2016 BENEFITS GUIDE - Alight · 2020-06-30 · If you (and/or your dependents) have Medicare or...

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription coverage. Please see page 22 for more details.

2016

BENEFITS GUIDEPLAN YEAR JANUARY 1 - DECEMBER 31, 2016

For more information, visit http://upointhr.com/thenetworkbenefits or call 1-877-248-8518

ABOUT THIS GUIDEThis Benefits Enrollment Guide (Guide) is a reference tool that contains a basic overview of the benefit plans offered to employees and physicians working at practices that are affiliated with The US Oncology Network or The US Rheumatology Network.

This Guide is NOT intended as a contract between you and McKesson Specialty Health or the practices of The US Oncology Network and/or The US Rheumatology Network. The Summary Plan Descriptions (SPDs) and contracts are the legal documents controlling eligibility and benefits under the plans. In the event of any conflict, the legal documents shall be binding and final. Please refer to the applicable SPD under the Benefits Online portlet of My Oncology Workspace for details regarding plan eligibility and provisions.

Physicians and employees working at practices affiliated with The US Oncology Network and The US Rheumatology Network have access to a robust and comprehensive benefits package with multiple options that allow participants to create the overall coverage packet that affords them the benefits that suit their budget and lifestyle. With three medical options, two dental options, two vision options and a variety of voluntary benefits, you have the ability to select the options that provide basic coverage at a cost-effective rate or more comprehensive coverage at a higher rate.

This Guide contains the following information:

Page 3 ............................2016 BENEFIT PLAN CHANGES

Page 4 ........................... YOUR 2016 ENROLLMENT CHECKLIST

Page 5 ............................ UNDERSTANDING ELIGIBILITY: Basic information on benefits and reimbursement accounts eligibility

Page 6 ...........................WHO IS AN ELIGIBLE DEPENDENT?

Page 7 ............................ QUALIFYING EVENTS: Overview of events that may allow you to make benefit changes during the year

Page 8 ........................... MAKING THE MOST OF YOUR CHOICES: Choosing the options that best fit your budget and lifestyle

Page 9 ...........................PREVENTIVE PROCEDURES COVERED AT 100%

Page 9 ........................ BENEFITS AT A GLANCE: Side-by-side comparisons of your 2016 options

Page 22 ..........................REQUIRED NOTICES

Back Cover ....................CONTACT INFORMATION

Please note: After your enrollment period ends, you will not be able to make any changes to your benefit elections until the next annual enrollment period unless you experience a qualifying event, whichever comes first. See the Section entiled “Qualifying Events” on page 5.


2016 Benefit Plan Changes: What’s NewPlease review the information about the benefits available before logging in or calling the Benefits Service Center to elect coverage.

• As a result of low participation and the overall cost of the PPO II program when compared to the value to plan participants, the PPO II plan will not be offered to physicians and employees in 2016.

• We’ve added a fourth tier of coverage for specialty prescription drugs to more equitably distribute the costs of those drugs, and we’ve capped the maximum copay per prescription at $100.

• We are pleased to announce that, effective January 1, 2016, Fidelity will administer and manage the Health Savings Account (HSA) plans for participants. This move is expected to improve the customer service experience for HSA plan participants.

Healthy Choices Wellness ProgramThe Healthy Choices Wellness Program is designed to encourage employees and their families to adopt healthier lifestyles while earning discounts on their medical premiums. Employees who complete their Biometric Screening and Vitality Health Review (VHR) receive a $40 monthly credit that will be applied to their medical premium for the 2016 plan year. Credits are applied as soon as administratively possible after completing the requirements, but not retroactively.

Eligibility All employees and physicians who are eligible to participate in one of the three medical plans offered to The US Oncology Network and The US Rheumatology Network are eligible for the program, except for New York Oncology Hematology.

Registering with Vitality You can register by accessing the Power of Vitality website via Upoint (Benefits Enrollment Site) at http://upointhr.com/thenetworkbenefits or at www.powerofvitality.com.

To register: • Enter the first name, last name, date of birth and work email address of the eligible physician/employee

• Enter the physician’s/employee’s six-digit employee ID

• Create a username and password

Biometric Screenings You can register to complete your biometric screening in one of two ways: • Online at https://we.blueprintforwellness.com

- User registration key: US Onc

- Unique ID: Six-digit employee ID# of the benefits-eligible physician/employee

• Via Telephone by contacting the Blueprint for Wellness Service Center at 1-855-623-9355

- Monday through Friday from 7am-8:30pm CST

- Saturday from 7:30am-4pm Central Time


YOUR 2016 ENROLLMENT CHECKLISTEnrollment can be overwhelming with all the options and choices available. To ensure your awareness of all the possible decisions that eligible employees face, please see the checklist below.

Medical Coverage You have THREE options:

£ Basic Consumer’s Choice

£ Consumer’s Choice

£ PPOI

PLEASE NOTE: Be sure to review the Prescription Drug coverage associated with each of these plans.

Dental Plan£ Basic Plan

£ Select Plan

Vision Plan£ Davis Vision

£ VSP

Life Insurance All eligible physicians and employees are enrolled in Core Life at no cost. The following additional coverage can be elected:

£ Employee Additional Life Insurance

£ Spouse Additional Life Insurance

£ Dependent Child(ren) Additional Life Insurance

Reimbursement Accounts These accounts allow you to set aside pre-tax dollars from your paycheck to pay certain health care and dependent care expenses. You are required to re-enroll every year you wish to participate.

£ Health Care Reimbursement Account

£ Dependent Care Reimbursement Account

Health Savings Account (HSA) Participants must re-enroll every year.

Selling Time Off With Pay (TOWP) Participants may sell as many as 40 hours for full-time or 20-hours for part-time to reduce the cost of their benefits and must indicate the number of hours to sell during enrollment each year.

Beneficiaries Enrollment serves as a reminder to take a moment and review the beneficiaries listed on your plans. Have you divorced, remarried, had children, lost parents or experienced any other life changes since your initial enrollment and designation of beneficiaries? Please consult page 21 and take a few moments to review your beneficiaries.


UNDERSTANDING ELIGIBILITYEligibility for benefits and participation in the reimbursement accounts is based on work location, employment status, and scheduled hours of work. The following provides general guidelines on benefits eligibility.

General Group Benefits Eligibility

General Minimum Requirements Benefits Available

Regular physicians and employees scheduled to work 20 or more

hours per week will be eligible for benefits on the first day of the

month that follows or coincides with 30 days of employment.

