2014 Benefits at a Glance Dear Team Member, As this year comes to a close, I would like to tell you how very proud I am of your commitment and dedication to our Health System. It is because of what you do every day that we are able to expand our services and maintain our benefits at a time when other organizations are cutting back benefits, implementing reductions in work force and closing down due to the prevailing economy. Our continued success is because of you… our greatest asset. Our updated Benefits at a Glance guide outlines the many vital benefits Southeast Georgia Health System offers to our team members, the cost associated with each benefit and the pay period premiums. I encourage you to review this guide and your current benefits so you can make an informed decision on changes to your coverage during the Open Enrollment sessions. Benefit changes will be effective January 1, 2014. Open Enrollment will be held Monday, Nov. 4 through Saturday, Nov. 16, 2013. Enrollment is mandatory each year are in a benefit eligible position. If you do not enroll, your current benefits coverage will be cancelled effective December 31, 2013. During Open Enrollment, you should: • • • • Meet with an experienced benefit counselor to review the available benefits and your existing coverage to help you determine the best selections for you; If desired, make changes (effective January 1, 2014); Verify and update dependent information Read benefits summary before signing to ensure coverage selected is correct and that all personal and family information is correct. As always, it is our goal to provide you with the best benefits available and ensure that you are satisfied with the options offered. We appreciate the safe, high quality and costeffective care you provide our customers every day. Sincerely, Gary R. Colberg, FACHE President / Chief Executive Officer TABLE OF CONTENTS New for 2014...................................................................................................... 2 Eligibility ............................................................................................................. 2 Before You Enroll .................................................................................................. 3 Adding a Dependent to your Coverage How to Enroll ....................................................................................................... 3 New Hires, Status Change, Qualifying Events Annual Open Enrollment Process ........................................................................... 3 GROUP BENEFITS Health Plan (including Prescription Drug Plan features) ............................................ 4 Disease Management - Wellness Program .............................................................. 5 Dental Plan .......................................................................................................... 5 Vision Plan .......................................................................................................... 6 Flexible Spending Accounts................................................................................... 6 Basic Term Life and AD&D Insurance ..................................................................... 7 Supplemental Term Life and Voluntary Portable Life ................................................. 7 Short-Term and Long-Term Disability ...................................................................... 8 Retirement Plan .................................................................................................... 9 529 College Savings Plan ..................................................................................... 9 Employee Assistance Program ............................................................................. 10 VOLUNTARY BENEFITS Pre-Paid Legal/Identity Theft ............................................................................... 10 Portable Whole Life Insurance ............................................................................. 11 Children’s Term Insurance Rider Long Term Care Rider Critical Illness Insurance ...................................................................................... 11 Cancer Insurance ............................................................................................... 12 Additional Benefits ............................................................................................. 13 Legal Notices ..................................................................................................... 13 Contact Information ............................................................................... Back Cover The Benefits at a Glance guide is designed to provide you with an overview of the benefits options we offer. The actual benefits available to you and the descriptions of these benefits are governed by the relevant Summary Plan Document (SPD) and our contracts. For more detailed plan information for all lines of coverage listed in the booklet call the Human Resources Department. Southeast Georgia Health System reserves the right to modify, change, revise, amend or terminate these benefit plans at any time. New for 2014 • Eligibility 2013 2014 $60.07 $116.80 $146.88 $184.97 $132.20 Team Member Only Team Member + Child(ren) Team Member + Spouse Family Part-Time Team Member (Team Member Coverage Only) $66.08 $128.48 $161.57 $203.47 $145.42 Health Insurance • Bi-weekly Premium Increase Team Member Only Team Member + Child(ren) Team Member + Spouse Family Part-Time Team Member (Team Member Coverage Only) Tobacco Surcharge If you or your covered spouse use tobacco, you will be required to pay an additional $25 per pay period. For the purposes of this program the following criteria will be applicable: • Tobacco use is classified as smoking (cigarette, e-cigarette, pipe or cigar) as well as smokless tobacco, such as snuff, dipping, or chewing tobacco. • Tobacco-free is defined as not having used tobacco products of any kind as described above for at least six months. Prescription • Co-pay Generic Brand – Preferred Brand – Non-Preferred Specialty Drugs – 20% co-pay with a $100 maximum $5.00 $25.00 $45.00 Generic Brand – Preferred Brand – Non-Preferred Specialty Drugs – 20% co-pay with a $100 maximum $7.50 $30.00 $50.00 Disease Management Generic Brand – Preferred Brand – Non-Preferred $0 $15.00 $35.00 Generic Brand – Preferred Brand – Non-Preferred $2.50 $20.00 $40.00 MetLife New Dental Carrier Premiums will not change and benefits are the same with additional benefit expansion for implants and adult orthodontia. Exchange Notice In 2014, the health care reform law creates an online marketplace for purchasing health insurance coverage, referred to as a Health Insurance Marketplace or an