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2010 Enrollment Guide

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					                                                                       benefits
In This Issue                                                          2010 Enrollment Guide




Inside Cover
Benefit Changes for 2010

Quick Summary Information
   Annual Open Enrollment Period.....................2
   Family Status Events .....................................2
   Dependent Coverage .....................................3

Medical Options ...................................................3
  Pre-Certification Listing ..................................3
  Prescription Information .................................4
  How You Can Help Reduce Costs .................4
  Wellness Program ................................... 6 & 8
  Health Management .......................................9
  Urgent or Emergency Care ..........................10
  Case Management ....................................... 11

Dental Options ...................................................12

Vision Options ...................................................15

Life Insurance Options.......................................15
    Supplemental Life Insurance........................16
    Dependent Life Insurance ............................16

Flexible Spending Account Options ...................17
   Healthcare Account ......................................17
   Dependent Account ......................................18
   Worksheet ....................................................19

Other Memorial Benefits
   Legal Insurance............................................20

e-Benefits Enrollment ........................................20

Frequently Asked Questions..............................21
          Summary of Benefit Changes for year                                                                    Plans III and IV are “DMO” Plans, which offer higher
                                                                                                                  coverage and lower out of pocket expenses compared to
          2010                                                                                                    traditional plans. These plans have no deductibles or
                                                                                                                  annual maximums. However, services must be provided by
          Each year, Memorial reviews the benefit plans offered to team                                           an Aetna DMO provider. There is no coverage for services
          member’s to ensure we are still meeting the needs of our team                                           provided by a non-DMO provider. Each covered participant
          members and their families, to ensure we are in compliance with                                         must select their DMO provider upon enrollment.
          all legal requirements, and to ensure we are able to support the                                        Participants can change their named provider monthly.
          on-going costs of the plans from an organizational perspective.
          Listed below are the changes Memorial will be making effective                                         Plan III does not offer orthodontia coverage, where Plan IV
          January 1, 2010 to the benefit plans:                                                                   offers orthodontia coverage for adults and children.

          Medical Plans                                                                                          Please note: Periodontal maintenance is more extensive
            Once again, participants in the Medical plan will have the                                           than the standard bi-annual cleaning, and is not considered
             opportunity to have their annual deductible waived for                                               basic or preventative service under the Aetna Plan.
             wellness services in 2010 by completing the on-line Health
             Risk Appraisal (HRA).                                                                          Premium Increase: There will be a 6% increase in the premium
                                                                                                            for the PPO Dental Plans I & II.
              Envision Rx Options will replace Partners Rx as the
               Pharmacy Benefits Manager (PBM) for the health plan.                                         There will be a 7% increase in the premium for the DMO Dental
               The change will result in significant savings to both                                        Plans III & IV.
               Memorial and plan participants.
                                                                                                            Please refer to the Dental Schedule of Benefits for changes in
              There will be no change in the co-pay arrangement for                                        the 2010 premium structure.
               prescription medications (see the Schedule of Benefits for
               an explanation of the co-pays). There will be slight                                         Vision Plan
               changes to the formulary medications. Please review the                                      Memorial will again offer a Vision plan for 2010 through Humana
               Envision Rx formulary to determine if the formulary status                                   Vision. To keep in line with helping you focus on your health the
               of your specific medication is impacted.                                                     2010 Vision plan will include the following:

              Office visits for Mental Health treatment (including addiction                                    Co-pay for services when visiting a network vision care
               treatment) will now be covered with the same co-pay                                                provider will continue to be $10 in 2010.
               structure of all other office visits ($20-MMG Physicians;
               $30-all other CHA Providers). Team members and their                                              15% discount for professional contact lenses services
               family members are still able to take advantage of (5) free                                        (evaluation and fitting fees).
               visits annually through memorial’s Employee Assistance
               Program (EAP).                                                                                    Flat rate Lasik and PRK vision correction services when
                                                                                                                  visiting a TLC Vision Lasik Advantage Center.
              There is no longer a calendar year limit on the number of
               covered office visits or a lifetime paid claims limit for Mental                             For more details please refer to the Vision section of this guide.
               Health treatment (including addiction treatment) under the
               Memorial Plan.                                                                               Premium: There will be NO INCREASE in the Vision premium
                                                                                                            this year. Please refer to the vision section of this guide for the
              Vaccination for the H1N1 virus will be covered like any                                      2010 premium structure.
               other immunization. See the Schedule of Benefits for
               specific details.                                                                            Flexible Spending Accounts
                                                                                                            Beginning in 2010, all participants in the Medical Flexible
          Premium Increase: There will be NO INCREASE in premiums.                                          Spending Account Plan will be issued a flex debit card. This
          Please refer to the Medical Schedule of Benefits for the 2010                                     debit card can be used to pay for your out-of-pocket medical
          premium structure.                                                                                expenses, including office visit co-pays, prescriptions and eye
                                                                                                            glasses at the point of sale! You will no longer have to pay for
          Dental Plans                                                                                      these services up front and wait for reimbursement from your
          Memorial will again offer four Dental Plans, Plan I, II, III, and IV                              flexible spending account.         The reimbursement will be
          through Aetna Dental. The four plan choices allow you the                                         immediate…there are no reimbursement claims to file for
          opportunity to select the coverage option that is right for you and                               medical, dental, prescription, or vision when you use your debit
          your family.                                                                                      card.

              Plan I focuses on preventative and basic services only.                                      “Use it or lose it” deadline extended! Remaining funds from
               Plan I is the most affordable option however, there is no                                    2009 can be carried over in to 2010, and be used for eligible
               coverage for major dental services.                                                          expenses incurred through March 15, 2010.

              Plan II covers Preventative, Basic, and Major Services,                                      Claims incurred between January 1, 2009 and March 15, 2010
               including orthodontia coverage for eligible dependents.                                      can be reimbursed from an individual’s 2009 flexible spending
                                                                                                            account. Claims can be filed through March 31, 2010 for
              Both Plans I and II allow you to utilize any dental provider                                 reimbursement using these funds. Any remaining unused funds
               with no penalty. However, if you choose to see an Aetna                                      at that time will be forfeited back to the plan.
               Network Dental Provider, you may benefit from additional
               network savings.                                                                             Please remember: If you currently have a Flexible Spending
                                                                                                            Account and wish to have an account in 2010 you need to re-
                                                                                                            enroll in the plan during open enrollment.


The benefits in this booklet are brief summaries and are not intended to be all inclusive of the various plan benefits. Please refer to your plan documents for a complete description of a specific benefit.

                                                                                                  1
                                                                               copy of your Benefit elections.          This will serve as your
           Need More Information?
     Any time you have questions, or would like more detailed                  confirmation statement.
information about any of the benefits available, please refer to the
telephone number and Web site directory listed on the back cover of this       Remember... you must re-enroll online each year during Open
guide. Or, simply call Memorial’s Benefits Counselor at 574-647-6509.          Enrollment if you want a Medical Flexible Spending Account
                                                                               and/or a Dependent Daycare Flexible Spending Account for

ANNUAL OPEN ENROLLMENT PERIOD                                                  the following year.

Memorial is pleased to offer a variety of insurance benefit options
                                                                               This guide outlines general information on Memorial’s insurance
which include: medical, dental, vision, supplemental life,
                                                                               plans. For more information, refer to Memorial’s Summary Plan
dependent life, and flexible spending accounts. As a benefits-
                                                                               Description, attend a Benefits Fair, Education Workshop, or
eligible team member, you will be given the option of enrolling in
                                                                               contact Memorial’s Benefit Counselor.
these programs or making changes to your current coverage
during Memorial’s Open Enrollment period.                                      FAMILY STATUS EVENTS
                                                                               Memorial holds Open Enrollment in the fall of each year. Changes
The 2010 Open Enrollment Period is November 1 through
                                                                               made during Open Enrollment (with the exception of life insurance
November 13, 2009.
                                                                               changes) are effective the first day of the new calendar year. The
                                                                               only other time you can make changes throughout the year to your
All changes made during Open Enrollment (with the exception of
                                                                               Memorial insurance coverage is within 31 days of a “Family
additions to life insurance coverage) will be effective January 1,
                                                                               Status Event”. Family Status Events are defined below.
2010.     If you are adding or increasing your life insurance
coverage you must complete a Health Statement and return this
                                                                                                      Qualified Family Status Events:
form to the Benefits Department. Additions made to supplemental
                                                                                 ■   Marriage, Divorce/Legal Separation/Annulment.
or dependent life insurance must be approved by the life insurance
                                                                                 ■   Death of a spouse or dependent.
company’s underwriter.         This process can take up to several               ■   Birth or Adoption.
months. Supplemental and/or dependent life will be effective the                 ■   Starting new or termination of employment of yourself or spouse.
                                                                                 ■   Reduction of assigned work hours on the part of the team
first of the month following underwriting approval.
                                                                                     member, spouse or dependent.
                                                                                 ■   Increase in assigned work hours on the part of the team member,
Once your insurance elections have been made, you cannot make                        spouse or dependent.
changes to your insurance coverage throughout the 2010 calendar                  ■   Team member, spouse or dependent going on Leave of Absence.
                                                                                 ■   Team member, spouse or dependent returning from Leave of
year unless you have a “Family Status Event” and you submit an
                                                                                     Absence.
Insurance Add/Change Form within 31 days of this event occurring.                ■   Team Member or spouse becomes Medicare eligible.
The only time you can change plans is during Open Enrollment.
                                                                               A team member who experiences a Family Status Event
                                                                               throughout the year should immediately contact Memorial’s Benefit
If you do not want to make any changes to your medical, dental or
                                                                               Department for insurance selection information and submit an
vision plans and you do not want a medical flexible spending
                                                                               Insurance Add/Change Form. The Insurance Add/Change Form,
account or dependent daycare flexible spending account in year
                                                                               along with proof of the event (example: photocopy of the birth
2010, it is not necessary for you to complete the Open Enrollment
                                                                               certificate or marriage license and social security card), must be
Process. However, review your dependent/beneficiary information
                                                                               returned to Benefits within 31 days of the event occurring. If
for accuracy, and make any necessary corrections. Please print a
                                                                               this deadline is missed, the Benefits Team will be unable to
                                                                               process the insurance enrollment change.



