing aids, hearing examinations and special
equipment for the hearing-impaired (i.e., telephone and television
adapters).
{00014391.DOCX-}
233
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Insulin
Amounts you spend on insulin, with or without a prescription.
Laser Eye Surgery
Laser eye surgery and radial keratotomy to improve vision.
Learning Disability
Fees you pay for tutoring for a specially trained tutor, provided such
tutoring is recommended by a doctor, and tuition fees you pay to a special
school for a child who has severe learning disabilities caused by mental or
physical impairments, provided your doctor recommends such a school and
the principal reason for attending such school is the availability of medical
care.
Nursing Home
Expenses for nursing home or home for the aged if primary reason for being
in the nursing home is to receive medical care (and not for personal
reasons).
Nursing Services
Wages and other amounts you pay for nursing services (including meals or
additional household upkeep needed as a result of the nursing attendant);
services don’t need to be performed by a registered nurse as long as the
services are usually performed by a nurse (e.g., giving medication, changing
dressings or bathing and grooming the patient).
Prescription Drugs
Prescription drugs, including birth control pills or other prescribed
contraceptives, and oxygen and its equipment. Exceptions may apply to
drugs prescribed for cosmetic or general health purposes.
Prosthetics
Artificial limbs and teeth and breast reconstruction and prosthesis
(following mastectomy for cancer).
Smoking-Cessation
Programs
Fees for smoking-cessation programs, but not amounts you pay for drugs
that do not require a prescription, such as nicotine gum or patches, that are
designed to help stop smoking.
Special Equipment
Part or all of the cost to install special equipment in your home or to modify
your home for a disability (reduced by the increase in value of your
property, if any—see Capital Expenses above).
Cost to install equipment or modify a car for a disability, or the difference in
cost between a regular car and a modified car.
Weight Loss Program
The cost of a weight loss program (excluding food, unless the food does not
satisfy normal nutritional needs, treats or alleviates an illness, and is
needed as substantiated by a physician), provided it is undertaken to treat
an existing disease diagnosed by a physician (e.g., heart disease, obesity, or
hypertension); you can’t submit the cost of weight loss programs if the
purpose is to maintain general good health.
Vision Care
Vision care, such as contact lenses (including saline solution and enzyme
cleaner), eyeglasses and eye examinations.
{00014391.DOCX-}
234
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Examples of Ineligible Health Care Expenses from A to Z
This list is not intended to be exhaustive. Please see IRS Publication 502 for more information.
Cosmetic Procedures
Expenses incurred primarily for cosmetic reasons, including hair transplants,
partial and full face lifts, liposuction, electrolysis, collagen injections, teeth
whitening, etc.
General Health
Expenses incurred for your general health, including vacations, health club
dues, exercise/fitness instruction, dancing lessons, swimming lessons and
health spa treatments such as massage, aromatherapy, etc., even if
recommended by your doctor.
Household Help
Expenses incurred for household help, even if recommended by your
doctor; child care expenses, even if child care is to enable you to receive
health care; diaper service costs unless the service is required to relieve the
effects of a specific disease. (Note: Food and household expenses for a
nursing attendant may be eligible for reimbursement.)
Long-Term Care
Expenses for long-term care services or long-term care insurance
premiums.
Over-the-Counter
Medications
Over-the-counter medications that you purchase without a prescription.
Vitamins and Dietary
Supplements
You can’t include vitamins and other dietary supplements that are merely
beneficial to your general health.
Weight Loss Programs
Expenses incurred for weight loss programs to promote general good
health, even if recommended by your doctor; you cannot include expenses
for food in a weight loss program, unless the food does not satisfy normal
nutritional needs, alleviates or treats an illness, and is needed as
substantiated by a physician.
A full explanation of these expenses and others is outlined in IRS Publication 502. You can get a copy
from the IRS’s Web site at www.irs.gov (click on “Forms and Publications” and then scroll down to “All
Forms and Publications”).
Please be aware that the rules governing IRS-qualified health care expenses are subject to change from
year to year. It’s your responsibility to ensure that your health care expenses qualify under the current
year’s list.
Don’t Forget!
You can’t be reimbursed for expenses that have been:
 Paid by a medical, prescription drug, mental health care, dental or vision plan,
 Reimbursed by another employer-sponsored spending account, or
 Claimed on your tax return.
Please be aware that expenses the IRS considers eligible for reimbursement may change from year-toyear. You must use the HCSA properly and only seek reimbursement for an eligible expense. If the
HCSA reimburses you for an ineligible expense, you’re responsible for repaying the money.
{00014391.DOCX-}
235
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
How Your HCSA Debit Card Works
The HCSA debit card allows you to pay for current-year health care expenses directly from your Health
Care Spending Account. You are issued a debit card if you make a minimum annual contribution of
$150.
You can use your HCSA debit card at your doctor’s or dentist’s office, pharmacy or vision care provider.
You do not need to provide supporting documentation if:
 The amount you are paying with your card is the amount of your Tenet-sponsored plan’s co-pay for
medical, dental or prescription drugs (including mail-order prescriptions).
 You have already filed your initial monthly orthodontia claim for the plan year and the amount is
the same as the previous orthodontia payment (and for the same provider).
 The amount you are paying is for a recurring charge — such as the co-insurance amount on a
prescription — for which you have previously filed a claim with the same provider.
When You Must Provide Supporting Documentation
When you use the HCSA debit card for certain expenses, you must provide supporting documentation.
If required, the Plan Administrator will contact you, outlining what is needed. Some examples are if:
 The amount you are paying with your HCSA debit card does not equal your medical plan’s co-pay.
For example, you can use the card but will also need to provide supporting documentation if you
use it to pay deductibles, co-insurance, non-covered items or co-pays under your spouse’s or
dependent’s plan.
 You use the card to buy eligible non-prescription items. If you are buying prescriptions at the same
time as the eligible non-prescription items, you should pay for your prescription as a separate
transaction. This way, you only need to include the eligible non-prescription items on your claim.
(Remember that you may not use the card to pay for any expenses that are not eligible for
reimbursement under the HCSA.)
 You are using the card for the first time during the plan year to pay for a recurring charge, like a
monthly orthodontia visit or a co-insurance amount on a prescription.
 The electronic transfer does not include enough information to determine if the purchase is for
eligible expenses.
If your health care provider or pharmacy does not accept debit cards or you choose not to use your
card, you may submit your receipts to the Plan Administrator for reimbursement.
When Your HCSA Participation Ends
Your HCSA participation ends on the earliest of the following dates:
 The date you no longer meet the eligibility requirements of the HCSA component program or the
TEBP for any reason (including death) other than termination of employment.
 The date you stop making contributions to your HCSA account. If your contributions stop before
the end of the calendar year, eligible expenses under the HCSA will be restricted to the time period
during which you were actively participating.
 The last day of the month of the last pay period during which you are employed by Tenet, assuming
you do not elect or are not eligible to continue your coverage under COBRA. If your employment is
terminated before the end of the calendar year, your payroll deductions will stop with your last
paycheck. However, you will still be able to request reimbursement under the HCSA for eligible
{00014391.DOCX-}
236
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
expenses incurred prior to your termination date. If you are eligible and you elect to continue your
HCSA coverage under COBRA by reason of your termination of employment, your right to COBRA
will become effective on the first day of the month following the date your Tenet employee
coverage ends. The date you take an unpaid leave of absence, unless your leave of absence is an
FMLA or USERRA leave and you elect to continue participation in the HCSA on the “Pay-As-You-Go”
method. (See the Life Events section of this SPD site for more information on FMLA and USERRA
leaves.)
 If you have elected to continue coverage in the HCSA under COBRA (see below), the date your right
to COBRA continuation coverage terminates.
 The date the HCSA component program under the TEBP or the TEBP is terminated.
Extending Your HCSA Participation Period Under COBRA
Under the Federal law known as COBRA, you may be entitled to continue your coverage under the
HCSA on an after-tax basis if you lose coverage under that component program on account of your
termination of employment (for reasons other than gross misconduct) or a reduction of your hours. If
you elect to continue your coverage under COBRA, you will continue to participate in the HCSA as a
“COBRA continue” for the period of your COBRA continuation right (and as long as you make your
required COBRA premiums). Your COBRA continuation right must be made available for the remainder
of the plan year in which your termination or reduction in hours occurs, unless at the time of such
termination or reduction in hours, the maximum benefit you could receive under the HCSA for the
remainder of the plan year is less than the amount of COBRA premiums that would be required to
continue coverage under the Health Care Spending Account.
In general, if you elect to continue your coverage under the HCSA as a COBRA continue, your required
COBRA premium will be 102 percent of your elected HCSA contribution amount in effect immediately
prior to your termination of employment or reduction in hours. You must elect COBRA continuation
coverage no later than 60 days from the later of (1) the date your coverage under the HCSA is lost due
to a termination of employment or reduction in hours, or (2) the date you receive the COBRA notice
from the Plan Administrator. Your first COBRA premium is due within 45 days after you elect COBRA
coverage.
It is Tenet’s responsibility to notify the Plan Administrator of your termination of employment or
reduction in hours. Upon receipt of this notice, the Plan Administrator will advise you of your COBRA
continuation rights, if any. For more information on COBRA continuation coverage, please contact your
Plan Administrator or refer to the Other Information section of this SPD site.
How the Dependent Day Care Spending Account
(DDCSA) Works
You can use the Dependent Day Care Spending Account (DDCSA) to reimburse yourself for eligible
dependent care expenses. The account is designed to give you a tax break on paying for dependent
care needed so that you and your spouse (if you are married) can work. For many, the DDCSA provides
a better tax break than claiming these dependent care expenses as a deduction or tax credit on their
tax return.
Please Be Aware
Because everyone’s tax situation is different, we encourage you to discuss your participation in this
account with your tax advisor before enrolling.
{00014391.DOCX-}
237
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Eligibility to Participate
To participate in the DDCSA, you must work or be a full-time student. If you are married, your Spouse
must also work, be a full-time student, or be mentally or physically incapable of self-support. For more
information on eligibility to participate in the DDCSA, please see the Eligibility and Enrollment section
of this SPD site.
Note: If you are identified as a highly compensated employee, you may have a lower contribution
maximum. Please contact your Plan Administrator for more information.
How Much You Can Set Aside Annually
Minimum Contribution
$130 for the year
Maximum Contribution
$5,000 for the year
The IRS may further limit how much you can contribute, based on your personal situation, as follows:
Your Contribution Is Limited to
Your Amount of Income …
 Your contribution to this account can’t exceed your actual or
expected income for the calendar year.
 If you’re married, your contribution can’t exceed the lesser of
your or your spouse’s actual or expected income for the
calendar year.