Exchange. You are not required to purchase insurance coverage through the Marketplace. Southeast Georgia Health System is continuing to offer health coverage as outlined in the proceeding “Group Benefits” pages. If you purchase coverage through the Marketplace, you may be eligible for a federal subsidy that lowers your monthly premiums or reduces your cost sharing. However, to receive this federal subsidy, you cannot be eligible for health plan coverage through Southeast Georgia Health System. The availability of coverage through the Marketplace does not affect your eligibility for coverage through Southeast Georgia Health System’s health plan. More information on the health care reform law and the Marketplaces is available at www.healthcare.gov. ELIGIBILITY E L Active A ct team members of Southeast Georgia Health System classified as: • Full F Time » 1.0 (eighty hours per pay period) » 0.9 (seventy-two hours per pay period) • Part P Time » 0.8 (sixty four hours per pay period)* » .75 (sixty hours per pay period)* » 0.7 (fifty-six hours per pay period) » 0.6 (forty-eight hours per pay period) *0 0.8 and .75 team members are considered full time for health insurance purposes only. Eligible Dependents are classified as: • Your legal spouse who resides in the United States • Child/stepchild/legal dependent child less than 26 years of age » If your dependent child is approaching 26 and is disabled, an application for continuation of dependent status must be made within 30 days of the child’s 26th birthday. 2 Before You Enroll • How to Enroll • Annual Open Enrollment Process BEFORE YOU ENROLL - THINGS TO KNOW If you are ADDING a dependent to your benefit coverage, you are REQUIRED to bring a copy of the below information/documentation: • Dependent social security card and date of birth • Acceptable proof of dependent information » Spouse: Marriage License » Child: Birth Certificate » Stepchild: Marriage License and Birth Certificate » Legal Dependent: Court Documentation that confirms legal guardianship/adoption Failure to submit the REQUIRED information/documentation will result in a delay of your enrollment, pending of your claims, and/or a forfeiture of your eligibility and/or the eligibility of your dependents until the next plan year. HOW TO ENROLL • New Hires » You will be given a specific date for your enrollment at General Orientation. You will be required to schedule an appointment time for that specified date with Roni Ferra from McGinty-Gordon & Associates by calling 912-268-4605. » You must enroll within 90 days from your date of hire. - Management-level positions and/or otherwise noted position, must enroll within 30 days from date of hire. • Status Change (Non-Benefit Eligible to Benefit Eligible) » Contact Human Resources by calling 912-466-3100 to schedule an appointment for enrollment. » You must enroll within 30 days from the date of your status change. • Qualifying Events (Examples of qualifying events: birth of baby, marriage, gain/loss of coverage). See your 2014 Summary Plan Description - Special Enrollment Rights for a complete list. » Contact Human Resources by calling 912-466-3100 to schedule an appointment for enrollment. » You must enroll within 30 days from the effective date of your qualifying event. Failure to enroll within the above given days will result in the forfeiture of your eligibility for enrollment until the beginning of the next plan year. ANNUAL OPEN ENROLLMENT PROCESS The MANDATORY benefit enrollment period will begin on November 4 through November 16, 2013. Your benefit elections will be effective January 1, 2014. Ways to Enroll: 1. Meet with an enroller for a one-on-one 20-minute enrollment session. Enrollment dates and times will be posted throughout the Health System. 2. Call a benefit enroller at 1-877-619-3478 to enroll you and answer your questions during the process. 3. Enroll yourself by accessing the on-line benefits enrollment system at http://www.ebportals.com/sghs • When prompted to Login To My Benefits, click the “Log-In” button. Follow the prompts to facilitate your login and benefit enrollment elections. • Call Support will be available for your convenience during the benefit enrollment period only Monday through Friday, 8am – 5pm Eastern Standard Time by calling 1-877-619-3478. 3 Health Plan HEALTH PLAN PROVIDED THROUGH GROUP RESOURCES (Full-Time & Part-Time Team Members are eligible) Refer to your mailed copy or the online intranet copy of the Summary Plan Description to find out more details on your health insurance. If you have claims questions, contact Group Resources at 1-800-749-9663. Coverage / Plan Deductible (individual/family) Super Preferred (SGHS owned/operated) Preferred Non-Preferred $0 $400 / $1,200 $1,000 / $3,000 Out-of-Pocket Maximum (individual/family) $2,000/$4,000 $2,000/$4,000 $3,000/$6,000 Physician Services Office/sick visits Hospital Visits Surgery in office $20 co-pay 90% no deductible N/A $20 co-pay 90% no deductible 80% after deductible 60% after deductible 60% after deductible 60% after deductible Chiropractic Service N/A 80% after deductible 80% after deductible Preventive Care/Wellness (annual GYN exam, mammogram, PSA, prostrate screen) 100% 100% after $20 co-pay N/A Routine Physical Exams 100% 100% after $20 co-pay N/A Routine Child Care & Immunizations (eligible child(ren) birth to 25 yrs old) 100% 100% after $20 co-pay N/A 90% no deductible 80% after deductible 60% after deductible 100% no deductible 80% after deductible 60% after deductible 100%* 80% after deductible 60% after deductible Inpatient Services (facility charges only) Outpatient Surgery Outpatient Diagnostic Services (x-ray, labs) Short Term Rehab Therapy (PT, OT, ST) 100% 80% after deductible 60% after deductible Emergency Room 80% after $100 co-pay 80% after $100 co-pay 80% after $100 co-pay Immediate Care / Urgent Care 100% after $25 co-pay 80% after $50 co-pay 80% after $50 co-pay 100%* N/A 60% after deductible N/A 90% no deductible 80% after deductible 80% after deductible 60% after deductible 60% after deductible Freestanding Diagnostics Lab & X-ray Testing (SGHS MRI & Imaging Center) Chemical Dependency Inpatient Outpatient Prescription Drug Co-Pays** Generic Preferred Formulary Brand Name Non-Preferred Formulary Brand Name Specialty Drugs Co-Payment amounts for all three Medical Plans $7.50 co-pay / $2.50 Co-pay for Disease Management Participants*** $30.00 co-pay / $20.00 Co-pay for Disease Management Participants*** $50.00 co-pay / $40.00 Co-pay for Disease Management Participants*** 20% to a maximum of $100 per fill For the most current 2014 Preferred Formulary Brand Name List, log onto www.catalystrx.com Any new specialty drugs, or prescription drugs/medications with a retail price of $1,000 or more