Medical, Dental, Vision, Group Term Life Insurance;

Short- and Long-term Disability plans; and Dependent Care and

Health Care Reimbursement Accounts

Group Benefits Eligibility Exceptions

Eligibility Requirements by Affiliate Benefits Available

New York Oncology Hematology (NYOH) regular, physicians and

employees scheduled to work 20 or more hours per week • NYOH medical plan

• BCBSTX medical plan

• Dental, Vision, Group Term Life insurance; Short- and

Long-term Disability plans; and Dependent Care and Health Care

Reimbursement Accounts

Venango Oncology Hematology Association (Venango)

regular physicians and employees scheduled to work 20

or more hours each week

• Venango Medical, Dental, and Vision plans

• Group Term Life insurance; Short- and Long-term Disability plans;

and Dependent Care and Health Care Reimbursement Accounts

Health Care and Dependent Care Reimbursement Accounts Eligibility

Eligible Not Eligible

Regular part-time and full-time physicians and employees

scheduled to work 20 or more hours per week, including

those who:

• Are employees of a sole proprietorship,

• Are < 2% owners in an “S” Corporation; or,

• Are employees or stockholders of a “C” corporation

Regular physicians and employees who:

• Work fewer than 20 hours per week

• Have K-1 status

• Are sole proprietors

• Are partners in a partnership

• Are >2 % owners in an “S” Corporation

• Are not paid through The US Oncology Network payroll system

Please note: If you are married to a physician or employee within The US Oncology Network or The US Rheumatology Network, you may not cover your spouse as a dependent, and only one of you may cover your eligible dependent children under The US Oncology Network Group Health Plans. If you are eligible to participate in the Plan as an employee, you may not be covered as a dependent child under your parent’s coverage under The US Oncology Network Group Health Plans.


Who is an Eligible Dependent for the Medical, Dental, Vision, and Life Insurance Plans? Spouse - An individual who is legally married to another individual.

Please note: The medical, dental and vision plans also allow employees to cover a domestic partner as defined below under Domestic Partner Eligibility.

Eligible dependent child - In general, a dependent child is defined as:

• Your natural born son or daughter

• Your stepson or stepdaughter

• Your legally adopted child

• Child of your child, who is your legal dependent for income tax purposes at the time of enrollment

• Child for whom you have received a court order requiring you to have financial responsibility for providing health insurance (you can only cover your child under the benefit plans the order specifies)

• Child for whom you are designated as his or her legal guardian

Your eligible dependent child must be an individual who has a relationship with you (your relationship must meet one of the definitions above) AND is under the age of 26.

Please note: The medical, dental, and vision plans also allow for employees to cover a domestic partner’s dependent child(ren) as defined below under Domestic Partner Eligibility.

Special Rule for Disabled Children A qualifying child of any age who is medically certified as disabled and dependent on you for support and maintenance can remain on the medical, dental, vision and/or life insurance plans. You must complete documentation required by each benefit plan carrier in order to continue your dependent’s coverage.

Domestic Partner Eligibility Domestic partners and dependents of your domestic partner are eligible for the medical, dental, and vision plans. If you choose to cover your domestic partner and/or dependents of your domestic partner, you will need to indicate on the enrollment site whether they qualify as your tax dependent for federal income tax purposes. Per IRS regulations, if your domestic partner and/or domestic partner’s dependent child(ren) qualifies as your tax dependent, the medical premiums for your domestic partner and/or domestic partner’s dependent child(ren) will be pre-tax. If your domestic partner and/or domestic partner’s dependent child(ren) does not satisfy the requirements as a tax dependent, then the value of the premiums for your domestic partner and/or domestic partner’s dependent child(ren) will be reported as taxable wages and is subject to federal income and employment taxes.

To determine whether your domestic partner and/or domestic partner’s child(ren) qualify as your tax dependents, please refer to the checklist available on Benefits Online under the Forms page. A definition of domestic partner is available on Benefits Online. The checklist is also available on the benefits enrollment site. It is your responsibility to determine whether your domestic partner and/or domestic partner’s dependent child(ren) meet the qualifications of a tax dependent. The domestic partner’s dependent must also meet the definition of dependent.


QUALIFYING EVENTSElection changes must be made within 31 days of the date you or your eligible dependent experiences a qualifying event. When you experience a qualifying event, you will need to submit a benefit election change via the enrollment site found on Benefits Online, at http://upointhr.com/thenetworkbenefits or by calling the Benefits Service Center at 1-877-248-8518.

You must submit your changes within 31 days of the qualifying event. If you do not meet this deadline, you will be required to wait until the next annual enrollment period or the next qualifying event, whichever comes first, to make any changes to your benefit elections.

Some mid-plan year election changes are not allowed. For instance, while you can change your medical plan elections to add or drop a dependent under certain circumstances, you cannot change medical plans mid-year, such as from the PPO I option to the Consumer’s Choice option. Your election changes must be consistent with your qualifying event and must be a direct result of that event. Special enrollment rules apply in cases of birth, adoption and marriage. To determine what changes are allowed, please contact the Benefits Service Center at 1-877-248-8518.

You and your eligible dependents who are eligible for coverage under the medical plans offered to physicians and employees at practices affiliated with The US Oncology Network or The US Rheumatology Network, but not currently enrolled for coverage, are eligible for a 60-day special enrollment period if either of two events occurs:

• You or your eligible dependents lose Medicaid or CHIP (The Children’s Health Insurance Program) coverage because you are no longer eligible OR

• You or your dependents become eligible for a premium assistance subsidy for the medical plans offered to affiliated physicians and employees of The US Oncology Network or The US Rheumatology Network under a Medicaid or CHIP program.

If you or your eligible dependent(s) qualifies for this special enrollment period, you must elect coverage in one of the medical plans offered to eligible physicians and employees within 60 days from the date of termination of coverage or date of determination of eligibility under Medicaid or CHIP.

The chart below highlights the most common qualifying events and the correlating effective dates.

Qualifying Event Effective Date of Election Change

Marriage Date of marriage

DivorceFirst day of the month following the date of divorce, or following

the date an election change is completed online, whichever is later

Birth of child, adoption, placement for adoption Date of birth, adoption, placement

Death of dependentFirst day of the month following the death or following the date an

election change is completed online, whichever is later

Dependent reaching maximum age under the benefit plansFirst day of the month following the date dependent reaches

maximum age

Dependent loss of employment or change in work schedule that

affects benefits eligibilityFirst day of the month following the event date

Qualified Medical Child Support OrderFirst day of the month following the date the order is received by

your local benefits contact or McKesson Specialty Health

Dependent loses eligibility in a state-sponsored health plan First day of the month following the event effective date

Eligibility or loss of eligibility for Medicare or Medicaid First day of the month following the event effective date

Start of or return from an unpaid leave of absence First day of the month following the event effective date


MAKING THE MOST OF YOUR CHOICESCarefully review your choices before making a decision about which medical plan option is best for you and your family. Be sure you consider all of the information like deductibles, copayments, premiums and out-of-pocket expenses, as well as your estimated healthcare needs now and in the future. Understanding how you plan to use your medical benefits can help you select the medical plan option that will best meet your healthcare and budget needs.