If You’re Married, Your Spouse
Also Contributes to a DDCSA,
and You File Income Taxes
Jointly …
You can set aside up to $5,000 per year to this account. However,
if your spouse also participates in another dependent care
spending account, the total combined amount you can set aside
each calendar year can’t exceed $5,000 per household (or the
lesser of the amount of your or your spouse’s income).
If You’re Married and You and
Your Spouse File Income Taxes
Separately …
You can set aside up to $2,500 each calendar year to this account,
subject to the income limitations outlined above.
If You’re Married and Your
Spouse Goes to School Full
Time or Is Physically or
Mentally Incapable of SelfSupport …
For each month that your Spouse is a full-time student or
physically or mentally incapable of self-support, your spouse will
be deemed to have income of $250, if you have one child needing
care, and $500, if you have two or more children needing care.
This means that if your Spouse is a full-time student or disabled
(mentally or physically incapable of self-support) for an entire
year, the most you can set aside is $3,000 per year for one child
or $5,000 per year for two or more children. (Note that even if
your spouse is deemed to have income of $500 per month for
twelve months, you are still limited by the household
contribution maximum of $5000 per year.)
If You Share Custody of Your
Children Because You and Your
Spouse Are Legally Separated
or Divorced …
In general, only the custodial parent (the parent with whom the
children spend the most nights per year) can contribute to a
dependent care spending account.
{00014391.DOCX-}
238
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
If You Are a Highly
Compensated Employee…
Certain highly compensated employees may have their
contributions to the DDCSA limited to comply with IRC sections
125 and 129 and the accompanying regulations.
For more information on these contribution limits, please see IRS Publication 503, available on the IRS
Web site at www.irs.gov (click on “Forms and Publications” and then scroll down to “All Forms and
Publications”).
Reimbursements will be made after your DDCSA is credited with your contribution. If there’s not
enough money in your account to meet the entire reimbursement request, you receive only the
amount available in your DDCSA at the time of your request.
If You and Your Spouse Both Work for Tenet
If you and your spouse are both eligible for participation in the Tenet Dependent Day Care Spending
Account, you can each enroll in the DDCSA. Please note, however, that the IRS limits the amount of
tax-free dollars a single household can contribute to the DDCSA to $5,000 annually.
PROFILE: Tracey
Tracey’s mother is in the hospital recovering from a heart attack. Her doctor anticipates an
extended recovery period, as her mother is currently not capable of caring for herself. Tracy is
considering having her mother move in with her and the kids and hiring a nurse’s aide to care for
her mother. If Tracey decides to do this, she can elect to increase the amount of her DDCSA
contribution to pay for the nurse’s aide expenses once her mother moves in ― as long as Tracey’s
mother qualifies as Tracey’s federal tax dependent (or would qualify as Tracey’s federal tax
dependent but for IRC sections 152(b)(1) and (b)(2), which contain certain inapplicable exceptions
to the definition of dependent, and section 152(d)(1)(B), which contains a gross income limitation),
and her mother’s moving in qualifies as a life event. To receive reimbursement under her DDCSA,
Tracey will need to report her life event by going to MyTenet.com for Tenet colleagues and
HealthyatTenet.com for Conifer employees and accessing the My Benefits link or by calling the
MyBenefits Customer Support Center at 1-877-468-3638. For more information on life events, see
the Life Events section of the TEBP SPD.
Eligible Dependents
You can use your DDCSA to pay for dependent care expenses for the following dependents:
 Children under age 13 whom you’re entitled to claim as a tax exemption,*
 Your spouse who is physically or mentally not able to care for himself or herself, and
 Dependents of any age who are physically or mentally incapable of self-care and who can be
claimed as your federal tax dependent (determined without regard to IRC sections 152(b)(1) and
(b)(2), which contain certain inapplicable exceptions to the definition of dependent, and (d)(1)(B),
which contains a gross income limitation for qualifying relatives).**
*
If you are a divorced or legally separated individual, you may participate in this account if you are
the custodial parent of your child, regardless of whether or not you claim your child as a tax
exemption. You are considered the custodial parent if your child lives with you for more than half
the year. If you are not the custodial parent, you can’t participate in this account, even if you can
claim the child as a tax exemption.
{00014391.DOCX-}
239
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
** If you have a dependent for which day care services are provided outside your home, your
dependent must either live with you or regularly spend at least eight hours per day in your home.
Please note that expenses for the care of your domestic partner are not reimbursable unless your
domestic partner qualifies as your federal tax dependent (determined without regard to IRC sections
152(b)(1), (b)(2) and (d)(1)(B)). For more information on determining dependent status, please contact
your tax advisor.
Estimating Your Dependent Care Expenses
To determine how much to set aside in the DDCSA, first estimate the amount of eligible expenses you
expect to incur during your “DDCSA participation period,” which is usually the calendar year for which
you’re enrolling and are making contributions.
DDCSA Worksheet
Estimated Annual
Expenses
Dependent child care during working hours, such as a qualified day care
center, nursery school (but not kindergarten) tuition or a babysitter
inside or outside your home for children under 13 years old
$
Dependent adult care during working hours for adult dependents who
live with you and who are physically or mentally incapable of self-care
$
After-school program
$
Summer day camp
$
FICA and other taxes you pay for dependent care providers
$
Total Estimated Expenses for January 1 – December 31
(or DDCSA Participation Period if Enrolling Mid-Year)
$
Please Be Aware …
It’s important to estimate your expenses carefully and to set aside only the amount you definitely
will use, because your DDCSA can reimburse expenses incurred only during your DDCSA
participation period. If you don’t incur enough eligible expenses by the end of the calendar year,
you’ll forfeit any unused money in your account. For more information on forfeitures, see
“Forfeitures.” Also, in most cases, you’ll need to pay for your out-of-pocket expenses up front and
then submit a claim form to get reimbursed, so be sure you’ve allotted for these expenses as part
of your overall budget.
What’s Eligible, What’s Not
To qualify for reimbursement through this account, the dependent care expense must:
Be Incurred So That
You (and Your
Spouse, if You’re
{00014391.DOCX-}
If your spouse is not employed, he or she must be a full-time student or be
mentally or physically incapable of self-support or caring for your children.
Your spouse is a full-time student if he or she is enrolled in the number of
240
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Married) Can Go to
Work
hours or classes that the school considers to be full-time for some part of
five calendar months during the year. The months do not need to be
consecutive.
Be Reported as
Income by the
Dependent Care
Provider
The dependent care provider must reflect payment from you as taxable
income. The individual must provide you with a Tax ID number or Social
Security number when hired by you.
In other words, the DDCSA can’t reimburse any amount that is:
Be Paid by You
 Reimbursed through another spending account, or
 Used as a dependent care deduction or tax credit on your income tax
return or the tax return of any other individual.
Be Incurred During
Your DDCSA
Participation Period
Because participation in the DDCSA is usually elected during annual
enrollment, your DDCSA participation period is normally a calendar year
(January 1 through December 31). However, if you enroll after January 1,
your DDCSA participation period begins on the participation effective date
shown on the enrollment website. Please refer to the Eligibility and
Enrollment section of the TEBP SPD for more information on eligibility and
mid-year enrollments.
Examples of Eligible Dependent Care Expenses from A to Z
Application and
Agency Fees
Application and agency fees are eligible if they are required to obtain
dependent care. However, forfeited deposits are not eligible if dependent
care is not provided.
Dependent Care in
Your Home
Wages, including Social Security and other income and employment taxes,
for a dependent care provider working in your home are eligible. Additional
costs for your provider’s room (if you have extra rent) and board, including
extra utilities, are eligible. You may count only those earnings that are
directly related to the household and in-home care services provided so
that you and your spouse can go to work. The caregiver can’t be your
spouse, a dependent whom you (or your spouse) claim as an exemption or
your child under age 19 (even if he or she is not a dependent). Expenses
you pay for household services are included as long as they are at least
partly for the well-being and protection of your dependent. This includes a
housekeeper, maid or cook.
Dependent Care
Outside Your Home
Expenses for dependent care provided outside your home may be eligible
for reimbursement as long as the dependent regularly spends at least 8
hours each day in your home. If the care is provided by a "dependent care
center," the center must comply with all applicable state and local
regulations, including licensing regulations.
A dependent care center is a center that provides care for more than 6
people (other than people residing at the center), and receives a fee,
payment, or grant for providing such services (even if the center is run on a
non-profit basis). Home dependent care providers who care for fewer than
{00014391.DOCX-}
241
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
seven individuals aren’t required by the IRS to be licensed; however, your
state’s licensing laws may differ. Remember that you must still provide the
Social Security number for this individual when you file your tax return.
Part-Time Work
If you or your spouse works part-time, you must allocate dependent care
expenses between days worked and days not worked. However, if you are
required or pay for dependent care on a periodic basis (such as weekly or
monthly) that includes days worked and days not worked, you are not
required to allocate expenses.
Dependent Care
During Short
Absences
If you or your spouse takes days off for illness or personal time on a short,
temporary basis (generally, less than 2 weeks is considered a short,
temporary basis), you do not have to allocate expenses between days
worked and days not worked if you are required to pay for dependent care
during your absence.
Public or Private
School
Certain dependent care services provided at a public or private school are
eligible. For children kindergarten and above, only the portion of the
schooling (i.e., portion of tuition) related to child care before school begins
and/or after school ends can be reimbursed.
Specialized Day Camp
Expenses for day camp are eligible, even if the day camp specializes in a
particular activity, such as soccer or computers.
A full explanation of these expenses and others is outlined in IRS Publication 503. You can get a copy
from the IRS’s Web site at www.irs.gov (click on “Forms and Publications” and then scroll down to “All
Forms and Publications”).
Please be aware that the rules governing IRS-qualified dependent day care expenses are subject to
change from year to year. You must use the DDCSA properly and only seek reimbursement for an
eligible expense. If the DDCSA reimburses you for an ineligible expense, you’re responsible for
repaying the money.
Please Be Aware…
Dependent care expenses incurred during a calendar year for which you don’t list the day care
provider’s name, address and taxpayer identification number on your federal income tax return are
not reimbursable under the plan. Note: No taxpayer identification number is required for taxexempt organizations.
Examples of Ineligible Dependent Care Expenses from A to Z
The following dependent care expenses can’t be reimbursed through the DDCSA:
 Cost of overnight camp
 Kindergarten tuition (portion of tuition not related to child care before school begins and/or after
school ends)
 Private school for a school-age child (portion of tuition not related to child care before school
begins and/or after school ends)
 Transportation to and from the dependent care site, unless provided by the dependent care
provider and the transportation meets the other requirements for eligibility
{00014391.DOCX-}
242
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
 Day care expenses that can be allocated to days not worked, for example, if you work three days a
week and pay on a daily basis for five days of day care, the payments for the two days not worked
are not eligible (however, if you are required to pay by the week, the payment for the week is
eligible)
 Day care expenses when either you or your spouse is absent from work for illness for more than a
short, temporary absence, even if you or your spouse continue to be considered an employee of
the employer and receive salary continuation payments
 Deposits or agency fees that are forfeited
When Your DDCSA Participation Period Ends
Your DDCSA participation period ends on December 31 of every year (unless the DDCSA or TEBP
terminates prior to that date). This means you can continue to be reimbursed up to the amount in your
account for eligible dependent care expenses incurred during the entire calendar year, even if
contributions stop before year-end.
