www.healthysteps4u.org 2012 Benefits Open Enrollment Active Employees Our 2012 Benefits Program OCTOBER 2011 At Stanford Hospital & Clinics and Lucile Packard Remember, you must make an election this year Children’s Hospital, providing extraordinary care in order to take advantage of the benefits offered. and healing humanity are at the heart of everything Until then, thank you for everything you do for our we do. Together, we are committed to serving the patients, our community, and for your own community, our patients and their families, and our health and well-being. employees, who make this commitment possible. Kind regards, Part of our employee service is providing a competitive benefits program that promotes good health and well-being, and offers protection and peace of mind. Dale Spartz Each year during Benefits Open Enrollment, you Vice President of Human Resources have the chance to review your options and select Stanford Hospital & Clinics the plans that are best for you and your family. This year, Open Enrollment will not be “business as usual.” There are new medical plan features that Greg Souza could impact your personal health care expenses. Vice President of Human Resources We encourage you to learn about these features, Lucile Packard Children’s Hospital ask questions and carefully evaluate which option is right for you. We are making some changes to 2012 benefits The benefit plan changes were designed to: because your family and SHC/LPCH cannot sustain rapidly rising costs of health care and • Focus on prevention and healthy living to comply with the rules and requirements related through our HealthySteps program to Health Care Reform. • Continue to give you incentives to use SHC and LPCH facilities From 2010 to 2011 we expect SHC/LPCH benefits • Offer more flexibility in when and expenses will have increased 13 percent. If we how to receive care don’t make changes now, costs are likely to • Be clear and easily understandable increase at a high rate each and every year this • Help you achieve your future savings decade. Since you pay a portion of the cost of and retirement goals services, your expenses would also rise. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 1 Contents 3 Your Open Enrollment Checklist 4 Your 2012 Benefit Choices 6 How to Enroll 7 Medical Plans 9 Health Savings Account Basics 12 New PPO and EPO Administrator and Provider Network 13 Prescription Drug Benefits 13 Our Health Plans in Action 16 Comparing Your Medical Plans 20 Wellness Incentive Program 22 Additional Benefits 23 2012 Semi-Monthly Health Care Contributions What’s New for 2012 7 Higher deductible and out-of-pocket maximum in PPO 7 Prescription drugs subject to annual deductible in PPO 8 Health Savings Account offered with PPO plan 11 New Exclusive Provider Organization 12 Kaiser HMO cost sharing changes 12 New PPO and EPO Plan Administrator and Network 20 Wellness incentive 22 Supplemental life and disability now only during Open Enrollment 23 Working spouse/eligible domestic partner access fee 24 New Open Enrollment website 2 2 0 1 2 O P E N E N R O L L M E N T G U I D E Your Open Enrollment Checklist Enroll October 24 – November 18, 2011 Benefits Open Enrollment is your once-a-year opportunity to enroll, drop or change your SHC/LPCH benefits. You must take action to elect your medical/vision and dental coverage that begins January 1, 2012. After November 18, your next opportunity to make changes will be next year’s Open Enrollment in the Fall of 2012, unless you experience a mid-year qualifying life event, such as having a baby or getting married. Your enrollment choices become effective on January 1, 2012. Open Enrollment action items Review your Open Enrollment materials. Use the new Medical Plan Cost Comparison Tool posted on the HealthySteps website (www.healthysteps4u.org). Attend an Open Enrollment meeting to learn more about your 2012 benefits. A schedule is available on the HealthySteps site. Enroll or make changes to your benefits by logging on to the new BenefitsConnect Open Enrollment website, available through HealthySteps, www.healthysteps4u.org. Set up your Health Savings Account (HSA) if you enroll in the PPO. Enroll in the Health Care Flexible Spending Account (for EPO and Kaiser participants only) and/or a Dependent Daycare Flexible Spending Account. FSA elections don’t carry over from year to year— you must enroll each year if you wish to participate. After you make elections during Open Enrollment, ensure your enrollment elections are captured correctly online before November 18, 2011. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 3 Your 2012 Benefit Choices Your needs and priorities are unique. That’s why there is no one-size-fits-all answer to which benefits plans are best. You have the flexibility to choose the coverage that fits your family. Benefit Your plan options Features to consider Medical* • Preferred Provider • No employee-paid premiums unless a working spouse access fee applies Organization (PPO) • Free preventive care including preventive prescriptions (includes prescription with Health Savings • Flexibility to use in- or out-of-network providers (with higher benefits drug coverage) Account (HSA) in-network) • SHC/LPCH inpatient hospital charges waived after deductible • Highest deductible among three medical plan options Use the Medical Plan • Health Savings Account (HSA) feature with HSA funding provided by Cost Calculator to SHC/LPCH compare your options (see page 24 for details) See page 9 for more information on how the new HSA feature works. • Exclusive Provider • Employee-paid premiums* Organization (EPO) • Free preventive care • You must use in-network providers to receive coverage (except in an emergency); referrals not needed • SHC/LPCH inpatient hospital charges waived • Lower deductible than PPO • Copays for physician office visits and prescription drugs with no deducible • Kaiser HMO • Employee-paid premiums if you earn $27.51 or more per hour* • Free preventive care • You must use Kaiser providers to receive coverage (except in an emergency) • Copays for most services and no deductibles • Waive all coverage Your next opportunity to elect medical/vision coverage will be the next Fall Open Enrollment, unless you experience a mid-year qualifying life event. Dental • DeltaCare USA • No employee-paid premiums DHMO • Choose up to three primary care dentists for your family from the DeltaCare network • Most preventive, diagnostic and basic services covered at 100% • Limited network • Includes adult orthodontia • Delta Dental PPO • Employee-paid premiums for spouse/eligible same-sex domestic partner • Visit any provider, but typically pay less in-network • No deductible for diagnostic preventive care including routine exams, cleanings and X-rays • Must meet annual deductible first, for basic and major care • Waive all coverage Your next opportunity to elect dental coverage will be the next Fall Open Enrollment, unless you experience a mid-year qualifying life event. Vision • VSP • Hospital-paid coverage for you and your family • Automatic enrollment when you sign up for a medical plan • Visit any licensed provider, but you will maximize your benefit when you use an in-network provider *House Staff premiums do not apply. 