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Including Additional Benefits 2016 ENROLLMENT GUIDE

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Including Additional Benefits 2016 ENROLLMENT GUIDE MESSAGE FROM DEBRA PLOUSHA MOORE Teammates, Carolinas HealthCare System 2016 Benefits Open Enrollment is from Monday, October 26, through Tuesday, November
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Including Additional Benefits 2016 ENROLLMENT GUIDE MESSAGE FROM DEBRA PLOUSHA MOORE Teammates, Carolinas HealthCare System 2016 Benefits Open Enrollment is from Monday, October 26, through Tuesday, November 10, Open Enrollment is an important time for you to actively enroll in the 2016 CHS LiveWELL Health Plan. Even if you plan to elect the same level of coverage you had in 2015, whether teammate-only or family, you must make elections during Open Enrollment for your 2016 benefits. We are offering one 2016 CHS LiveWELL Health Plan with a Health Savings Account (HSA). To support you, as a consumer on a consumer-directed health plan, we are providing additional resources and tools A dedicated CHS LiveWELL Health Plan helpline to assist with any questions you may have about the 2016 CHS LiveWell Health Plan during Open Enrollment created just for CHS teammates A new and better HSA vendor Bank of America An online healthcare services and pharmacy CHS Cost Estimator Tool to help you make more educated decisions about your health care Many of you have requested assistance with the math as it relates to making decisions about health and retirement. We heard you and have enclosed a custom CHS Health and Retirement Slide Calculator Tool to help you consider good/better/best options when making your decisions about your HSA and 401(k). Please take a few minutes to read the instructions on the card and consider a variety of choices related to your savings. Our new Your Health and Retirement at CHS website includes many resources to educate and inform you as a consumer. If you have additional questions, contact Benefits Administration, Workforce Relations, or our new dedicated CHS LiveWELL Health Plan Helpline at Please know, while it is important for you to enroll in your benefits now, your attention to Your Health and Retirement at CHS should be ongoing. I want you to be engaged in your physical and financial health, so you enjoy the healthy, successful career and retirement you deserve. In good health, DEBRA PLOUSHA MOORE In addition to information about the 2016 CHS LiveWELL Health Plan, this Guide provides you with a comprehensive list of Additional Benefits options, such as dental, vision, short- and long-term disability, dependent care and identity theft protection. Debra Plousha Moore Chief Human Resources Officer Executive Vice President TABLE OF CONTENTS TABLE OF CONTENTS 1. ENROLLMENT CHECKLIST / NEW IN YOUR ROLE AS A HEALTHCARE CONSUMER CHS LIVEWELL HEALTH PLAN AND HEALTH SAVINGS ACCOUNT 4. ADDITIONAL SAVINGS ACCOUNT OPTIONS 5. PRESCRIPTION DRUG BENEFITS 6. DENTAL AND VISION BENEFITS 7. Supplemental Coverage Income Protection Benefits Life Benefits 8. PREVENTION AND CHS LIVEWELL 9. RETIREMENT PLANNING 10. TOOLS, RESOURCES AND CONTACT INFORMATION ADDITIONAL BENEFITS OPTIONS NEED HELP ENROLLING IN YOUR BENEFITS? Refer to the inside back cover of this Enrollment Guide for instructions. 3 1. ENROLLMENT CHECKLIST / NEW IN 2016 ENROLLMENT CHECKLIST o Review all information in this Guide o Review new CHS LiveWELL Health Plan offerings for 2016 o Consider lifestyle changes and how much you will contribute to your Health Savings Account (HSA) o Consider additional benefits you may want to purchase o Enroll in coverage by the deadline: November 10, 2015, or 31 days of eligibility Health Plan Dental / Vision Additional Benefits o Review retirement plan contribution rates and investment elections NEED HELP ENROLLING IN YOUR BENEFITS? Refer to the inside back cover of this Enrollment Guide for instructions. NEW BENEFIT CHANGES FOR 2016 o The 2016 CHS LiveWELL Health Plan is a consumer-directed health