Contributions to your DDCSA will stop on the last pay period of the year. Your contributions will end
before then if one of the following occurs:
 You no longer meet the eligibility requirements of the DDCSA component program or the TEBP for
any reason (including death).
 You stop making contributions to your DDCSA account.
 Your employment is terminated.
 You take a leave of absence, unless your leave of absence is an FMLA or USERRA leave and you
elect to continue participation in the DDCSA on the “Pay-As-You-Go” method. (See the Life Events
section of the TEBP SPD for more information on FMLA and USERRA leaves.)
 The date the DDCSA component program under the TEBP or the TEBP is terminated.
You cannot continue participation in this account under COBRA.
Please Be Aware
You can receive reimbursement for eligible dependent care expenses incurred after your
contributions stop (see list above) as long as the expenses are incurred during the same calendar
year. Your request for reimbursement must be postmarked by March 31 of the following year.
How to File a Claim for Reimbursement under the HCSA
or the DDCSA
The claims administrator for the HCSA and DDCSA is:
AonHewitt
Your Spending Account™
P.O. Box 785040 Orlando, FL 32878-5040
Phone: 1-877-46-TENET
Fax: 1-888-211-9900
{00014391.DOCX-}
243
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Accessing Your Account
Go to MyTenet.com for Tenet colleagues and HealthyatTenet.com for Conifer employees and access
the My Benefits link.
On the Your Spending Account website, you can:
 Complete your HCSA and DDCSA claim form online by choosing “Submit Claims.”
 Review the status of your claims.
 Learn about eligible expenses.
 Check your current account balance(s).
Your Spending Account (YSA) Card
If you use your YSA card for your HCSA, you don’t need to submit a claim. Your Spending Account will
notify you if you need to provide receipts or other documentation. Even if you use your YSA card, it is
important to save your receipts in case you are required to provide supporting documentation.
Submitting an HCSA or DDCSA Claim
Your Spending Account offers the convenience of creating your claim form online. From the Your
Spending Account website, simply choose “Submit Claims” to get started. After entering your claim
information, the next steps are to:
 Print the page.
 Sign and date the page.
 Fax or mail the page to Your Spending Accounts (at the address or fax number listed above) with
receipts or other documentation by the due date provided in this Spending Accounts SPD section.
You must provide proper supporting documentation so that your claim can be approved. This includes
receipts or other documentation, such as an Explanation of Benefits (EOB) statement from your health
plan. If the supporting documentation is not submitted within 30 days after receipt of your claim form,
the pending claim form is cancelled and you will need to resubmit the claim along with receipts and/or
other documentation to have your claim processed.
Your final reimbursement request for the HCSA/DDCSA participation period must be postmarked by
March 31 of the following calendar year.
Claims Summary
For DDCSA Claims
For HCSA Claims
 If you use a care provider or day care
service, your receipt must contain the
following:
 For health care claims, an itemized receipt must
include the following:
 Dates of service
 Name of service provider
 Name of dependent receiving
services
 Amount paid
 Tax ID number or Social Security
{00014391.DOCX-}





244
Date of service
Name of service provider, supplier or pharmacy
Name of patient
Name of drug, product or service
Amount paid
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
For DDCSA Claims
 Number of service provider
 Reimbursements will be made after
your DDCSA is credited with your
contribution. If there’s not enough
money in your account to meet the
entire reimbursement request, Your
Spending Account will reimburse only
the amount available in your DDCSA at
the time it receives your
reimbursement request.
 As your DDCSA receives additional
contributions, you’ll receive additional
reimbursement checks until the entire
reimbursement request is paid.
For HCSA Claims
 For prescription drugs, remember to submit the
receipt that the pharmacist has attached to the
prescription, instead of the cash-register receipt.
 If you have medical insurance, proof of any amount
paid by other coverage — such as an Explanation of
Benefits (EOB) — is required. However, EOBs aren’t
required for:
 Prescriptions*
 Dental, vision or hearing expenses*
 Receipts stating that the amount is for a copayment
 Access Your Spending Account for more
documentation requirements concerning medical
necessity, orthodontia and other services.
*Note that independent verification of expenses may still be required. Please contact the Claims
Administrator for more information.
Explanation of Benefits (EOB)
Each time you receive a reimbursement check from Your Spending Account, you’ll also receive an
Explanation of Benefits (EOB). The EOB explains how the reimbursement was determined or gives the
reason a claim was denied. If you have questions regarding your reimbursement request, contact Your
Spending Account directly.
You have up to 90 days after the end of the plan year (your claim must be postmarked by March 31) to
submit the completed claim form and attachments to Your Spending Account to receive
reimbursement.
Claims Review and Detailed Description of Claims Process
If you disagree with AonHewitt’s decision regarding a claim for benefits, you can have your claim
reviewed as described in the Other Information section of this SPD site. The Other Information section
describes the claims review process in detail.
Forfeitures under the HCSA and the DDCSA
As required by law, you’ll forfeit any spending account contributions you haven’t used by the end of
the plan year. This is known as the “use it or lose it” rule. So it’s important to estimate your health care
and dependent care expenses carefully when deciding how much you want to contribute and to set
aside money for only those expenses you can reasonably expect to incur throughout the year.
Any money remaining in your spending account(s) after the final reimbursement request has been
processed for the applicable participation period will be forfeited back to the Plan Administrator to
help reduce the administrative costs of the plan. Reimbursement requests must be postmarked by
March 31 of the following plan year.
{00014391.DOCX-}
245
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
How the Health Reimbursement Account Program
Works
As with the Health Care Spending Account (HCSA) or with a Health Savings Account (HSA), money in
your Health Reimbursement Account (HRA) Program may be used to reimburse yourself for eligible
health care expenses, as long as those expenses have not been reimbursed under or paid for by
another plan. Note: If you participate in both the HCSA Program and the HRA Program, expenses will
not be reimbursed from the HRA Program until the HCSA is exhausted.
Eligibility to Participate
Participation in the Health Reimbursement Account (HRA) Program is tied to participation in either the
Gold or Health & Reimbursement Plan under the Medical Benefit Program. If you have enrolled in
either the Gold or Health & Reimbursement Plan, you will be automatically enrolled in the HRA
Program. (However, you may elect to permanently opt out of HRA Program coverage. Please contact
the Plan Administrator for more information.) If you have elected not to participate in the Medical
Benefit Program or have selected a Medical Benefit Program option other than the Gold or Health &
Reimbursement Plan, you are not eligible to participate in the HRA Program.
Your dependents do not participate in the HRA Program; however, expenses incurred by your
dependents may be eligible for reimbursement. See "What's Eligible, What's Not" below for more
information.
Contributions to the HRA Program
All contributions to the HRA Program will be made by your Employer. You are not permitted to make
any contributions to the HRA Program. (Note: Your Employer may change the amount of the HRA
Program contribution at any time prior to making the contribution.) If you enroll in either the Gold or
Health & Reimbursement Plan after the first day of the plan year (see the Life Events section of this SPD
for information on events entitling you to a mid-year enrollment), your HRA Program contribution may
be prorated.
What's Eligible, What's Not
The HRA Program allows for reimbursement of qualifying health care expenses incurred by you or your
eligible dependents. To qualify for reimbursement under the HRA Program, the expense must:
Qualify as a
Reimbursable Health
Care Expense
You may only obtain reimbursement for qualifying health care expenses (as
determined by the IRS). For a good reference guide on expenses eligible for
reimbursement under the plan, see IRS Publication 502.
Be Incurred by You,
Your Spouse, Your
Child under age 26, or
by an Individual Who
Qualifies as a
Dependent According
to the IRS
You may obtain reimbursement for expenses incurred by your federal tax
dependent. Since the IRS definition of a dependent differs from the
definition used in Tenet’s health plan, your dependent under Tenet’s health
plan may not qualify as a dependent for purposes of reimbursement under
the HRA Program. For purposes of the HRA Program, a federal tax
dependent is a dependent within the meaning of IRC section 152
(determined without regard to sections 152(b)(1), (b)(2), and (d)(1)(B)).
{00014391.DOCX-}
246
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
The HRA Program cannot reimburse you for any amount that is:
 Paid by any medical, prescription drug, mental health care, dental, vision
or other health care plan (in other words, you must be responsible for
paying the cost),
Be Paid by You
 Reimbursed through a spending account (including the HCSA) or other
reimbursement program*,
 Used as a medical deduction on your income tax return, or
 Used to pay premiums for any medical, prescription drug, mental health
care, dental, vision or other health care plan.
*If you participate in both the HCSA and the HRA Program, expenses will
not be reimbursed from the HRA Program until your HCSA is exhausted.
Be Incurred During
Your HRA Program
Participation Period
Because participation in the HRA Program is tied to participation in either
the Gold or Health & Reimbursement Plan under the Medical Benefit
Program, your HRA Program participation period is normally a calendar year
(January 1 through December 31). However, if you enroll in the Gold or
Health & Reimbursement Plan under the Medical Benefit Program after
January 1, your HRA Program participation period begins on the date your
coverage under the Gold or Health & Reimbursement Medical Plan begins.
Examples of Eligible Expenses
The same rules and requirements regarding reimbursement of qualifying health care expenses apply to
the HRA Program as to the HCSA. Please see "Examples of Eligible Health Care Expenses from A to Z"
under the HCSA Program above for more information on the requirements for obtaining
reimbursement under the HRA Program and the expenses eligible for reimbursement.
Submitting an Expense for Reimbursement under the HRA Program
Expenses that are paid on your YSA card do not need to be submitted for reimbursement. All other
expenses may be submitted to:
AonHewitt
Your Spending Account™
P.O. Box 785040 Orlando, FL 32878-5040
Phone: 1-877-46-TENET
Fax: 1-888-211-9900
When Your HRA Program Coverage Ends
Your participation in the HRA Program ends on the earliest of the following dates:
 The date your coverage under either the Gold or Health & Reimbursement Plan ends for any
reason.
 The date the HRA Program is terminated.
 The date the Medical Benefit Program is terminated.
 The date the TEBP is terminated.