MUST BE REVIEWED/APPROVED prior to fulfillment. This process could take up to two (2) days depending upon the response time of the caring physician. * Claims for physicians’ reading services will be paid at the Preferred plan rate of 80%. ** At retail pharmacy: 30-day supply: 1x co-pay, 60-day supply: 2x co-pay, 90-day supply: 3x co-pay. Through mail order: 90-day supply: 3x co-pay. *** Team Members and compliant participating in the Disease Management Program (DMP) through Southeast Georgia Health System will receive reduced co-pays for prescription drugs. **** For Mental Health information please refer to the 2014 health insurance summary plan document. • Pre-certification must be completed with iPROCERT (1-800-319-9416) for certain procedures and all inpatient stays, otherwise benefit coverage will decrease by 50%. Team Members must contact iPROCERT at least 72 hours prior to any scheduled admission for a medical condition, mental and nervous disorder, chemical dependency treatment, outpatient surgical procedures performed outside the physician’s office, chemotherapy, purchase or rental of durable medical equipment, home healthcare, the beginning of hospice care, private duty nursing, and infusion services. In case of an Health Insurance Rates Bi-weekly emergency Hospital admission or emergency surgery, iPROCERT must be notified within two working days of admission. Team Member Only $66.08 What is the difference between physician listings under CGRHN and First Health? Team Member + Child(ren) $128.48 • CGRHN—local providers in the Coastal Georgia Regional Healthcare Network. A list of providers is Team Member + Spouse $161.57 available on the intranet or in Human Resources. Family $203.47 • First Health—physicians who are outside CGRHN. A list of providers is available on the First Health website (www.firsthealth.com). Part-Time Team Member $145.42 (Team Member Coverage Only) 4 Disease Management Program • Dental Plan DISEASE MANAGEMENT - WELLNESS PROGRAM PROVIDED THROUGH SOUTHEAST GEORGIA HEALTH SYSTEM (Full-Time & Part-Time Team Members are eligible) The disease management program offered by Southeast Georgia Health System is available to team members and their dependents who are covered under the Southeast Georgia Health System’s group health insurance plan, who are taking prescription medication(s), and are under the care of a physician for one or more of the following conditions: Diabetes • High Blood Pressure • High Cholesterol • Asthma • GERD (Acid Reflux) There is no cost to participate in this program. Any medications written for any of the above disease states have a reduced co-payment for as long as the team member participates in the program, remains in compliance, and is covered under the Health System’s health insurance. Other benefits of the program include: • free scheduled contact with a case manager—contact must be maintained to continue the program and to receive the following prescription drug co-pay benefits: $2.50 Generic; $20 Preferred Formulary Brand Name; $40 Non-Preferred Formulary Brand Name • free blood pressure and/or blood sugar monitoring devices • free educational materials specific to the enrolled disease state(s) Participation in the disease management program is voluntary and confidential. If you are interested in this program, a Disease Management program application is available in the Human Resources Department at either the Brunswick or Camden Campuses. DENTAL PLAN PROVIDED THROUGH METLIFE (Full-Time & Part-Time Team Members are eligible) Benefits In-Network (PPO Providers) Diagnostic & Preventive Benefits 100% Basic Benefits / Restorative Benefits / Denture Repairs 80% UCR* Endodontic Benefits / Periodontic Benefits / Crowns & Cast Restorations / Prosthodontic Benefits and Orthodontic Benefits 50% UCR* Deductible Amount Per Calender Year $50 Team Member / $150 Family (Deductible applies to all benefits except Diagnostic & Preventive Services or Orthodontic Services) Standard Dental Annual Maximum Per Enrollee $1,200 Lifetime Orthodontic Maximum per Enrollee $1,000 MetLife will receive credit for any amounts paid under the Applicant’s previous dental care plan for Orthodontic Benefits. These amounts will be credited towards the maximum amounts payable. Orthodontic amounts paid will be credited on a per lifetime basis. • The percent of eligible charges that the plan pays whether you use MetLife PPO (in-network) providers or out-of-network providers is the same. However, in-network claims are processed at negotiated rates, that may generally lower your out of pocket costs. • UCR = Usual, Customary and Reasonable: Dental Rates Bi-weekly Team Member Only $14.55 Team Member + Child(ren) $30.99 • Usual — A usual fee is that fee regularly charged and received for a given service by an individual Team Member + Spouse $26.21 Dentist, i.e., his “usual” fee. • Customary — A fee is customary when it is within the range of “usual” fees charged and received by Family $42.54 Dentists of similar training for the same service within the geographic area determined byMetLife to be relevant. • Reasonable — A fee is reasonable if it is usual and customary or if it falls above usual or customary or both, but is determined to be justified considering the special circumstances. Example of UCR applied to a claim: If your dentist charges $100 for a procedure and the plan’s Usual, Customary and Reasonable (UCR) maximum for that procedure is $80, then you would be responsible for the $20 difference. Prior to receiving extensive dental care, we recommend that your dentist submits a pre-determination notice to MetLife to determine your total estimated out-of-pocket costs. 5 Vision Plan • Flexible Spending Accounts VISION PLAN PROVIDED THROUGH EYEMED (Full-Time & Part-Time Team Members are eligible) Benefit Vision Exam Contact Lenses* Conventional Disposables Medically Necessary Standard Plastic Lenses Single Vision Bifocal Trifocal Standard Progressives Frames Preferred Non-Preferred Frequency $10 co-payment Up to $35 maximum amount Once every 12 months Allowance Up to $135 Up to $135 $0 co-payment; Paid-in-Full Max Amount Up to $108 Up to $108 Up to $200 Once every 12 months Co-Payment $25 $25 $25 $25 up to $55 allowance Max Amount Up to $25 Up to $40 Up to $65 Up to $40 $0 co-payment; up to $120 allowance Up to $60 maximum amount Once every 12 months Once every 24 months *Standard Contact Lens fitting—spherical clear contact lenses in conventional wear and planned replacement. Examples include but are not limited to disposable, frequent replacement, etc. A team member may purchase either glasses or contacts under this coverage, but not both. Once the allowed benefit has been used, members may receive a 40% discount on purchases of complete pairs of