                                                                           2
                                                                               Medical Options
                     Your choice of Coverage Categories:                       If you decide to have medical coverage through Memorial, you
     If you are married or have dependents, you have the option to elect
                                                                               need to first choose a Medical Plan and then a Coverage
coverage for only yourself and not for your spouse or dependents. You
                                                                               Category. There are several medical plans from which you can
may choose from the following coverage categories:
                                                                               choose. These include:
■    Employee - coverage for team member alone.
■    Employee +1 - coverage for team member plus one family member.
                                                                                         Choose Your Medical Plan
■    Family - coverage for team member and two or more dependent
                                                                                    ■    Plan A - $200 deductible
     family members.
                                                                                    ■    Plan B - $500 deductible
                                                                                    ■    Plan C - $800 deductible
DEPENDENT COVERAGE
                                                                                    ■    Plan D - $1,000 deductible
If your dependent has reached the age of 19 and is covered on                       ■    Waive (No Medical Coverage)
one of Memorial’s Medical Plans the dependent can continue                     Be sure to review the “Schedule of Benefits” as you make your decision.
coverage to the end of the year in which he/she turns age 19. If
the child is a full time student, then he/she will be covered until the        PRE-CERTIFICATION LISTING
end of the month in which he/she turns age 23 (or until graduation,            To help control expenses, under all Memorial medical plans, there
whichever comes sooner). It is the team member’s responsibility                is a listing of medical procedures and services which must be pre-
to submit proof of full time student status to Meritain Health at the          certified. The patient or family member must call Community
beginning of each Fall and Winter semesters.                                   Health Alliance (CHA) pre-certification phone number listed on the
                                                                               back of the Memorial insurance identification card. This call must
If your dependent has reached the age of 19 and is covered on
                                                                               be made at least two weeks in advance of services being
one of Memorial’s Dental Plans the dependent can continue
                                                                               rendered or within 24 hours of an emergency. If you do not
coverage to the end of the month in which he/she turns age 19. If
                                                                               pre-certify, reimbursement under Memorial’s medical plans
the child is a full time student, then he/she will be covered until the
                                                                               will be reduced by 50% of all eligible charges. Please note
end of the month in which he/she turns age 23 (or until graduation,
                                                                               that retroactive pre-certifications will not be granted.
whichever comes sooner). It is the team member’s responsibility
to submit proof of full time student status to Aetna Dental. Aetna             Listed below are procedures and services requiring pre-certification
will only require proof the dependent is a ‘Full-Time Student’                 in year 2010:
at the beginning of each Fall semester.                                        All 23 hour observation stays.
                                                                               All In-Patient admissions.
Dependents covered under Memorial’s Vision Plan are eligible for               Extend Care Facility, Skilled Nursing Facility (SNF), or
                                                                               Hospice Care.
coverage until the end of the month in which the dependent turns
                                                                               Outpatient Services:
age 24.                                                                          1. Blepharoplasty
                                                                                 2. Blocks, Injections (no more than 3 per request)
There is no age restriction for disabled children who are primarily              3. Bunionectomy
                                                                                 4. Cheiloplasty
supported by the team member. Documentation of “disabled”
                                                                                 5. Hammer Toe Repair
status must be submitted to the appropriate health or dental                     6. Myringotomy with tubes
                                                                                 7. Nasal and Sinus Surgery
carrier. A dependent that is no longer eligible because he/she
                                                                                 8. Sleep Studies
attains the maximum age is eligible to continue benefits under                   9. Plantar Fasciitis
                                                                                 10. Septoplasty
federal continuation provisions (COBRA). It is the team member’s
                                                                                 11. Ultrafast CT Scan
responsibility to notify Memorial’s Benefit Services Representative              12. Varicose Vein Therapy
                                                                                 13. Injectable Medications
when a dependent child is no longer eligible.
                                                                                 14. Orthotic and Prosthetic Services
                                                                                 15. Endoscopy, Esophago-Gastro-Duodenoscopy


                                                                           3
  16.  ERCP (endoscopic retrograde cholangiopancreatography)              Please refer to the formulary listing on the web @
  17.  Nerve Entrapment Surgery (including Carpal Tunnel Syndrome)        www.envisionrx.com to determine what medications are
  18.  Tonsillectomy and Adenoidectomy                                    considered formulary.
  19.  Cardiac & Pulmonary Rehabilitation
  20.  Devices for Pain Management                                        Compound prescriptions purchased at Mar-Main Pharmacy will
  21.  DME (Durable Medical Equipment) over $500.00
  22.  HHC (Home Healthcare) *Nursing, IV Meds, Fluids, Home              continue to be filed electronically with Envision Rx options. These
       Health Aide, etc.                                                  Prescriptions will be reimbursed at the non-formulary co-pay (50%)
  23. Occupational Therapy—Must pre-cert at start of therapy
  24. Physical Therapy—Must pre-cert at start of therapy                  of usual and customary.           Additionally, Mar-Main Pharmacy will
  25. Speech Therapy—Must pre-cert at start of therapy                    continue to offer a 15% discount to all team members on the
  26. Headache Clinic Referral (see policy)
  27. Bariatric Surgery (Gastric By-pass Surgery)                         purchase of all over-the-counter (OTC) items and consulting
  28. Esophageal Manometry                                                services.
  29. Radiation and Chemotherapy (Hospital setting, Clinic or
       Provider office)
  30. MRI                                                                 HOW YOU CAN HELP REDUCE COSTS
  A $2,000 facility co-pay does apply to services rendered at
  locations other than Memorial.                                          The benefit options have costs for coverage, which are called
                                                                          premiums. In some instances, you are paying for these premiums
PRESCRIPTION DRUG BENEFIT                                                 with     before-tax     dollars   deducted      from    your     paycheck.
Each of Memorial’s medical plans includes prescription drug               Unfortunately, it is simply not possible for the organization to
coverage. With Memorial’s prescription drug formulary, your co-           absorb the full impact of health care costs.               As healthcare
payments will be based on a three-tiered plan. This means that            expenses continue to rise, it is important that everyone does his or
your co-payments depend on whether your physician prescribes a            her part in helping to reduce these costs. There are many things
generic drug, brand name drug on the formulary list (also known           you can do to help minimize the amount you pay for healthcare.
as “preferred drugs”), or a brand name drug that is not on the            Remember, these are personal choices, but you may:
formulary list (also known as “non-preferred drugs”). A $5.00               ■       Choose a medical plan that best fits the needs of your family.
minimum co-payment will apply to all tiers.                                 ■       Take advantage of the Flexible Spending Accounts.
                                                                            ■       Use network physicians, facilities and providers whenever
Tier 1 drugs are generally generic drugs.                                           possible.
Tier 2 drugs are those that have been evaluated and chosen for              ■       Always review your medical bills for billing errors.
                                                                            ■       Use the emergency room only in emergency situations.
their clinical value and overall cost-effectiveness, and are on the         ■       Use generic prescriptions when possible.
formulary list.                                                             ■       Follow your physician’s orders to avoid set backs.
                                                                            ■       Make it a practice to exercise, eat healthy and get plenty of
Tier 3 drugs are those that have been evaluated but are not on the                  rest on a regular basis.
formulary list or are new drugs on the market that have not yet             ■       Never change prescription medications to over-the-counter
                                                                                    medications without first speaking to your physician.
been evaluated.                                                             ■       Don’t take double doses of prescription medication thinking
                                                                                    you will be better quicker...more is not better in this case.
                                                                            ■       If you are diabetic, check your blood sugar on a regular basis.
Prescription Drug Program                                                   ■       Have a physical every year (including PAP’s and breast
                  Memorial                                                          exams for females).
                                      Network        Mar-Main
                   Family
                                     Pharmacy        Pharmacy               ■       Have regular dental check-ups and cleanings to catch
                 Pharmacy
                                   % of Coverage
                                                                                    potential problems before they become major dental
  Generic Drugs         85%             75%         N/A                             procedures like caps and crowns.
 Preferred Drugs        70%             60%         N/A
                                                    50%
  Non-Preferred                                                                             How You Pay
                     50%            50%          (Compound
      Drugs
                                                 Drugs only)                        The amount you pay for insurance coverage is called premiums. All
 Note: Drugs purchased at an out-of-network pharmacy are not
 covered.                                                                        your premiums are taken equally, typically on a before tax basis, from each
                                                                                 of your Memorial paychecks. See each Schedule of Benefits for specific
                                                                                 premium information.



                                                                      4
                                                                                Medical Schedule of Benefits
                                                                                      Plans A, B and C
                                                                                                              NETWORK                                                                     OUT-OF-NETWORK
                                                                                  PLAN A                        PLAN B                      PLAN C                    PLAN A                 PLAN B                    PLAN C
Deductible
•     Single                                                                     $200                        $ 500                       $ 800                        $200                    $ 500                 $ 800
•     Single + 1                                                                 $600                        $1,000                      $1,600                       $600                    $1,000                $1,600
•     Family                                                                     $600                        $1,000                      $1,600                       $600                    $1,000                $1,600
Co-Insurance                                                                                                 80% Covered                                                                      60% Covered
Out-of-Pocket Maximum
•     Single                                                                     $1,200                      $1,500                      $1,800                       $2,200                  $2,500                $2,800
•     Single + 1                                                                 $2,600                      $3,000                      $3,600                       $4,600                  $5,000                $5,600
•     Family                                                                     $2,600                      $3,000                      $3,600                       $4,600                  $5,000                $5,600

Maximum Lifetime Benefit                                                   This benefit applies to any and all Health Insurance Claims. A Maximum Lifetime Benefit of $2,000,000 is available for services provided by Memorial Health
                                                                           System; of which only $1,000,000 may be used for other providers.

         PRE-CERTIFICATION & PRE-APPROVAL REQUIRED                                                      See Pre-certification list for all procedures requiring pre-certification under this plan.
                          COVERED SERVICES                                                                    NETWORK                                                                     OUT-OF-NETWORK
Inpatient & Outpatient Care at Memorial Hospital of South Bend
•      Semi-Private Room/ICU/CCU                                          90% Covered - After deductible
       Delivery or Operating Room                                                                                                                                Not Applicable
•                                                                         90% Covered - After deductible
•      Drugs/Equipment & Supplies                                         90% Covered - After deductible
Inpatient & Outpatient Care at hospitals other than Memorial
All Hospitals/Surgery Centers except Memorial Hospital, South Bend        $2,000 co-pay/80% after deductible                                                     $2,000 co-pay/60% after deductible
Outpatient Diagnostic Procedures-Laboratory, X-rays, Mammograms
•      South Bend Medical Foundations Sites/Rad. Inc.                     90% Covered – After deductible                                                         60% after deductible
•      Memorial Hospital and MMG Locations                                90% Covered – After deductible                                                         60% after deductible
•      Other Hospitals or Physician Charges                               80% after deductible                                                                   60% after deductible
Emergency Care
•       Memorial Hospital of South Bend Trauma Center (Co-pay waived if   $200 Co-pay – Per Visit (Please note: If an ER visit is for a non-                     Not Applicable
ER visit results in In-patient Admittance or 23 hr. observation)          emergency diagnosis, charges for any labs and/or x-rays will be subject
                                                                          to deductible and co-insurance)                                                        60% after deductible
•      Med Point Facilities (Excludes Med Point Express)                  $50.00 Co-pay – Per Visit                                                              $2,000 Co-pay / 60% after deductible
•      Other Hospitals
                                                                          $2,000 Co-pay / 80% after deductible
Physicians In-Patient Care                                                80% after deductible                                                                   60% after deductible
Physician Surgical Services                                               80% after deductible                                                                   60% after deductible
                                                                          $15.00 Co-pay - Med Point Express
Physician Office Visits
                                                                          $20.00 Co-pay - MMG Providers                                                          60% after deductible
(Including Mental Health office visits)
                                                                          $30.00 Co-pay - all other network providers
Prosthetics/Orthotics                                                     80% after deductible                                                                   60% after deductible
Mastectomy Bras
                                                                          80% after deductible                                                                   60% after deductible
•     Limit of 6 per lifetime
Organ Transplants
•     Excludes experimental/investigational                               80% after deductible                                                                   60% after deductible
•     $250,000 maximum per transplant
Pregnancy
                                                                          80% after deductible                                                                   60% after deductible
•     Excludes dependent pregnancy
                                                                          90% after deductible–Memorial Air Ambulance
Ambulance Service/Transport                                                                                                                                      80% after deductible
                                                                          80% after deductible–all other network providers
                                                                          90% after deductible-Memorial Hospital, MMG sites, SBMF)
Diagnostic Laboratory                                                                                                                                            60% after deductible
                                                                          80% after deductible-all other network providers
                                                                          90% after deductible-MHO, MMG sites, MRI Cntr., Radiology Inc,
                                                                          Jefferson Medical Arts Radiology, Memorial Lighthouse Img., LaPorte
Diagnostic X-Ray                                                                                                                                                 60% after deductible
                                                                          Radiology Inc.)
                                                                          80% after deductible-all other network providers
 Acupuncture
 •       12 visits per calendar year                                      80% after deductible                                                                   60% after deductible
 Durable Medical Equipment
 •       Requires Pre-certification above $500                            80% after deductible                                                                   60% after deductible
 •       Lifetime maximum $100,000
 Home Health Care
 •       Must use Memorial Home Care when service is available (Subject   80% after deductible                                                                   60% after deductible
to Pre-Cert. and Utilization Review)
 Hospice Care
 •       Subject to Pre-certification/Utilization Review                  80% after deductible                                                                   60% after deductible
 Bariatric Surgery
 •       Pre-certification required                                       90% after deductible at Memorial Hospital only                                         Not Covered
 •       $30,000 lifetime maximum on all charges related to diagnosis
 Routine Newborn Care (Infant must be added within 31 days of birth)
 (First four days of facility charges covered under Mother,               80% after deductible                                                                   60% after deductible
  if exceeds four days remainder covered under child)
 Oral Maxillofacial Surgery
 •       Covered if medically necessary                                   80% after deductible                                                                   60% after deductible
 Skilled Nursing Facility
 •       Limited to Semi-Private room rate- within 7 days of 5 day        80% after deductible                                                                   60% after deductible
admittance; 100 days/calendar year limit
                                                                                                     Continued on next page