{00014391.DOCX-}
247
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Extending Your HRA Program Participation Period Under COBRA
Under the Federal law known as COBRA, you may be entitled to continue your coverage under the HRA
Program if you lose coverage due to a qualifying event. Because you are only eligible to participate in
the HRA Program if you participate in either the Gold or Health & Reimbursement Plan under the
Medical Benefit Program, you must elect COBRA continuation coverage with respect to your Gold or
Health & Reimbursement Plan coverage under the Medical Benefit Program in order to continue your
coverage under the HRA Program. If you elect COBRA continuation coverage with respect to the Gold
or Health & Reimbursement Plan under the Medical Benefit Program, coverage under the HRA Program
will automatically be extended for as long as you remain enrolled in such Gold or Health &
Reimbursement Plan. (You may, however, elect to permanently waive your right to continued
participation in the HRA Program.) If you do not elect to continue your Gold or Health
&Reimbursement coverage under COBRA (or you switch to another Medical Benefit Program option),
your coverage under the HRA Program will end. For more information on COBRA continuation
coverage, please see the Other Information section of this SPD.
Helpful Information About the Spending Accounts
(HCSA and DDCSA) and the HRA Program
You can learn additional information about the HCSA, the DDCSA, and the HRA Program offered under
the TEBP by reviewing the other sections of the TEBP SPD. The complete SPD includes information on
eligibility and enrollment, procedures for appealing claim denials, qualified medical child support
orders, authority to amend and terminate the TEBP and all of the benefit programs (including the
spending accounts), COBRA continuation rights and your rights under the Health Insurance
Portability and Accountability Act (HIPAA).
Here’s a list of some quick facts you may need to know:
Employer and Plan
Sponsor
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
(469) 893-2000
Plan Administrator
Tenet Benefits Administration Committee
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
(469) 893-2000
Claims Administrator
for the HCSA and the
DDCSA
AonHewitt Your Spending Account™
P.O. Box 785040
Orlando, FL 32878-5040
Phone: 1-877-46-TENET
Fax: 1-888-211-9900
Claims Administrator
for the HRA Program
AonHewitt Your Spending Account™
P.O. Box 785040
Orlando, FL 32878-5040
Phone: 1-877-46-TENET
Fax: 1-888-211-9900
{00014391.DOCX-}
248
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Agent for Service of
Legal Process
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
(469) 893-2000
Legal process may also be served on the Plan Administrator.
Plan Effective Date
The HCSA, the DDCSA, and the HRA Program are component programs in
the TEBP, which was originally effective as of October 1, 1977. The TEBP
was amended and restated effective January 1, 2015.
Employer
Identification Number
95-2557091
Plan Number
515
Plan Year
January 1 through December 31.
Type of Plan
The HCSA is a welfare benefit program offering reimbursement for
qualifying health care expenses. The DDCSA is a welfare benefit program
offering reimbursement for approved dependent care expenses. The HRA
Program is a welfare benefit program offering reimbursement for
qualifying health care expenses. See the Other Information section for
more information.
Funding of Benefits
Your benefits under the HCSA and the DDCSA are funded by your employee contributions to the
accounts. For more information on contributions, please review “How Much You Can Set Aside
Annually for the HCSA” and the “How Much You Can Set Aside Annually for the DDCSA.” Your benefits
under the HRA Program are funded by employer contributions.
Tax Consequences of Participation in the Spending Accounts
Your contributions to the HCSA and DDCSA are made a pre-tax basis by reducing your salary. Employer
contributions to the HRA Program and reimbursement of qualifying health care expenses are provided
on a tax-free basis. For more information on the tax consequences of participating in the spending
accounts or the HRA Program, please see your tax advisor.
Your Rights Under ERISA and HIPAA
For a statement explaining your rights under the Employee Retirement Income Security Act of 1974
(ERISA) and HIPAA, see the Other Information section of this TEBP SPD.
Glossary
Federal Tax Credit (for dependent care expenses only)
This is a credit you receive from the federal government on your federal income tax return for
dependent care expenses. This credit reduces your income taxes. You can’t claim the federal tax credit
and participate in the DDCSA.
{00014391.DOCX-}
249
-------------------------------------------------------------- SPENDING ACCOUNTS SUMMARY PLAN DESCRIPTION, 2017 --------------------------------------------------------
Forfeited Money
The money (1) you lose if you don’t claim all the contributions you made to the HCSA and/or DDCSA
within a calendar year, or (2) forfeited under your HRA Program account on the date your participation
in such account terminates.
Pre-Tax Contributions
Contributions deducted from your paycheck before taxes are taken out. This lowers your gross income,
so you pay less in taxes.
{00014391.DOCX-}
250
Life and AD&D Summary
About This Summary Plan Description (SPD)
This summary provides an overview of the life and accidental death and dismemberment (AD&D)
insurance options provided under the Tenet Life Benefit Program and the Tenet Accidental Death and
Dismemberment (AD&D) Program, both component programs in the Tenet Employee Benefit Plan
(TEBP). For more detailed information on your life and AD&D coverage, please see the certificate of
coverage for these programs available at MyTenet.com for Tenet colleagues and HealthyatTenet.com
for Conifer employees, which are incorporated into and will be considered part of, the TEBP SPD.
Note: Certain Tenet facilities and subsidiaries maintain their own SPD summarizing benefits under
the Tenet Employee Benefit Plan.
Summary of Benefits Details
Unum Life Insurance Company of America
Portland, Maine
Policy Holder: Tenet Healthcare Corporation
Policy Number: 292000
Policy Effective Date: August, 1, 2001; Amended January 1, 2015
Anniversary Date: January 1
Your Tenet Life and AD&D Benefit Programs
To make sure you and your family have ample financial protection, Tenet offers basic (core) and
supplemental life and accident insurance coverages.
Core Coverages
Tenet provides you with life and accident insurance coverage as part of your core benefits (provided
you’re eligible), so you’re never without a basic level of protection. These core coverages are free to
you.
Benefit
Coverage Highlights
Basic Life Insurance
100% paid by Tenet.
(Full-time employees only—see the certificate of
coverage available at MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer
employees or the Eligibility and Enrollment
section for more information
Amount of coverage is 1 times your annual pay
(up to a maximum of $50,000), rounded up to
the next higher thousand if not an even
thousand.
Basic Personal Accident Insurance - also known
as Accidental Death & Dismemberment (AD&D)
{00014391.DOCX-}
100% paid by Tenet.
Amount of coverage is 1 times your annual pay
(up to a maximum of $50,000), rounded up to
251
-------------------------------------------------------------------------------- LIFE AND AD&D SUMMARY, 2017 -------------------------------------------------------------------------
(Full-time employees only—see the certificate of
coverage available at MyTenet.com for Tenet
colleagues and HealthyatTenet.com for Conifer
employees or the Eligibility and Enrollment
section for more information)
the next higher thousand if not an even
thousand.
Supplemental Coverages
To give you added protection and peace of mind, Tenet offers supplemental life insurance coverage for
you, as well as life insurance coverage for your eligible dependents — all at low group rates. These
coverages make the financial foundation provided by your core benefits even stronger. For a look at
how Tenet’s life and accident insurance coverages may be affected by events that happen in your life,
please see the Life Events section.
Benefit
Coverage Highlights
You elect and pay for coverage.
Supplemental Employee Life
Insurance
(Only Full-time and Part-time
1 employees are eligible for
this coverage)
Amount of coverage is based on your annual pay.
Coverage options are 1, 2, 3, 4, 5 or 6 times your annual pay,
rounded up to the next higher thousand if not an even thousand.*
Coverage amounts over $750,000 require Evidence of Insurance
(EOI).
Coverage amount is subject to plan maximum for supplemental
life of $2,500,000.
You elect and pay for coverage.
Spouse Life Insurance
(including domestic partners
as defined in the certificate
of coverage)
Coverage options are $5,000, $10,000, $25,000, $50,000 or
$100,000.*
Coverage amounts of $100,000 and over require EOI.
Maximum coverage cannot exceed 100% of the Supplemental
Employee Life coverage you choose.
You elect and pay for coverage.
Child Life Insurance
Coverage options are $5,000, $10,000 or $25,000 per child up to
age of 26.*
Maximum coverage cannot exceed 100% of the Supplemental
Employee Life coverage you choose.
Supplemental Employee
Accidental Death &
Dismemberment (AD&D)
Insurance
(Only Full-time and Part-time
1 employees are eligible for
this coverage)
{00014391.DOCX-}
You elect and pay for coverage.
Amount of coverage is based on your annual pay.
Coverage options are 1, 2, 3, 4, 5 or 6 times your annual pay,
rounded up to the next higher thousand if not an even thousand.*
Coverage amount is subject to the plan maximum for
supplemental AD&D of $500,000.
252
-------------------------------------------------------------------------------- LIFE AND AD&D SUMMARY, 2017 -------------------------------------------------------------------------
Benefit
Coverage Highlights
Spouse Supplemental
Accidental Death and
Dismember (AD&D)(includes
domestic partners as defined
in the certificate of coverage)
You elect and pay for coverage.
Child Accidental Death and
Dismemberment (AD&D)
Coverage options are $25,000, $50,000 or $100,000.*
You elect and pay for coverage.
Coverage option is $10,000 or $25,000 per eligible child up to age
26.*
*Option availability may vary if you are covered by a collective bargaining agreement.
{00014391.DOCX-}
253
Business Travel Accident
Summary Plan Description
About This Summary Plan Description (SPD)
The Tenet Business Travel Accident Program is an insured benefit program which provides benefits in
the event of injury while traveling as an employee. The Business Travel Accident Program is a
component program in the Tenet Employee Benefit Plan (TEBP), a comprehensive welfare benefits plan
intended to qualify as a cafeteria plan within the meaning of Internal Revenue Code (IRC) section 125.
This document summarizes key provisions of the Business Travel Accident Program and, along with the
certificate of coverage for the Business Travel Accident Program (available online at MyTenet.com for
Tenet colleagues and HealthyatTenet.com for Conifer employees or by contacting Hartford Life and
Accident Insurance Company at 1-888-563-1124.
For more information on the Business Travel Accident Program, please see the benefits booklet as well
as review the other sections of this SPD.
Note: Certain Tenet facilities and subsidiaries maintain their own SPD summarizing benefits under
the Tenet Employee Benefit Plan.
Certificate of Insurance Details
Your benefits under the Tenet Business Travel Accident Program are insured through an insurance
policy by Hartford Life and Accident Insurance Company. Below is some helpful information about
your Business Travel Accident insurance coverage.
Insurer: Hartford Life and Accident Insurance Company, Hartford, Connecticut
Policyholder: Tenet Health System Medical, Inc. and Subsidiaries
Policy Number: ETB-112533
Policy Effective Date: January 1, 2015
Certificate Effective Date: The date you enter a Class of Eligible Persons
This is not a policy of workers’ compensation insurance. The Policyholder and/or the Employer does
not become a subscriber to the workers’ compensation system by purchasing this policy.
{00014391.DOCX-}
254
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Schedule of Benefits
The Tenet Business Travel Accident Program provides benefits in the event you are injured while
traveling in a Hazard category for which you are insured under the policy. The Hazard categories and
benefits and amounts applicable to each Hazard category are summarized in the chart below.