You have a choice of three different medical options:

Basic Consumer’s ChoiceHighest Deductible/Lowest Cost

Consumer’s ChoiceHigh Deductible/Low Premium

PPO IGood Coverage/Mid-Level Premium

• Lowest Premiums

• Coverage in the event of major medical condition

• Preventive care paid at 100%

• Non-Preventive care paid at $0 until deductible is met

• Participants can contribute to a Health Savings Account

• Low Premiums

• Coverage in the event of major medical condition


• Non-Preventive care paid at $0 until deductible is met

• Participants can contribute to a Health Savings Account

• Moderately higher premiums


• Network and non-Network benefits

• Greater predictability of out-of-pocket expenses

Budgeting For The Consumer’s Choice Plan Promoting increased consumerism and educated decision-making about health care options, the Consumer’s Choice plans cou-pled with a Health Savings Account (HSA) are an attractive option for relatively healthy employees who primarily use health care in a preventive way and are seeking protection in the event of a major medical condition. In 2016, individuals with Employee Only coverage may contribute up to $3,350, and individuals with family coverage may contribute up to $6,750 into an HSA. If you are age 55 or older and not enrolled in Medicare, you may also contribute an additional $1,000 as a catch-up contribution. To decide if this option is right for you, you need to understand how the Consumer’s Choice plan works.

• You decide whether to open an HSA and how much to contribute.

• Your contributions are deducted from your paycheck pre-tax (or after-tax if not eligible for pre-tax contributions) and are deposited into your HSA. Due to IRS regulations, physicians in a K-1 status, sole proprietors, partners in a partnership, two percent or more owners in an “S” corporation, or those not paid through the payroll system will not be eligible to contribute pre-tax dollars to the HSA.

• Because you pay less in premiums, you can contribute those savings to an HSA.

• Because the HSA is portable and rolls over from year to year, any unused contributions can be saved for the future

The HSA is administered by Fidelity Investments. If you enroll in the HSA, you will receive information from Fidelity Investments at your work e-mail address with instructions on how to establish your HSA account. The contributions that you are making through payroll deductions will be placed in a shell account and will not be available to you for qualified medical expenses until you set up your Fidelity HSA. For detailed information regarding HSA’s, please contact Fidelity at 1-800-544-3716 or visit the website at www.netbenefits.com.

Please note: To be eligible for an HSA, an individual must be covered by an HSA-qualified High Deductible Health Plan (HDHP) such as the Consumer’s Choice plan and must not be covered by other health insurance that is not an HDHP. You are not eligible for an HSA after you have enrolled in Medicare. If you had an HSA before you enrolled in Medicare, you can keep it. However, you cannot continue to make contributions to an HSA after you enroll in Medicare.


Please remember that in accordance with Health Care Reform guidelines, distributions for nonqualified medical expenses will be taxed at a rate of 20 percent, and over-the-counter drugs are not eligible expenses. You can only be reimbursed for prescription drugs and insulin.

Preventive Procedures Covered at 100% Regular gender- and age-appropriate routine tests and screening procedures are a vital part of maintaining your health. The medical plans gender- and age-appropriate preventive care, empowering covered participants to proactively manage their health. Covered procedures include:

• Well child visits • Well woman exams • Mammograms

• Immunizations • Well man exams • Prostate screening

To determine whether a particular procedure is considered preventive and covered at 100%, please contact the Benefits Service Center at 1-877-248-8518.

BENEFITS AT A GLANCEMedical Benefits You may choose from three medical plan options underweritten by Blue Cross Blue Shield of Texas. The following pages provide a side-by-side comparison of how common services are covered. A full description of covered services can be found in the Summary Plan Description. The covered treatments and services for each plan are the same. The level of coverage, the deductibles, and the copayments distinguish the plans from each other.

Please note: Venango Hematology Association does not participate in the BCBSTX Medical Plan Options.


Blue Cross Blue Shield of Texas Consumer Choice Plan Options

Your Options Basic Consumer’s Choice Consumer’s Choice

Type of Service Network Provider Non-Network Provider Network Provider Non-Network Provider

Calendar Year Deductible (CYD)

$2,750 Employee Only

$5,500 All other tiers







Out-of-Pocket Maximum









Network deductibles and out-of-pocket expense will only apply toward network deductibles and out-of-pocket expense.Non-Network deductibles and out-of-pocket expense will also apply toward network deductibles and out-of-pocket expense.

Lifetime Maximum Covered expenses are unlimited

Hospital Expenses

• Inpatient 80% after CYD 50% after CYD 80% after CYD 50% after CYD

• Outpatient Services 80% after CYD 50% after CYD 80% after CYD 50% after CYD

• Emergency Room Treatment (Emergencies)

80% after CYD 80% after CYD 80% after CYD 80% after CYD

• Non-Emergency Use of the Emergency Room


Preventive Care 100% 50% after CYD 100% 50% after CYD

Urgent Care Clinic 80% after deductible is met

50% after deductible is met



Physician’s Office(Including lab and X-ray)


Maternity Care 80% after CYD 50% after CYD 80% after CYD 50% after CYD

Medical-Surgical Services


Home Health Care(60 visit Maximum per year)


Mental Health Care

• Inpatient Hospital 80% after CYD 50% after CYD 80% after CYD 50% after CYD

• Outpatient Facility 80% after CYD 50% after CYD 80% after CYD 50% after CYD

• Office Visits 80% after CYD 50% after CYD 80% after CYD 50% after CYD

Please note: For the Consumer’s Choice Plans, the individual deductible and out-of-pocket maximum are only applicable to employees enrolled in Employee Only coverage. Employees with covered dependents must satisfy the family deductible and out-of-pocket maximum before coinsurance and copays apply.

Non-Network services must be preauthorized with member services or penalties may be applied.


