2012 Benefits Open Enrollment by yaosaigeng

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									                   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.




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                  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




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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.




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                  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.




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 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.




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                                                          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.




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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.




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                  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




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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.




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                  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.




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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.




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                  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.




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                  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.




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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.




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                  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.


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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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