plan with a Health Savings Account (HSA) for all eligible teammates o CHS will contribute initial dollars as well as matching dollars to help you save toward your annual deductible o Maximum annual HSA contribution for family coverage has increased o Bank of America is our new and improved HSA and Flexible Savings Account (FSA) vendor o The prescription drug list for preventive medications has been expanded o Teammates may choose any pharmacy to fill their medications until meeting their deductible o Veterinary Pet Insurance is a new offering for 2016 o Hospital Admission Insurance is a new offering for 2016 YOUR HEALTH AND RETIREMENT AT CHS CONSISTS OF MANY OPPORTUNITIES FOR YOU TO PLAN, PARTNER AND PARTICIPATE FOR A HEALTHY PHYSICAL AND FINANCIAL FUTURE: CHS LiveWELL HEALTH PLAN HEALTH AND RETIREMENT SAVINGS ACCOUNT (HSA) DENTAL AND VISION BENEFITS PRESCRIPTION DRUG BENEFITS ADDITIONAL BENEFIT OPTIONS PREVENTION AND CHS LIVEWELL 401(K) AND ADVANTAGE RETIREMENT SAVINGS PLAN NEW HEALTHCARE SERVICES AND PHARMACY-CHS COST ESTIMATOR TOOL o In 2016, CHS will provide an online CHS Cost Estimator Tool that will give all CHS LiveWELL Health Plan members the ability to compare the price and quality of both medical and prescription needs. This will help you be more motivated and prepared when making decisions regarding a medical service or prescription need. o To support you in making a decision regarding medical services or prescription needs, it is helpful to know your current Health Savings Account (HSA) balance and how much you have paid toward your deductible. The CHS Cost Estimator Tool will provide a centralized location for you to view your HSA balance and how much you have paid toward your deductible. ANSWER THE FOLLOWING QUESTIONS AS YOU EVALUATE YOUR ELECTIONS FOR 2016: o Consider your family s actual use of benefits in the prior year. Did you meet your deductible? o Are you contributing the right amount in your HSA and/or Limited Purpose FSA? o Are you taking advantage of all CHS LiveWELL Incentives? o Will your family or health needs change in 2016? Will your eligible dependents increase or decrease? Will you be expecting a baby? Are you anticipating surgery? o Did you meet the plan s out-of-pocket maximum? Keep in mind the health plan has an out-of-pocket maximum. This limits your financial spend, because once you meet the deductible and the maximum, the health plan pays 100%. o Are you making the most of your coverage? Did you receive a routine exam and preventive screenings? o Are you using generic medications and prescription home mail service whenever possible? ENROLLMENT CHECKLIST / NEW IN 2. YOUR ROLE AS A HEALTHCARE CONSUMER We all play a role in our healthcare costs. Being an active healthcare consumer means knowing the cost of your care and making informed decisions. There are many tools and resources available to help you achieve this, such as: CHS On-Site Care CHS Virtual Visit Nurse Advice Line CHS Back Pain Clinic Teammate Injury Helpline Employee Assistance Program (EAP) Online enrollment support and education tools Financial Health support including budgeting and retirement planning sessions To ensure you are getting the appropriate care for your planned and unexpected healthcare needs, it is important to be aware of the services that provide various levels of care and the cost associated with each of these options. FIND A PHYSICIAN: or carolinashealthcare.org/physician-directory If you are in search of a Primary Care Physician, we have many resources to assist you! Based upon your preferences related to location, gender, specialty and language, CHS can help you find a Primary Care Physician to address your healthcare needs. 