Blue Cross Blue Shield of Texas Preferred Provider Organization Options

Your Options PPO I

Type of Service Network Provider Non-Network Provider

Calendar Year Deductible (CYD) $1,000 Individual

$3,000 Family

$2,000 Individual

$4,000 Family

Out-of-Pocket Maximum $3,500 Individual

$6,500 Family

$6,500 Individual

$12,000 Family

Lifetime Maximum Covered expenses are unlimited

Hospital Expenses

• Inpatient 80% after $500per admission deductible

50% after $500per admission deductible

• Outpatient Services 80% after CYD 50% after CYD

• Emergency Room Treatment (Emergencies)

75% after$350 copay

(waived if admitted)

75% after$350 copay


• Non-Emergency Use of the Emergency Room

75% after$350 copay


50% after$350 copay and CYD(waived if admitted)

Preventive Care 100% 70% after CYD

Urgent Care Clinic 100% after $75 copay


Physician’s Office(Including lab and X-ray)

100% after $30 copay

70% after CYD

Maternity Care 80% after CYD 50% after CYD

Medical-Surgical Services 80% after CYD 50% after CYD

Home Health Care(60 visit Maximum per year)

80% after CYD 50% after CYD

Mental Health Care

• Inpatient Hospital 80% after $500per admission deductible

50% after $500per admission deductible

• Outpatient Facility 80% after CYD 50% after CYD


Pre-Certification Process for All Medical Plans To complete the pre-certification process, you, your physician, provider of services, or a family member must call the appropriate toll-free numbers listed on the back of your ID card between 7:30 a.m. and 8:00 p.m. Monday-Friday to satisfy all medical pre-certification requirements for the services listed below. Calls after these working hours will be recorded and returned the next working day.

Please note: All hospital stays listed below must be pre-certified by BCBSTX to ensure your maximum benefit.

• Inpatient Hospital Expense

• Extended Care Expense

• Home Infusion Therapy

• Chemical Dependency

• Serious Mental Illness

• Mental Health Care

• If you transfer to another facility or to or from a specialty unit within the facility

Out-of-Pocket Maximum Exclusions for Consumer’s Choice Plan The Out-of-Pocket Maximum for the Consumer’s Choice plan will NOT include the expenses below:

• Services, supplies, or charges limited or excluded by the Plan

• Expenses not covered because a benefit maximum has been reached

• Any Eligible Expense paid by the Primary Plan when BCBSTX is the Secondary Plan for purposes of coordination of benefits

• Penalties for failing to obtain preauthorization

• Any remaining unpaid Medical-Surgical Expense in excess of the benefits provided for Covered Drugs

Coinsurance Stop-Loss Amount for the PPO I Plan

The Coinsurance Stop-Loss Amount for the PPO I plan will NOT include the expenses below:

• Services, supplies or charges limited or excluded by the Plan

• Expenses not covered because a benefit maximum has been reached

• Any Eligible Expense paid by the Primary Plan when BCBSTX is the Secondary Plan for purposes of coordination of benefits

• Any deductibles

• Penalties for failing to obtain preauthorization

• Any remaining unpaid Medical-Surgical Expense in excess of the benefits provided for Covered Drugs

Prescription Drugs Each medical plan includes a prescription drug program, provided by Prime Therapeutics, which covers an array of prescription drugs and medical supplies. The prescription drug program uses participating pharmacies. You will typically receive a higher level of benefits when you use a participating pharmacy than when you use a non-participating pharmacy. In 2016, there will be a fourth tier of prescription coverage for specialty drugs. Plan participants will pay a 20% copay for certain specialty drugs up to a $100 co-payment. This additional coverage tier helps to more equitably distribute the cost of these medications.

Please note: Some prescription drugs may not be covered by the selected medical plan. You may review the medical plans’ limitations and exclusions on Benefits Online for further details or by calling BCBSTX at 1-800-521-2227.


A summary of each medical plan’s prescription drug benefit is outlined below.

Your options Consumer’s Choice Plans PPO Plan

In-networkOut-of-network

(Member files claim)In-network

Out-of-network (Member files claim)

DeductibleYou must meet your medical calendar year deductible, then you will be responsible for the appropriate copayment amount.

This program has a $55 deductible per covered member for preferred and non-preferred brand name drugs. There is no deductible for generic drugs.

Retail Pharmacy Up to a 30-day supply

• Generic $5 after CYD $5

80% to allowable amount minus copay

• Preferred Brand-name Drug*

$35 after CYD $35

• Non-preferred Brand-name Drug*

$50 after CYD $50

• Specialty Drug 20% Copay up to $100

Mail Service ProgramMail order form available on Benefits Online

You must meet your medical calendar year deductible, then you will be responsible for the appropriate copayment amount.

This program has a $55 deductible per covered member for preferred and non-preferred brand name drugs. There is no deductible for generic drugs.

Up to a 90-day supply Up to a 90-day supply

• Generic $12.50 $12.50

• Preferred Brand-name Drug*

$87.50 $87.50

• Non-Preferred Brand-name Drug*

$125 $125

• Specialty Drug 20% Copay up to $250

* If you choose to purchase a preferred/non-preferred brand name drug when a generic equivalent is available, you will be required to pay the difference between the cost of the generic and the preferred/non-preferred brand name drug, plus the preferred/non-preferred brand name copay.

Dental Benefits Employees have a choice of participating in the Basic or Select plan option.

With both the Basic and Select plans, you can receive services from a dentist contracting with Ameritas Group. Contracting dentists have agreed to charge a negotiated fee for services to reduce your out-of-pocket costs. If you use a non-contracting dentist, benefits will be paid according to the usual and customary charge for the service. To locate a contracting dentist, go to www.ameritas.com or call 1-844-212-1430.

The Basic and Select plan may not pay benefits for dental work that began prior to your effective date of coverage. Neither the Basic or Select plan pays benefits for dental conditions covered under the medical plan(s).

Dental Plan Deductibles There is a dental deductible of $75 per covered individual, which is a calendar year deductible that begins each January.

Pre-treatment Please note: You are not required to file a pre-authorization form when receiving dental services; however, we recommend that you ask your dentist to file for a pre-treatment estimate with the claims office before the work is done. The estimate paperwork will be processed and a copy returned to you and the dentist, so both parties will know the exact amount of benefits payable and any remaining financial obligation.


Dental Rewards Employees who file at least one claim during the plan year, but meet less than $500 of their annual maximum benefit, will be able to roll over $250 into the next plan year, providing for a greater maximum benefit of as much as $750 in the subsequent plan year. For more information, call the Ameritas Group Customer Relations Department at 1-844-212-1430.