Classes of Eligible Persons:
Class 1: All active, full-time employees and all part-time 1 employees of the Employer.
See the Eligibility and Enrollment section of the TEBP SPD for more information.
Class 2: All senior vice president and above level of employees of the Employer.
Hazard
(see the “Hazards”
section for a full
description of each
hazard)
Benefit
(see the “Benefits”
section for a full
description of benefits)
Amount
C-12, C-41, C-57
ADD
$100,000 ($500,000 for employees in Class 2)
AHV
10% of principal sum to maximum of $25,000
BCB
See Benefit page
COMA
See ADD amount
REHAB
10% of principal sum to maximum of $25,000
SBLT (seatbelt)
10% of principal sum to a maximum of
$25,000
AB
5% of principal sum to maximum of $25,000
THERP
10% of principal sum to maximum of $25,000
ADD
Principal sum: $1,000,000
COMA
See ADD amount
C-19
If you are covered under more than one Hazard or Class on the date of accident, you will be
considered to be covered under the one Hazard or Class with the largest benefit amount.
Aggregate Limitation: Hazard: C-12, C-41, C-57
Aggregate Amount: $6,000,000
$6,000,000 shall be the total limit of the Company’s liability for all benefits payable under the policy
because of injury sustained due to any one aircraft accident.
Aggregate Limitation: Hazard: C-19
Aggregate Amount: $10,000,000
$10,000,000 shall be the total limit of the Company’s liability for all benefits payable under the
policy because of Injury sustained due to any one aircraft accident.
Form PA-6056 A2 (112533) (1)
{00014391.DOCX-}
255
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Accidental Death and Dismemberment Reduction On and After Age 70
On the date of your attainment of ages 70, 75, 80 and 85, your amount of Principal Sum will reduce.
The reduced amount will be determined by multiplying the Amount of Principal Sum shown in the
“Schedule of Benefits” and applicable to you by the percentage shown below for your attained age:
Insured Person’s Age:
Age 70 - 74
Age 75 - 79
Age 80 - 84
Age 85 or over
Percentage of Principal Sum:
65%
45%
30%
15%
If you are age 70 or over, you will not be eligible for a Principal Sum Amount that is more than the
Percentage of Principal Sum shown above for your attained age.
Benefit Limitations:
 Accidental Death and Dismemberment Benefit: Loss Period: 365 days*
* For residents of Pennsylvania, the 365 day Loss Period does not apply to loss of life
 Coma Benefit: Waiting Period: 30 days
 Rehab Benefit: Loss Period: 365 days.
Definitions
AB
Air bag benefit
ADD
Accidental death and dismemberment benefit
Aggregate Limitation
The total benefit payable for any number of employees involved in any one accident
AHV
Adaptive home and vehicle benefit
Airworthiness Certificate
A valid and current “Standard Airworthiness Certificate” issued by the FAA
BCB
Bereavement counseling benefit
Business Trip
A bona fide trip: a) while on assignment or at the direction of the Employer for the purpose of
furthering the business of the Policyholder; b) which begins when you leave your residence or place of
regular employment, whichever last occurs, for the purpose of beginning the trip; c) which ends when
you return to your residence or place of regular employment, whichever first occurs; and d) excluding
travel to and from work, bona fide leaves of absence and vacations
{00014391.DOCX-}
256
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Civil Aircraft
A civil or public aircraft which: a) has an Airworthiness Certificate; b) is piloted by a person who has: 1)
a current pilot certificate with the appropriate aircraft category rating for that aircraft; and 2) a current
medical certificate which is appropriate for the operation of that aircraft; and c) is not operated by the
militia, or armed forces of any state, national government or international authority
COMA
Coma benefit
Common Carrier
A conveyance operated by a concern, other than the Employer, organized and licensed for the
transportation of passengers for hire and operated by an employee of that concern
Employer
The Policyholder, Tenet Health System Medical, Inc., or any affiliate of the Tenet Health System
Medical, Inc. that has adopted the Tenet Business Travel Accident Program (in accordance with the
procedures set forth in the TEBP) as a participating employer. An affiliate of Tenet Health System
Medical, Inc. is any entity that is a member of the same group of affiliated entities as Tenet Health
System Medical, Inc. within the meaning of sections 414(b), (c) or (m) of the Internal Revenue Code,
except that for purposes of this definition, 51 percent will be substituted for 80 percent.
Extra-Hazardous Aviation Activity
An aircraft while it is being used for one or more of the following activities: Acrobatics or stunt flying,
racing or any endurance test, crop dusting or seeding, spraying, exploration, pipe or power line
inspection, any form of hunting, bird or fowl herding, aerial photography or banner towing, any test or
experiment, firefighting, any flight which requires: a) a special permit; or b) waiver; from the FAA, even
though granted.
FAA
The Federal Aviation Administration of the United States or the similar aviation authority for the
country of the aircraft’s registry, if the country is recognized by the United States
Injury
Injury means, and you are covered for, bodily injury resulting directly and independently of all other
causes from an accident which occurs: a) while you are covered under; and b) in the manner specified;
in a Hazard applicable to your Class. Loss resulting from: a) sickness or disease, except a pus-forming
infection which occurs through an accidental wound; or b) medical or surgical treatment of a sickness
or disease; is not considered as resulting from injury.
Insured Person, you or your
An eligible person while he or she is covered under the policy
Insurer
Hartford Life and Accident Insurance Company, Hartford, Connecticut
Loss Period
The amount of time the insured person has to file a claim
{00014391.DOCX-}
257
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Military Transport Aircraft
A transport aircraft operated by: a) the United States Air Mobility Command (AMC); or b) a national
military air transport service of any country
Passenger
A person who is not: a) the operator or driver; or b) the pilot, student pilot or a crewmember; of a
conveyance at the time of accident
Policyholder Aircraft
An aircraft which is owned, leased, or operated by or on behalf of the Policyholder or Employer
Principal Sum
The amount payable due to any one accident
REHAB
Rehabilitation benefit
SBLT
Seat belt benefit
THERP
Therapeutic counseling benefit
Trip
A trip which: a) begins when you leave your residence or place of regular employment, whichever last
occurs, for the purpose of beginning the trip; and b) ends when you return to your residence or place of
regular employment, whichever first occurs
Scheduled Aircraft
A Civil Aircraft operated by a scheduled airline which: a) is licensed by the FAA for the transportation of
passengers for hire; and b) publishes its flight schedules and fares for regular passenger service
Waiting Period
The time shown in the policy before benefits are payable
We, Us or Our
The insurance company named on the face page
Determination of Individual Coverage
Effective Date
You become an Insured Person on the later of: a) the Policy Effective Date; or b) the date you enter a
Class of Eligible Persons. The Classes of Eligible Persons are set forth in the “Schedule of Benefits.”
{00014391.DOCX-}
258
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Termination
Benefits under the Business Travel Accident Program are insured through an insurance policy issued by
the Insurer. Your coverage under this policy terminates on the earlier of: a) the date the policy
terminates; or b) the date you do not qualify in any Class of Eligible Persons. Your participation in
Tenet’s Business Travel Accident Program terminates on the earlier of: a) the date you cease to meet
the eligibility requirements for coverage; b) the date the Employer terminates the Business Travel
Accident Program; c) the date the Employer terminates the TEBP, or d) the date this policy terminates
and the Policyholder or Employer does not replace it with a successor policy. Termination will not
affect any claim for loss due to an accident which occurs before the effective date of the termination.
The Policyholder’s failure to report that a person ceased to qualify in a Class of Eligible Persons will not
continue coverage in that Class beyond the date he or she ceased to qualify.
This policy may be terminated at any time by the Policyholder or by the Insurer. The Tenet Business
Travel Accident Program and/or the TEBP may be terminated at any time by the Employer.
Hazards and Benefits Determined By Class
You are covered under the Hazard and for the Benefits applicable to the Class in which you qualify: a)
beginning on the date you enter the Class; and b) ending on the date you leave the Class. If you qualify
in more than one Class on the date of accident, you will be considered to qualify in the one Class with
the largest Benefit Amount.
Exclusions
The policy does not cover any loss resulting from:
1. Intentionally self-inflicted Injury, suicide or attempted suicide, while sane or insane (in Missouri,
while sane);
2. War or act of war, whether declared or undeclared;
3. Injury sustained while in the armed forces of any country or international authority;
4. Injury sustained while on any aircraft, unless, and only to the extent, a Hazard specifically describes
such coverage;
5. Injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a
prescription, including sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless
the drug is taken as prescribed or administered by a licensed physician;
6. Injury sustained while committing or attempting to commit a felony.
Aggregate Limitation
If: a) two or more Insured Persons, in the same or different classes, are injured as the result of any one
accident, which occurs in the manner specified in the Hazard(s) identified in the Schedule of Benefits;
and b) the total of all amounts payable for all Insured Persons, in the absence of this provision, exceeds
the Aggregate Amount shown opposite the Hazard (shown in the “Schedule of Benefits”); the amount
for each person will be proportionately reduced so that the total will equal the Aggregate Amount. This
means that if the total of all amounts payable for all persons exceeds the Aggregate Amount shown
opposite the Hazard, the benefit amount for each Insured Person will be adjusted depending on a) the
number of Insured's in the accident and, b) their respective classes.
{00014391.DOCX-}
259
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Hazards
HAZARD C-12: 24-Hour Business Trip Coverage
This Hazard covers Injury resulting from an accident which occurs anywhere in the world during a
Business Trip, including: a) an Injury resulting from an accident which occurs while you are a passenger
on, boarding, or alighting from a Civil Aircraft or Military Transport Aircraft: or b) Injury resulting from
being struck by an aircraft.
Exclusions
This Hazard does not cover Injury resulting from an accident which occurs while you are on, boarding,
or alighting from: a) an aircraft engaged in an Extra-Hazardous Aviation Activity; or b) a Policyholder
Aircraft. Refer to the “Definitions” and “Exclusions” sections for modifications, limitations, and
exclusions affecting this coverage.
HAZARD C-19: Specified Aircraft Coverage Trip
This Hazard covers Injury resulting from accident which occurs anywhere in the world while you are on
a Trip as a passenger, pilot, operator, or member of the crew on, boarding or alighting from, or being
struck by an aircraft which is on file with the Employer and which is owned by the Employer, which
includes a properly serviced substitute aircraft, and which aircraft is being operated at the time with
consent of the Employer and piloted by a properly certified pilot whose name is on file with the
Employer, or a properly certified substitute, holding a current and valid certificate of competency of a
rating authorizing him or her to pilot this aircraft and who has logged a minimum of 1,000 hours as a
pilot, at least 500 of which were logged in single or multi-engine aircraft of like basic design.