                                                                                                    5
                                                                                                              NETWORK                                                        OUT-OF-NETWORK
  Spinal Manipulation/Chiropractic
  •      24 visits per calendar year                                          80% after deductible                                                        60% after deductible
  •      $70 max. allowable charge per visit (all services)
  Therapy                                                                     90% at Memorial or MMG Provider after deductible
  •      Occupational, Physical or Speech                                     80% after deductible                                                        60% after deductible
  Compound Drugs                                                              50% Co-pay when purchased at Mar-Main Pharmacy                              Not Covered
  Prescription Drug Program                                                   Memorial Family Pharmacy         Other Network Pharmacies
  •      Generic Drugs                                                        15% Co-pay                        25% Co-pay
  •      Preferred (Formulary) Drugs                                          30% Co-Pay                        40% Co-pay
  •      Non-Preferred (Non-Formulary) Drugs                                  50% Co-pay                        50% Co-pay
Minimum co-pay of $5.00 per prescription.
Over the counter medications, with the exception of Prilosec OTC, Claritin                                                                                Non-network Pharmacies Not Covered
OTC, Zyrtec OTC, and OTC Smoking Cessation Medications are not
covered by the plan. (Smoking cessation meds are subject to plan
limitations)
A listing of formulary drugs is available from HR/Ben. and is subject to
periodic updates. Refer to your formulary website for detailed information
on this program.



                                                                                 Wellness Benefits Program


                      Participants age 18 and over who complete their on-line HRA by the specified deadline will have their deductible waived for their Annual Wellness Services.
                               Preventative Service                                         Plan Guidelines                                In-Network Benefit Under Memorial's Plan
                     Routine Wellness Exams & Immunizations
                                     Birth to Age 1                                                     6 Exams                 Covered at 100%
                                       Age 1 to 2                                                2 Exams per year               Covered at 100%

                                       Age 2 to 6                                                    1 Exam per year            Covered at 100%

                                      Age 6 to 18                                                    1 Exam per year            Covered at 100%

                                     Age 18 & Over                                                   1 Exam per year            1st $100 paid at 100%; remaining balance covered at 80% after the deductible
                                                                                                                                Covered at 90% after the deductible if services are rendered by designated
                         Gynelogical PAP & related lab fees                                                                     Memorial providers
                                                                                                        1 per year
                                  Age 18 & Over                                                                                 Covered at 80% after the deductible if services are rendered by any other network
                                                                                                                                provider
                                                                                                                                Covered at 90% after the deductible if services are rendered by designated
                                Routine Mammography                                                                             Memorial providers
                                                                                                        1 per year
                                    Age 40 & Over                                                                               Covered at 80% after the deductible if services are rendered by any other network
                                                                                                                                provider
                                                                                                                                Covered at 90% after the deductible if services are rendered by designated
                                     Routine PSA                                                                                Memorial providers
                                                                                                        1 per year
                                     Age 40 & Over                                                                              Covered at 80% after the deductible if services are rendered by any other network
                                                                                                                                provider
                                                                                                                                Covered at 90% after the deductible if services are rendered by designated
                                    Colonoscopies                                                                               Memorial providers
                                                                                                     1 every 10 years
                                    Age 50 & Over                                                                               Covered at 80% after the deductible if services are rendered by any other network
                                                                                                                                provider
                                                                                                                                Covered at 90% after the deductible if services are rendered by designated
                                                                                                                                Memorial providers;
                                   Routine Lab work                                                     1 per year
                                                                                                                                Covered at 80% after the deductible if services are rendered by any other network
                                                                                                                                provider
                                                       Routine Wellness/Preventative Services provided by an Out-of-Network Provider are not covered.



                   PLAN A, B AND C MONTHLY PREMIUMS FOR YEAR 2010; EFFECTIVE JANUARY 1 THROUGH DECEMBER 31, 2010
                      To calculate your per pay period deduction multiply the monthly premium by 12 months; then divide by the number of pay periods you are paid in a year.
                                                                               PLAN A                                      PLAN B                                        PLAN C
  FULL TIME (70+ hrs/PP)
  •           Single                                           $ 92.65/month                              $ 41.98/month                                 $ 24.62/month
  •           Single +1                                        $ 168.74/month                             $ 106.45/month                                $ 73.34/month
  •           Family                                           $ 242.56/month                             $ 145.79/month                                $ 107.60/month
  PART TIME (40-69 Hrs/PP)
  •          Single                                                    $ 231.62/month                                   $ 68.87/month                                   $ 51.55/month
  •          Single +1                                                 $ 421.88/month                                   $ 185.81/month                                  $ 146.20/month
  •          Family                                                    $ 606.43/month                                   $ 253.41/month                                  $ 215.21/month
  PART TIME (32-39 Hrs/PP)
  •          Single                                                    $ 463.27/month                                   $ 339.77/month                                  $ 268.02/month
  •          Single +1                                                 $ 843.73/month                                   $ 615.28/month                                  $ 482.57/month
  •          Family                                                    $1212.87/month                                   $ 929.98/month                                  $ 685.73/month




                                                                                                       6
                                                                                       Medical Schedule of Benefits
                                                                                                 Plan D
                                                                                                                    NETWORK                                                                    OUT-OF-NETWORK
Deductible
•     Single                                                                                                         $1,000                                                                           $1,000
•     Single + 1                                                                                                     $2,500                                                                           $2,500
•     Family                                                                                                         $2,500                                                                           $2,500
Co-Insurance                                                                                                       80% Covered                                                                      60% Covered
Out-of-Pocket Maximum
•     Single                                                                                                           $3,500                                                                           $4,500
•     Single + 1                                                                                                       $3,500                                                                           $4,500
•     Family                                                                                                           $3,500                                                                           $4,500
                                                                                This benefit applies to any and all Health Insurance Claims. A Maximum Lifetime Benefit of $2,000,000 is available for services provided by Memorial Health
Maximum Lifetime Benefit                                                        System; of which only $1,000,000 may be used for other providers.

          PRE-CERTIFICATION & PRE-APPROVAL REQUIRED                                                           See Pre-certification list for all procedures requiring pre-certification under this plan.
                          COVERED SERVICES                                                                          NETWORK                                                                    OUT-OF-NETWORK
Inpatient & Outpatient Care at Memorial Hospital of South Bend
•      Semi-Private Room/ICU/CCU                                               80% Covered - After deductible
•      Delivery or Operating Room                                                                                                                                       Not Applicable
                                                                               80% Covered - After deductible
•      Drugs/Equipment & Supplies                                              80% Covered - After deductible
Inpatient & Outpatient Care at hospitals other than Memorial
All Hospitals/Surgery Centers except Memorial Hospital, South Bend             $2,000 Co-pay/80% after deductible                                                       $2,000 Co-pay/60% after deductible
Outpatient Diagnostic Procedures-Laboratory, X-rays, Mammograms
•      South Bend Medical Foundations Sites/Rad. Inc.                          90% Covered – After deductible                                                           60% after deductible
•      Memorial Hospital and MMG Locations                                     90% Covered – After deductible                                                           60% after deductible
•      Other Hospitals or Physician Charges                                    80% after deductible                                                                     60% after deductible
Emergency Care
•       Memorial Hospital of South Bend Trauma Center (Co-pay waived if        $200 Co-pay – Per Visit (Please note: If an ER visit is for a non-                       Not Applicable
ER visit results in In-patient Admittance or 23 hr. observation)               emergency diagnosis, charges for any labs and/or x-rays will be subject to
                                                                               deductible and co-insurance)                                                             60% after deductible
•      Med Point Facilities (Excludes Med Point Express)                       $50.00 Co-pay – Per Visit                                                                $2,000 Co-pay / 60% after deductible
•      Other Hospitals
                                                                               $2,000 Co-pay / 80% after deductible
Physicians In-Patient Care                                                     80% after deductible                                                                     60% after deductible
Physician Surgical Services                                                    80% after deductible                                                                     60% after deductible
                                                                               $15.00 Co-pay - Med Point Express
Physician Office Visits                                                        $20.00 Co-pay - MMG Providers                                                            60% after deductible
(including Mental Health office visits)
                                                                               $30.00 Co-pay - all other network providers
Prosthetics/Orthotics                                                          80% after deductible                                                                     60% after deductible
Mastectomy Bras
                                                                               80% after deductible                                                                     60% after deductible
•     Limit of 6 per lifetime
Organ Transplants
•     Excludes experimental/investigational                                    80% after deductible                                                                     60% after deductible
•     $250,000 maximum per transplant
Pregnancy
                                                                               80% after deductible                                                                     60% after deductible
•     Excludes dependent pregnancy
                                                                               90% after deductible–Memorial Air Ambulance
Ambulance Service/Transport                                                                                                                                             80% after deductible
                                                                               80% after deductible–all other network providers
                                                                               90% after deductible-Memorial Hospital, MMG sites, SBMF)
Diagnostic Laboratory                                                                                                                                                   60% after deductible
                                                                               80% after deductible-all other network providers
                                                                               90% after deductible-MHO, MMG sites, MRI Cntr., Radiology Inc,
                                                                               Jefferson Medical Arts Radiology, Memorial Lighthouse Img., LaPorte
Diagnostic X-Ray                                                                                                                                                        60% after deductible
                                                                               Radiology Inc.)
                                                                               80% after deductible-all other network providers
 Durable Medical Equipment
 •              Requires Pre-certification above $500                          80% after deductible                                                                     60% after deductible
 •              Lifetime maximum $100,000
 Home Health Care
 •              Must use Memorial Home Care when service is available          80% after deductible                                                                     60% after deductible
(Subject to Pre-Cert. and Utilization Review)
 Hospice Care
 •              Subject to Pre-certification/Utilization Review                80% after deductible                                                                     60% after deductible
 Bariatric Surgery
 •              Pre-certification required                                     90% after deductible at Memorial Hospital only                                           Not Covered
 •              $30,000 lifetime maximum on all charges related to diagnosis
 Routine Newborn Care (Infant must be added within 31 days of birth)
 (First four days of facility charges covered under Mother,                    80% after deductible                                                                     60% after deductible
  if exceeds four days remainder covered under child)
 Oral Maxillofacial Surgery
 •              Covered if medically necessary                                 80% after deductible                                                                     60% after deductible
 Skilled Nursing Facility
 •              Limited to Semi-Private room rate- within 7 days of 5 day      80% after deductible                                                                     60% after deductible
admittance; 100 days/calendar year limit
 Spinal Manipulation/Chiropractic
 •              24 visits per calendar year                                    80% after deductible                                                                     60% after deductible
 •              $70 max. allowable charge per visit (all services)

                                                                                                 Continued on next page




                                                                                                          7
                                                                              NETWORK                                                                        OUT-OF-NETWORK
  Therapy                                                                     90% at Memorial or MMG Provider after deductible
  •             Occupational, Physical or Speech                              80% after deductible                                                           60% after deductible
  Compound Drugs                                                              50% Co-pay when purchased at Mar-Main Pharmacy                                 Not Covered
  Prescription Drug Program                                                   Memorial Family Pharmacy         All Other Network Pharmacies
  •             Generic Drugs                                                 15% Co-pay                        25% Co-pay
  •             Preferred (Formulary) Drugs                                   30% Co-Pay                        40% Co-pay
  •             Non-Preferred (Non-Formulary) Drugs                           50% Co-pay                        50% Co-pay
Minimum co-pay of $5.00 per prescription.
Over the counter medications, with the exception of Prilosec OTC, Claritin
                                                                                                                                                             Non-network Pharmacies Not Covered
OTC, Zyrtec OTC, and OTC Smoking Cessation Medications are not
covered by the plan. (Smoking cessation meds are subject to plan
limitations)
A listing of formulary drugs is available from HR/Ben. and is subject to
periodic updates. Refer to your formulary website for detailed information
on this program.