Ameritas Dental Plan Options

Your options Basic Plan Select Plan

Your payroll contributions Lowest Highest

Type of service

Preventive Procedures – Routine exams, cleanings (up to three times per year), space maintainers, fluoride applications (under age 19), bitewing X-rays, oral evaluations

100%

Basic Procedures – Sealants (under age 17), fillings, extractions, endodontics, oral surgery, periodontics, anesthesia, stainless steel crowns, denture repair, and X-rays (excluding bitewing)

80% after deductible

Major Procedures – Crowns repair, bridgework, dentures, implants Not covered 50% after $75 calendar year deductible

Not covered50% after $75 calendar year

deductible

Orthodontia Procedures – Child and adult Not covered 50%

Deductible Amounts

Preventive Procedures $0

Basic Procedures – calendar year per person $75 $75

Orthodontia Procedures Not covered $0

Maximum Benefit

Preventive, Basic and Major (Select Plan) Procedures - calendar year per person

$1,000 $2,000

Orthodontia Procedures - Lifetime per person Not covered $1,000

Allowance Table In Panel Out of Panel In Panel Out of Panel

• Preventive Procedures Negotiated Fee

UCR* at 90%

Negotiated Fee

UCR* at 90%

• Basic Procedures Negotiated Fee

UCR* at 90%

Negotiated Fee

UCR* at 90%

• Major ProceduresN/A N/A

Negotiated Fee

UCR* at 90%

• Orthodontia Procedures N/A N/A UCR* UCR*

Dental Rewards

• Annual Threshold $500

• Carryover Amount $250

• Maximum Carryover $1,000

*Usual, Customary and Reasonable fees


Vision Benefits You have the opportunity to choose between Davis Vision (below) and VSP (page 16).

Please note: Each vision plan has different rates. Please refer to your enrollment worksheet for the 2016 rates for each vision plan.

Davis Vision Network Benefits Include: Examination One eye examination, including dilation when professionally indicated, every 12 months covered at 100% after a $10 copayment.

Frame and spectacle lenses • One pair of spectacle lenses every 12 months, • An eyeglass frame every 12 months. You may choose from

- A frame from the Davis Vision “Premier Collection” (a $225 retail value) covered at 100% after a $25 copayment; or

- A $150 CREDIT plus a 20% discount on any overages toward a network provider’s frame

Many lens types and coatings (all ranges of prescriptions and sizes, glass or plastic, oversize lenses, fashion and gradient tinting, glass grey prescription sunglasses, and polycarbonate lenses) ARE INCLUDED while others are offered at significantly discounted prices.

Contact lenses In lieu of eyeglasses, you may select contact lenses. Davis Vision contact lens collection includes evaluation, fitting, follow-up, and as many as four boxes/multi-packs. In lieu of the Davis Vision contact lens collection, members may use a $150 allowance plus a 15% discount off any overage toward the provider’s own supply. If selecting standard soft contact lenses, you are entitled to an evaluation/fitting after a $25 copayment. For specialty contact lenses, a $60 allowance, plus a 15% discount off any overage will be applied toward the evaluation/fitting after a $25 copayment. Medically necessary contact lenses will be covered in full with prior approval.

Laser Vision Discounts of up to 25% off the participating provider’s normal charges or 5% off any advertised special (whichever is lower).

Lens 123 Mail order contact lens replacement program offers a fast and convenient way to purchase replacement contact lenses at significant savings.

For more information, call 1-800-LENS-123 or visit the LENS 1-2-3! website at www.lens123.com. Sample Cost Savings*

Average Retail Cost You Pay You Save

Examination (including Dilation)

$75 $10 $65

Frame and Spectacle Lenses $285 $25 $260

Tints $20 $0 $20

Warranty $30 $0 $30

Total $410 $35 $375

*Savings based on in-network usage where a collection frame is selected.

For information on out-of-network coverage visit www.davisvision.com and enter client code 7256.


VSP Vision Network Benefits Include:The “Signature Plan” is a premier full-service plan with choice, flexibility, and maximum value through a VSP Preferred Provider.

Plan CoverageWellVision Exam® • Thorough eye exam covered in full after $10 copay1

Lenses

• Glass or plastic, single vision, lined bifocal, or lined trifocal prescription lenses are covered in full1

• Cost controls on lens options, saving our members an average of 35-40%

• 30% off unlimited additional pairs of prescription glasses2

• 30% off unlimited non-prescription sunglasses2

• Dependent children of members are eligible for covered in full polycarbonate prescription lenses

Frames• Frames are covered in full1 up to the retail allowance of $150 for a wide selection of frames

• 20% off any amount exceeding allowance

Contact Lenses

• 15% off contact lens services, excluding materials

• Instead of eyeglasses, elective contact lens services and materials are covered in full up to $140 toward any type of prescription contact lenses

• Refit and replacement contact lens wearers may qualify for a covered in full3 contact lens exam and a six-month supply of approved lenses, including toric, multifocal, and silicone hydrogel

• Necessary contact lenses are covered in full1 for members who have specific conditions for which contact lenses provide better visual correction

Value-added BenefitsDiabetic EyeCare ProgramSM • Provides additional coverage for services specifically targeted toward members with Type 1 diabetes

Laser VisionCare Program

• VSP-contracted laser centers provide discounts for laser surgery including PRK, LASIK, and Custom LASIK4

• Discounts average 15% off or 5% off if the laser center is offering a promotional price5

• Members who’ve had PRK, LASIK, or Custom LASIK vision correction surgery can use their frame benefit for sunglasses, instead of a prescription pair of glasses

Low Vision

• Low vision is vision loss sufficient enough to prevent reading and performing daily activities

• With pre-approval from VSP, low vision supplemental testing is covered every two years

• VSP will pay 75% of the cost for approved low vision aids, up to the maximum of $1,000 (less any amount paid for supplemental testing) per member every two years

Retinal Screening • VSP Preferred Providers offer guaranteed pricing, which ensures that members won’t pay more than $39 for a routine retinal screening

Exclusions

Plan Limitations

The following items are excluded under this plan:

• Two pairs of glasses instead of bifocals

• Replacement of lenses, frames, or contacts

• Medical or surgical treatment

• Orthoptics, vision training, or supplemental testing

Items not covered under the contact lens coverage:

• Insurance policies or service agreements

• Artistically painted or non-prescription lenses

• Additional office visits for contact lens pathology

• Contact lens modification, polishing, or cleaning

1 Less any applicable copay.2 30% discount applies to glasses purchased the same day as the member’s eye exam from the same VSP Preferred Provider who provided the exam. Members will also receive 20% off unlimited additional pairs of glasses valid through any VSP Preferred Provider within 12 months of the last covered eye exam.3 If a member selects a lens from a tier that is above their allowance they pay the difference. If a member selects a lens from a tier that is below their allowance they may apply the remaining balance toward additional contact lenses. This program was designed for standard fit members, VSP Preferred Providers will determine if a member qualifies.4 Other LASIK procedures may be performed at an additional cost to the member.5 LaserVision Care discounts are only available from VSP-contracted facilities.