4 2 0 1 2 O P E N E N R O L L M E N T G U I D E Benefit Your plan options Features to consider Flexible Spending • Health Care FSA** • Set aside pre-tax money from your paycheck to pay for eligible Accounts (FSAs) out-of-pocket health care expenses • Contribute up to $3,000 for the 2012 plan year • Not available for PPO participants • Dependent Daycare • Set aside pre-tax money from your paycheck to pay for eligible FSA dependent daycare expenses • Contribute up to $5,000 for the 2012 plan year Savings Account • Health Savings • Available to PPO participants only Account (HSA)** • Funding provided by SHC/LPCH for eligible PPO participants • Contribute your own additional pre-tax money • Portable if you retire or leave the organization Wellness Incentive • Health Incentive • Funding by SHC/LPCH when SHALA is completed online by Account (HIA) or HSA December 31, 2011 for PPO participants** • HIA funds must be used during the 2012 plan year for health care expenses Supplemental Disability • Supplemental • Coverage supplementing California SDI, up to 60% of your base pay, and Life Insurance Short-Term Disability up to $1,846 per week (in addition to hospital- • Benefit paid up to 180 days or no longer disabled paid coverage) • Supplemental • Provides benefit of up to 662/3% of base pay, up to $8,000 per month Note: Statement of Long-Term Disability • Benefit paid until age 65 or no longer disabled Health approval is required when you • Supplemental Life • Additional insurance coverage available for you, up to a maximum of enroll/increase your Insurance $3 million combined Basic and Supplemental Life Insurance current coverage. • Supplemental • Insurance coverage available for your spouse up to $200,000 Spouse Life Insurance • Dependent Child Life • Insurance coverage available for your dependent child up to $10,000 • Accidental Death • Benefits paid in the event of a qualifying injury, illness or accidental and Dismemberment death up to $1 million (AD&D) Insurance Group Legal Hyatt Legal Plan • You may drop coverage during 2012 Open Enrollment ** CRONA Relief B are not eligible for this benefit. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 5 How to Enroll Enroll October 24 – November 18, 2011 Step 1 1. Log on to the new BenefitsConnect website available through www.healthysteps4u.org, beginning October 24. 2. Click "BenefitsConnect Enroll Today" to access the new enrollment system. 3. Enter your User ID and Password. 4. User ID: Employee ID number, without leading zeros. 5. Password: Last four digits of your Social Security number and month and day of your date of birth (SSSSMMDD). Note: The new enrollment system is compatible with Internet Explorer 7 and 8, Safari 5.x, Firefox 3.x, and Chrome 10.x browsers. Step 2 • Follow the instructions and submit your benefits choices. • You have the ability to save changes as a draft on the new BenefitsConnect enrollment website; the elections will not take effect until you accept and submit. • Print and save your 2012 Benefits Confirmation statement for your records. Additional Information You must take action and actively select the following plans and programs to participate for 2012: • Medical/vision • Health Care FSA • Dependent Daycare FSA • Health Savings Account (HSA) – You will need to enroll whether you are electing to make your own contributions in addition to SHC/LPCH contributions. When you enroll, you will need to decide how much — if any — you would like to contribute for the year. You may enroll in, change or drop the following plans and programs. If you make no changes, your previous elections will roll over to 2012: • Dental • Supplemental Life Insurance • Supplemental Disability Insurance • Group Legal (drop coverage only) – Note: The process for dropping Group Legal coverage is different than making your other elections. See page 21 for an explanation of how to drop coverage if you are already enrolled. 6 2 0 1 2 O P E N E N R O L L M E N T G U I D E Medical Plans Preventive Care Covered at 100% All SHC/LPCH medical plans will provide 100% coverage for preventive care from in-network providers, with no deductibles or copays. This means you and your family can receive the important preventive care services you need to manage your health, such as routine physical exams, screenings and lab tests, all covered at 100%, with no out-of-pocket costs. Preferred Provider Option (PPO) with Health Savings Account (HSA) With the PPO plan, you pay no employee premiums. It’s also flexible, providing you the option to see any licensed provider you want, each time you need care. Beginning January 1, 2012, in-network services will be provided by UnitedHealthcare Options PPO providers. More information on the new provider network is provided on page 12. You do not need to select a primary care provider (PCP) and do not need a referral to see a specialist in or out of the network. The PPO plan offers the greatest flexibility in determining when and where you receive care, while still offering protection against large medical claims through the annual out-of-pocket maximum. You will receive the greatest savings when you come to SHC/LPCH for inpatient hospital care. New Deductibles and Out-of-Pocket Maximums The annual deductibles and out-of-pocket maximums are increasing for 2012. Coverage Annual deductible Annual out-of-pocket (in-network) maximum (in-network) Employee only $1,200 $2,400 Employee + 1 or more dependents $2,400 $4,800 The deductibles and out-of-pocket maximums can be met by one individual or any combination of individuals covered by the plan. The new HSA feature, detailed on page 9, is meant to help you save money toward your health care expenses, as well as offset the higher deductible. You can use the money you and SHC/LPCH contribute to the HSA to pay for out-of-pocket expenses that count toward the deductible. This reduces the amount you have to spend out-of-pocket before the plan pays benefits. An Example Kate, her spouse and their two children are enrolled in the PPO. They use in-network providers only. Their family deductible is $2,400 and can be reached by one person, or any combination of family members. If Kate's personal expenses or the family’s combined expenses reach $2,400, the family deductible has been satisfied for the remainder of the year, and she and her family members’ eligible services will be covered (at 80% for most services) by the plan. If Kate's personal expenses or the family’s combined in-network expenses reach $4,800 (the out-of-pocket maximum) the entire family has reached its annual limit and the family's eligible services for the rest of the year will be covered at 100%. Prescription Drugs Subject to Medical Plan Deductible Beginning January 1, 2012, preventive generic and preventive formulary brand name prescription drugs are covered at 100% and are not subject to the deductible for PPO participants. (A list of eligible preventive prescriptions is available on the Express Scripts website, www.express-scripts.com and on the HealthySteps website.) You will pay for other prescription drugs in full, until your 2012 medical plan deductible has been met. Once the deductible has been met, the prescription drug plan will pay a percentage of the cost of covered medications. See page 19 for coinsurance on prescription drugs. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 7 New Health Savings Account (HSA) Feature When you enroll in the PPO, you may open an HSA. SHC/LPCH will contribute money to your HSA. You may also contribute your own pre-tax money to the account as long as you meet the eligibility criteria outlined on page 10. You can use the account to pay for eligible health care expenses. PPO Features Not Changing Many of the key features of the medical plan component will not change for 2012: • You will receive a higher level of benefits when you use in-network providers. • After you meet the annual deductible, the PPO pays a percentage of the cost of care (80%) and you pay the remaining percentage (20% coinsurance). • In-network preventive care is covered at 100%. • Mental health and substance abuse treatment is provided through OptumHealth. PPO plan members may use any licensed provider for medically necessary care. However, when you use OptumHealth providers for pre-authorized care, the plan pays a higher benefit level. Note: House Staff pay no coinsurance on mental and substance abuse care, after reaching their deductible. Family members of House Staff pay 20% coinsurance. Prescription drug coverage will continue through Express Scripts. Overview of PPO Changes for 2012 2012 PPO Plan with HSA In-network Out-of-network Annual deductible $1,200 employee only $2,400 employee only $2,400 employee + 1 or more dependents $4,800 employee + 1 or more dependents Annual out-of-pocket limit $2,400 employee only $4,800 employee only $4,800 employee + 1 or more dependents $9,600 employee + 1 or more dependents SHC/LPCH contributions to $400 employee only savings account $800 employee + 1 or more dependents Physician and specialist visits Plan pays 80% of charges after deductible Plan pays 60% of charges after deductible Emergency services Plan pays 80% of charges after deductible Plan pays 60% of charges after deductible Non-preventive Plan pays 80% of charges after deductible Plan pays 60% of charges after deductible prescription drugs Provider network UnitedHealthcare Options PPO N/A 8 2 0 1 2 O P E N E N R O L L M E N T G U I D E Health Savings Account Basics A Health Savings Account, or “HSA,” is an employee-owned, tax-advantaged savings and investment account to pay for health care expenses both now and after retirement. The HSA is only available if you enroll in the PPO medical plan. SHC/LPCH will contribute quarterly to your account – in January, April, July and October, for a total yearly contribution of either $400 or $800. You own the full value of the account. If you terminate employment before the quarterly SHC/LPCH HSA contribution is made to your account, you forfeit that contribution and no further contributions from SHC/LPCH will be made. Health Savings Account Contributions For 2012, IRS regulations allow for HSA savings up to $3,100 (individual), $6,250 (family) and an additional $1,000 catch-up contribution for those who are 55 and older by December 31, 2012. SHC/LPCH’s contribution counts toward this maximum. The tax advantages of Health Savings Accounts refers to federal income taxes. The state of California does not recognize HSAs; therefore, California state income tax will apply to your contributions. SHC/LPCH Contributions* You May Contribute** Employee $400 Employee up to $2,700 Employee + 1 or more dependents $800 Employee + 1 or more dependents up to $5,450 * Individuals who have a 2011 Health Care FSA balance as of December 31, 2011 will receive their first contribution in April 2012. ** The IRS limits annual HSA contribution amounts. Therefore, if you earn $100 for completing the SHALA, the amount you may contribute to the HSA will decrease by $100. See page 20 for more information. If you participated in the Health Care FSA for 2011 and will enroll in the PPO with HSA for 2012 IRS rules require that you exhaust all your 2011 FSA funds before you can make your own contribution or receive a contribution from SHC/LPCH. If you have funds remaining at the end of the year that will be subject to the grace period ending in March 2012, SHC/LPCH will not be able to make a contribution to your account until April, after the grace period is complete. Plan now to use up any remaining funds in your 2011 Health Care FSA so you can receive your HSA funds beginning in January. You will not be eligible to establish an HSA if you enroll in a 2012 Health Care Flexible Spending Account. An HSA can be used to pay for your or your eligible dependents’ health care services before the annual deductible has been met or for your share of the cost of services after the deductible has been met. Any balance in the health savings account can also be used to pay for eligible health expenses in the future. Your HSA: • Is 100% owned by you • Is portable—take it when you leave or retire • Accumulates from year to year • Allows funds to be withdrawn tax free as long as they are used to pay for qualified medical expenses. By law, HSA money can only be used for yourself, your spouse and your tax dependents. If your eligible domestic partner meets IRS qualifications to be considered a tax dependent, you can use your HSA funds for his or her medical expenses. If they do not meet this qualification, they are not eligible. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 9 Am I Eligible for an HSA? You are eligible to open an HSA if you meet these criteria: • You are enrolled in the PPO medical plan • You or your covered dependents are not covered by another non-high deductible health plan (for example, your spouse’s plan) • You are not enrolled in a Health Care Flexible Spending Account (either yours or your spouse/eligible same-sex domestic partner’s) • You are not enrolled in Medicare. If you are enrolled in Medicare and you enroll in the PPO, you will be eligible for SHC/LPCH contributions, which will be deposited into a Health Incentive Account. Managing Your Health Savings Account When you enroll in the PPO, you will establish a Health Savings Account with HealthEquity. HealthEquity is the largest and oldest health savings trustee in the United States. More information about how to manage your HSA will be sent to you by HealthEquity after Open Enrollment. What Medical Expenses Qualify for HSA Reimbursement? You’re able to use your Health Savings Account to pay for or be reimbursed for a variety of medical goods and services. A few examples include: • Acupuncture • Chiropractor visits • Dental care • Long-term care and nursing expenses • Orthodontia • Surgery • Therapy • Vision correction surgery • Wheelchairs A few examples of non-qualified medical expenses include: • Babysitting and child care for a healthy baby (use your Dependent Daycare FSA instead) • Elective cosmetic surgery • Non-prescription drugs, medicines and supplements (unless prescribed) • Health club dues The complete list of qualified and non-qualified medical expenses is included in the IRS’ Publication 502, located online at www.irs.gov/pub/irs-pdf/p502.pdf. 10 2 0 1 2 O P E N E N R O L L M E N T G U I D E Exclusive Provider Organization (EPO) With the new Exclusive Provider Organization (EPO) plan, you pay an employee premium and receive benefits when you use network providers. The difference between an EPO and an HMO is that with the EPO, you can see any network doctor at any time. You do not need a referral from a primary care doctor. Services such as X-rays can be done at any network facility. The new EPO will use the UnitedHealthcare Options PPO network. All services must be received by a UnitedHealthcare Options PPO provider in order to be covered by the plan. The EPO annual deductible is much smaller than the PPO plan, but you will not be eligible to have a Health Savings Account. You are eligible to enroll in the Health Care FSA. Prescription drug coverage is included in the EPO plan, through Express Scripts. Prescription drug benefits can be found on page 19. Annual deductible = $300 per person, $750 family limit Each covered individual must meet his/her $300 annual deductible before the plan will pay coinsurance for that individual. • If you are enrolled in family coverage but only one person has medical expenses, you will only pay the $300 per-person deductible. • If you have two people enrolled, and you both have medical expenses, you will each have to reach the $300 per person deductible separately. • If you have three or more people enrolled, no one person will have to meet more than the $300 per-person deductible, and the entire family together