                                                                                   Wellness Benefits Program

                         Participants age 18 and over who complete their on-line HRA by the specified deadline will have their deductible waived for their Annual Wellness Services.
                                   Preventative Service                                             Plan Guidelines                             In-Network Benefit Under Memorial's Plan
                         Routine Wellness Exams & Immunizations
                                         Birth to Age 1                                                       6 Exams                 Covered at 100%
                                           Age 1 to 2                                                     2 Exams per year            Covered at 100%
                                           Age 2 to 6                                                     1 Exam per year             Covered at 100%

                                           Age 6 to 18                                                    1 Exam per year             Covered at 100%

                                         Age 18 & Over                                                    1 Exam per year             1st $100 paid at 100%; remaining balance covered at 80% after the deductible
                                                                                                                                      Covered at 90% after the deductible if services are rendered by designated
                              Gynelogical PAP & related lab fees                                                                      Memorial providers
                                                                                                             1 per year
                                       Age 18 & Over                                                                                  Covered at 80% after the deductible if services are rendered by any other
                                                                                                                                      network provider
                                                                                                                                      Covered at 90% after the deductible if services are rendered by designated
                                    Routine Mammography                                                                               Memorial providers
                                                                                                             1 per year
                                        Age 40 & Over                                                                                 Covered at 80% after the deductible if services are rendered by any other
                                                                                                                                      network provider
                                                                                                                                      Covered at 90% after the deductible if services are rendered by designated
                                         Routine PSA                                                                                  Memorial providers
                                                                                                             1 per year
                                         Age 40 & Over                                                                                Covered at 80% after the deductible if services are rendered by any other
                                                                                                                                      network provider
                                                                                                                                      Covered at 90% after the deductible if services are rendered by designated
                                        Colonoscopies                                                                                 Memorial providers
                                                                                                          1 every 10 years
                                        Age 50 & Over                                                                                 Covered at 80% after the deductible if services are rendered by any other
                                                                                                                                      network provider
                                                                                                                                      Covered at 90% after the deductible if services are rendered by designated
                                                                                                                                      Memorial providers;
                                       Routine Lab work                                                      1 per year
                                                                                                                                      Covered at 80% after the deductible if services are rendered by any other
                                                                                                                                      network provider

                                                          Routine Wellness/Preventative Services provided by an Out-of-Network Provider are not covered.



                            PLAN D MONTHLY PREMIUMS FOR YEAR 2010; EFFECTIVE JANUARY 1 THROUGH DECEMBER 31, 2010
                                To calculate your per pay period deduction multiply the monthly premium by 12 months; then divide by the number of pay periods you are paid in a year.
                                                                                                                                                           PLAN D
 FULL TIME (70+ hrs/PP)
 •           Single                                                                                       $ 12.22/month
 •           Single +1                                                                                    $ 50.61/month
 •           Family                                                                                       $ 85.59/month
 PART TIME (40-69 Hrs/PP)
 •           Single                                                                                       $ 24.46/month
 •           Single +1                                                                                    $ 117.91/month
 •           Family                                                                                       $ 171.19/month
 PART TIME (32-39 Hrs/PP)
 •           Single                                                                                       $ 223.88/month
 •           Single +1                                                                                    $ 400.88/month
 •           Family                                                                                       $ 566.51/month




                                                                                                      8
    HEALTH MANAGEMENT                                                               If you choose to participate in the Club Health Program, you will
    Memorial is dedicated to improving the quality of life for the people           receive additional benefits that those individuals who choose not to
    of our community. We believe that the path to achieving this starts             be a part of the program will not receive.
    with our team members and their families. As such, Memorial is                  Team members, spouses, and dependents over age 18 that
    pleased to introduce Club Health as our Health Management                       complete the on-line HRA will have their deductible for their
    Program.                                                                        annual WELLNESS BENEFITS waived!

    The first step in joining Club Health is the Health Risk Appraisal
                                                                                    See page 6 for a complete listing of benefits covered and the
    (HRA). This is an online questionnaire that all individuals covered
                                                                                    coverage amount under the Wellness Plan.
    by the Memorial Health Plan can complete. The HRA is designed
    to determine an individual’s risk factors and provide suggestions                                            Without the HRA…
                                                                                      Claims will be covered at the 80/90% AFTER deductible has been met.
    on how to improve health. To complete the HRA, go to the Meritain
    Health Member Web Site (www.mymeritain.com) and click on the                                                   With the HRA…

    HRA link. For instructions on how to access the Meritain Member                    Claims will be covered at 80/90% BEFORE deductible has been met.

    Web Site, please see page 10.                                                      Please note that the annual deductible will still apply to all other
                                                                                         medical conditions, as specified in the schedule of benefits.

                                                                                    The deductible waiver does not apply to dependents under age 18.
           Club Health Members receive:
                                                                                    You must complete an HRA every year to be eligible for the
■     A health assessment performed by a Nurse Health Coach.                        annual deductible waiver. All covered dependents over age
■     Access to a 24-hour Nurse Line, including a Health Information Library.       18 must complete the HRA.
■     Education and information on diet, exercise, and other important health
      topics.                                                                       For more information regarding the HRA and Club Health, please
■     Regular contact with a Health Coach to discuss your medication and            contact Memorial’s Benefits Counselor at (574)647-6509, or Club
      other health needs and concerns.                                              Health at (866)537-5445.
■     WAIVER OF DEDUCTIBLE FOR ANNUAL WELLNESS BENEFITS.
                                                                                                     Preventative Service’s Under the Wellness Program
                                                                                                         Routine Wellness Exams & Immunizations
                                                                                                                        Birth to Age 1
                                                                                                                          Age 1 to 2
                                                                                                                          Age 2 to 6
    Through the HRA, an individual might be identified as a good
                                                                                                                        Age 6 to 18
    candidate for Meritain’s Health Management Plan, known as “Club                                                  Age 18 & Over
                                                                                                            Gynelogical PAP & related lab fees
    Health”. This program is designed to give individuals the                                                        Age 18 & Over
                                                                                                                 Routine Mammography
    knowledge and tools to help them understand and manage their                                                     Age 40 & Over
                                                                                                                      Routine PSA
    health. Club Health is available “free of charge” for members with                                               Age 40 & Over
                                                                                                                     Colonoscopies
    chronic conditions such as Asthma, Diabetes, and Heart Disease,                                                  Age 50 & Over
    among others, and those who are “at risk” for developing chronic                                                 Routine Lab work

    medical conditions.
                                                                                               Club Health Membership Deadline:
    If you are eligible for this program, Club Health nurses can help                   All covered team members and their dependents 18 yrs. & older are
    you and your family to better understand your health. They will                 eligible to take advantage of this opportunity. To have the deductible waived

    work with you and your physician to make sure you understand                    for wellness services for 2010, plan participants must join and complete the
                                                                                    HRA by February 1, 2010. New team members will have 60 days following
    your condition.
                                                                                    their date of hire to complete the HRA in order to be eligible for this additional
                                                                                    benefit.



                                                                                9
                                                                                      Room when we need urgent care. Some people assume that the
           How to Access the Meritain Health Member Web Site:                         ER is the only option for after-hours medical care. While the
                                                                                      Emergency Room is one option, Med-Point Urgent Care centers
   If you are new to the Meritain Member Website:
                                                                                      and Med-Point Express could be appropriate options as well. Your
                                                                                      specific illness or injury should determine which level of care is
From www.mymeritain.com under the “Member Section” click on “To create a
                                                                                      appropriate.
new user account”.
1. When the “New Member Registration” page opens, enter your Group ID#
  (found on your ID card)                                                                                                           Emergency care is
                                                                                                                                    necessary for medical
2. When the “Member Registration” page opens, enter your:
  ■     ID number (social security number or unique ID number) in the                                                               emergencies         that
        Member ID field                                                                                                             require     immediate
  ■     Birth Date
  ■     First and Last name                                                                                                         care to avoid disability
  ■     Zip Code
                                                                                                                                    or death (suspected
3. On the second “Member Registration” page, enter:
   ■    Username                                                                                                                    heart     attacks       or
   ■    Password                                                                                                                    strokes, and major
   ■    Secret Question
   ■    Secret Answer                                                                                                               trauma such as a
   ■    Email Address
                                                                                                                                    head injury, severe
4. The “Verify Information” page will open. Please check all information for
   accuracy.                                                                          pain, and uncontrolled bleeding). Urgent care is care that can
5. Click the “Click here to Log In with your new account” link to log into            safely be postponed for the time it takes to contact a physician for
   www.mymeritain.com.
                                                                                      instructions on obtaining treatment (such as earaches, sprains,
*Your computers internet security settings must be set to the default settings
to complete the HRA.                                                                  minor fractures, lacerations, rashes, fever, back pain, and colds).

 If you completed the HRA in past years:
                                                                                      Choosing the right level of care can lower your out of pocket

You will use the same user name and password you had previously created.              expenses, and will help keep Memorial’s medical plan expenses
If you have forgotten your password, click on the “forgot password” link. You         under control. A visit to the emergency room for non-emergency
will be asked your security question which will allow you to retrieve your
                                                                                      care can cost 3-4 times more than a visit to an Urgent Care
password. Your information will be sent to the e-mail address you provided
when you originally registered on the Meritain website.                               Center, such as Med-point, for the same ailment. In 2009, the
                                                                                      average cost of an Emergency Room visit paid by the Memorial
                                                                                      medical plan was over $1100. Many of these visits were for a non-
   Participation in Club Health is free and voluntary.               It is not
                                                                                      emergent diagnosis. On the other hand, the average cost of an
   mandatory to complete the on-line HRA.               Once an individual
                                                                                      office visit paid by the Memorial medical plan in 2009 was $68.
   completes the HRA and joins Club Health, he/she does have the
                                                                                      The average cost of out-patient x-rays were $501, while the
   option of “opting out” of the program at any time. However,
                                                                                      average cost of out-patient labs were $63. Please keep in mind
   individuals who do not fully participate in the Club Health Program
                                                                                      that your monthly premiums are determined by the amount of the
   will not be eligible to have their deductible waited for their annual
                                                                                      claims cost the plan pays. The higher the cost of the claims that
   wellness benefits.
                                                                                      are paid, the higher your premiums will be.

   URGENT CARE OR EMERGENCY CARE?
                                                                                      Of course, you should ALWAYS seek immediate emergency
   One of the more difficult healthcare choices you may be faced with
                                                                                      care for true medical emergencies! For urgent care situations,
   is where to go when you need medical attention for a sudden injury
                                                                                      consider the following options. These options will help you receive
   or illness. Many times, our first thought is to go to the Emergency
                                                                                      appropriate treatment in a timely manner.


                                                                                 10
Your Regular Physician:                                                      We want you to receive the best and most timely care for any
During normal business hours, call your physician to determine the           sudden injuries or illnesses. These guidelines are provided to help
best course of action. Your doctor may be able to provide                    you do just that.
immediate treatment, or he/she may refer you to a specialist,
Urgent Care center, or clinic. Many doctors also provide an after-
hours number that you can call to determine whether or not your
situation requires immediate care.


Urgent Care Centers (Med-Point):
During and after normal business hours, Urgent Care centers are
open to provide medical treatment. They are staffed with
physicians and nurses that are experienced in handling illnesses
and injuries. They can run diagnostics such as x-rays and labs,
and, if necessary, refer you to a specialist.