Life Insurance Benefits Physicians and employees at practices affiliated with The US Oncology Network and The US Rheumatology Network (excluding Texas Oncology physicians) receive a basic amount of group term life and AD&D insurance from MetLife in an amount equal to one times your basic annual earnings (as defined by the Life policy), up to a maximum benefit of $50,000. Under the life insurance plan, benefits reduce according to the following age schedule.

Texas Oncology physicians will receive basic group term life and AD&D coverage in the amount of $200,000. Under the life insurance plan, benefits will reduce according to the age schedule on the left.

Physicians and employees at practices affiliated with The US Oncology Network (includ-ing Texas Oncology physicians) and The US Rheumatology Network will also receive a flat $2,000 life insurance benefit for your spouse and a $1,000 life insurance benefit for your eligible dependent child(ren). Domestic partner’s dependent child(ren) are not eligible.

In addition, you may be eligible to elect additional life insurance coverage for yourself, your spouse (but not your domestic partner), and your eligible dependent child(ren) [but not your domestic partner’s eligible dependent child(ren)] as outlined in the table below.

Please note: It is your responsibility to ensure you are only covering eligible dependents under the benefit plans. If it is determined that you are covering an ineligible dependent, that dependent’s coverage will be denied or terminated.

MetLife Additional Group Term Life Benefits

Physicians & Employees(Excluding Texas Oncology Physicians)

Texas Oncology Physicians

Employee Additional Life Insurance Eligible employees can purchase supplemental coverage in $10,000 increments to a maximum of $680,000

Eligible employees can purchase supplemental coverage in $10,000 increments to a maximum of $530,000

Spouse Additional Life Insurance You may purchase additional spouse coverage in $10,000 increments to a maximum of $250,000

Dependent Child(ren) Additional Life Insurance

You may purchase additional eligible dependent child(ren) coverage in the amount of $10,000

Please note: Additional life insurance may require underwriting approval through MetLife.

Note: If you work at least 30 hours per week, qualify and wish to become insured for an amount of Employee Additional Life Insurance coverage in excess of $250,000; if you work at least 20 hours per week, qualify and wish to become insured for an amount of Employee Additional Life Insurance coverage in excess of $150,000; or to increase your coverage after your initial enrollment date, the excess or increased amount will be subject to medical underwriting approval. You may apply for Spouse Additional Life Insurance coverage up to $20,000 without medical underwriting approval if you apply when you first become eligible for benefits or when your spouse is first eligible for coverage. All Spouse Additional Life Insurance amounts greater than $20,000, late applications, and requests for coverage increases require medical underwriting approval. Spouse Additional Life Insurance may not exceed 100% of your combined group term life coverage.

Age Coverage

65 65%

70 50%

75 35%


Disability BenefitsThe disability plans provide continued income if an illness or injury prevents you from working for a period of time and you are approved for benefits by MetLife, the disability carrier.

The short term disability plan pays you benefits if you are absent from work for the consecutive number of business days (or after being hospitalized) as specified below, because of a qualifying disability and are approved for benefits by MetLife. Your short term disability benefits are paid for up to 26 weeks at the levels specified in the following table.

MetLife Short-term Disability

Affiliation Weekly Benefit Amount Waiting period

Maximum Benefit Period

Physicians and employees at practices affiliated with The US Oncology Network and The US Rheumatology Network (excluding Texas Oncology physicians)

66 2/3% of the first $1,500 of your insured pre-disability earnings reduced by deductible income. Plan weekly maximum is $1,000 and weekly minimum is $15

14 daysUp to 26 weeks

New York Physicians and Employees State Disability Plan*

50% of the first $340 of your insured pre-disability earnings reduced by deductible income. Plan weekly maximum is $170


New Jersey Physicians and Employees State Disability Plan*

66 2/3% of the first $753 of your insured pre-disability earnings reduced by deductible income. Plan weekly maximum is $561.


*New York and New Jersey physicians and employees receive state disability in addition to the short-term disability plan.

MetLife Long-term Disability

The long-term disability plan pays you a percentage of your monthly pay if you are unable to work for more than 180 days because of a qualifying disability and are approved for benefits by MetLife. Long-term disability benefits are coordinated with any Social Security disability benefits, Worker’s Compensation or other similar benefits that you are eligible to receive (except for any private disability insurance you may have). The combination of all disability payments will equal the percentage of pay replacement specified below.

Monthly Benefit Amount Waiting period Maximum Benefit Period

Non-physicians – 60% of the first $25,000 of your insured pre-disability earnings reduced by deductible income. Plan maximum monthly benefit is $15,000 and monthly minimum is $100 or 10% of your LTD benefit before reduction by deductible income, whichever is greater

180 days after remaining

continuously disabled

Determined by the age when disability begins as follows:

Age Maximum Benefit Period

61 or younger Up to age 6562 42 months63 36 months64 30 months65 24 months66 21 months67 18 months68 15 months

69 & older 12 months

Physicians – 60% of the first $41,666.67 of your insured pre-disability earnings. Plan maximum is $25,000 monthly benefit, and monthly minimum is $100 or 10% of your LTD benefit before reduction by deductible income, whichever is greater.



Health Care Reimbursement Accounts (HCRA) and Dependent Care Reimbursement Accounts (DCRA) are voluntary benefits that allow you to set aside pre-tax dollars from your paycheck to pay certain health care and dependent care expenses. To participate in a HCRA or DCRA, you must re-enroll each year. Participants are no longer allowed to receive reimbursement for over-the-counter drugs from their HCRA’s. Only prescription medications and insulin are eligible for reimbursement. If you plan to set aside money in your HCRA for orthodontic services, please contact BPAS for guidance related specifically to orthodontic reimbursement.

Account TypeHealth Care*** Reimbursement Account (HCRA)

Limited Scope HCRA*/*** (for those enrolled in the Health Savings Account and the Consumer’s Choice plan)

Dependent Care Reimbursement Account (DCRA)

Annual contribution limit

$2,550 per year $2,550 per year$5,000 per year/$2,500 if married and filing separate tax returns**

Eligible expenses (general)

Health Care expenses not covered by your medical, dental or vision benefits

Dental and vision expenses not covered by your plan, as well as medical expenses that are in excess of your deductible

Qualified day care for child under age 13; or disabled adult dependent or elderly dependent who spends at least eight hours per day in your home

Deadlines to submit claims

Active participants have up to 90 days following the end of the calendar year (March 31) to submit their 2015 eligible HCRA and DCRA expenses. You must submit claims by the deadline, or you will lose the money you have left in your account from the prior year. HCRA participants who terminate during the calendar year have 90 days following their termination to submit claims.