eye glasses and a 15% discount on conventional contact lenses. FLEXIBLE SPENDING ACCOUNTS Vision Rates Bi-weekly Team Member Only $2.43 Team Member + Child(ren) $4.87 Team Member + Spouse $4.61 Family $7.14 PROVIDED THROUGH STANLEY, HUNT DUPREE & RHINE (Full-Time & Part-Time Team Members are eligible) Flexible Spending Accounts (FSA) may be used to pay for many types of health care expenses that are not covered under your benefit plan and dependent care expenses incurred for you to go to work with before-tax dollars. There are two spending accounts available. You may choose one, both or neither depending on your situation: • Unreimbursed Medical Spending Account—allows you to set aside as much as $2,500 per year for unreimbursed expenses such as deductibles, co-payments, physicals, acupuncture, vision care, orthodontia expenses and more. *Over-the-counter drugs are not eligible expenses. • Dependent Child Care Spending Account—If you are married and file a joint return, or you file a single or head of household return, the annual IRS limit is $5,000. If you are married and file separate returns, you can each elect $2,500 for the calendar year. *Dependent cards are funded bi-weekly with your bi-weekly payroll deductions are available upon funding. You MUST re-enroll each year in order for the FSA to continue to the upcoming new year. Contributions: The money you contribute is deducted from your paycheck before federal and state taxes and Social Security are applied. In effect, you will be paying your bills with tax-free money because you pay no taxes on the money when it’s deposited or when you’re reimbursed. The result can lower taxes and create more spendable income. Tax-Free Reimbursement: You may use your debit card to pay for eligible expenses, or you may submit a claim form for reimbursement. Dependent care expenses are reimbursed up to the total amount accumulated in your account. IRS regulations do not allow you to change your contributions during the year, except for qualifying events. Special Note: “Use-It-Or-Lose-It” Rule: You will have until March 16, 2015 to spend all the 2014 funds in your Flexible Spending Account. You will have until March 31, 2015 to file claims for reimbursement for your 2014 eligible expenses. IRS regulations require that any remaining balance be forfeited. Therefore it is very important that you carefully estimate your expenses before electing your annual Flexible Spending Account contributions. For a complete listing of reimbursable health and dependent care expenses, call the IRS at 800-829-3676 and request Publications #502 (health care) and #503 (dependent care), or access these publications through the Internet at: www.irs.ustreas.gov. 6 Life and AD&D Insurance BASIC TERM LIFE AND AD&D INSURANCE PROVIDED THROUGH AETNA (Full-Time Team Members are only eligible) These benefits are provided by the Health System at no cost to the team member. Eligible team members are provided life insurance at 2x annual salary to a maximum of $500,000. This employer paid benefit is available to full-time team members and provides $1,500 for each of your eligible dependents. Team members must designate a beneficiary for this coverage. Base annual earnings are used to determine your benefits under the group policy. Any income you receive such as, but not limited to, commissions, bonuses, dividends, overtime, and differentials will be excluded from this calculation. Accidental Death & Dismemberment insurance is included with Basic Term Life for team members coverage only and can double your face value - per policy requirements. SUPPLEMENTAL TERM LIFE AND VOLUNTARY PORTABLE TERM LIFE INSURANCE PROVIDED THROUGH AETNA (Full-Time & Part-Time Team Members are eligible) Issue Limits • Team members who are newly eligible for this benefit have a guarantee issuance of up to two times their annual salary up to a maximum of $500,000 do not need to complete an Evidence of Insurability (EOI) form. • For those team members who did not elect this coverage when first offered at the time of hire or are making changes to their policy face value election, an Evidence of Insurability (EOI) must be completed. What is Evidence of Insurability? EOI is a statement of medical history to determine if a team member is approved for coverage when the amount of life insurance that team member desires is in excess of the guarantee issue (GI) amount for the group. • Coverage will pend EOI approval from Aetna. If approved by Aetna, coverage and payroll deductions will begin. • AGE REDUCTIONS: Rates are age based and will change accordingly each year. Please refer to the table on the right for rates per $1,000 of life coverage by age. • Team members must enroll for supplemental life to become eligible for dependent life coverage. Team Member • All team members - Choice of 1 to 5x annual salary to a maximum of $500,000. • New Hires will be offered a guarantee issue of 2x base earnings up to $200,000. • Age Reductions: Benefit amount reduces by 35% at age 65, by 60% at age 70 and by 75% at age 75 and above. Spouse • Choice of $10,000 to $100,000 in $10,000 increments. • Spouses of new team members will be offered a guaranteed issue of up to $30,000 in $10,000 increments. Children • Choice of $5,000 or $10,000. Age Rate/$1,000 < 25 $.04 25 - 29 $.04 30 - 34 $.05 35 - 39 $.07 40 - 44 $.10 45 - 49 $.15 50 - 54 $.23 55 - 59 $.36 60 - 64 $.44 65 - 69 $.61 70 - 74 $.97 75 - 79 $1.32 80 - 84 $1.32 80> $1.32 Dependent Spouse Coverage $ .35 per $1,000 of coverage Dependent Child Coverage (Birth to age 25) $5,000 Option = $.50 $10,000 Option = $1.00 Deduction will change accordingly based on age and annual salary. If you declined Supplemental Term Life or Voluntary Portable Term Life Insurance when first eligible you will be expected to submit Evidence of Insurability (EOI) to AETNA for approval. 