           Med-Point Hours & Locations:
                    1815 E. Ireland Rd - 8:00am – 8:00pm
                     6913 N. Main St - 8:00am – 10:00pm
                      4630 Vistula Rd. – Noon – 8:00pm                       CASE MANAGEMENT

                    All locations are open (7) days a week.                  When a serious condition, such as cancer, occurs, a person may
                                                                             require long-term, perhaps lifetime care.

                                                                             Case Management is a program whereby a case manager
MEDPOINT express:
                                                                                                                 monitors these patients and
Those who have a minor illness can now stop at MEDPOINT
                                                                                                                 explores,      discusses,        and
express. Patients can see a nurse practitioner for minor health
                                                                                                                 recommends              coordinated
conditions such as strep throat, earache, flu, pink eye and
                                                                                                                 and/or      alternate    types    of
allergies. They can also prescribe most medications, administer
                                                                                                                 appropriate               medically
vaccinations and perform health screenings. No appointments are
                                                                                                                 necessary care. The case
necessary and visits usually take about 15 minutes. It provides
                                                                                                                 manager consults with the
quick, affordable, quality health care in a fast, convenient setting.
                                                                                                                 patient, the family, and the
                                                                                                                 attending physician in order to
           Med-Point Express Hours & Locations:
                                                                                                                 develop a plan of care. The
             South Bend – 926 Erskine Plaza (Inside Martin’s)
                                                                                                                 case manager will coordinate
                  Elkhart – 3900 East Bristol (Inside Martin’s)
                                                                             and implement the Case Management Program by providing
             Valparaiso – 2400 Morthland Dr. (Inside Wal-Mart)
Monday – Friday        10:00am to 6:00pm                                     guidance and information on available resources and suggesting
Saturday               9:00am – 4:00pm                                       the most appropriate treatment plan. The treatment plan must be
Sunday                 11:00am to 4:00pm                                     agreed upon by all parties involved.

Valparaiso Location Only:                                                    Each treatment plan is individually tailored to a specific patient and
Monday – Friday        8:00am to 8:00pm                                      should not be seen as appropriate or recommended for any other
Saturday               9:00am – 4:00pm                                       patient, even one with the same diagnosis.
Sunday                 11:00am to 4:00pm


                                                                        11
              Non-Participation Penalty:                                       Plan I focuses on preventative and basic services only. There is
                                                                               no coverage for major dental services.
Case Management is a voluntary service. Individuals identified as candidates
for case management are not required to participate in the program.
                                                                               Plan II offers coverage for preventative, basic, and major services,
However, if an individual declines to participate in the case management
                                                                               including orthodontia coverage for eligible dependents.
program, the annual out of pocket maximum will increase $1,000 for that
                                                                               Both Plans I and II allow you to utilize any dental provider with no
individual.
                                                                               penalty. However, if you choose to see an Aetna Network Dental
                                                                               Provider, you may benefit from additional network savings.
For example, Mary is covered under Memorial’s Plan A. Her
annual out of pocket maximum for the year is $1,200. Mary is
                                                                               Plans III and IV are “DMO” Plans, which offer higher coverage and
diagnosed with a serious illness, and is invited to participate in the
                                                                               lower out of pocket expenses compared to traditional plans. These
case management program. Mary declines to participate in the
                                                                               plans have no deductibles or annual maximums. However,
program. Mary’s out of pocket maximum is then increased to
                                                                               services must be provided by an Aetna DMO provider. There is
$2,200 for the year.
                                                                               no coverage for services provided by a non-DMO provider. Each
                                                                               covered participant must select their DMO provider upon
         Do we have your correct address?                                      enrollment. Participants can change their named provider monthly
Anytime you have a change of address please remember to submit a               by first contacting the dental provider to ensure they are a DMO
change form to the Payroll Department. Address Change forms are found
                                                                               Provider and that they are taking new patients, then contacting
on the Human Resources Intranet site.
                                                                               Aetna to request the change.


Dental Options                                                                 Plan III does not offer orthodontia coverage, where Plan IV offers
Memorial’s dental plans are fully insured options administered by
                                                                               orthodontia coverage for adults and children.
Aetna Dental.



                                                                                         See next page for Dental Schedule of Benefits




                                                                                       Has your name changed?
                                                                               If you have had a name change submit a change form to the HR
                                                                               Department. Name Change forms are found on the Human Resources
                                                                               Intranet site. Send a copy of your new Social Security Card with the form.




                                                                                       Need to contact Aetna Dental?


                                                                               Anytime you have a question about your dental benefits through Aetna
                                                                               Dental you can contact Aetna directly by calling (800)255-8464. You can
                                                                               also visit the website at www.aetna.com to track claims for you and your
                                                                               dependents and even change your Preferred Provider all on-line.




                                                                          12
        Dental Schedule of Benefits – PPO Plan I                                                               Dental Schedule of Benefits – PPO Plan II
                 Covered Services                                Benefits Payable                                 Covered Services                           Benefits Payable
 Annual Deductible*                                                                                 Annual Deductible*
   Individual                                                     $50                                 Individual                                                    $50
   Family                                                         $150                                Family                                                       None
 Preventive Services                                             100%                               Preventive Services                                            100%
 Basic Services                                                   80%                               Basic Services                                                  80%
 Major Services                                              Not Covered                            Major Services                                                  60%
 Annual Benefit Maximum                                          $1,000                             Annual Benefit Maximum                                         $1,500
 Office Visit Co-pay                                              N/A                               Office Visit Co-pay                                             N/A
 Orthodontic Services**                                      Not Included                           Orthodontic Services**                                          60%
 Orthodontic Deductible                                          None                               Orthodontic Deductible                                          $50
           *The deductible applies to: Preventative & Basic services only                           Orthodontic Lifetime Maximum                                   $1,200
                                                 Network             Non-Network                                  *The deductible applies to: Basic & Major services only
 Preventive                                                                                       **Orthodontia is covered only for children (appliance must be placed prior to age 20)
 • Oral examinations (a)                           100%                 100%                                                                               Network       Non-Network
 • Cleanings, including scaling and                                                                  Preventive
                                                   100%                 100%
    polishing (a) Adult/Child                                                                        • Oral examinations (a)                                 100%             100%
 • Fluoride (a) (under age 16)                     100%                 100%                         • Cleanings, including scaling and polishing (a)
 • Sealants (permanent molars only) (a)            100%                 100%                                                                                 100%             100%
                                                                                                        Adult/Child
 • Bitewing X-rays (a)                             100%                 100%                         • Fluoride (a) (under age 16)                           100%             100%
 • Full mouth series X-rays (a)                                                                      • Sealants (permanent molars only) (a)                  100%             100%
                                                       100%                    100%
                                                                                                     • Bitewing X-rays (a)                                   100%             100%
 • Space Maintainers                                   100%                    100%                  • Full mouth series X-rays (a)                          100%             100%
Basic                                                                                                • Space Maintainers                                     100%             100%
 • Amalgam (silver) fillings                                                                        Basic
                                                        80%                    80%
                                                                                                     • Root canal therapy Anterior teeth / Bicuspid teeth     80%              80%
 • Composite fillings (anterior teeth only)             80%                    80%
                                                                                                     • Scaling and root planing (a)                           80%              80%
 • Stainless steel crowns                               80%                    80%
                                                                                                     • Gingivectomy*                                          80%              80%
 • Uncomplicated extractions                            80%                    80%
                                                                                                     • Amalgam (silver) fillings                              80%              80%
 • Root canal therapy (Anterior teeth /
                                                        80%                    80%                   • Composite fillings (anterior teeth only)               80%              80%
   Bicuspid teeth)
                                                                                                     • Stainless steel crowns                                 80%              80%
Major
                                                                                                     • Incision and drainage of abscess*                      80%              80%
 • Gingivectomy*                                   Not Covered             Not Covered
                                                                                                     • Uncomplicated extractions                              80%              80%
 • Inlays                                          Not Covered             Not Covered
                                                                                                     • Surgical removal of erupted tooth*                     80%              80%
 • Onlays                                          Not Covered             Not Covered
                                                                                                     • Surgical removal of impacted tooth (soft tissue)*      80%              80%
 • Crowns                                          Not Covered             Not Covered
                                                                                                     • Root canal therapy, molar teeth                        80%              80%
 • Full & partial dentures                         Not Covered             Not Covered
                                                                                                     • Osseous surgery (a)*                                   80%              80%
 • Pontics                                         Not Covered             Not Covered
                                                                                                     • Surgical removal of impacted tooth (partial bony/
 • Root canal therapy, molar teeth                 Not Covered             Not Covered                                                                        80%              80%
                                                                                                        full bony)*
 • Osseous surgery (a)*                            Not Covered             Not Covered
                                                                                                     • General anesthesia/intravenous sedation*               80%              80%
 • Surgical removal of impacted tooth
                                                   Not Covered             Not Covered               • Crown Lengthening                                      80%              80%
   (partial bony/ full bony)*
                                                                                                    Major
 • General anesthesia/intravenous
                                                   Not Covered             Not Covered               • Inlays                                                 60%              60%
   sedation*
                                                                                                     • Onlays                                                 60%              60%
 • Denture repairs                                 Not Covered             Not Covered
 • Crown Lengthening                               Not Covered             Not Covered               • Crowns                                                 60%              60%
 • Crown Build-Ups                                 Not Covered             Not Covered               • Full & partial dentures                                60%              60%
                   Dental Plan I - 2009 Monthly Premiums                                             • Pontics                                                60%              60%
                                                                                                     • Denture repairs                                        60%              60%
FULL TIME (70+ Hrs./Pay Period)
                                                                                                     • Crown Build-Ups                                        60%              60%
   •    Employee                                                $ 11.14
                                                                                                     • Denture repairs                                        60%              60%
   •    Employee +1                                             $ 24.63
                                                                                                     • Crown Lengthening                                      60%              60%
   •    Family                                                  $ 40.98
                                                                                                     • Crown Build-Ups                                        60%              60%
PART TIME (40-69 Hrs. Pay Period)
   •    Employee                                                $ 13.37                                             Dental Plan II - 2009 Monthly Premiums
   •    Employee +1                                             $ 29.56                            FULL TIME (70+ Hrs./Pay Period)
   •    Family                                                  $ 49.18                               •    Employee                                              $ 36.48
PART TIME (32-39 Hrs. Pay Period)                                                                     •    Employee +1                                           $ 46.17
   •    Employee                                                $ 14.85                               •    Family                                                $ 65.96
   •    Employee +1                                             $ 32.84                            PART TIME (40-69 Hrs. Pay Period)
   •    Family                                                  $ 54.64                               •    Employee                                              $ 43.77
                                                                                                      •    Employee +1                                           $ 55.40
                                                                                                      •    Family                                                $ 79.15
                                                                                                   PART TIME (32-39 Hrs. Pay Period)
                                                                                                      •    Employee                                              $ 48.63
     * - Certain services may be covered under the medical plan.                                      •    Employee +1                                           $ 61.56
     **Orthodontia is covered only for children (appliance must be placed prior to age 20)            •    Family                                                $ 87.94
     (a) – Frequency and/or age limitations may apply to these services