24-HOUR NURSE ADVICE LINE: Call anytime night or day 24 hours a day, 7 days a week to talk with a caring, experienced registered nurse. This provides you with an easy way to receive trusted health information and advice from the comfort of your home. The Nurse Advice Line can help: Decide when self-care, a doctor visit or the emergency room is the right choice Check your symptoms and determine next steps of care Understand a medical condition or recent diagnosis Obtain medical information Prepare questions for doctor visits Find out more about prescriptions or over-the-counter medicines HOW TO ENROLL To enroll, follow the steps in the inside back cover, or call and speak with a benefits counselor to find out more about your options. Speak with a benefits counselor by calling: Monday Friday, 8 a.m. 8 p.m. Remember, a benefits counselor can answer your questions and help you select the benefits that make the most sense for you and your family. Before you call, be prepared with the names, social security numbers and birth dates of your eligible dependents, as this information may be required. CHS VIRTUAL VISIT: carolinashealthcare.org/virtualvisit CHS Virtual Visit gives teammates access to a Carolinas HealthCare System medical provider 24 hours a day, 7 days a week via camera-enabled tablet, smart phone or computer. CHS Virtual Visit addresses a range of issues including: Seasonal allergies Skin conditions Cold, cough, bronchitis and flu Lower back pain Sinus and upper respiratory infections Urinary tract infections Conjunctivitis/pink eye Enrollment is required before receiving treatment, which only takes a few minutes. It is recommended that members enroll before treatment is needed at carolinashealthcare.org/virtualvisit. Initial enrollment should be completed using a desktop computer. Additional support is available at or CHS VIRTUAL VISIT COSTS Before Deductible $35 After Deductible $5 CHS ON-SITE CARE: or peopleconnect.carolinas.org/chs-on-site-care When you are at work and health symptoms arise, CHS has multiple On-Site Care locations available for convenient, reliable and cost-effective care. Visit CHS On-Site Care for: Cold and flu symptoms Ear and sinus infections Seasonal allergies Minor injuries and illnesses (including occupational injuries) CHS LiveWELL Know Your Numbers screenings and lab results review Healthy Weight Reward weigh-ins Prediabetes A1c screenings YOUR ROLE AS A HEALTHCARE CONSUMER ON-SITE CARE COSTS: TIER 1 TIER 2 TIER 3 Before Deductible $40 $70 $120 After Deductible $10 $10 $10 For those enrolled in the 2016 CHS LiveWELL Health Plan, teammate pricing for CHS On-Site Care and CHS Virtual Visit is lower than in previous years. 7 2. YOUR ROLE AS A HEALTHCARE CONSUMER CHS URGENT CARE: carolinashealthcare.org/urgent-care Facilities are located in North and South Carolina and are equipped to treat minor illnesses and injuries such as: Fever Occupational medicine Sinus infections and allergies Ear and eye infections Cold or flu symptoms Cough Minor cuts, burns or skin rashes Sore throat Animal / insect bites Headache Sprains and minor bone fractures Minor injuries School, sports, camp and work physicals EMERGENCY DEPARTMENT In the event of an emergency, call 911. If appropriate, consider accessing the CHS Emergency Department for help with the following: Chest pain Problems related to pregnancy Stroke Severe burns Poisoning - local Poison Control Center: Difficulty breathing Severe allergic reaction Loss of consciousness Serious trauma or injury Seizures Deep cuts or bleeding that won t stop Abdominal pain Large bone fractures NEED HELP ENROLLING IN YOUR BENEFITS? Refer to the inside back cover of this Enrollment Guide for instructions. YOUR ROLE AS A HEALTHCARE CONSUMER 9 CHS LIVEWELL HEALTH PLAN AND HEALTH SAVINGS ACCOUNT TEAMMATE & DEPENDENT ELIGIBILITY AND VERIFICATION ELIGIBLE DEPENDENTS INCLUDE YOUR: Spouse Children up to age 26 Unmarried children of any age who are incapable of self-support due to a mental or physical disability, which began prior to age 26, and who are primarily dependent upon you (contact MedCost at for required disability certification forms) DEPENDENT VERIFICATION Documentation is required to verify eligibility of all dependents being enrolled in the medical, dental and vision plans. It is considered fraudulent to cover non-eligible individuals on your plans. A request to verify new dependents will be mailed to