will not have to pay more than $750 in deductibles, even if no single person meets the $300 per person deductible on his or her own. Once you reach your deductible for the year, coinsurance begins. Out-of pocket maximum = $1,800 per person, $3,500 family. The out-of-pocket maximum is a combination of the deductible and all coinsurance, and it is the maximum dollar amount you pay out of your pocket for covered charges. • No one person will exceed $1,800 in out-of-pocket charges during the year – once the individual out-of- pocket maximum is met, the plan will pay for 100% of their covered services for the rest of the year. • If you meet the family out-of-pocket maximum of $3,500, everyone enrolled will have all covered services paid 100% for the rest of the plan year. • Office visit and prescription drug copayments are not included in the deductible or out-of-pocket maximum, they are paid separately. Like the PPO, preventive care is covered at 100%, with no deductible or copays for EPO participants. Mental health and substance abuse treatment benefits are also covered in the EPO. These services are provided by OptumHealth. Information about EPO employee premiums can be found on page 23, and a detailed plan comparison begins on page 16. An Example Kate, her spouse and their two children are enrolled in the EPO plan. Each family member has a $300 deductible. When Kate meets the $300 individual deductible, the plan begins to pay benefits for her. When a second family member meets his/her $300 deductible, the plan begins to pay benefits for that person. When a third family member's expenses reach $150 (for a total of $750 in family expenses), the $750 family deductible will have been met. Once the family deductible has been met, the plan will pay benefits for all family members, even those who did not meet their individual deductible. The out-of-pocket maximum works the same way. There is an out-of-pocket maximum of $1,800 for each family member. If one member of the family reaches his/her $1,800 out-of-pocket maximum, the plan pays 100% of expenses for that person for the remainder of the year. If three family members' out-of-pocket costs reach the $3,500 family limit, the plan pays 100% of expenses for all family members for the remainder of the year. The Anthem Blue Cross HMO will not be offered in 2012. If you are currently enrolled in that plan, you must select a new medical plan for 2012. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 11 Kaiser HMO With the Kaiser HMO plan, you pay an employee premium and see providers in the Kaiser HMO network only. You must use Kaiser doctors and facilities to receive benefits for non-emergency care. In most cases, each time you need care, you may see any Kaiser Permanente doctor. You do not need to select a primary care physician (PCP). You have no annual deductible and are covered at 100% for most services. Mental health and substance abuse treatment is provided through Kaiser Permanente. You must use a Kaiser Permanente mental health provider to receive benefits. New for 2012 • For 2012, employees who earn $27.51 or more per hour will share the cost for both employee and children’s coverage – you’ll find more information about employee-paid premiums on page 23. • Prescription copayments at a Kaiser Pharmacy will increase from $5 (generic) and $20 (brand) to $10 (generic) and $25 (brand) for a 30-day retail supply. Mail-order prescriptions will be $20 (generic) and $50 (brand) for a 100-day supply. • Emergency room copays will increase from $35 to $50. New PPO and EPO Administrator and Provider Network Beginning January 1, 2012, UMR, a division of UnitedHealthcare will replace Anthem Blue Cross as the plan administrator. That means: • Medical claims will be processed through UMR. To check the status of a claim, or review an explanation of benefits (EOB), you will contact UMR (www.umr.com; (877) 842-3210). • Providers in the UnitedHealthcare Options PPO will be considered “in-network” for PPO and EPO participants. Providers who do not participate in this network will be considered “out-of-network.” Is Your Doctor In-Network? • Go to www.umr.com to see if a doctor or facility participates in the new UnitedHealthcare Options PPO network. • Click “Find a provider,” then, “Medical.” Transition of Care If you have certain medical conditions and your current health care provider does not participate in the UnitedHealthcare Options PPO network, benefits may be paid at in-network benefit levels for a transition period of up to 90 days. The following patients may be eligible for transition of care benefits: • Cancer patients, if under active treatment with chemotherapy/radiation therapy • Transplant patients, if under active treatment (seeing a physician on a regular basis, on transplant list, ready at any time for transplant) • Hospitalized patients at the time of the effective date • Pregnant patients in the second or third trimester, and up to eight weeks postpartum • Those with a post acute injury or who have had surgery within the past three months. You must call UMR (877) 842-3210 to request a transition of care consideration two weeks before the effective date (January 1, 2012) or within the first 30 days after the effective date to become eligible for the transition of care review. If, after January 1, 2012, you choose to continue care outside of the UnitedHealthcare Options PPO network without prior approval, benefits will be paid at the out-of-network level. 12 2 0 1 2 O P E N E N R O L L M E N T G U I D E Prescription Drug Benefits When you enroll in a medical plan, you will automatically receive prescription drug benefits. • If you are enrolled in the PPO or EPO plans, you receive coverage through Express Scripts. • If you select the Kaiser Permanente HMO, prescription coverage is provided through Kaiser. You must use a Kaiser Pharmacy to receive benefits. • Details of prescription drug benefits can be found on page 19. The EPO and Kaiser HMO plans both have set co-pays for prescription drugs. New for 2012, in the PPO plan you will no longer have set co-pays for prescription drugs. Instead, the plan will pay 80% of your in-network charges, or 60% of your out-of-network charges, once you reach your annual deductible. Changes for 2012 Preventive prescription drugs can help you maintain a good quality of life and keep you from developing health conditions later on. In 2012, the PPO will cover a broader range of generic and formulary brand preventive prescription drugs at 100%, at no out-of-pocket cost to you. Non-formulary brand preventive drugs are $50 for a 30-day supply. The types of preventive drugs covered at 100% include medication for high blood pressure, cholesterol, bone density, anticoagulants, vaccines, antiviral treatment, prenatal vitamins, diabetes, breast cancer prevention, and asthma. The new list of preventive prescription drugs covered at 100% is available on the HealthySteps website, www.healthysteps4u.org Our Health Plans in Action Which health plan is right for you and your situation? Read these illustrative examples of fictional SHC/LPCH employee scenarios to see how the plans compare. Example 1: Generally healthy employee and spouse Jessie is a non-represented employee. She and her husband are generally in good health. Her husband’s status at his work does not provide access to company-sponsored health coverage. They see the doctor only for annual wellness check-ups and labs, and Jessie takes one maintenance medication. PPO with HSA EPO Kaiser HMO Annual premium (employee + $0 $3,684 $2,796 spouse) ($153.50 x 24 pay periods) ($116.50 x 24 pay periods) Wellness exams and labs No charge No charge No charge Prescription (1 non-preventive $240 $120 $120 generic 12-month retail supply) ($20 assumed cost for ($10 copay for generic ($10 copay for generic generic drugs x 12 months) drugs x 12 months) drugs x 12 months) SHC/LPCH contribution to $800 N/A N/A savings account Jessie’s total out-of-pocket cost $0 $3,804 $2,916 HSA rollover dollars $560 N/A N/A Based on the anticipated medical needs of Jessie and her husband, related expenses for 2012 and the SHC/LPCH- funded savings account in the PPO plan, Jessie’s annual out-of-pocket costs would be $0 under the PPO Plan; $3,804 under the EPO plan and $2,916 under the Kaiser HMO plan. Plus, if Jessie enrolls in the PPO with HSA plan, $560 will roll over to her Health Savings Account in the following year, when SHC/LPCH will make a new automatic contribution to her Health Savings Account. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 13 Which Medical Plan is Right for Me? All SHC/LPCH medical plans cover preventive care at 100% and offer protection against large or catastrophic expenses. They differ in a few key ways: • Cost to participate, • Flexibility in choice of providers, • Flexibility to control what you spend (predictable costs), and • The ability to save for future health expenses. You may want to consider the PPO plan if you: • Prefer a plan without employee-paid premiums, • Use network doctors, but would like the freedom to see out-of-network doctors, • Seek regular preventive care, • See a doctor just a few times per year (other than preventive appointments), or • Would like to take advantage of the tax and savings benefits of an HSA. You may want to consider the EPO or Kaiser HMO plans if you: • Will exclusively use in-network services, • Don’t mind paying more for coverage in exchange for a plan with a low deductible (EPO) or no deductible (Kaiser HMO), or • Like predictable copayments for office visits and prescription drugs. Example 2: Typical employee and child Robert, a non-represented employee, and his son are generally healthy, but they occasionally have sports-related injuries. In addition to seeing the doctor for annual wellness check-ups, Robert takes one maintenance medication and is planning to have a minor outpatient knee surgery in 2012, with an assumed cost of $2,500, while his son may visit the emergency room for a soccer injury. PPO with HSA EPO Kaiser HMO Annual premium $0 $1,908 $1,320 (employee + child) ($79.50 x 24 pay periods) ($55 x 24 pay periods) Outpatient surgical $2,400 (deductible) + $20 $300 (per-person deductible) $100 procedure (20% coinsurance after + $220 (10% coinsurance after deductible) deductible) Emergency room (not $300 (20% coinsurance); $300 (per-person deductible) $50 admitted) (assumed cost of $1,500) + $120 (10% coinsurance after deductible); (assumed cost of $1,500) Prescription $48 (20% coinsurance after $120 $120 (1 generic 12-month deductible); ($10 copay for generic drugs ($10 copay for generic retail supply) ($20 assumed cost for x 12 months) drugs x 12 months) generic drugs x 12 months) SHC/LPCH $800 N/A N/A contribution to savings account Robert’s total $1,968 $2,968 $1,590 out-of-pocket cost Based on the anticipated medical needs of Robert and his son, and related expenses for 2012, Robert’s annual out-of- pocket costs would be $1,968 under the PPO Plan; $2,968 under the EPO plan and $1,590 under the Kaiser HMO plan. 14 2 0 1 2 O P E N E N R O L L M E N T G U I D E Example 3: Family with high medical plan utilization Marcus, a non-represented employee, has a heart condition, and his wife is dealing with regular migraines. His wife works part-time, so she is not eligible for health coverage through her employer. In addition to seeing the doctor for annual wellness checkups, they see specialists every few months and regularly take formulary and non-formulary medications. They will both visit hospitals other than SHC and LPCH in 2012 (with an assumed cost of $10,000 per person). PPO with HSA EPO Kaiser HMO Annual premium $0 $4,536 $3,336 (employee + family) ($189 x 24 pay periods) ($139 x 24 pay periods) Hospital stay at Marcus: $2,400 (deductible) + Marcus: $300 (deductible) + $970 $500 non-SHC/LPCH $1,520 (20% of coinsurance); (10% of coinsurance); ($250 hospital stay hospital Wife: $0 (deductible met) + Wife: $300 (deductible) + $970 copayment per adult) $880 (coinsurance, up to (10% coinsurance after deductible); out-of-pocket maximum) Total=$2,540 1 formulary $0 $300 ($25 for Marcus’ formulary $300 ($25 for brand drugs prescription (deductible, and out-of-pocket drugs x 12 months) x 12 months) maximum reached) 4 specialist visits $0 $140 ($35/visit x 4 visits) $140 ($35/visit x 4 visits) (deductible, and out-of-pocket maximum reached) 1 generic $0 $120 ($10 for generic drugs x 12 $120 ($10 for generic drugs prescription (deductible, and out-of-pocket months for Marcus’ wife) x 12 months) maximum reached) SHC/LPCH $800 N/A N/A contribution to savings account Marcus’ total $4,000 $7,636 $4,396 out-of-pocket cost Based on the anticipated medical needs of Marcus and his family, and related expenses for 2012, Marcus’ annual out-of- pocket costs would be $4,000 under the PPO Plan; $7,636 under the EPO plan and $4,396 under the Kaiser HMO plan. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 15 Comparing Your Medical Plans To see how your estimated 2012 costs compare under each plan, use the Medical Plan Cost Calculator on the HealthySteps website. (See page 24 for more details.) Services PPO with HSA EPO Kaiser Permanente HMO In-Network Out-of-Network* Annual Deductible $1,200/employee-only $2,400/employee-only $300/per person None (applies to medical and coverage coverage $750/family limit mental health/substance $2,400/employee + $4,800/employee + abuse) one or more covered one or more covered dependents dependents SHC/LPCH $400/employee-only coverage N/A N/A Contribution to HSA $800/employee + one or more covered dependents Annual Out-of-Pocket $2,400/employee-only $4,800/employee-only $1,800/per person $1,500/individual Maximum – includes coverage coverage $3,500/family $3,000/family deductible (applies to $4,800/employee + $9,600/employee + Copayments do medical and mental one or more covered one or more covered not apply to this health/substance abuse) dependents dependents; maximum Deductibles, copayments and amounts charged by out-of-network providers above UCR do not apply to this maximum. Maximum Lifetime Unlimited Unlimited Unlimited Unlimited Benefit Choice of Physicians You must use You may use any You must use You must use Kaiser UnitedHealthcare licensed provider UnitedHealthcare facilities; all care and Options PPO network Options PPO covered services must providers for network providers; be approved by a Kaiser in-network benefits you do not need physician to select a Primary Care Physician (PCP) Claim Forms No, except for out-of- Yes No, except for No, except for non-Kaiser network emergency out-of-network emergency services services emergency services Hospital Care 80% of charges, 60% of UCR charges 90% of charges 100% after $250 Room and Board,** after deductible;** after deductible; after deductible** copayment per admission Surgeon, Physician Visit precertification required precertification precertification and Anesthesiologist required or $300/ required admission penalty applies (waived if emergency admission) Office Care Physician Visit 80% of charges after 60% of UCR charges $20/visit $20/visit deductible after deductible Routine Physical No charge 60% of UCR charges No charge No charge after deductible * Usual Customary and Reasonable (UCR) charges are the fees normally charged for medical services or supplies in a particular geographic location. ** PPO and EPO hospital coinsurance is $0 if admitted to SHC or LPCH. The reimbursement of this copayment will be administered by SHC/LPCH. Professional fees excluded. 