7 Short-Term Disability • Long-Term Disability SHORT-TERM DISABILITY PROVIDED THROUGH AETNA (Full-Time Members only are eligible) Short-Term Disability (STD) insurance provides you with weekly income if you are unable to work or have a reduced income due to an illness or injury unrelated to your occupation. • Team Members who are newly eligible for this benefit and elect a Buy-Up option will not need to complete and Evidence of Insurability (EOI). • For those team members who did not elect a Buy-Up option when it was first offered at the time of hire and are buying up from the Core Plan, an Evidence of Insurability (EOI) must be completed. • Election of this benefit does not guarantee coverage. Coverage will pend EOI approval from Aetna. Benefit Core Plan Buy-Up A Buy-Up B Buy-Up C Core - 60% to amaximum of $1,000 per week Core - 60% to amaximum of $1,000 per week Buy-up - 70% to amaximum of $1,500 per week Buy-up - 70% to amaximum of $1,500 per week Elimination (Waiting) Period* 30 days - Accident 30 days - Sickness 15 days - Accident 15 days - Sickness 30 days - Accident 30 days - Sickness 15 days - Accident 15 days - Sickness Benefit Duration 22 weeks after elimination period 24 weeks after elimination period 22 weeks after elimination period 24 weeks after elimination period Weekly Benefit Contributions 100% Employer paid Team Members pay premiums for the Buy Up option depending upon election of Buy-Up A, B, or C. * Elimination Period - consecutive calendar days. Deduction amounts are subject to change in accordance with your base salary. A Team Member can use up to 24 hours of Paid Time Off per pay period in addition to STD collection, unless elimination period has not been met. LONG-TERM DISABILITY PROVIDED THROUGH AETNA (Full-Time Members only are eligible) Long Term Disability (LTD) benefits provide continuing partial income replacement if your disability continues beyond 24 weeks. LTD is available after one year of employment. Monthly Benefit Percentage Definition of Disability 60% to a maximum of $8,000 Unable to work for 24 weeks with a loss of 20% of income Duration of Benefits Age 65, SSNRA (Social Security Normal Retirement Age) Elimination Period 6 months for all team members Contributions Pre-Existing Condition 100% employer paid 3/12* * The pre-existing conditions limitation is 3/12. A pre-existing condition is one for which an individual has seen a medical practitioner or taken medication in the 3 months prior to his or her coverage effective date. Benefits will not be paid for any pre-existing condition until the earlier of 3 consecutive months ending on or after the effective date of coverage during which the individual has not seen a medical practitioner or taken medication for a condition; OR the individual remains insured under this plan for 12 consecutive months. 8 If you declined the Buy-Up option for Short-Term Disability Insurance when first eligible and you now wish to elect this option, you will be expected to submit Evidence of Insurability (EOI) to AETNA for approval. Retirement Plan • 529 College Savings Plan RETIREMENT PLAN PROVIDED THROUGH MASS MUTUAL FINANCIAL GROUP We offer the following Retirement Options: 403(b), 457, and Roth 403(b). Plans may vary based on campuses. Team Member Eligibility: You are immediately eligible to contribute to the plan. You are eligible for base and matching contributions if you: • are age 18 or older and • have completed one year of service during which you have worked at least 1000 hours per calendar year. • Based on IRS guidelines, you may also be eligible to contribute an additional $5,500 if you are age 50 or older. In order to receive the additional $5,500 for over 50 catch-up contributions you must complete an election form each year. Team Member Contributions: You may contribute as much as 100% of your annual salary up to $17,500* per year. Employer Match: For each $1.00 you contribute, Southeast Georgia Health System will contribute: • $.50 on the first 5% of your salary (2.5%) if you have less than six (6) years of service. • $.75 on the first 5% of your salary (3.75%) if you have six (6) or more years of service. • After 1 year of service and 1,000 hours, the Health System contributes 2.25% of your base salary each pay period. Vesting: You are always 100% vested in your own contributions. You will be 100% vested in the Health System’s contributions to your account after you have completed three years of service with at least 1,000 hours worked in each of those three plan years of service. If interested in this plan, contact our Retirement Plan Specialist who can assist you with the required paperwork. Contact information located on back cover. If interested in contacting Mass Mutual directly, you may call the toll-free number at1-800-743-5274 Monday throughFriday 8am-8pm. *Amount subject to change per IRS guidelines. 529 COLLEGE SAVINGS PLAN (Full-Time & Part-Time Team Members are eligible) A College Advantage account may be used for tuition, room, board and other qualified expenses at any accredited college in the U.S. If that child decides not to attend college, the account owner can leave the assets invested in the account cou ount nt for later use, change beneficiaries to another family member ber er or withdraw the assets and pay income tax and an additional 10% federal tax on earnings. College Advantage account owners contribute after tax money but pay no taxes while the account accumulates. Also, withdrawals used to pay for qualified higher education expenses are free from federal income tax. The ability to save tax-free can make a big difference in how much college savers can accumulate over time. If interested in this plan, please contact the Retirement Plan Specialist who can assist you with the required paperwork. 9 Employee Assistance Program (EAP) • Legal Services/Identity Theft EMPLOYEE ASSISTANCE PROGRAM (EAP) PROVIDED THROUGH HORIZON HEALTH Southeast Georgia Health System provides EAP to protect its most valued asset - YOU. We have contracted with Horizon Health EAP Services to provide you and each of your eligible dependents with access to professional assistance for the challenges of everyday living. Services Available through Horizon Health: • Confidential Counseling Sessions to deal with difficult periods in life » 24/7 telephonic assessment and triage » Face-to-face counseling sessions - up to 7 visits per incident per calendar year » Telephonic counseling - unlimited number of issues per year • WorkLife Benefit » Eldercare, childcare, and dependent care consultation and referral - unlimited number of issues per year » Medicare counseling - unlimited number of issues per year » Convenience services - unlimited number of issues per year • Financial Consultation » One free 30-minute telephonic or face-to-face consultation per each new issue with a financial counselor on topics including credit counseling, debt counseling and budgeting, mortgages, retirement planning, and tax questions with local referrals and web access - unlimited number of issues per year » Library of forms, articles, and FAQ’s, calculators • Legal Consultation » One free 30-minute telephonic or face-to-face consultation with a network attorney or mediator per each new issue unlimited number of issues per year » 25% discount off usual rates for subsequent work and network attorney or mediator » Free simple will preparation » 10% discount off usual rates for telephonic and online assistance to help prepare legal documents such as divorce forms, estate planning forms, immigrations forms, and others PREPAID LEGAL / IDENTITY THEFT SHIELD • Identity Theft Consultation » One free 60-minute telephonic