homes from Dependent Verification Services. To qualify as an eligible dependent for a Health Savings Account (HSA) or Flexible Spending Account (FSA), dependents must be claimed as a dependent on your tax return MAKING CHANGES TO YOUR BENEFITS You can make changes to your benefit elections upon new eligibility, when you have a qualifying event or during Open Enrollment. A QUALIFYING EVENT INCLUDES: Marriage, annulment, divorce or death of a spouse Birth, adoption or death of a child Recognition of marriage Employment change for you, your spouse or a dependent child that results in a loss or gain of healthcare coverage or other loss of health plan coverage Child loss of eligibility Enrollment or removal from daycare, which allows changes to your Dependent Care Flexible Spending Account (for eligible child and adult care) If you experience a qualifying event during the year, be sure to go to peopleconnect.carolinas.org/submit-key-life-events or contact Benefits Administration at or within 31 days of the change. You may make changes online at YourHRLink for marriage, divorce, birth and adoption. All other events require a paper form please contact Benefits Administration. The benefits changes you make must be consistent with your qualifying event. WORKING SPOUSE RATE FOR 2016 If your covered spouse is eligible for medical coverage through his/her employer (not applicable if your spouse works for Carolinas HealthCare System), but you choose to enroll him/her in the CHS LiveWELL Health Plan, you must choose either the Teammate + Working Spouse or Teammate + Working Spouse + Child(ren) coverage options. The rates for these options are higher, in order to offset the increased cost of covering spouses who have access to other coverage. Before you enroll in healthcare benefits for 2016, be sure to review all of your coverage options in the CHS LiveWELL Health Plan, as well as the coverage your spouse has access to through his/her employer. NON-SMOKER/NON-TOBACCO USER CERTIFICATION By choosing the non-smoker/non-tobacco user coverage option, you certify that neither you nor your covered dependents smoke or use tobacco products, or you are currently enrolled in a tobacco cessation program. If it is unreasonably difficult due to a medical condition, or if it is medically inadvisable, for you or anyone you cover to stop tobacco usage, please contact Benefits Administration at or for assistance in developing another way to receive the non-smoker/non-tobacco user health plan rate. SMOKER/TOBACCO USER PREMIUM SURCHARGE The smoker/tobacco user health plan premium surcharge encourages you to make healthy decisions regarding tobacco use. This premium rate increase impacts tobacco users (teammates and any covered dependents.) RESOURCES FOR SMOKERS/TOBACCO USERS Through CHS LiveWELL, you have access to resources and support that are designed to help you kick the tobacco habit for good. You also have access to prescription drug coverage through the CHS LiveWELL Health Plan to help you quit. If it is determined that you are not paying the appropriate health plan premium, you will be required to retroactively pay the smoker/tobacco user premium surcharge or the working spouse premium. Further disciplinary action may be taken as well CHS LIVEWELL HEALTH PLAN AND HEALTH SAVINGS ACCOUNT 11 CHS LIVEWELL HEALTH PLAN AND HEALTH SAVINGS ACCOUNT BI-WEEKLY MEDICAL PREMIUMS FULL-TIME TEAMMATE FULL-TIME TEAMMATE Earning $30K PART-TIME TEAMMATE Non-tobacco Tobacco Non-tobacco Tobacco Non-tobacco Tobacco Teammate Only $19.67 $22.62 $9.52 $12.47 $27.78 $31.95 Teammate + Spouse $ $ $ $ $ $ Teammate + Working Spouse $ $ $ $ $ $ Teammate + Children $ $ $ $ $ $ Teammate + Spouse, Children $ $ $ $ $ $ Teammate + Working Spouse, Children $ $ $ $ $ $ Deducted 26 times per calendar year (Note: Monthly teammates multiply premium by 26 and divide by 12, or see monthly rate schedule on healthandretirement.carolinashealthcare.org) TEAMMATE ONLY EXPERIENCE FULL-TIME A full-time teammate works in a role classified with standard hours per week PART-TIME