16 2 0 1 2 O P E N E N R O L L M E N T G U I D E Comparing Your Medical Plans (cont’d) Services PPO with HSA EPO Kaiser Permanente HMO In-Network Out-of-Network* Adult Preventive No charge 60% of UCR charges No charge No charge Services after deductible Child Preventive No charge 60% of UCR charges No charge No charge Services after deductible Specialist Visit 80% of charges after 60% of UCR charges $35/visit $35/visit deductible after deductible Allergy Tests and 80% of charges after 60% of UCR charges $20/visit; injections $3/visit/injection; Injections deductible after deductible covered at 90% after $20/testing deductible Immunizations No charge 60% of UCR charges No charge No charge after deductible Lab and X-ray 80% of charges after 60% of UCR charges 90% of charges after No charge (non-preventive) deductible after deductible deductible Outpatient Surgery 80% of charges after 60% of UCR charges 90% of charges after $100 per procedure deductible after deductible deductible Chiropractic Care 80% of charges after 60% of UCR charges $35/visit; 30-visit Discounts apply deductible; 30-visit after deductible; maximum per calendar through Kaiser maximum per calendar 30-visit maximum year Permanente’s year (combined in- per calendar year Healthyroads and out-of-network (combined in- and out- program maximum) of-network maximum) Acupuncture 80% of charges after 60% of UCR charges 90% of charges after Discounts apply deductible; $30/visit after deductible; $30/ deductible; $30 per through Kaiser maximum; 12-visit visit maximum; 12-visit visit maximum; Permanente’s maximum per calendar maximum per calendar 12-visit maximum Healthyroads year (combined in- year (combined in- per calendar year program and out-of-network and out-of-network maximum) maximum) Infertility Diagnosis 80% of charges after 60% of UCR charges $35/visit for counseling $20/visit deductible after deductible and consultation; 50% covered expenses for infertility studies and tests (does not apply to out-of-pocket maximum) Physical, Speech and 80% of charges after 60% of UCR charges $35/visit office setting; $20/visit Occupational Therapy deductible; limited to after deductible; 90% after deductible (restorative services a 60-visit maximum limited to a 60-visit hospital setting; 60-visit only) per calendar year maximum per calendar maximum per calendar (combined with year (combined with year (combined with physical, occupational physical, occupational physical, occupational or speech therapy) or speech therapy) or speech therapy) (combined in- and out- (combined in- and out- of-network maximum) of-network maximum) * Usual Customary and Reasonable (UCR) charges are the fees normally charged for medical services or supplies in a particular geographic location. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 17 Comparing Your Medical Plans (cont’d) Services PPO with HSA EPO Kaiser Permanente HMO In-Network Out-of-Network* Emergency and Urgent Care Emergency 80% of charges after deductible 90% of charges after $50/visit (waived if In Area deductible admitted) Emergency 80% of charges after deductible 90% of charges after Worldwide coverage Out-of-Area deductible provided for emergency services due to unforeseen illness or injury; $50/visit (waived if admitted) Urgent Care 100% after deductible $20/visit $20/visit at Kaiser facilities Ambulance 100% after deductible 100% after deductible No charge when medically indicated and authorized by plan physician Skilled Nursing Facility 80% of charges after 60% of UCR charges 90% of charges after 100%; 100-day deductible; 100-visit after deductible; deductible; 100-day maximum per plan year maximum per calendar 100-visit maximum per maximum per calendar (must live within the year calendar year year service area) Home Health Care 80% of charges after 60% of UCR charges 90% of charges after 100% with Kaiser deductible; 100-visit after deductible; deductible; 100-visit approval; part-time maximum per calendar 100-visit maximum per maximum per calendar or intermittent only; year calendar year year and one visit by 100-visit maximum per a home health aide for calendar year (must live four hours or less within the service area) Vision Screening 80% after deductible; 60% of UCR charges 90% after deductible; No charge well child screening after deductible well child screening 100% up to age 21 100% up to age 21 Hearing Exams 80% after deductible; 60% of UCR charges 90% after deductible; No charge well child screening after deductible well child screening 100% up to age 21 100% up to age 21 Dental Benefits Not covered, except for Not covered, except for Not covered, except for Not covered emergency treatment; emergency treatment; emergency treatment 80% of charges after 60% of charges after $35/visit office setting; deductible deductible 90% after deductible hospital setting Durable Medical 80% of charges after 60% of UCR charges 90% of charges after 80% when prescribed Equipment deductible; includes after deductible; deductible; includes by a Kaiser physician hearing aids (limited to includes hearing aids hearing aids (limited to (must live within the one hearing aid per ear (limited to one hearing one hearing aid per ear service area) every three years) aid per ear every three every three years) 50% for external sexual years) dysfunction devices * Usual Customary and Reasonable (UCR) charges are the fees normally charged for medical services or supplies in a particular geographic location. 18 2 0 1 2 O P E N E N R O L L M E N T G U I D E Comparing Your Medical Plans (cont’d) Services PPO with HSA EPO Kaiser Permanente HMO In-Network Out-of-Network* Transplant Services 80% of charges after Must use Center of 90% of charges after For covered transplant deductible; must Excellence deductible; must services, you pay the be performed at a be performed at a same cost sharing Center of Excellence Center of Excellence as other services not facility and subject facility and subject related to a transplant to utilization review to utilization review program program Mental or Nervous Mental Health Care Mental Health Care Mental Health Care Mental Health Care Disorders provided through provided through provided through provided through OptumHealth OptumHealth OptumHealth Kaiser Permanente Inpatient 80% of charges after 60% of UCR charges 90% of charges after $250/admission deductible** after deductible deductible Outpatient 80% of charges after 60% of UCR charges $20/visit Individual: $20/visit; deductible** after deductible Group: $10/visit Substance Abuse Substance abuse Substance abuse Substance abuse Substance abuse care provided through care provided through care provided through care provided through OptumHealth OptumHealth OptumHealth Kaiser Permanente Inpatient 80% of charges after 60% of UCR charges 90% of charges after $250/admission deductible** after deductible deductible for detoxification only; Transitional Residential Recovery Services (TRRS), $100 copayment per admission Outpatient 80% of charges after 60% of UCR charges $20/visit Individual: $20/visit deductible** after deductible Group: $5/visit Prescription Drugs Provided through Provided through Provided through Provided through Express Scripts Express Scripts Express Scripts Kaiser Permanente Preventive Retail & Mail–order Retail Retail 30-day supply Retail 30-day supply 100%, no deductible 60% of UCR after Generic: $10/ Generic: $10/ for generic and deductible prescription prescription formulary Mail-order Formulary brand: $25/ Brand: $25/prescription Non–formulary brand: Not covered prescription when prescribed by a $50/prescription (retail); plan physician $100/prescription (mail Non-formulary brand: order); (deductible $50/prescription Mail-order 100-day waived) supply Mail-order 90-day supply Generic: $20/ Non-preventive 80% of charges after prescription deductible Generic: $20/ prescription Brand: $50/prescription when prescribed by a Formulary brand: $50/ plan physician prescription Non-formulary brand: $100/prescription * Usual Customary and Reasonable (UCR) charges are the fees normally charged for medical services or supplies in a particular geographic location. ** House Staff are covered at 100% after deductible. Family members of House Staff are covered at 80% after deductible. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 19 Wellness Incentive Program SHC/LPCH is committed to your health and wellbeing – personally, financially and in the workplace. That’s why we launched our HealthySteps wellness program. HealthySteps encourages individuals to make informed health decisions and measures the impact of prevention activities. The first step towards your good health is completing the Stanford Health and Lifestyle Assessment (SHALA). This fully confidential health risk assessment will provide an instant personal health report, which includes an outline of your risk for diseases, and suggests behavior targets for improving your health. It’s also a helpful tool you can use as a starting point for conversations with your health professional, family members and wellness providers. When you complete the SHALA before December 31, 2011, you will earn $100 to use for your health expenses in 2012! Here’s how you can earn $100 in about 20 minutes: • Log on to the HealthySteps website at www.healthysteps4u.org, then click on the Stanford Health and Lifestyle Assessment link. • Complete the assessment. • SHC/LPCH will automatically deposit your reward into either your Health Savings Account (if enrolled in the PPO) or a Health Incentive Account (if enrolled in the EPO or HMO in January, 2012). Health Incentive Account (HIA) If you enroll in the EPO or Kaiser HMO, your wellness incentive will be deposited into a Health Incentive Account that will be set up for you. You’re free to use this money any time during the year to help pay for your medical expenses. Similar to an FSA, the funds in this account do not roll over at the end of the year, so you must use all your HIA money in 2012. Health Savings Accounts and Health Incentive Accounts are managed by HealthEquity. You will receive a welcome packet with detailed instructions on using your new account. Dental Plans You have the option to choose between two dental plans. Remember, you do not pay employee premiums for the DeltaCare DHMO. Delta Dental PPO DeltaCare USA DHMO • Employee premiums required for spouse/eligible domestic • No employee premiums partner and family coverage • You may choose a primary care dentist from the • You can visit any dental care provider you wish DeltaCare network • When you use a provider in the PPO network, you typically • You may select up to three different primary care pay less because network providers have agreed to provide dentists for your family dental care to members at lower, negotiated rates • Most preventive, diagnostic and basic services are • After you pay an annual deductible, you pay a percentage of covered at 100% the bill, called coinsurance, for most dental services • You pay a copayment for major and restorative services. • Diagnostic and preventive care are covered at 100% and are not subject to the deductible. 20 2 0 1 2 O P E N E N R O L L M E N T G U I D E Vision Plan When you enroll in one of the medical plans, you and your enrolled family members automatically receive vision coverage through VSP. Remember, you do not pay employee premiums for vision benefits – this cost is included in any premiums you pay for medical coverage. Each time you need eye care or eyewear (glasses, contact lenses), you can visit any licensed provider you wish. However, you’ll maximize your benefits when you visit a VSP in-network provider. Flexible Spending Accounts (FSAs) Flexible Spending Accounts allow you to set aside pre-tax money each year to pay for certain eligible health care and dependent daycare expenses. You must enroll in an FSA during Open Enrollment if you want to participate in 2012. Your 2011 elections do not carry over. Your contributions are automatically deducted from your paycheck before taxes are withheld, which means your taxable income will be lower. Health Care FSA — Contribute up to $3,000 in 2012 You can only participate in the Health Care FSA if you enroll in the EPO or Kaiser HMO plan, or waive medical coverage. If you enroll in the PPO, you will use the Health Savings Account. The Health Care FSA can be used to pay for medical, dental and vision expenses incurred on or before December 31, 2012, by you, your spouse or eligible dependents. (You can use your FSA funds to pay for your eligible domestic partner’s medical expenses only if they are considered a tax dependent under IRS qualifications.) You may be reimbursed for eligible expenses at any time during the plan year, up to the amount you elected for the year, even if you have not yet contributed that amount to the FSA. You must submit all claims incurred for the 2012 calendar year by March 15, 2013. Dependent Daycare FSA — Contribute up to $5,000 in 2012 Use your Dependent Daycare FSA to pay for child care or elder care while you are at work. You may contribute up to $5,000 per year. You may submit claims for reimbursement of eligible expenses, up to the amount of contributions available in your account at the time of submission. Note: The IRS limits your annual contributions to the Dependent Daycare FSA to $5,000 or less depending on your marital and tax-filing status. Please refer to the chart on the BenefitsConnect website for more information. Beginning January 1, 2012, HealthEquity will manage all FSA Accounts. After December 31, 2011 all remaining 2011 claims, as well as all 2012 claims, should be sent to HealthEquity for reimbursement. You may contact HealthEquity through the pre-enrollment website, www.healthequity.com/shclpch, or by phone, (877) 395-6548. Group Legal Plan If you are currently enrolled in Group Legal coverage, you can drop coverage during Open Enrollment. New enrollments in Group Legal are not offered at this time. To drop Group Legal coverage; log on to www.HR4Uonline.org during Open Enrollment and follow instructions to send an email requesting that you drop coverage. You will receive an email response from the HR Business Center confirming your request was processed. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 21 Additional Benefits In addition to providing coverage for your health and legal needs, SHC/LPCH also offers you and your family additional benefits to help you protect your finances and manage your life. Some of the benefits below are automatic and paid for by SHC/LPCH. You may elect to add others, such as Supplemental Life, AD&D, and Supplemental Short-Term and Long-Term Disability. For more information about these and other benefits available through SHC/LPCH, visit BenefitsConnect at www.shclpchbenefitsconnect.com. Life, AD&D and BTA Insurance SHC/LPCH offers several benefit options to protect your survivors in case you, your spouse or dependent die, including: • Basic Life: Provides a benefit to your beneficiary in the event of your death. SHC/LPCH provides Basic Life Insurance to all eligible employees. You do not pay for this coverage. • Supplemental Life*: You can buy additional coverage for yourself. The maximum amount of your combined Basic and Supplemental Life Insurance is $3 million. • Supplemental Spouse Life*: You can buy coverage for your spouse up to $200,000. • Dependent Child Life*: You can buy coverage for your dependent child up to $10,000. • Accidental Death & Dismemberment (AD&D): Helps protect your family against financial loss if you are severely injured or killed in an accident. Your benefit is based on the amount and coverage level you select and the nature of your loss. • Business Travel Accident (BTA) Insurance: BTA provides a benefit if you die or are severely injured as the direct result of an accident while traveling on Hospital business as an eligible employee. BTA coverage is automatic and paid for by SHC/LPCH. * Rates are based on the age of the covered participant. 