* If you are enrolled in a Consumer’s Choice plan and setup a Health Savings Account (HSA), you may also enroll in the Limited Scope HCRA. A Limited Scope HCRA allows you to set aside pre-tax dollars to pay for dental and vision expenses as well as medical expenses that are in excess of your deductible. ** Discrimination Testing: Federal Law might limit your plan year DCRA contributions if you are highly compensated. Each year, the plan administrator calculates the maximum plan year contribution amount for highly compensated employees based on a formula provided by the IRS. Yearly goals may be reduced based on the results from the testing. Notification will be sent via email if your plan year goal requires modification.

*** You may roll over as much as $500 of unused funds remaining in your HCRA as of the end of the plan year. The rolled over funds can be used for reimbursement of qualified medical expenses incurred during the following plan year.

Please note: IRS regulations and Health Care Reform determine which expenses are eligible and which are not. For more information regarding eligible expenses contact BPAS at 1-866-401-5272, visit Benefits Online via My Oncology Workspace or visit the IRS website and reference Section 213(b) expenses.


ADDITIONAL BENEFITS

Knowing that good health involves much more than physical wellness, McKesson Specialty Health offers a variety of comprehensive benefits to help physicians and employees at practices affiliated with The US Oncology Network and The US Rheumatology Network manage their physical, emotional and financial health. For additional information, visit Benefits Online via My Oncology Workspace.

Wellness Programs

Healthy Choices Healthy Choices is the premier wellness program for physicians and employees in The US Oncology Network and The US Rheumatology Network. The program, administered by Vitality, features a robust online portal that provides employees tools and resources, such as e-learning courses, health assessments, and risk calculators while also providing rewards and incentives to lower their medical premiums. This cutting edge wellness program helps participants identify health concerns and the tools to make the positive changes to achieve better health.

Blue Cross Blue Shield The BCBSTX medical plan is rich with information and resources to help you manage your health and achieve and maintain a healthy lifestyle. Blue Access, the BCBSTX members-only website, gives plan members access to many useful tools to help them better manage their health. In addition to Special Beginnings, a healthy pregnancy program, users can access lifestyle management programs, including tobacco cessation and weight management. The BCBSTX Personal Health Manager offers a free health risk assessment and other helpful tools, including exercise and nutrition plans, healthy recipes, and a reward system that lets plan participants earn valuable Blue Points, which can be redeemed for gift cards to local stores, fitness products, and other items. Log on to www.bcbstx.com/members for more information regarding Personal Health Manager.

Also visit Benefits Online via My Oncology Workspace to access information on tobacco cessation, preventive health, condition management, fitness, and stress management programs.

Perks Program The Perks Program through Beneplace features discounts from a variety of vendors for everything from fitness club memberships to consumer electronics. The Perks Program also gives you access to discounted rates on auto, home, legal, and pet insurance through national providers. While some voluntary benefits allow employees to opt in and out of participation at any time during the year, the legal insurance plan offered through ARAG Legal limits participation to the employer-sponsored annual enrollment period or during the benefits eligibility period as a new hire employee. Employees wishing to enroll in the ARAG legal plan or terminate their participation in the plan, must do so during the annual enrollment period. To view the website, go to http://www2.beneplace.com/uson.

Guidance Resources Program You and the members of your immediate family (spouse and eligible dependent child(ren) are eligible to use the Guidance Resources® Program (GRP) immediately upon employment. This comprehensive, interactive service provides expert resources and unique tools to assist you in every aspect of your life, all in a secure, easy-to-use, personalized environment. Access is available by phone or Internet 24 hours a day, seven days a week. Just call toll-free 1-877-477-8766 or visit www.guidanceresources.com and enter the Company ID: USON123.


BENEFICIARIES

Keeping your beneficiary designations up to date helps ensure your benefits get to your chosen recipients in a timely manner in the event of your death. As a basic rule, you should review primary and contingent beneficiaries on your life insurance policies and 401(k) account at least annually. Beneficiary designations should also be reviewed upon major life changing events such as the birth of a child or a change in marital status. The process for establishing, reviewing, and updating beneficiaries is easy and can be done online as follows:

Life Insurance Beneficiary Designation To review, establish, or update beneficiaries on your MetLife Core Life and/or Additional Life Insurance policy:

• Go to http://upointhr.com/thenetworkbenefits

• Enter your User Name and Password as prompted. (If you have previously provided an email address to Your Benefits Resources, you can reset your password online and have your new password emailed to you. If you haven’t previously provided an email address to Your Benefits Resources, you will need to call the Benefits Service Center at 1-877-248-8518 to reset your password.)

• Enter or change your beneficiary information as prompted.

If you have any questions regarding your life insurance coverage, please contact the Benefits Service Center at 1-877-248-8518

401(k) Plan Beneficiary Designation To confirm, establish, or update beneficiaries in your 401(k) plan:

• Go to Fidelity’s website at www.401k.com.

• Log in using your Username and Password (If you have not yet registered, you may do so by clicking on Register Now or Enroll Now and following the prompts.)

• Click on the Your Profile tab.

• Select Beneficiaries under the About You section.

• Enter or change your beneficiary information as prompted.

If you are satisfied with your prior designations, you do not need to do anything. However, if you want to be able to view them in the Fidelity website, you must re-designate them there. Any designation you make is subject to applicable notarized spousal consent requirements in the event you are married and are naming anyone other than your spouse as the primary beneficiary on your account.

For any questions about the Fidelity’s website or other 401(k)-related issues, contact Fidelity Customer Service at 1-800-890-4015.


REQUIRED NOTICESStatement of ERISA Rights As a participant in the medical, dental, vision, life, disability, long-term care plans and the HCRA available to physicians and employees at practices affiliated with The US Oncology Network or The US Rheumatology Network (collectively “the ERISA Plan”), you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all ERISA Plan participants

shall be entitled to:

• Examine, without charge, at the Plan Administrator’s office and at other specified locations, such as work sites and union halls, all ERISA Plan documents, including insurance contracts, collective bargaining agreements, and copies of all documents filed by the ERISA Plan with the U.S. Department of Labor, such as detailed annual reports and ERISA Plan descriptions.

• Obtain copies of all ERISA Plan documents and other ERISA Plan information upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for the copies.

• Receive a summary of the ERISA Plan’s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. In addition to creating rights for ERISA Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the ERISA Plan. The people who operate your ERISA Plan, called “fiduciaries” of the ERISA Plan, have a duty to do so prudently and in the interest of you and other ERISA Plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

If your claim for a benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have the right to have the ERISA Plan review and reconsider

your claim.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials from the ERISA Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day (indexed for inflation) until you receive the materials, unless the materials were not sent for reasons beyond the

control of the Plan Administrator.

If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan’s money,

or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees; for example, if it finds your claim is frivolous.