consultation per each new issue with a fraud resolution specialist - unlimited number of issues per year » Specialist assists employees with restoring their identity and good credit » Free “ID Theft Emergency Response Kit” » Specialist advises client on how to dispute fraudulent debts due to ID theft » Counselor follows up with the member and monitors progress • HorizonCareLink Online EAP Services » Free live webinars » Child and elder care searches and resources » School and college tools » Adoption resources » Veterinarian and pet care researches » Psychological health resources » Assessments and wellness resources » Money and time-saving resources It’s Confidential As provided by law, your use of Horizon’s services is confidential. Information related to your participation in the EAP will not be shared with anyone without your written permission. It’s Convenient Horizon’s network of professionals are located near your home and place of employment. Appointments are available at times convenient to your schedule. It’s Easy to Use Horizon provides a national, toll-free 800 number for emergencies and crisis intervention, and to request an initial appointment. The hotline is available 24 hours a day, 7 days a week. Horizon Health 1-866-252-4468 PROVIDED THROUGH LEGAL SHIELD (Full-Time & Part-Time Team Members are eligible) Pre-Paid Legal Services: Local attorneys participate in the program (see HR for details). Toll-free phone consultations on legal issues are available Monday through Friday from 8 am – 5 pm. Identity Theft Shield Highlights: Credit Report—Evaluation of current credit standing with detailed analysis. Credit Monitoring—Suspicious activities will be brought to your attention, providing you with early identity theft detection. Identity Restoration—Complete assistance with the devastating and overwhelming process of restoring your name and credit. Eligible dependent children: up to age 23 and a full-time student (12 credit hours per semester). 10 Individual or Family Rates Bi-weekly Pre-Paid Legal Only $6.81 Identity Theft Only $5.98 Pre-Paid Legal and Identity Theft $11.40 Whole Life Insurance • Critical Illness Insurance WHOLE LIFE INSURANCE - WITH CHILDREN’S TERM LIFE AND LONG TERM CARE RIDERS PROVIDED THROUGH ING EMPLOYEE BENEFITS (Full-Time & Part-Time Team Members are eligible) Whole Life Insurance offers protection, cash accumulation, and cash value loan privileges – all in one policy. Whole Life Insurance is also portable. If you ever leave employment, you can take your insurance coverage with you and your premium amounts and cash value are guaranteed as long as you meet the required premium payments. Coverage: Team Member and spouse may elect a minimum of $5,000 of coverage up to a maximum of $500,000. • Team Member coverage purchased up to $100,000 is Guaranteed Issue (GI) without additional Evidence of Insurability (EOI). • Pay period deductions will not be taken in an amount greater than the premiums for the GI amount until the EOI is approved by ING What is Evidence of Insurability? EOI is a statement of medical history to determine if a team member is approved for coverage when the amount of life insurance that team member desires is in excess of the guarantee issue (GI) amount. • Team Member may apply for Spouse and Dependent Children/Grandchildren coverage even if the team member does not apply, |pending EOI approval. • An optional Accidental Death Benefit (ADB) may be added that provides an additional benefit amount if the insured dies in a covered accident. • Eligible dependent children = up to age 24. Children’s Term Insurance (CTR) Rider: CTR provides insurance coverage to dependent children and dependent grandchildren in $1,000 increments up to $10,000. One premium covers all eligible dependents. The premium will be in addition to the base premium on the purchased Whole Life Policy. (Subject to eligibility requirements. Please see an enroller for details.) Long Term Care (LTC) Rider: This rider allows the insured to receive accelerated payment of their death benefit if they are receiving qualified care to assist with daily living, including home health care, adult day care or confinement to a long term care facility. The minimum insurance amount for this rider is $12,500. • A monthly benefit of 4% of the death benefit is available for up to 25 months if the insured is confined to a long term care facility. • A monthly benefit of 2% of the death benefit is available for up to 50 months if the insured is receiving home health or adult day care. • Each month a long term care payment is made, the life insurance death benefit will be restored and the full insurance amount remains available. Example LTC Rider with Restoration and Extension of Benefits: Suzanne Smith purchased a $50,000 Whole Life Insurance policy. At age 46, she suffers a stroke. Because she is confined to a long term care facility, she is eligible for a monthly benefit of 4% of the death benefit of her policy for up to 25 months. Each month a long term care benefit payment is made, an equal amount will be restored to the life insurance death benefit. If, after that 25 months, she continues to be confined to a long term care facility, she will be eligible to receive up to another 25 months of payments. • $50,000 death benefit x 4% per month = Monthly benefit of $2,000 for 25 months. • Each month a payment is made, $2,000 will be restored to the life insurance death benefit. The $50,000 death benefit remains available in the event of death. After the first 25 months, Suzanne is eligible to receive another 100% of the face amount: $50,000 face amount x 4% per month = an extended monthly benefit of $2,000 for up to another 25 months. • Total Potential Benefit for Suzanne Smith: $150,000. CRITICAL ILLNESS INSURANCE PROVIDED THROUGH UNUM (Full-Time & Part-Time Team Members are eligible) Many people believe they will be covered by their medical policies should a critical condition arise. Unaware of the many hidden costs involved, they find out too late that their needs exceed the terms of their standard medical plan. Unum's specified critical illness policy pays a lump sum benefit, based on the date of diagnosis, up to 100% of the policy’s face amount if you are diagnosed with one of the critical illnesses listed below. You may choose a face amount from $5,000 to $50,000 in $5,000 increments. Team Member must be enrolled to have spouse/child on plan. If illness occurred and the elected Percentage Face Amount was paid out to the policy holder; the following will take place: (1.) The policy will be canceled automatically at the time of payment, and (2.) Policy holder must advise HR within thirty (30) days of payment so that deductions can be stopped. This is an individual policy