2012 rates are available on the BenefitsConnect site. Keep in Mind... Open Enrollment is now your once-a-year opportunity to add, increase or decrease your elections for supplemental life and supplemental STD and LTD insurance, unless you experience a qualifying life event during the year. If you do not experience a qualifying life event, you will not be able to make adjustments to your coverage other than during Open Enrollment. Short- and Long-Term Disability (STD and LTD coverage) Disability coverage provides a vital benefit when you are unable to work over a short or longer period of time. These “income protection” benefits will pay you a percentage of your earnings while you are disabled. Any disability claim always begins with the California State Disability Insurance Plan (SDI). In addition, you may purchase Supplemental Short-Term Disability (STD) coverage that’s coordinated with your SDI benefits — providing a greater overall SDI/STD benefit. The Long-Term Disability (LTD) plan begins to pay a benefit to you when you are disabled for longer than six months (effective January 1, 2012 — currently, LTD pays benefits after one year of disability). Basic LTD is paid for by SHC/LPCH, but you may elect to purchase Supplemental LTD that pays a greater benefit. 22 2 0 1 2 O P E N E N R O L L M E N T G U I D E 2012 Semi-Monthly Health Care Contributions As in past years, our goal is to provide you with benefit options that meet your health needs, while also managing costs for both you and SHC/LPCH. In 2012, SHC/LPCH will continue to pay for the majority of premium costs. The chart below shows 2012 employee costs for medical/vision and dental benefits. You are responsible only for the amounts listed in the “Employee” columns. If your spouse or eligible domestic partner declines coverage through his or her employer and joins a SHC/LPCH medical plan, a working spouse access fee may apply. Medical + Vision Employee Only Employee + Employee + Employee + Spouse/Eligible Child(ren) Family Domestic Partner Employer Employee* Employer Employee* Employer Employee* Employer Employee* PPO $307.50 $0 $673.00 $0 $553.50 $0 $919.00 $0 EPO $327.00 $44.00 $658.50 $153.50 $588.00 $79.50 $919.50 $189.00 Kaiser $240.00 $32.50 $496.50 $116.50 $408.50 $55.00 $665.00 $139.00 Permanente HMO** * Premiums do not apply to House Staff. ** If your hourly rate of pay is $27.50 or less as of August 31, 2011 or on your date of hire, whichever is later, and you enroll in the Kaiser HMO plan, then you will pay no contributions for you or any dependents. Dental Employee Only Employee + Employee + Employee + Spouse/Eligible Child(ren) Family Domestic Partner Employer Employee Employer Employee Employer Employee Employer Employee Delta Dental PPO $27.50 $0 $40.00 $12.50 $51.00 $0 $63.50 $12.50 DeltaCare USA $8.00 $0 $15.00 $0 $14.00 $0 $21.50 $0 NOTE: Imputed income will be assessed if you are covering an eligible domestic partner under your health benefits. Refer to HR4Uonline or the BenefitsConnect website, www.shclpchbenefitsconnect.com, for the definition of an eligible domestic partner. Working Spouse/Eligible Domestic Partner Access Fee SHC/LPCH wants to ensure all employees and eligible family members have access to quality health coverage. In the case where a spouse or eligible domestic partner has access to other coverage but decides not to take it and instead joins a SHC/LPCH plan, we will ask that family to contribute a “spouse/eligible domestic partner access fee.” This is because we are absorbing costs for health care that would have been paid for by the spouse’s employer. The $50 monthly fee will be collected on a pre-tax basis using payroll deductions; for eligible domestic partners, the fee will be collected after taxes. The fee will apply if you meet all the following criteria: • Your spouse/eligible domestic partner is employed • Your spouse/eligible domestic partner is offered health coverage from his/her employer as a part of their benefits package • Your spouse/eligible domestic partner declines that coverage • You enroll your spouse/eligible domestic partner in a SHC/LPCH plan • You earn $27.51 or more per hour as of August 31, 2011, or your date of hire, whichever is later. 2 0 1 2 O P E N E N R O L L M E N T G U I D E 23 Open Enrollment Resources NEW: Medical Plan Cost Comparison Tool How do you know which medical plan option is best for you? Although medical expenses are somewhat unpredictable, you can compare estimated out-of-pocket costs among our three plans. Try out our new, powerful medical plan cost comparison tool on the HealthySteps website, www.healthysteps4u.org. Enter some basic, anonymous information (for example, whether you will enroll in employee- only or family coverage) and an estimation of your medical needs for the coming year. You’ll see a side-by-side look at how your annual yearly health care expenses might play out under each of our medical plans. Informational Meetings Want to know more? We’ve set up some meetings during the Open Enrollment period to help answer any questions you might have. Open Enrollment Meeting Schedule – All Sites Thursday, Oct. 20 12:00pm – 1:00pm Outpatient Center (Redwood City) – B2 Conference Room 2 :00pm – 3:00pm 3375 Hillview Ave, Conference Room 1023 (Purple Room) 3:00pm – 4:00pm 3375 Hillview Ave, Conference Room 1023 (Purple Room) Friday, Oct. 21 9:30am – 10:30am 4100 Bohannon Drive, Conference Rooms 120/121 Tuesday, Oct. 25 12:00pm – 1:00pm LPCH Auditorium 3:30pm – 4:30pm LPCH Auditorium Wednesday, Oct. 26 7:30am – 8:30am LPCH Auditorium 11:30am – 12:30pm LPCH Auditorium 7:15pm – 8:15pm LPCH Auditorium Thursday, Oct. 27 12:30pm – 1:30pm LPCH Auditorium 3:30pm – 4:30pm Outpatient Center (Redwood City) – B2 Conference Room Tuesday, Nov. 1 12:00pm – 1:00pm LPCH Auditorium 3:30pm – 4:30pm LPCH Auditorium 7:15pm – 8:15pm LPCH Auditorium Wednesday, Nov. 2 7:30am – 8:30am LPCH Auditorium 11:30am – 12:30pm 3375 Hillview Ave, Conference Room 1023 (Purple Room) Saturday, Nov. 5 7:30am – 8:30am LPCH Auditorium 12:30pm –1:30pm LPCH Auditorium Sunday, Nov. 6 7:30am – 8:30am LPCH Auditorium 12:30pm –1:30pm LPCH Auditorium Wednesday, Nov. 9 8:30am – 9:30am 1510 Page Mill, Rooms 3090/3091 Thursday, Nov. 10 2:30pm – 3:30pm 1510 Page Mill, Rooms 3090/3091 Tuesday, Nov. 15 1:30pm – 2:30pm 4100 Bohannon Drive, Conference Rooms 120/121 Questions? Access the latest information through BenefitsConnect at www.shclpchbenefitsconnect.com. If you have Open Enrollment questions, call toll-free, (855) 604-8079. 24 2 0 1 2 O P E N E N R O L L M E N T G U I D E About this Open Enrollment Guide The information in this guide provides overviews of the benefit plans offered to you. More complete descriptions of the plans are contained in your Benefits Handbook and other plan documents that govern these plans. If there is a discrepancy between this guide and the plan documents, the plan documents will govern in all cases.
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