Exclusions
This Hazard does not cover Injury resulting from accident which occurs while the above aircraft is: a)
carrying passengers for hire; or b) engaged in an Extra-Hazardous Aviation Activity. Refer to the
“Definitions” and “Exclusions” sections for modifications, limitations, and exclusions affecting this
coverage.
HAZARD C-41: Commutation Coverage
This Hazard covers Injury resulting from accident which occurs while you are commuting directly
between your residence and place of regular employment: a) by automobile or other conveyance not
normally used by you for commuting; and b) during a strike, power failure, major breakdown or similar
event which results in the discontinuance or interruption of one or more public transportation systems
regularly used by you; on a regularly scheduled workday. Refer to the “Definitions” and “Exclusions”
sections for modifications, limitations and exclusions affecting this coverage.
HAZARD C-57: Sojourn or Personal Deviation Business Trip Coverage
This Hazard covers Injury resulting from an accident which occurs anywhere in the world during a
Sojourn or Personal Deviation from a covered Business Trip.
Sojourn or Personal Deviation from a Business Trip means personal trips taken by you: a) during a
Business Trip; and b) which are not assignments from or at the direction of the Employer for the
purpose of furthering the business of the Employer; and c) which do not exceed a total of 14 days.
Exclusions
This Hazard does not cover Injury resulting from an accident which occurs while you are on, boarding,
or alighting from an aircraft engaged in an Extra-Hazardous Aviation Activity. Refer to the “Definitions”
and “Exclusions” sections for modifications, limitations and exclusions affecting this coverage.
{00014391.DOCX-}
260
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Benefits
Accidental Death and Dismemberment Benefit
If your Injury results in any of the following losses within the Loss Period after the date of accident, we
will pay the sum shown opposite the loss (under “Benefit Amount” in the chart below).
We will not pay more than the Principal Sum for all losses due to the same accident.
For Loss of:
Benefit Amount:
Life
The principal sum
Both hands or both feet or sight of both eyes
The principal sum
One hand and one foot
The principal sum
Speech and hearing
The principal sum
Either hand or foot and sight of one eye
The principal sum
Movement of both upper and lower limbs (quadriplegia)
The principal sum
Movement of both lower limbs (paraplegia)
Three-quarters the principal sum
Movement of both upper and lower limbs of one side of the
body (hemiplegia)
One-half the principal sum
Either hand or foot
One-half the principal sum
Sight of one eye
One-half the principal sum
Speech or hearing
One-half the principal sum
Thumb and index finger of either hand
One-quarter the principal sum
Loss means with regard to: a) hands and feet, actual severance through or above wrist or ankle joints;
b) sight, speech or hearing, entire and irrecoverable loss thereof; c) thumb and index finger, actual
severance through or above the metacarpophalangeal joints; d) movement of limbs, complete and
irreversible paralysis of such limbs.
Exposure
Exposure to the elements will be presumed to be Injury if: a) it results from the forced landing,
stranding, sinking or wrecking of a conveyance in which you were an occupant at the time of the
accident; and b) the policy would have covered Injury resulting from the accident.
Disappearance
You will be presumed to have suffered loss of life if: a) your body has not been found within one year
after the disappearance of a conveyance in which you were an occupant at the time of its
disappearance; b) the disappearance of the conveyance was due to its accidental forced landing,
stranding, sinking or wrecking; and c) the policy would have covered Injury resulting from the accident.
{00014391.DOCX-}
261
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Adaptive Home and Vehicle Benefit
If your injury results in a covered loss, other than loss of life, and a benefit is payable under the
Accidental Death and Dismemberment Benefit described above, in addition to a payout for the
Accidental Death and Dismemberment Benefit, we will pay the lesser of: a) a percentage of the
Principal Sum; or b) the actual cost; for the one-time cost of alterations incurred within two years from
the date of the accident to your: a) principal residence; and/or b) Private Automobile, to make the
residence accessible or the private automobile drivable or rideable by you. In no event will payment
under this benefit exceed the Maximum Amount for this benefit.
The Percentage of Principal Sum and Maximum Amount are shown in the “Schedule of Benefits.”
The benefit will be payable only if: a) such home alterations are: i) made by a person or persons
experienced in such alterations; and ii) recommended by a recognized organization associated with the
Loss; and b) such vehicle alterations are: i) carried out by a person or persons experienced in such
alterations; and ii)) approved by the Motor Vehicle Department.
Private automobile means a four wheeled, private passenger car: station wagon, pick-up truck, van or
jeep-type automobile which is not being used as a conveyance which is organized and licensed for the
transportation of passengers.
Bereavement Counseling Benefit
If a Principal Sum is payable under this Policy for your loss of life, in addition to a payment for the loss
of life, we will pay for the expenses paid by your dependent Spouse and Children for Bereavement
Counseling up to: a) $100 per visit; and b) a maximum amount of $500 per covered person per
accident.
Expenses for Bereavement Counseling must be first incurred by your dependent Spouse and Children
(as such terms are defined below) within 90 days after the date of your death.
Proof of Bereavement Counseling expenses must be given to Us within one year after the date of your
death.
Bereavement Counseling means treatment or counseling for the grief reaction resulting from your loss
of life. Counseling must be provided by a licensed therapist, counselor, or psychiatrist who is registered
or certified to provide psychological treatment or counseling.
Spouse means your wife or husband who is not legally separated or divorced from you at the date of
the accident.
Children, as used in this Bereavement Counseling benefit description, means your unmarried child,
unmarried grandchild in the legal custody of and residing with you, stepchild, legally adopted child
from the date of placement in your home, or foster child, who is: a) under the age of 26; and b)
primarily dependent on you for support and maintenance.
Coma Benefit
If, as the result of an Injury, you: a) become Comatose within 31 days from the accident (causing such
Injury); and b) remain continuously Comatose for at least the number of days shown as the Waiting
Period; we will pay 1% of the Comatose Maximum Benefit Amount for each month after the Waiting
Period that you remain in a Coma.
Payment will cease on the earliest to occur of: 1) the end of the month in which you die; 2) the end of
the month in which you recover from the Coma; or 3) when the total payment equals the Comatose
Maximum Benefit Amount. The Comatose Maximum Benefit Amount equals the Principal Sum less all
other payments under the Accidental Death and Dismemberment Benefit for the Injury.
{00014391.DOCX-}
262
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Coma or Comatose means complete and continuous: a) unconsciousness; and b) inability to respond to
external or internal stimuli.
The amount of the Principal Sum and the Waiting Period are shown in the “Schedule of Benefits.”
Rehabilitation Benefit
If your Injury results in any loss payable under this policy, other than loss of life, within the loss period
after the date of accident, we will pay a benefit equal to the lesser of: a) the Expenses Incurred for
rehabilitative training; b) the applicable percentage of your principal sum (as set forth in the “Schedule
of Benefits”); or c) the applicable maximum amount; for rehabilitative training.
The expense must be incurred within 2 years of the date of accident.
The Loss Period, the Percentage of Principal Sum and the Maximum Amount are shown in the
“Schedule of Benefits.”
Rehabilitative Training means any training which: a) is required due to your Injury; and b) prepares you
for an occupation in which you would not have engaged except for the injury.
Expenses Incurred means the actual cost: a) of the training; and b) of the materials needed for the
training.
Seat Belt and Air Bag Benefit
If your Injury results in a covered loss under Accidental Death and Dismemberment Benefit described
above and occurs while you are: a) a passenger riding in; or b) the licensed operator of; an Automobile,
and while wearing a Seat Belt at the time of the Accident as verified on the police report, then the
amount of the Principal Sum will be increased by the applicable Percentage of the Principal Sum (as set
forth in the “Schedule of Benefits”) up to the Maximum Amount.
In addition, if you are entitled to the above Seat Belt Benefit, we will pay an additional Percentage of
the Principal Sum (as set forth in the “Schedule of Benefits”) up to the Maximum Amount as an Air Bag
benefit if: a) you were positioned in a seat with a factory installed Air Bag; b) you were properly
strapped in the Seat Belt when the Air Bag inflated; and c) the police report establishes that the Air Bag
inflated properly upon impact.
Accident, as used in this benefit, means the unintentional collision of an automobile during which you
are wearing a seat belt.
Air Bag means an inflatable supplemental passive restraint system installed by the manufacturer of the
Automobile, or proper replacement parts as required by the automobile manufacturer’s specifications
that inflate upon collision to protect you from Injury and death.
Automobile means a duly registered, four-wheeled, private passenger car, pick-up truck, self-propelled
motor home or sport utility vehicle which is not being used as a Common Carrier.
Seat Belt means an unaltered belt, lap restraint or lap and shoulder restraint installed by the
manufacturer of the Automobile, or proper replacement parts as required by the automobile
manufacturer’s specifications; or a child restraint device that meets the standards of the National
Safety Council and is properly secured and utilized in accordance with applicable state law and
recommendations of its manufacturer for children of like weight age and weight.
Exclusions
This benefit does not cover Injury resulting from accident which: a) occurs while you are under the
influence of any intoxicant, excitant, hallucinogen, or any narcotic or other drug, or similar substance as
verified in the police accident report (unless administered under the advice of a physician); and you are
operating the automobile.
{00014391.DOCX-}
263
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Therapeutic Counseling Benefit
If you: a) incur a loss, other than a loss of life, covered as an Accidental Death and Dismemberment
Benefit under this policy; and b) within 90 days require Therapeutic Counseling due to the loss; we will
pay the lesser of: a) the Reasonable Expenses incurred for Therapeutic Counseling; b) the applicable
percentage of your Principal Sum (as set forth in the “Schedule of Benefits”); or c) the applicable
Maximum Amount.
The Therapeutic Counseling Services must be incurred within one year from the date of loss.
Therapeutic Counseling means treatment or counseling provided by a licensed therapist or counselor
registered or certified to provide psychological treatment or counseling.
Reasonable Expenses means fees and prices which do not exceed those generally charged for similar
Therapeutic Counseling in the local area where received by you.
For purposes of this benefit, we reserve the right to determine Reasonable Expenses. An Expense is
considered to be incurred on the date of the Therapeutic Counseling is rendered.
The Maximum Amount, Percentage and Principal Sum are shown in the “Schedule of Benefits.”
Claims
Notice of Claim
The person who has the right to claim benefits (the claimant or beneficiary, or his or her authorized
representative) must give us written notice of a claim within 30 days after a covered loss begins. If
notice cannot be given within that time, it must be given as soon as reasonably possible. The notice
should include your name and the policy number. Send it to our office in Hartford, Connecticut or give
it to our agent. Address and contact details for both are found in the ERISA Information section below.
Claim Forms
When we receive the notice of claim, we will send forms to the claimant for giving us proof of loss. The
forms will be sent within 15 days after we receive the notice of claim. If the forms are not received, the
claimant will satisfy the proof of loss requirement if a written notice of the occurrence, character and
nature of the loss is sent to us.