                                                                                             13
                      Dental Schedule of Benefits – DMO Plan III                                              Dental Schedule of Benefits – DMO Plan IV
                 Covered Services                                  Benefits Payable                               Covered Services                         Benefits Payable
 Annual Deductible                                                                                 Annual Deductible
   Individual                                                         None                            Individual                                                None
   Family                                                             None                            Family                                                    None
 Preventive Services                                                  100%                         Preventive Services                                          100%
 Basic Services                                                        80%                         Basic Services                                                80%
 Major Services                                                        60%                         Major Services                                                60%
 Annual Benefit Maximum                                               None                         Annual Benefit Maximum                                       None
 Office Visit Co-pay                                                    $0                         Office Visit Co-pay                                            $0
 Orthodontic Services                                              Not Covered                     Orthodontic Services (Adult and Child)                   $2,400 co-pay
                                                              Network      Non-Network             Orthodontic Deductible                                       None
                                                                                                   Orthodontic Lifetime Maximum                                   ***
 Preventive                                                                                       *** 24 months of comprehensive orthodontic treatment plus 24 months of retention
 • Oral examinations (a)                                       100%            Not Covered
 • Cleanings, including scaling and polishing (a)                                                                                                     Network        Non-Network
                                                               100%            Not Covered
    Adult/Child                                                                                    Preventive
 • Fluoride (a) (under age 16)                                 100%            Not Covered
                                                                                                   • Oral examinations (a)                              100%         Not Covered
 • Sealants (permanent molars only) (a)                        100%            Not Covered
                                                                                                   • Cleanings, including scaling and polishing (a)
 • Bitewing X-rays (a)                                         100%            Not Covered                                                              100%         Not Covered
                                                                                                      Adult/Child
 • Full mouth series X-rays (a)                                100%            Not Covered
                                                                                                   • Fluoride (a) (under age 16)                        100%         Not Covered
 • Space Maintainers                                           100%            Not Covered
                                                                                                   • Sealants (permanent molars only) (a)               100%         Not Covered
Basic                                                                                              • Bitewing X-rays (a)                                100%         Not Covered
 • Root canal therapy                                           80%            Not Covered         • Full mouth series X-rays (a)                       100%         Not Covered
 • Anterior teeth / Bicuspid teeth                              80%            Not Covered         • Space Maintainers                                  100%         Not Covered
 • Scaling and root planing (a)                                 80%            Not Covered        Basic
 • Gingivectomy*                                                80%            Not Covered
                                                                                                   • Root canal therapy
 • Amalgam (silver) fillings                                    80%            Not Covered
                                                                                                   • Anterior teeth / Bicuspid teeth                    80%          Not Covered
 • Composite fillings (anterior teeth only)                     80%            Not Covered
                                                                                                   • Scaling and root planing (a)                       80%          Not Covered
 • Stainless steel crowns                                       80%            Not Covered
                                                                                                   • Gingivectomy*                                      80%          Not Covered
 • Incision and drainage of abscess*                            80%            Not Covered
                                                                                                   • Amalgam (silver) fillings                          80%          Not Covered
 • Uncomplicated extractions                                    80%            Not Covered
                                                                                                   • Composite fillings (anterior teeth only)           80%          Not Covered
 • Surgical removal of erupted tooth*                           80%            Not Covered
                                                                                                   • Stainless steel crowns                             80%          Not Covered
 • Surgical removal of impacted tooth (soft tissue)*            80%            Not Covered
                                                                                                   • Incision and drainage of abscess*                  80%          Not Covered
Major                                                                                              • Uncomplicated extractions                          80%          Not Covered
 • Inlays                                                       60%            Not Covered         • Surgical removal of erupted tooth*                 80%          Not Covered
 • Onlays                                                       60%            Not Covered         • Surgical removal of impacted tooth (soft
                                                                                                                                                        80%          Not Covered
 • Crowns                                                       60%            Not Covered           tissue)*
 • Full & partial dentures                                      60%            Not Covered        Major
 • Pontics                                                      60%            Not Covered         • Inlays                                             60%          Not Covered
 • Root canal therapy, molar teeth                              60%            Not Covered         • Onlays                                             60%          Not Covered
 • Osseous surgery (a)*                                         60%            Not Covered         • Crowns                                             60%          Not Covered
 • Surgical removal of impacted tooth (partial bony/                                               • Full & partial dentures                            60%          Not Covered
                                                                60%            Not Covered
   full bony)*                                                                                     • Pontics                                            60%          Not Covered
 • General anesthesia/intravenous sedation*                     60%            Not Covered         • Root canal therapy, molar teeth                    60%          Not Covered
 • Denture repairs                                              60%            Not Covered         • Osseous surgery (a)*                               60%          Not Covered
 • Crown Lengthening                                            60%            Not Covered         • Surgical removal of impacted tooth (partial
 • Crown Build-Ups                                              60%            Not Covered                                                              60%          Not Covered
                                                                                                     bony/ full bony)*
                   Dental Plan III - 2009 Monthly Premiums                                         • General anesthesia/intravenous sedation*           60%          Not Covered
                                                                                                   • Denture repairs                                    60%          Not Covered
BENEFITS ELIGIBLE TEAM MEMBERS (16 Hrs. or more a week)
                                                                                                   • Crown Lengthening                                  60%          Not Covered
   •    Employee                                        $ 16.86
                                                                                                   • Crown Build-Ups                                    60%          Not Covered
   •    Employee +1                                     $ 32.89
   •    Family                                          $ 53.98                                                    Dental Plan IV - 2009 Monthly Premiums
                                                                                                  BENEFITS ELIGIBLE TEAM MEMBERS (16 Hrs. or more a week)
                                                                                                     •    Employee                                     $ 18.12
                                                                                                     •    Employee +1                                  $ 35.33
                                                                                                     •    Family                                       $ 57.98




    * - Certain services may be covered under the medical plan.
    **Orthodontia is covered only for children (appliance must be placed prior to age 20)
    (a) – Frequency and/or age limitations may apply to these services




                                                                                             14
Vision Options                                                                    You will also receive additional discounts on non-covered

Vision coverage helps you pay vision expenses for you and your                                                                   prescription             glasses

family.    Coverage is provided by Humana.              To receive the                                                           (including sunglasses), lens

maximum benefit under the plan you should use a Humana-In                                                                        options       and       designer

Network Provider. To check if a provider is “in-network” visit the                                                               frames from the same VCP

Humana website at www.humanavisioncare.com.                                                                                      doctor within 12 months of
                                                                                                                                 your last eye exam.
Vision – Schedule of Benefits



                                                        Out-of-Network
 Vision Care Services           Network Provider
                                                           Provider                      All Eligible Team Members              Vision Monthly Premiums
Exam/material co-pay                                                                               Employee                             $ 6.58
                                    $10/$15                    N/A
                                                                                                 Employee +1                            $ 13.14
Exam with dilation as                                                                                Family                             $ 19.62
                           100% after co-pay             $35 allowance              To calculate your per pay period deduction multiply the monthly premium by 12,
necessary                                                                                  then divide by the number of pay periods you are paid in a year.
Lenses
• Single vision            100% after co-pay          $25 after co-pay
• Bifocal                  100% after co-pay          $40 after co-pay            Life Insurance Options
• Trifocal                 100% after co-pay          $60 after co-pay

Frames                     $40 wholesale frame        $40 retail allowance        BASIC LIFE INSURANCE AND ACCIDENTAL DEATH AND
                           allowance
                                                                                  DISMEMBERMENT
Contact lenses                                                                    Memorial provides basic life and accidental death and
• Elective (conventional   $110 Contact lens          $110 Contact lens
and disposable)            allowance                  allowance                   dismemberment insurance to all full-time team members. You are
• Medically necessary      100%                       $210 allowance
                                                                                  considered full-time if you have assigned hours of at least 35 per
Frequency (based on
                                                                                  week. This coverage is provided at no cost to you. The amount of
date of service)
• Examination                            Once every 12 months                     coverage you receive is based on your classification (example:
• Lenses or contact                      Once every 12 months
lenses                                                                            executive, manager, non-manager, etc.).
• Frame                                  Once every 24 months

Wholesale frame                                                                   You do not need to elect to have this coverage-it is automatically
                                    $80-$120 approximate retail value
allowance
                                                                                  provided for you. You will, however, need to let us know who your
How does the wholesale frame allowance work?
                                                                                  beneficiary(ies) is by completing the beneficiary information in
Benefits include a wholesale frame allowance. If the wholesale cost
exceeds the frame allowance, members pay twice the wholesale                      PeopleSoft.
difference. They never pay full retail.
                           The contact lens allowance applies to                  For active team members who are age 70 or older, there is a 50%
                           professional services (evaluation and fitting
                           fee) and materials. Members receive a 15%              reduction in the benefit paid to your beneficiary(ies) when you die.
Contact lens allowance
                           discount on professional services. The                 A conversion option is available for individuals who retire or
                           discount for professional services is available
                           for 12 months after the covered eye exam.              terminate employment from Memorial and who submit a Life
                            Lasik and PRK                                         Insurance Conversion Form within 31days of termination.
Members receive substantial reductions when procedures are done by
network providers.
Members can expect to pay no more than $1,800 per eye for conventional                        Human Resources Forms
Lasik procedures and $2,300 per eye for custom Lasik or they can use
                                                                                  All benefit forms are available on the Human Resources “Intranet” site.
designated TLC Vision Lasik Advantage Centers that have the following
fixed prices:                                                                     Under Employee, click Human Resources, and then click on appropriate

• Conventional Lasik                          $895 per eye                        tab.
                                                                                  SUPPLEMENTAL LIFE INSURANCE
• Custom Lasik                                $1,295 per eye
• Custom Lasik with IntraLase                 $1,895 per eye

                                                                             15
Life insurance is an important part of your financial planning and                    Coverage includes:
provides financial security for your family if you die. Memorial                      Spouse                                   $10,000
team members, who have assigned hours of 16 or more per week,                         Children (6 months-19 years)             $10,000
may elect to purchase Supplemental Life Insurance coverage for                        Children (14 days-6 months)              $   100
themselves in $10,000 increments. If you are full-time, you can
                                                                                      Coverage can be extended to age 23 for dependent children who
purchase up to a maximum of $200,000 (or 5 times your pay
                                                                                      are full-time students at an accredited secondary school of
whichever is less) and if you are part-time you can purchase up to
                                                                                      education. The cost is $3.00 per month regardless of the number
a maximum of $100,000 (or 5 times your pay whichever is less). A
                                                                                      of dependents insured. You must maintain a minimum of $20,000
health statement is required for amounts over $50,000 or if
                                                                                      supplemental life insurance to be eligible for dependent life
you are considered a “late enrollment”.
                                                                                      insurance. A health statement is required for each family
                                                                                      member if considered a “late enrollment”.
           Late Enrollment
     If you are enrolling in the life insurance benefit at any time other than        If you wish to add Supplemental and/or Dependent Life Insurance
when you first become eligible for the benefit (ex: upon hire), you are               during Open Enrollment, complete the enrollment process in
considered a “late enrollee” and must complete a health statement.                    PeopleSoft, then click the link that will allow you to print the
Enrollment during open enrollment is considered “late enrollment”.                    necessary forms. Return the completed forms to the Benefits
                                                                                      Department by December 15th, 2009.           Failure to return the
                                                                                      completed Health Statements by the specified deadline will result
Supplemental Life Insurance premiums are based on your age and
                                                                                      in denial of coverage.
the amount of coverage you elect. Coverage is not available for
anyone at or over the age of 70. A conversion option is available
                                                                                      Please remember that this coverage will not be effective until the
for individuals who retire or terminate employment from Memorial
                                                                                      first of the month following underwriting approval.
and who submit a Life Insurance Conversion Form within 31days
of termination.
                                                                                      If you currently have Supplemental and/or Dependent Life
                                                                                      Insurance and are keeping your current coverage level or
                   Supplemental Life Insurance Rates                                  decreasing your coverage you do not need to submit an Evidence
                                       Rate per $1000 in coverage
                  Age                                                                 of Insurability Form. Your coverage will be effective January 1,
                                                per month
           Under age 34                           $ .07
                                                                                      2010.
           Ages 35 – 39                           $ .10
           Ages 40 – 44                           $ .15
           Ages 45 – 49                           $ .25
           Ages 50 – 54                           $ .42
           Ages 55 – 59                           $ .65
           Ages 60 – 64                           $1.00
           Ages 65 – 69                           $1.75
           Ages 70 or older                 Not available
      Rates are subject to change without notice.


DEPENDENT LIFE INSURANCE
Memorial team members who are assigned to 16 hours or more
per week may elect to purchase dependent life insurance for their
spouse and eligible dependent children.




                                                                                 16
Flexible Spending Account Options                                                  When your carry-over balance has been exhausted, your new

A key part of Memorial’s Benefit Program is the Flexible Spending                  2010 balance will be used.