therefore the carrier will need to approve eligibility or changes prior to deductions being made. Covered Critical Illness % of Face Amount Paid Heart Attack 100% Major Organ Transplant* 100% Permanent Paralysis* 100% End-Stage Renal (Kidney) Failure 100% Coronary Artery Bypass Surgery 25% Health Screening Benefit Rider $50/calendar year per insured * Please refer to your policy for complete definitions of covered critical illness. Health Screening Benefit Rider All insured covered by a critical illness policy or critical illness rider will automatically receive this rider. • Pays $50 per calendar year per Insured for covered health screening tests. • Benefits are payable for covered health screening tests performed after the insured fulfills a 30-day waiting period. • There is an additional premium for this rider. • The rider terminates when the base policy terminates. Premiums are based on age and level of coverage desired. If you declined Whole Life or Critical Illness Insurance when first eligible you will be expected to submit Evidence of Insurability (EOI) to ING or Unum for approval. 11 Cancer Insurance CANCER INSURANCE PROVIDED THROUGH AFLAC (Full-Time & Part-Time Team Members are eligible) The voluntary cancer insurance plan offered by AFLAC provides benefits when a covered Team Member/dependent experiences a cancer illness. Please refer to the AFLAC product description for details on types of coverage, waiting periods, and costs. Brochures are available in HR. This is an individual policy therefore the carrier will need to approve eligibility or changes prior to deductions being made. Benefits Initial Treatment Benefit Initial Diagnosis Hospital Confinement (1-30 days) (+30 days) Wellness Injected Chemotherapy Aflac Premier Cancer Care Aflac Classic Cancer Care Initial Treatment Benefit built in Initial Diagnosis Benefits Initial Treatment Benefit built in Initial Diagnosis Benefits $6,000 Insured/Spouse; $12,000 for children $4,000 Insured/Spouse; $8,000 for children $300 employee/spouse per day, $375 dependent child per day $200 employee/spouse per day, $250 dependent child per day $600 employee/spouse per day, $750 dependent child per day $400 employee/spouse per day, $500 dependent child per day $100 per year, per person $75 per year, per person $900 per week - No lifetime max. $600 per week - No lifetime max. Hormonal - $400 per month up to 24 months; after 24 month pays $100 per month Hormonal - $250 per month up to 24 months; after 24 month pays $75 per month Non-Hormonal - $400 per prescription up to $1,200 per month Non-Hormonal - $250 per prescription up to $750 per month Topical Cream Benefit $200 per prescription per month $150 per prescription per month Radiation $500 per week - No lifetime max. $350 per week - No lifetime max. Experimental Treatment $500 per week when charged/$125 per week if no charge $350 per week when charged/$100 per week if no charge Immunotherapy (per covered person) $500 once per calendar month - Lifetime max. of $2,500 $350 once per calendar month - Lifetime max. of $1,750 Oral Chemotherapy $150 per calendar month - No lifetime max. $100 per calendar month - No lifetime max. Private Duty Nursing Services Anti-Nausea $150 per day while confined in a hospital - No lifetime max. $100 per day while confined in a hospital. No lifetime max. Anesthesia & Surgery The maximum daily benefit will not exceed $4,250 - based on the surgery schedule listed in the policy The maximum daily benefit will not exceed $6,250 - based on the surgery schedule listed in the policy Outpatient Hospital Surgical Benefit $300 per day (In addition to Surgical Benefit) - No lifetime max. $200 per day (In addition to Surgical Benefit) - No lifetime max. Skin Cancer Surgery $50 - $600 daily benefit, this amount includes anesthesia - No lifetime max. on number of operations $35 - $400 daily benefit, this amount includes anesthesia - No lifetime max. on number of operations Blood & Plasma Prosthesis Reconstructive Surgery Ambulance Transportation Lodging (No lifetime max.) Bone Marrow Transplantation Stem Cell Transplantation Extended-Care Facility Hospice ($12,000 lifetime max.) Home Health Care Egg Harvesting And Storage $100 x number of days confined/$175 per day outpatient Nonsurgical - $175 per occurrence - $350 lifetime max. Surgical - $3,000 with a lifetime max. of $6,000 Surgical - $2,000 with a lifetime max. of $4,000 $3,000 daily maximum for reconstructive surgery and 25% benefit paid for anesthesia $2,000 daily maximum for reconstructive surgery and 25% benefit paid for anesthesia $250 Ground/$2,000 Air $250 Ground/$2,000 Air $.50 per mile up to $1,500 max - No lifetime max. $.40 per mile up to $1,200 max - No lifetime max. $80 per day for a family, limited to 90 days/per calendar year $65 per day for a family, limited to 90 days/per calendar year $10,000 per covered person, lifetime max. is $10,000 - Donor $1,000 $7,000 per covered person, lifetime max. is $7,000 - Donor $750 $7,000 with a lifetime max. of $10,000 $7,000 with a lifetime max. of $10,000 $150 per day up to 30 days per year $100 per day up to 30 days per year $1,000 for first day; $50 per day thereafter $1,000 for first day; $50 per day thereafter $150 per visit, limit of 10 visits per hospitalization and 30 visits per calendar year for each covered person $100 per visit, limit of 10 visits per hospitalization and 30 visits per calendar year for each covered person $2,000 Lifetime max. per covered person $1,350 Lifetime max. per covered person Specified Disease $1,000 payable once per covered specified disease; $200 a day (1-30 days), $500 a day (over 31 days) $1,000 payable once per covered specified disease; $200 a day (1-30 days), $500 a day (over 31 days) Waiver of Premium Included after 90 continuous days, if unable to do all of the usual and customary duties of your occupation Included after 90 continuous days, if unable to do all of the usual and customary duties of your occupation Waiting Period Age-Band Coverage Family Coverage 12 $150 x number of days confined/$250 per day outpatient Nonsurgical - $250 per occurrence - $500 lifetime max. 30-day waiting period for the effective date of the policy 30-day waiting period for the effective date of the policy Includes the insured and spouse up to age 75 Includes the insured and spouse up to age 75 Includes the insured, spouse and the dependent children to age 25 Includes the insured, spouse and the dependent children to age 25 If you declined Cancer Insurance when first eligible you will be expected to submit Evidence of Insurability (EOI) to AFLAC. Additional Benefits • Legal Notices Paid Time Off (PTO): provides each regular full-time and part-time team member (.6 FTE or above) with prescribed number of hours PTO is