Proof of Loss
Proof of loss must be sent to us in writing within 90 days after: a) the end of a period of our liability for
periodic payment claims; or b) the date of the loss for all other claims. If the claimant is not able to
send it within that time, it may be sent as soon as reasonably possible without affecting the claim. The
additional time allowed cannot exceed one year unless the claimant is legally incapacitated.
Time of Claim Payment
We will pay any daily, weekly or monthly benefit due: a) on a monthly basis, after we receive the proof
of loss, while the loss and our liability continue; or b) immediately after we receive the proof of loss
following the end of our liability. We will pay any other benefit due immediately, but not later than 60
days, after we receive the proof of loss.
{00014391.DOCX-}
264
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Payment of Claims
We will pay any benefit due for loss of your life: a) according to the beneficiary designation in effect at
the time of death; otherwise b) if no beneficiary is designated, according to the beneficiary designation
under the Group Life Insurance Policy issued to the Policyholder or Employer and in effect at the time
of your death; or c) if no beneficiary is designated under your Group Life Insurance Policy, to your
survivors, in equal shares, in the first of the following classes to have a survivor at your death: 1)
spouse, spouse will include your domestic partner, provided you have executed a Domestic Partner
Affidavit acceptable to us, establishing that you and your partner are domestic partners for purposes of
this Policy. You and your domestic partner will continue to be considered domestic partners provided
you both continue to meet the requirements described in the Domestic Partner Affidavit. Spouse, with
respect to California residents only, will include an individual who is in a registered domestic
partnership with you in accordance with California law. Reference to your marriage or divorce shall
include your registered partnership or dissolution of your registered domestic partnership, 2) children,
3) parents, 4) brothers and sisters. If there is no survivor in these classes, payment will be made to your
estate.
All other benefits due and not assigned will be paid to you if living. Otherwise, the benefits will be paid
according to the preceding paragraph.
Benefits will be paid into a checking account which will be owned by: a) you; or b) the beneficiary or
beneficiaries named in writing by you. The checking account owner may elect a lump sum payment by
writing a check for the full amount in the checking account. However, a checking account will not be
established for a benefit payable to your estate or for a Principal Sum that is less than $10,000 or for
any claim that the claim department determines is more appropriately adjudicated through the
issuance of a lump sum payment. If a benefit due is payable to: a) your estate; or b) your beneficiary
who is either a minor or not competent to give a valid release for the payment; the Insurer may pay up
to $1,000 ($3,000 for residents of Florida) of the benefit due to some other person. The other person
will be someone related to you or your beneficiary by blood or marriage who we believe is entitled to
the payment. The Insurer and the Business Travel Accident Program will be relieved of further
responsibility to the extent of any payment made in good faith.
Appealing Denial of Claim
If a claim for benefits is wholly or partially denied, notice of the decision shall be furnished to you or
your authorized representative no later than 90 days after the Insurer receives your claim for benefits,
unless we determine that special circumstances require an extension of up to ninety additional days for
processing the claim. If the Insurer determines that an extension of time for processing the claim is
necessary, you or your authorized representative will be notified of the extension prior to the
expiration of the initial 90-day period.
This written decision wholly or partially denying your claim will: a) give the specific reason or reasons
for denial; b) make specific reference to policy provisions on which the denial is based; c) provide
description of any additional information necessary to prepare the claim and an explanation of why it is
necessary; and d) provide an explanation of the review procedure, including time limits for appeals and
a statement of the claimant’s right to bring a civil action following an adverse benefit determination on
appeal.
On any denied claim, you or your authorized representative may appeal to the Insurer for a full and fair
review. You may: a) request a review upon written application within 60 days of receipt of claim denial;
b) review pertinent documents free of charge; and c) submit issues, comments, and documents and
records relating to the claim in writing. Our review will take into account all information submitted by
you or your authorized representative relating to the claim, without regard to whether such
information was submitted or considered in the initial benefit determination.
{00014391.DOCX-}
265
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
We will make a decision no more than 60 days after receipt of the request for review, except in special
circumstances that require an extension of time for processing the claim (such as the need to hold a
hearing), but in no case more than 120 days after we receive the request for review. If the Insurer
determines that an extension of time is necessary, the Insurer will notify you or your authorized
representative of the extension within the initial 60-day period. If the extension is due to you or your
authorized representative’s failure to submit information necessary to decide your claim, the period for
making a determination upon appeal will be tolled from the date the Insurer notifies you or your
authorized representative of the extension until the date you or your authorized representative
responds to the request for additional information.
If the Insurer denies your claim on appeal, in whole or in part, the Insurer will provide written
notification of the decision, which will include the following: a) the specific reasons for the denial; b) a
reference to the specific policy provisions on which the decision is based; c) a statement that you are
entitled to receive, upon request and free of charge, access to and copies of all documents and records
relevant to the claim; and 4) a statement describing any available voluntary appeal procedures and of
your right to bring a legal action.
Physical Examinations and Autopsy
While a claim is pending we have the right at our expense: a) to have the person who has a loss
examined by a physician when and as often as is reasonably necessary; and b) in case of death to make
an autopsy, where it is not forbidden by law.
Legal Actions
You cannot take legal action against us: a) before 60 days following the date proof of loss is sent to us;
b) after 3 years (6 years for residents of South Carolina) following the date proof of loss is due (for
Florida residents, after the expiration of the applicable statute of limitations following the date proof of
loss is due). You must exhaust the claims procedure process (including appeal of your claim) described
above before you may bring a legal action against Us or the Policyholder.
Naming a Beneficiary
You may name a beneficiary or change a revocably named beneficiary by giving your written request to
the Employer. Your request takes effect on the date you execute it, regardless of whether you are living
when the Employer receives it. We will be relieved of further responsibility to the extent of any
payment we made in good faith before the Employer received your request.
Assignment
We will recognize any assignment you make under this policy, provided it is duly executed, and a copy
is on file with us. Neither we, nor the Employer assume responsibility for the validity or effect of an
assignment
Important Notices
To Obtain Information or Make a Complaint
You may call The Hartford’s toll-free telephone number for information or to make a complaint at 1888-563-1124. You may also write to The Hartford at: PO Box 2999, Hartford, CT 06104-2999. You may
contact the Texas Department of Insurance to obtain information on companies, coverage, rights or
complaints at 1-800-252-3439. You may write the Texas Department of Insurance at: PO Box 149104,
Austin, TX 78714-9104, or fax (512) 475-1771.
Web: www.tdi.state.tx.us
Email: [email protected]
{00014391.DOCX-}
266
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Premium or Claim Disputes
Should you have a dispute concerning your premium or about a claim you should contact the agent or
The Hartford first. If the dispute is not resolved, you may contact the Texas Department of Insurance.
This notice is for information only and does not become a part or condition of the document.
Aviso Importante
Para Obtener Información o Para Someter Una Queja
Usted puede llamar al número de teléfono gratis de The Hartford para información o para someter una
queja al: 1-888-563-1124. Usted también puede escribir a The Hartford: PO Box 2999, Hartford, CT
06104- 2999. Puede comunicarse con el Departamento de Seguros de Texas para obtener información
acerca de compañías, coberturas, derechos, o quejas al 1-800-252-3439. Puede escribir al
Departamento de Seguros de Texas: PO Box 149104, Austin, TX 78714-9104. FAX # (512) 475-1771.
Web: http://www.tdi.state.tx.us
Email: [email protected]
Disputas Sobre Primas o Reclamos
Si tiene una disputa concerniente a su prima o a un reclamo debe comunicarse con el agente o The
Hartford primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI).
Este aviso es solo para propósito de información y no se convierte en parte o condición del documento
adjunto.
State Notices
Texas
Texas law establishes a system, administered by the Texas Life, Accident, Health and Hospital Insurance
Guaranty Association (“the Association”), to protect policyholders if their life or health insurance
company fails to or cannot meet its contractual obligations. Only the policyholders of insurance
companies which are members of the Association are eligible for this protection. However, even if a
company is a member of the Association, protection is limited and policyholders must meet certain
guidelines to qualify. (The law is found in the Texas Insurance Code, Artic21.28 D.)
Because of statutory limitations on policyholder protection, it is possible that the association may not
cover your policy or may not cover your policy in full.
Eligibility For Protection By The Association
When an insurance company which is a member of the Association is designated as impaired by the
Texas Commissioner of Insurance, the Association provides coverage to policyholders who are:
 Residents of Texas at the time that their insurance company is impaired
 Residents of other states, ONLY if the following conditions are met:



The policyholder has a policy with a company based in Texas;
The company has never held a license in the policyholder's state of residence;
The policyholder's state of residence has a similar guaranty association; and
{00014391.DOCX-}
267
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------

The policyholder is not eligible for coverage by the guaranty association of the policyholder’s
state of residence.
Limits of Protection by the Association
 Accident, Accident and Health Insurance, or Health Insurance: up to a total of $200,000 for one or
more policies for each individual covered
 Life Insurance: net cash surrender value up to a total of $100,000 under one or more policies; or
death benefits up to a total of $300,000 under one or more policies on any one life,
 Individual Annuities: net cash surrender amount up to a total of $100,000 under one or more
policies owned by one contract holder.
 Group Annuities: net cash surrender amount up to $100,000 in allocated benefits under one or
more policies owned by one contract holder; or Net cash surrender amount up to $5,000,000 in
unallocated benefits under one contract holder regardless of the number of contracts.
The insurance company and its agents are prohibited by law from using the existence of the
association for the purpose of sales, solicitation, or inducement to purchase and forms of insurance.
When you are selecting an insurance company, you should not rely on coverage by the association.
Texas Life, Accident, Health and Hospital
Service Ins. Guaranty Association
301 Congress, Suite 500
Austin, Texas 78701
800-982-6362
Texas Department of Insurance
P.O. Box 149104
Austin, Texas 7871
800-252-3439
ERISA Information
You can learn additional information about the Tenet Business Travel Accident Program and the other
component programs offered under the TEBP by reviewing the other sections of this online SPD. The
complete SPD includes information on participating employers in the TEBP, eligibility and enrollment,
and authority to amend and terminate the TEBP.
Here’s a list of some facts you may need to know about the Tenet Business Travel Accident Program:
EMPLOYER AND PLAN SPONSOR
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
PLAN ADMINISTRATOR
Tenet Benefits Administration Committee
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
CLAIMS ADMINISTRATOR
The Hartford
Group Life/AD&D Claims Unit
P. O. Box 2999
{00014391.DOCX-}
268
------------------------------------------------------------------ BUSINESS TRAVEL ACCIDENT PLAN DESCRIPTION, 2017 -----------------------------------------------------------
Hartford, CT 06104-2999
888-563-1124
AGENT FOR SERVICE OF LEGAL PROCESS
Tenet Healthcare Corporation
1445 Ross Avenue, Suite 1400
Dallas, Texas 75202-2703
469-893-2000
Legal process may also be served on the Plan Administrator.