Accounts. By using these accounts, you can reduce the money
                                                                                   A second key IRS rule states that you cannot increase, decrease
you pay out of your pocket for federal and state income and Social
                                                                                   or stop the amount being deducted from each of your paychecks
Security taxes. In fact, money contributed to these accounts is
                                                                                   for either healthcare or dependent daycare flex deductions unless
never taxed.
                                                                                   you have a change in “Family Status Event” and you submit and

You need to carefully and conservatively decide if you want to                     Add/Change Form to the Human Resources/Benefits Department

contribute to these accounts because the Internal Revenue                          within 31 days of the event.

Service (IRS) has designed the rules that govern these plans. To
                                                                                   Keep in mind that your dependents for this plan are those who
help you see the benefit of participating, use Flexible Spending
                                                                                   qualify as your dependents for income tax purposes during the
Account Worksheet, page 19.              This worksheet helps you to
                                                                                   calendar year you participate in the plan. Participation in either
determine any predictable eligible expenses you may have in the
                                                                                   Flexible Spending Accounts does not require you or dependents to
upcoming year.          The minimum amount you can deduct per
                                                                                   be enrolled in Memorial’s medical plans. Therefore, if you or any
paycheck is $5.00 ($130.00 annually).
                                                                                   of your eligible dependents incur out-of-pocket medical expenses,
                                                                                   you may use this plan to reimburse yourself for them.
             Use it or Lose It
         IRS rules state that if you contribute money and don’t use it by a
certain date, you lose it.                                                                  If you currently have a flexible spending account and
                                                                                       you wish to continue this, you must re-enroll in the
                                                                                       benefit each year.
Under the IRS regulations, you now have until March 15th of the
following year to use your flexible spending account contributions.
For example, in 2009 you contributed $1000 to your flexible
                                                                                   HEALTHCARE FLEXIBLE SPENDING ACCOUNT
spending account. Eligible expenses incurred from January 1,
                                                                                   Eligible healthcare expenses are charges you, your spouse, or
2009 through March 15, 2010 can be reimbursement under the
                                                                                   eligible dependents incur during a calendar year* in which you are
flex spending plan. Any remaining funds after March 15 will be
                                                                                   contributing to the spending account. These expenses cannot be
forfeited.
                                                                                   reimbursed by another plan and may not have been incurred
                                                                                   before or after the plan year in which you contributed to the
                                                                                   spending account. HealthCare expenses that qualify as allowable
                                                                                   deductions for federal income tax purposes are eligible.


                                                                                   A good way to budget for the coming year is to record what you
                                                                                   spent during the current year. To help you do that, a worksheet
                                                                                   has been created (page 19). Write down the expenses you paid
                                                                                   so far this year (cannot exceed $4,500). After eliminating any one-
                                                                                   time expenses, such as a major operation, estimate conservatively
                                                                                   what you are going to spend on these expenses next year and add
                                                                                   them together for your annual total.
If you have a remaining flex account balance from 2009 that
carries over to 2010, and you also elect to have a flex account in
2010, your remaining 2009 balance will be used first in 2010.


                                                                              17
When enrolling in the Flexible Spending Plan in PeopleSoft, you                 DEPENDENT DAYCARE SPENDING ACCOUNT
can calculate your per-pay-period contribution by clicking on the               Generally, any dependent daycare expenses you incur, so that
worksheet link and entering your annual contribution. This amount               you and your spouse can work outside the home, are eligible for
will change if you miss being paid by Memorial or if this deduction             the Dependent Daycare Account. These expenses typically qualify
goes into arrears.                                                              for the dependent daycare tax credit on your federal income tax
                                                                                return.
Beginning in 2010, participants will receive a flex debit card to use
to pay for eligible flexible spending expenses at the point of sale.            For expenses incurred out of your home, expenses must be for a
Use of debit card eliminates the need to file reimbursement claims              qualifying dependent under age 13 or for a dependent that
for your eligible expenses. However, you will still need to keep                regularly spends at least eight hours a day in your home (an
your receipts and other documentation for your records in the                   elderly parent, for instance).
event you are audited. If you prefer, you will still have the option of
filing paper claims for reimbursement rather than using the debit               Using the space below, list the amounts you paid this year and
card.                                                                           expect to pay next year:


                                                                                                                          This Year       Next Year
                                                                                 Weekly Expenses
                                                                                 # of weeks                           x               x
                                                                                 TOTAL                                =               =



                                                                                The resulting figure is your annual contribution amount (cannot
                                                                                exceed $5,000). The annual amount will be divided by the number
                                                                                of pay periods in the year to determine the amount to be deducted
                                                                                from each of your Memorial paychecks (minimum $5.00 per
                                                                                paycheck). This amount will change if you miss being paid by
                                                                                Memorial or if this deduction goes into arrears.
Your entire flexible spending account balance is available for use
beginning on January 1, 2010.          The debit card will only be
accepted for qualified flexible spending account purchases. Once
you have exhausted your flex account elections for the year, your
debit card will no longer function for the remainder of the year.




           IRS Guidelines
        IRS guidelines allow reimbursement for expenses incurred through
March 15 of the following year.




                                                                           18
                                                       FLEX SPENDING WORKSHEET

                                                                                                     THIS YEAR                NEXT YEAR
MEDICAL EXPENSES (not covered by the medical insurance plan)

Medical deductible                                                                                  _______________           ______________
Medical co-insurance (including amounts over the usual customary)                                   _______________           ______________
Prescription drugs                                                                                  _______________           ______________
Routine physical examinations                                                                       _______________           ______________
Vaccinations and immunizations                                                                      _______________           ______________
Laboratory fees                                                                                     _______________           ______________
Well-baby care                                                                                      _______________           ______________
Hospital private room charges                                                                       _______________           ______________
X-ray fees                                                                                          _______________           ______________
Experimental surgery (so long as it is a legal operation)                                           _______________           ______________

DENTAL EXPENSES (not covered by the dental plan)

Routine expenses                                                                                    _______________           ______________
Orthodontia expenses                                                                                _______________           ______________
Artificial teeth                                                                                    _______________           ______________

VISION EXPENSES (not covered by the vision plan)

Eye examinations                                                                                    _______________           ______________
Eyeglasses                                                                                          _______________           ______________
Frames                                                                                              _______________           ______________
Lenses                                                                                              _______________           ______________
Contact Lenses                                                                                      _______________           ______________
Contact lens solution                                                                               _______________           ______________

HEARING EXPENSES

Ear examinations                                                                                    _______________           ______________
Special telephone (for a deaf dependent)                                                            _______________           ______________
Hearing aids                                                                                        _______________           ______________

OTHER EXPENSES

Therapy (speech, physical, occupational)                                                            _______________           ______________
Syringes, needles and injections                                                                    _______________           ______________
Physician-directed weight loss                                                                      _______________           ______________
Guide dog                                                                                           _______________           ______________
Halfway house (care for helping an individual adjust from life in a mental
     hospital to community living)                                                                  _______________           ______________
Alcohol or drug dependency payments to treatment centers                                            _______________           ______________
Hypnosis                                                                                            _______________           ______________
Analysis fees (psychotherapy by a licensed practitioner)                                            _______________           ______________
Chiropractic charges (within the scope of license)                                                  _______________           ______________
Acupuncture (performed by licensed practitioner)                                                    _______________           ______________
Learning disability tutoring by licensed school or therapist for a dependent
     with severe learning disability                                                                _______________           ______________
Nursing home confinement for treatment of illness or injury
     (regular nursing home care is not eligible)                                                    _______________           ______________
Wheelchairs or crutches                                                                             _______________           ______________


TOTAL (may not exceed $4,500 annually)                                                              _______________           ______________


Now, divide your total by 26 to get your bi-weekly; 52 to get your weekly; and 12 to get your monthly contribution amounts.




                                                                               19
Pre-paid Legal Services & Identity Theft                                       you are a victim of this type of crime, the benefit will assist you in
Protection                                                                     restoring your identity.

This benefit helps team members and their families in everyday life
legal situations. This benefit will cover the team member and                  You may enroll in this benefit during Open Enrollment. Enrollment

family.                                                                        forms will be available at the Benefits Fair, or by contacting
                                                                               Memorial’s Benefits Counselor.             New Hires should contact
Participants in this benefit will have access to attorneys all over the        Memorial’s Benefit Counselor to enroll.
United States, who will provide immediate assistance, even for
pre-existing matters.                                                          The cost of this benefit is $25.91 per month.




                                                                                            This benefit includes:


                                                                                    ■    A current evaluation of your credit report.
                                                                                    ■    Continuous credit report monitoring, and notice of any unusual
                                                                                         activity.
                                                                                    ■    Identity Restoration Assistance from Licensed Investigators.
                                                                                    ■    Fraud Alert Notifications sent on your behalf to all three credit
                                                                                         repositories, Social Security Administration, Federal Trade
                                                                                         Commission, US Postal Service, and affected credit card
                                                                                         companies and financial institutions.
                                                                                    ■    Access to legal counsel.




                                                                               e-Benefits Enrollment
                                                                               The Benefits Enrollment link in PeopleSoft allows you to review
            Pre-Paid Legal Services offered are                                options and enroll in your benefits. After your initial enrollment, the
                                                                               only time you may change your benefit elections is during
  ■       Preparation for team member and team member’s spouse,
                                                                               Memorial’s annual open enrollment period or a qualified status
          including living wills and power of attorney
                                                                               change.
  ■       Debt Collection Defense
  ■       Document Preparation                                                 1.        From your Peoplesoft Home page, click on Employee
  ■       Civil Litigation Defense                                                       Self Service.
  ■       Important Document Review
                                                                               2.        Under Employee Self Service, click on Benefits link.
  ■       Identity Restoration in the event of Identity Theft
                                                                               3.        From your Benefits Home page, click on Benefits
  ■       Unlimited phone consultations for virtually any legal matter
                                                                                         Enrollment.
                                                                               4.        To begin your enrollment as well as make any changes,
                                                                                         click the Select button.
The Identity Theft Protection benefit is included with the Pre-Paid
                                                                               5.        Instructions are included on the page with a deadline of
Legal benefit. This offers team members protection from the
                                                                                         when the information needs to be completed by. Every
fastest growing crime in the country—Identity Theft. Additionally, if
                                                                                         team member needs to complete enrollment information
                                                                                         on the computer.