accrued bi-weekly and is based upon a team members approved FTE status, length of service and based on prorated actual hours worked. Team members can accrue up to maximum of 600 hours. PTO Cash-In: After being employed for one year, team members may cash up to eighty (80) hours of PTO per calendar year. NON-EXEMPT HOURS ACCRUED PER PAY PERIOD Full-Time (0.9 & 1.0) Part-Time (0.8) Part-Time (0.6) Less than 2 years 7.077 2.461 1.846 2 years- < 4 years 4 years- < 6 years 6 years- < 8 years 8 years- < 10 years 10 years- < 20 years 20 years and over 7.385 7.692 8.000 8.308 8.615 10.154 2.708 2.953 3.200 3.446 3.692 4.923 2.031 2.215 2.400 2.584 2.769 3.692 EXEMPT Less than 2 years 2 years- < 4 years 4 years- < 6 years 6 years- < 8 years 8 years- < 10 years 10 years- < 20 years 20 years and over HOURS ACCRUED PER PAY PERIOD 8.615 8.923 9.230 9.538 9.846 10.154 10.769 Additional Leaves: • Family Medical Leave - is available to Team Member for self or their eligible dependent. Team Member must be employed for 12 months and have worked 1250 hours in the last 12 months from date of onset to be eligible. See policy SHR #75 for more details. • Educational Leave – Team members who are planning on attending school and can not work full-time status may be eligible for this leave option. See policy SHR#76 for more details. • Bereavement Leave – Team members who may be in need to take leave due to a death in the family, as defined: Immediate family is confined to the Team Member’s or current spouse’s relationship: father, mother, brother, sister, current spouse, child, grandparents/grandchildren, legal guardian, step-parents/stepchildren/ step-brothers and stepsisters. Leave can be paid up to three (3) consecutive days of their normal schedule work. See policy SHR#77 for more details. Holiday Pay: The following holidays are recognized by SGHS: New Year’s Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day and Christmas Day. For payroll purposes, holidays are recognized on the official calendar day (from midnight to midnight). See policy SHR#71 for more details. Scholarship Program: Scholarship assistance is typically provided to allied health or nursing school students who are willing to commit to a certain time frame of full-time employment in their goal position with Southeast Georgia Health System. See policy SHR #33 for more details. Tuition Reimbursement Program: Team members classified as full time that have completed twelve months of continuous full time employment. Upon satisfactory completion of each course of an approved curriculum, the team member is eligible for reimbursement up to a maximum of $4,000 per fiscal year. See policy SHR #79 for more details. For further information about any of these benefits or policies, call Human Resources at 912-466-3100. LEGAL NOTICES NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS: If you are declining enrollment for yourself or you dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and you dependents in this plan if you or your dependants lose eligibility for that other coverage (or if the employer stops contributing towards you or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contribution toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself or your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. SECTION 125 PRE-TAX BENEFIT AUTHORIZATION NOTICE: Before-tax deductions will lower the amount of income reported to the federal government. This may result in slightly reduced Social Security benefits. If you do not enroll eligible dependents at this time, you may not enroll them until the next open enrollment period. You may not drop the coverage you elected until the next open enrollment period. You may only make a change or drop coverage elections before the next open enrollment period under the following circumstances: • A change in marital status, or • A change in the number of dependents due to birth, adoption, placement for adoption or death of a dependent, or • A change in employment status for myself or my spouse, or • Open enrollment elections for my spouse, or • A change in dependents eligibility, or • A change in residence or worksite. • Any change being made must be appropriate and consistent with the event and must be made within 30 days of when the event occurred. WOMEN’S HEALTH and CANCER RIGHTS ACT OF 1998 Annual Notice: The Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breast, prostheses, and complications resulting from a mastectomy, including lymph edema. Call you plan administrator at 912-466-3199 for more information. NEWBORNS’ ACT DISCLOSURE: Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provide, 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. 13 CONTACT INFORMATION Name Contact Phone Web Site / E-Mail Fax Basic Life and AD&D & Supplemental Life AETNA 800-523-5065 www.aetna.com Life Claims 800-238-6239 Benefits Administrator Diana Mathena 912-466-3102 [email protected] 912-466-3113 AFLAC 800-992-3522 www.aflac.com Credit Union Marshland Federal Credit Union 912-466-3150 www.marshlandfcu.coop Critical Illness UNUM 800-635-5597 www.unum.com Dental MetLife 800-438-6388 www.metlife.com/dental Cancer 912-466-3153 859-389-6505 Disease Management Southeast Georgia Health System Employee Assistance Program Aetna Resources for Living EAP 866-252-4468 24 hours a day www.horizoncarelink.com Login: SGHS Password: EAP Flexible Spending Accounts Stanley, Hunt, Dupree & Rhine 800-768-4873 www.shdr.com/flex 252-293-9049 HR Manager - Camden Sharon Zawislak 912-576-6412 [email protected] 912-576-6404 Human Resources Main Number Toll Free Number 912-466-3100 800-678-9250 www.sghs.org 912-466-3113 Medical Group Resources Incorporated Main - 800-749-9963 Claims - 888-620-1297 www.groupresources.com For Claims: 770-623-4022 Pharmacy Catamaran 888-727-5560 www.catamaranrx.com 888-727-5560 PPO Provider Network CGRHN First Health Refer to the Human Resources or the Intranet for a list of providers 800-226-5116 www.firsthealth.com Precertification for Medical 912-466-3113 I-Procert Group #5541 800-319-9416 Legal Shield 800-654-7757 www.legalshield.com Mass Mutual Jim Jacobs Retirement Plan Specialist 800-743-5274 www.massmutual.com/retire 912-466-3175 [email protected] 912-466-3113 AETNA 800-488-2386 www.aetna.com Claims 866-667-1987 Vision EyeMed Customer Service 866-723-0514 www.eyemedvisioncare.com Claims 866-293-7373 Whole Life & Long Term Care ING Employee Benefits 800-537-5024 www.ingemployeebenefits-us.com Email: [email protected] 612-342-3051 AMTRUST 877-528-7878 [email protected] 800-487-9654 Pre-paid Legal & Identity Theft Retirement Plan Specialist & College Savings Plan Short-Term & Long-Term Disability Workers’ Compensation
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