PLAN EFFECTIVE DATE
The Business Travel Accident Program is a component program in the TEBP, which was
originally effective as of October 1, 1977. The TEBP was amended and restated effective as of
January 1, 2015.
EMPLOYER IDENTIFICATION NUMBER
95-2557091
PLAN NUMBER
515
PLAN YEAR
January 1 to December 31
TYPE OF PLAN
Insured welfare benefit plan offering benefits for certain injuries sustained while traveling.
Funding of Benefits
Benefits under the Business Travel Accident Program are fully insured by Hartford Life and Accident
Insurance Company. Your employer pays the cost of your premiums for the insurance offered under
the Business Travel Accident Program.
Tax Consequences of Participation in Business Travel Accident Program
In general, benefits provided to you under the Business Travel Accident Program will not be subject to
federal income tax. Please consult with your tax advisor for more information or exceptions to this
rule.
Your Rights Under ERISA
For a statement explaining your rights under the Employee Retirement Income Security Act of 1974
(ERISA), see the Other Information section of the TEBP SPD.
{00014391.DOCX-}
269
Appendix 1
ACA Compliance Full-Time Employee
Determination Policy
About This Appendix 1
This Appendix 1 to the Summary Plan Description (SPD) for the Tenet Employee Benefit Plan (TEBP)
explains the procedure Tenet Healthcare Corporation (Tenet) and its affiliates will use to determine
whether an employee is a full-time employee within the meaning of the Affordable Care Act and the
regulations issued thereunder (an "ACA Full-Time Employee"). As set forth in the Eligibility and
Enrollment section of this SPD, this Appendix 1 applies for purposes of determining employee eligibility
for coverage under the Medical Program (including the Health Care Reimbursement Account Program)
and the Prescription Drug Program only. This Appendix 1 does not apply to any individual excluded
from coverage under the Tenet benefit programs as set forth under "Who's Not Eligible?" in the
Eligibility and Enrollment section of this SPD.
Definitions
The definitions set forth in the SPD for the TEBP apply to this Appendix 1. In addition, please take note
of the following additional definitions used for purposes of this Appendix 1:
ACA Compliant Coverage
Affordable Coverage that provides Minimum Value.
ACA Full-Time Employee
An Employee that is determined, in accordance with this Appendix 1 and applicable IRS rules and
regulations implementing the Affordable Care Act, to work at least thirty (30) hours per week for the
Employer.
Administrative Period
The period beginning on the date immediately following a Standard Measurement Period or Initial
Measurement Period, as applicable, and extending until the last day of the second calendar month
beginning on or after the end of such measurement period. During this Administrative Period, an
Employee may elect to enroll in the Medical Benefit Program (and the associated Prescription Drug
Benefit Program), if eligible. With respect to any new Variable Employee, Seasonal Employee, or PartTime Employee, the Administrative Period plus the Initial Measurement Period combined will not
extend beyond the last day of the first calendar month beginning on or after the one-year anniversary
of such Employee’s start date.
Affordable Coverage
With respect to a particular Employee, coverage for which such Employee’s share of annual group
health coverage premiums for self-only coverage does not exceed 9.5 percent of the Employee’s
household income for the taxable year. In accordance with Internal Revenue Service (“IRS”) guidance,
{00014391.DOCX-}
270
------------------------------------------------------------------------------------------ APPENDIX 1, 2017 ------------------------------------------------------------------------------------
the Employer may use one of the following safe harbors to approximate the amount of an Employee’s
household income
 The annual wages paid to the Employee by the Employer, as reported in Box 1 of Form W-2,
 The Employee’s rate of pay, if applicable requirements are met, or,
 The Federal poverty line for a single individual for the applicable calendar year.
In addition, the Employer may rely on other safe harbors or IRS guidance that may be provided in the
future regarding affordability of coverage.
Initial Measurement Period
The 11-month period beginning on a Variable, Seasonal, or Part-Time Employee's date of hire.
Initial Stability Period
The 12-month period beginning immediately after the Administrative Period following the Initial
Measurement Period; provided, however, that the Initial Stability Period will not exceed the remainder
of the first entire standard measurement period (plus any associated administrative period) for which a
Variable Employee, Seasonal Employee, or Part-Time Employee has been employed.
Minimum Value
A coverage standard in which a medical benefit program pays at least 60% of the benefits provided
under such program.
Ongoing Employee
A Variable, Seasonal, or Part-Time Employee who has been employed for at least one Standard
Measurement Period.
Part-Time Employee
An Employee who is reasonably expected at the Employee's date of hire not to be an ACA Full-Time
Employee (or a Variable Employee or Seasonal Employee) or an Employee who is classified by the
Employer as a "part-time 2" employee.
Seasonal Employee
An Employee hired for a position for which the customary annual employment period is six months or
less, and which starts in approximately the same part of the year.
Standard Measurement Period or SMP
Each 12-month period beginning on October 15 and ending the following October 14 used to
determine if an Ongoing Employee is eligible to participate in the Medical Benefit Program and the
Prescription Drug Benefit Program; provided, however, that the first Standard Measurement Period
began January 1, 2014 and ended October 14, 2014. At the discretion of the Plan Administrator, the
Employer may elect to shorten the SMP as prescribed under the Affordable Care Act and related IRS
guidance.
Stability Period
Each 12-month period beginning immediately after an Administrative Period.
Variable Employee
{00014391.DOCX-}
271
------------------------------------------------------------------------------------------ APPENDIX 1, 2017 ------------------------------------------------------------------------------------
An Employee who, upon being newly hired to provide services to the Employer, cannot be determined
to be reasonably expected to work on average at least 30 hours per week.
Procedure
Full-Time Employees
Ongoing Employees who are ACA Full-Time Employees will be offered ACA Compliant Coverage. With
respect to new Employees who are reasonably expected to be ACA Full-Time Employees as of the date
of hire, the Employer will also offer ACA-Compliance Coverage to such Employees. (Note: The
Employer may also make offers of coverage to additional employees as specified in the SPD. For
example, employees classified as "full-time" or "part-time 1" by the Employer will be eligible for
coverage under the Medical Benefit Program and the Prescription Drug Benefit Program as set forth in
the SPD.) In the event that the status of any ACA Full-Time Employee (or any employee who has
received an offer of coverage due to being classified by the Employer as a "full-time" or "part-time 1"
employee) changes to Variable Employee, Seasonal Employee, or Part-Time Employee (including a
reclassification as a part-time 2 employee), the Employer will continue his or coverage eligibility status
at the time of the change in employment status (i.e., eligible or non-eligible) through the end of the
Plan Year. The Employee’s hours will then be measured during the applicable Initial Measurement
Period or SMP, depending on the length of the Employee’s employment at the time of his change in
hours, for subsequent eligibility for coverage. If the Employee becomes ineligible for ACA Compliant
Coverage resulting from averaging less than 30 hours a week during the applicable Measurement
Period, he or she will be offered the opportunity to elect to continue his coverage pursuant to COBRA.
Variable Employees, Seasonal Employees, and Part-Time Employees
For Ongoing Employees who are Variable Employees, Seasonal Employees, or Part-Time Employees, the
Employer will review the Employee’s hours measured for each SMP during the Administrative Period
immediately following such SMP. If the individual Employee averaged at least 30 hours per week during
the applicable SMP, the Employee will be treated as a Full-time Employee and offered ACA-Compliant
Coverage for the immediately following Stability Period, regardless of the Employee’s number of hours
of service during the next SMP, so long as the he or she remains an Employee. However, if an Ongoing
Employee’s hours drop below an average of 30 hours per week during a future SMP, that Employee will
not be treated as a Full-time Employee for the Stability Period immediately following such SMP. Offers
of coverage and enrollment of Employees will take place during the Administrative Period immediately
following each SMP, except as provided below for new Variable, Seasonal, or Part-Time Employees. If
an Ongoing Employee who is a Variable Employee, Seasonal Employee, or Part-Time Employee is
promoted to a full-time position (i.e. a position classified by the Employer as a full-time or part-time 1
position) or to a position where it is reasonably expected for the Employee to be employed on average
at least 30 hours per week, he or she will be offered ACA Compliant Coverage effective as of the 31st
day following the status change.
New Variable, Seasonal, or Part-Time Employees generally will not be offered the opportunity to enroll
in ACA-Compliant Coverage during their Initial Measurement Period. The Employer will measure the
hours of such employees during their Initial Measurement Period, applying similar rules to those
described for Ongoing Employees above, in order to determine whether the Employees will be treated
as ACA Full-Time Employees on a going forward basis. If a Variable, Seasonal, or Part-Time Employee
meets the standards for an ACA Full-Time Employee (i.e., averages at least 30 hours per week) during
the Initial Measurement Period, such Employee will be treated as an ACA Full-Time Employee and
offered ACA-Compliant Coverage for the duration of the Stability Period coinciding with or immediately
following the end of the Initial Measurement Period, as long as he or she remains an Employee. In
addition, if a Variable, Seasonal, or Part-Time Employee meets the standards for an ACA Full-Time
Employee during the SMP that would apply to an Ongoing Employee, the Employee will be treated as
an ACA Full-Time Employee and offered ACA-Compliant Coverage for the Stability Period following that
{00014391.DOCX-}
272
------------------------------------------------------------------------------------------ APPENDIX 1, 2017 ------------------------------------------------------------------------------------
SMP, as long as he or she remains an Employee. If a Variable, Seasonal, or Part-Time Employee does
not meet the standards for an ACA Full-Time Employee during the Initial Measurement Period, then
such employee will not be treated as an ACA Full-Time Employee for the Initial Stability Period. Offers
of coverage and enrollment of eligible Employees will take place during the Administrative Period
immediately following the applicable Initial Measurement Period. After the Initial Measurement
Period, Variable, Seasonal, and Part-Time Employees described in this paragraph will be treated as
Ongoing Employees, for purposes of determining their potential Full-time status.
If a newly hired Variable, Seasonal, or Full-Time Employee’s position changes to that of a full-time
Employee (i.e., a position classified by the Employer as full-time or part-time 1) or to a position where it
is reasonably expected for the Employee to be employed on average at least 30 hours per week, such
Employee will be offered ACA-Compliant Coverage effective as of 31st day following the status change.
Responsibility for the review and revision of this Appendix 1 has been assigned to the Plan
Administrator. This Appendix 1 will be reviewed and evaluated periodically from its effective date. To
the extent that new IRS regulations or other guidance under the Affordable Care Act would require
modification of any of the procedures described above, this Appendix 1 will be deemed to have been
automatically amended to permit compliance with such regulations or guidance.
{00014391.DOCX-}
273