                                                                          20
6.              Before Submitting your work, it is important to print a             Frequently Asked Questions and Answers
                copy of your information in case of an error. This will             Q: What is an annual deductible?
                serve as your confirmation statement. Please keep                   A: The annual deductible is the amount of covered charges which must be
                this statement for your records.              Compare your          paid by the participant in a calendar year before benefits can be paid by

                confirmation statement with the benefit information listed          the plan. Each year, a person covered by the plan must “meet” (or pay)

                on your first paycheck in 2010.            If you notice any        the covered charges up to the amount of their annual deductible listed in
                                                                                    the schedule of benefits. Once the deductible has been paid by the
                discrepancies, please       contact Memorial’s       Benefit
                                                                                    participant, the plan will begin to pay benefits as described in the schedule
                Counselor immediately. A link is provided on the page to
                                                                                    of benefits. Each person only pays the deductible once per calendar year.
                print your elections.
                                                                                    Office-visit co-pays and prescription drug co-pays do not count towards
7.              An Enrollment Summary is listed on the page. It is here             the annual deductible amount.
                that you can Edit any information for which you qualify.
                                                                                    Q: What does the annual out of pocket maximum mean?
                To begin this process, click the Edit button.
                                                                                    A: Out of pocket expenses are also referred to as “co-insurance”; and

If you do not wish to return to                                                     refer to the amount (after the deductible) of the covered charges that the
                                                                                    participant must pay. Each calendar year, covered charges are paid by
the Enrollment Summary to
                                                                                    the plan at the percentage shown in the schedule of benefits. The
correct any choices, click
                                                                                    participant is responsible for paying the remaining balance of these
Continue and Submit your
                                                                                    covered charges. (This amount would be the participant’s co-insurance
benefit choices. You will                                                           amount.) Once the participant has paid co-insurance up to the out of
receive              a        Submit                                                pocket maximum listed in the schedule of benefits the plan will pay the
Confirmation screen, click                                                          covered charges at 100% for the remainder of the calendar year, and the
OK.                                                                                 participant will no longer be responsible for a co-insurance amount. Office-
                                                                                    visit co-pays and prescription drug co-pays do not count towards the
                                                                                    annual out of pocket maximum. The out of pocket amount paid by a
                                                                                    participant starts over again at $0.00 each January 1.
Exiting PeopleSoft
         1.          To exit PeopleSoft, click on the Sign Out link                 Q: How are benefits handled for a pre-existing condition?
                     located on the top right side of the PeopleSoft                A: A pre-existing condition is an injury or sickness for which a person
                     window.                                                        receives treatment, incurs expenses or receives a diagnosis from a
                                                                                    physician during the 90 days immediately preceding the effective date of
PeopleSoft Tips to Remember                                                         coverage under Memorial’s plan. Limited benefits will be paid for pre-
     ■        Do not use your Back button on your Tool bar. Your data               existing conditions during the first 12 months of coverage. The 12 month
              will not be saved when you use the Back button. If you                period will be reduced for new enrollees by the number of documented

              need to go back to a previous page, use the Previous                  days of credited healthcare coverage that an individual had under another

              button or use the links located on the bottom of your page.           plan prior to their enrollment. To receive this credit, you must send a copy
                                                                                    of the “Certificate of Creditable Coverage” to Meritain Health.
     ■        When PeopleSoft is saving your information, you will see
              flashing in the right side of your screen.                            Q: How does Coordination of Benefits (C.O.B.) work?
     ■        Fields that have an * next to them are required.                      A: Coordination of Benefits establishes rules for the order of payment of
                                                                                    Covered Charges when two or more plans – including Medicare – are
                                                                                    paying. When a Covered Person is covered by this Plan and another
                Need More Help Accessing e-benefits in PeopleSoft?                  plan, or the Covered Person’s Spouse is covered by this Plan and by
                                                                                    another plan or; the couple’s Covered Children are covered under two or
Contact Memorial’s Help Desk at 574-647-7254
                                                                                    more plans, the plans will coordinate benefits when a claim is received.




                                                                               21
The plan that pays first according to the rules will pay as if there were no         Q: What does “Non-Network” provider or the term “Out-of-Network”
other plan involved. When this Plan is secondary, the Plan will pay up to            refer to?
its normal Plan benefits. The total reimbursement will never be more than            A: Non-Network or Out-of-Network means any services by providers who
the maximum payable by the Plan. The plan will deduct any benefits                   do not participate in the Network of Providers. Typically allowable Out-of-
payable by the primary carrier and pay the balance of charges up to what             Network services are paid at 60% (after deductible) instead of 80% (after
the Plan would normally pay. The balance due, if any, is the responsibility          deductible) for allowable services provided by In-Network providers.
of the Covered Person.
                                                                                     Q: How are out-of-network services defined?
An example would be: Barb is the spouse of a Memorial team member.                   A: Out-of-Network applies to all physicians, facilities and providers who
She is covered under Memorial’s Plan as secondary and under her                      are not part of the Provider Networks. Remember, Memorial’s plans allow
employer’s Plan as primary. The allowable charge is $100.00 and Barb                 you to choose each time you need care whether that care is received from
used an in-network provider. Assuming Barb has met her deductible for                an in-network provider or not. The difference is that the cost to you is
the year, her employer’s Plan would pay $80.00 and Memorial’s Plan                   lower, and the coverage levels are higher if you use a network provider.
would pay the remaining $20.00
                                                                                     Q: Which providers are “In-Network”?
Q: Can you apply for medical, dental, vision and life insurance at                   A: To determine if your provider is in-network or to inquire about other in-
any time during the year?                                                            network     providers,   you   should    visit   the   CHA     website     at
A: No. Only within 31 days of first becoming eligible for benefits, during           www.chanetwork.com for a Medical provider or the Aetna website at
open-enrollment, or in some instances within 31 days of a change in                  www.aetnadental.com for a dental provider. You decide each time you
family status (i.e., marriage/divorce, gain/loss of coverage, etc.). Refer to        need services whether to use an In-Network provider.
Memorial’s Summary Plan Description for details concerning a change in
                                                                                     Q: Why is it beneficial to use an In-Network Provider?
family status.   Contact your Benefit Counselor immediately when a
                                                                                     A: The benefits of using a network provider are: 1) Your cost will be
change in family status occurs.
                                                                                     lower because the carriers have negotiated rates that are significantly
Q: Are prescription drugs covered under the plan?                                    lower than regularly billed charges; 2) The Network Provider will file your
A: Yes, when you enroll in a medical plan option. Team members can go                claims for you; 3) The Network Provider will only bill your deductibles and
to Memorial’s Family Pharmacy or any participating pharmacy to get their             co-insurance, not the full amount of the charges or any amount above
prescriptions filled. With Memorial’s prescription plan, your co-payments            “reasonable and customary” 4) Your coverage under the plan is higher if
will be based on a three-tiered plan. Refer to the Medical Options in this           you use a Network Provider [Generally 80% co-insurance (after
Enrollment Guide for more information.                                               deductible) compared to 60% co-insurance (after deductible) if you do not
                                                                                     use an in-network provider].
Q: What is meant by “reasonable and customary”?
A: A medical fee is considered “reasonable and customary” (RTC) when                 Q: How do I file a claim?
it is in the normal range of amounts charged for that type of treatment or           A: If you use an In-Network provider, the provider will file the claim for
service in your part of the country. For example, if the normal amount               you. If you choose to use an Out-of-network provider you must ask your
charged by doctors in your area is $50 but your doctor charges $60, the              provider to send your claim to the carrier at the address on back of your
plan will consider only $50 for payment and you will be responsible for the          I.D. card for payment consideration. The carrier will consider all allowable
balance of $10 (RTC charges are waived as long as you use an in-                     claims for payment according to Memorial’s Plan. In either case, a
network provider).                                                                   monthly claims summary statement will be sent to your home that explains
                                                                                     how the bill was paid. If you have questions once you receive your
Q: What does PPO mean?
                                                                                     summary statement, contact the carrier directly.
A: PPO means Preferred Provider Organization. A PPO provider is one
who has agreed to charge you a discounted price. Memorial’s plans are                Q: How do I file a claim under the HealthCare Spending Account?
all PPO Plans, which use the Community Health Alliance (CHA) network                 A: Meritain Health pays claims for Memorial’s flexible spending accounts.
of providers for the Medical Plans, and Aetna providers for the Dental               There are two ways to file your HealthCare Flexible Spending Account
Plans.                                                                               claims:




                                                                                22
Meritain Health processes all Memorial medical and dental claims. After              NOTES:
processing your claim under the respective medical plan, Meritain Health
will automatically apply the portion of the bill that you are responsible for        ______________________________________________________
(such as deductibles, co-insurance amounts) toward your HealthCare
Spending Account and will mail the check to your home address.
                                                                                     ______________________________________________________
If you do not want Meritain Health to automatically reimburse from your
HealthCare Flexible Spending Account, you will need to complete a form               ______________________________________________________
obtained from the Human Resources website or contact Memorial’s
Benefit Counselor. Once this form is on file with Meritain Health, you will          ______________________________________________________
need to submit a “Flexible Spending Reimbursement” Form to Meritain
Health for each reimbursement you are requesting.           Reimbursement
                                                                                     ______________________________________________________
Forms are available from your Benefit Services Counselor or under the
“Forms” section of the Human Resources Intranet Web site.
                                                                                     ______________________________________________________
Please    remember,     you   must    complete     a   “Flexible   Spending
Reimbursement” Form and attach your itemized paid receipt for all dental
                                                                                     ______________________________________________________
prescriptions and vision claims. Automatic reimbursement is not possible
for these types of services. Send this completed form directly to Meritain
                                                                                     ______________________________________________________
Health.

Q: How do I file a claim under the Dependent Daycare Spending                        ______________________________________________________
Account?
A:   You need to complete the “Flexible Spending Reimbursement
                                                                                     ______________________________________________________
Request” form, attach your itemized paid receipt(s) and return all materials
directly to Meritain Health for processing.       The “Flexible Spending
                                                                                     ______________________________________________________
Reimbursement” form can be obtained from your Benefits Counselor or
under the “Forms” section of the Human Resources Intranet Web site.
                                                                                     ______________________________________________________
NOTE:     Remember that, under this account, you can only receive
payments for claims up to the balance in this account at the time the                ______________________________________________________
request is made.

Q:   If both my spouse and I work for Memorial, can we carry                         ______________________________________________________
insurance on one another?
A: No. You cannot be simultaneously covered under medical, dental                    ______________________________________________________
and/or vision both as a team member and as a dependent. Additionally,
you cannot have Dependent Life Insurance coverage on one another.                    ______________________________________________________


                                                                                     ______________________________________________________




                                                                                23
Important Numbers You Should Know


Health Insurance                                Medical Pre-Certification                        Rewards for Savings
For questions regarding Memorial’s Medical      To pre-certify your medical procedure you will   Have questions on your different investment
insurance plans call Meritain Health directly   need to call Community Health Alliance           options call Diversified Investment
at (866)841-0852 or visit their website         (CHA) directly at (574)647-1824 or toll free     Advisors at their toll free customer service
www.meritain.com.                               (800)301-1824.                                   phone line (800)755-5801 or visit their
                                                                                                 website www.divinvest.com.

Dental Insurance                                Medical Network Providers                        To talk one-on-one with a representative who
For questions regarding Memorial’s Dental       To inquire about an In-Network Medical           is located in the hospital call (574)647-1026;
insurance plans call Aetna Dental directly at   Provider in IN or MI you can call (574)284-      or to talk with an HR Representative
(800)255-8464 or visit their website            1820 or visit the Community Health               regarding your plans for retirement call
www.aetna.com.                                  Alliance          (CHA)     website      at      (574)647-6509              or           e-mail
                                                www.chanetwork.com. If you just have             dgillispie@memorialsb.org .
                                                general questions please call (574)647-1820
                                                or toll free (888)689-2242.

Flexible Spending Accounts                      Dental Network Providers                         National Bond & Trust
For questions regarding either of Memorials     To inquire about an In-Network Dental            Questions concerning the purchase of US
Medical or Dependent Flexible Spending          Provider in IN or MI you can call (800)255-      Savings Bonds through payroll deduction can
Accounts call Meritain Health directly at       8464 or visit the Aetna Dental website at        be directed to (800)426-9314.
(800)748-0003 x-2235 or visit their website     www.aetna.com.
www.meritain.com.
                                                                                                 Health Management Program
Prescription                                    MMG Providers                                    For general questions on Memorial’s Health
To inquire about pharmacy benefits call                                                          Management Program call the customer
                                                To inquire about an MMG Provider, visit          service line at (866)537-5445. To create an
Envision Rx directly at (800)361-4542, or to    Memorial’s Intranet site under Employee tab
find the Tier level of your medication visit                                                     HRA Account visit www.mymeritain.com. If
                                                click Human Resources, then click MMG
their website www.envisionrx.com                                                                 you need help creating your account you can
                                                Providers.                                       call (800)828-6922.



Vision                                          Pre-Paid Legal Services                          Memorial’s Benefit Options
To inquire about vision benefits or to find a   Employees with questions regarding Pre-          Other benefit related questions can be
vision care provider, simply call Humana at     Paid Legal Services can call the toll free       directed to Memorial’s Benefit Counselor at
the toll free number (866)537-0229 or visit     number (866)220-7757.    For enrollment          (574)647-6509       or     e-mailed      to
their website www.humanavisioncare.com.         information, contact Memorial’s Benefit          dgillispie@memorialsb.org.
                                                Counselor.

				
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