A part-time teammate works in a role classified with standard hours per week Preventive Care is covered at 100% FAMILY EXPERIENCE Preventive Care is covered at 100% Your Health Savings Account (HSA) is the key you can build savings It will be important for you to save in the HSA, by putting in the difference between your 2016 premium and what you pay in premiums on a PPO Plan (such as Choice 20) Dollars in your HSA are not taxed when you put them in or take them out for healthcare expenses Based on your selections and annual earnings, CHS will put dollars in your HSA and will match a certain amount of the dollars you put in your HSA Anything you earn for your CHS LiveWELL Incentive will go in your HSA Teammates may contribute to an HSA pretax until they enroll in Medicare. For help in understanding how Medicare and your healthcare costs fit into your retirement goals, call the Bank of America helpline for CHS teammates at or N.C. Seniors Health Insurance Information Program at (or a similar program if you live in another state.) PREVENTIVE CARE The CHS LiveWELL Health Plan covers preventive care at 100% Taking part in regular preventive care is one of the best ways to stay healthy. It is also a great way to catch problems early, when they are most treatable Typically categorized as preventive and covered at 100% are: mammograms, PAP smears, colonoscopies, immunizations and wellness office visits (associated with routine office visits) Although Preventive Care is covered at 100%, if a condition is detected, additional tests are needed, or the visit becomes diagnostic, a charge will occur and a bill will be sent to you 2016 CHS LIVEWELL HEALTH PLAN AND HEALTH SAVINGS ACCOUNT 13 CHS LIVEWELL HEALTH PLAN AND HEALTH SAVINGS ACCOUNT DEDUCTIBLES Deductibles are the amount you owe for covered healthcare services before the CHS LiveWELL Health Plan begins to pay. For teammates on teammate only coverage, the deductible is $1,850. The CHS LiveWELL Health Plan will not pay until the deductible is met. The deductible may not apply to all services. CHS Provider Network Provider Out of Network Teammate Only $1,850 $2,600 $4,000 Family Plans $3,700 $5,200 $8,000 CHS On-Site Care: $40 - $120 per visit before deductible is met Virtual Visits: $35 per visit before deductible is met CO-INSURANCE Co-insurance is your share of the costs of a covered healthcare service after your deductible is met. After the deductible is met, you share the cost with CHS. Below is the chart with the percentage you pay. The CHS LiveWELL Health Plan will pay 70-75% of your healthcare expenses and you will pay 25-30%, if you use a CHS provider. CHS Provider Network Provider Out of Network PCP Office Visit 25% 30% 50% Specialist Visit 25% 30% 50% MRI, CT & PET Scans 25% 30% 50% Urgent Care & ER Visits 25% 25% 50% In/Out Patient - Physician 25% 30% 50% In/Out Patient - Facility 30% 40% 50% CHS On-Site Care: $10 per visit after deductible is met Virtual Visits: $5 per visit after deductible is met Infertility Treatment (covered only at Carolinas HealthCare System Reproductive Medicine and Infertility) is covered at 100% after deductible with a $25,000 lifetime maximum OUT-OF-POCKET MAXIMUM Out-of-pocket maximum is the maximum amount you pay annually before the CHS LiveWELL Health Plan pays 100% for covered healthcare services. This maximum amount includes deductibles, co-insurance, copayments, pharmacy or similar charges for qualified expenses. This limit does not include premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits. CHS Provider Network Provider Out of Network Teammate Only $5,600 $6,450 $11,000 Family Plans $11,200 $12,900 $22,000 Please note: There is no yearly or lifetime benefit maximum for your health coverage. In addition, there are no pre-existing condition limitations WHAT IS A HEALTH SAVINGS ACCOUNT? A Health Savings Account (HSA) is an account that includes contributions from both you and Carolinas HealthCare System. You use funds from your HSA to pay for your eligible
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