If you have any questions about the ERISA Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest office of the Pension and Welfare Benefits Administration, U. S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits Administration, U. S. Department of Labor, 200 Constitution Avenue, N. W.,

Washington, D.C. 20210. Continuation Coverage Rights Under COBRA

Introduction

This Notice (“Notice”) is furnished pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) and applies to anyone who has recently become covered under one or more of the health plans (which include medical, dental, and vision and/or the HCRA) available to physicians and employees at practices affiliated with The US Oncology Network or The US Rheumatology Network. The medical, dental and vision plans are referred to throughout this Notice as the “Health Plan.” This Notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage with respect to the above Health Plans in which you are enrolled. This Notice generally explains COBRA continuation coverage, when it may become available to you and your family,

and what you need to do to protect the right to receive it.

The right to COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Health Plan when

they would otherwise lose their group health coverage.

For additional information about your rights and obligations under the Health Plan and under federal law, you should review the Health Plan’s Summary Plan Description(s) or

contact the Plan Administrator.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Health Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this Notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your


dependent children could become qualified beneficiaries if coverage under the Health Plan is lost because of the qualifying event. Under the Health Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA

continuation coverage.

Should an actual qualifying event occur in the future, the Plan Administrator will send you additional information and the appropriate election form at that time. Please take special note, however, of your notification obligations, which are

highlighted below.

Qualifying Events for an Employee

If you are an employee covered by the Health Plan, you will become a qualified beneficiary if you lose your coverage under the Health Plan because either one of the following qualifying

events happens:

• Your hours of employment are reduced; or

• Your employment ends for any reason other than your

gross misconduct.

Qualifying Events for a Covered Spouse

If you are the spouse of an employee covered by the Health Plan, you will become a qualified beneficiary if you lose your coverage under the Health Plan because any of the following qualifying

events happens:

• Your spouse dies;

• Your spouse’s hours of employment are reduced;

• Your spouse’s employment ends for any reason other than

his or her gross misconduct;

• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both). (Note: An employee becoming entitled to Medicare benefits generally does not render that employee ineligible for Health Plan coverage. As a result, it is likely that your spouse’s Medicare entitlement will not be a qualifying event unless your spouse voluntarily declines coverage under the Health Plan and you

lose Health Plan coverage as a result.); or

• You become divorced or legally separated from your spouse.

Qualifying Events for Covered Dependent Children

Your dependent children will become qualified beneficiaries if they lose coverage under the Health Plan because any of

the following qualifying events happens:

• The parent-employee dies;

• The parent-employee’s hours of employment are reduced;

• The parent-employee’s employment ends for any reason other than his or her gross misconduct;

• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both). (Note: An employee becoming entitled to Medicare benefits generally does not render that employee ineligible for Health Plan coverage. As a result, it is likely that your Medicare entitlement will be a qualifying event unless you voluntarily decline coverage under the Health Plan and your dependent child loses Health Plan coverage as a result.);

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the

Health Plan as a “dependent child.”

When is COBRA Coverage Available?

The Health Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment (other than by reason of gross misconduct), or reduction of hours of employment, death of he employee, or the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event.

You Must Give Notice of All Qualifying Events

For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. This Notice must be provided on the “Change Form,” which can be obtained from your Human Resources Contact. The “Change Form” must be completed and returned to your Human Resources Contact, along with applicable

documentation described in the form.

How is COBRA Coverage Provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of

their children.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage lasts for

up to a total of 36 months for your eligible dependents.


When the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA

continuation coverage can be extended.

Disability Extension of 18-Month Period of Continuation Coverage

If you or anyone in your family covered under the Health Plan is determined by the Social Security Administration (“SSA”) to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must notify the Plan Administrator of the SSA’s determination within 60 days after the later of (1) the SSA’s determination, or (2) the date on which the qualifying event occurs, and in all cases before the end of the 18-month period of COBRA continuation coverage. If the qualified beneficiary is determined by the SSA to no longer be disabled,

you must notify the Plan Administrator of that fact within 30 days of the SSA’s determination. The notices required in this paragraph must be provided on the “Change Form,” which can be obtained from your Human Resources Contact. The “Change Form” must be completed and returned, along with the SSA determination, to the COBRA Administrator at the address listed in the “Plan

Contact Information” Section of this Notice.

Second Qualifying Event Extension of 18-Month Period of Continuation Coverage

If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Health Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under

Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Health Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Health Plan had the first qualifying event not occurred. In all of these cases, you must notify the Plan Administrator of the second qualifying event within 60 days of the second qualifying event. This notice must be provided on the “Change Form,” which can be obtained from your Human Resources Contact. The “Change Form” must be completed and returned, along with applicable documentation described in the form, to the COBRA Administrator at the address listed in the “Plan Contact Information” Section of this Notice.

Health Care Reimbursement Account Limit

Under COBRA, continuation coverage under the HCRA offered to affiliated physicians and employees of The US Oncology Network is limited to the remainder of the plan year of the current HCRA, rather than the 18, 29 or 36 month

maximum benefit periods generally available under COBRA.

Because the HCRA operates on a calendar year basis, this means that coverage may be continued until the end of the calendar

year in which your qualifying event occurs.

If You Have Questions

Questions concerning your Health Plan or your COBRA continuation coverage rights should be addressed to the contact identified below. For more information about your rights ERISA, including COBRA, the Health Insurance Portability and Accountability Act (“HIPAA”), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee

Benefits Security Administration (“EBSA”) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are

available through EBSA’s website.)

Keep Your Plan Administrator Informed of Address Changes

In order to protect your family’s rights, you should keep the Plan Administrator informed of any changes in your address and the the addresses of your family members. You may use the “Change Form” to provide notice of an address change. If your address changes while you are an affiliated physician or are an employee of the US Oncology Network, provide the notice of address change to your Human Resources Contact. If your address changes after you or your spouse has terminated employment with the US Oncology Network or an affiliated employer, provide the notice of address change to the COBRA Administrator at the address listed under the “Plan Contact Information” Section of this Notice. You should also keep a copy, for your records, of

any notices you send to the Plan Administrator.


Plan Contact Information

As discussed above, notice regarding an SSA disability determination, a second qualifying event, or an address change following a termination of employment should be provided to the COBRA Administrator. The COBRA Administrator’s

contact information is as follows:

COBRA Services100 Half Day RoadP.O. Box 1530Lincolnshire, IL 60069-1530

Phone: 1-877-248-8518/Fax: 1-877-883-8295

To obtain information regarding the Health Plan and COBRA continuation coverage, call or write the

following contact person for the Plan Administrator:

Benefits ServicesMcKesson Specialty Health10101 Woodloch Forest, The Woodlands, Texas 77380

Toll-free phone: 1-800-381-2637

Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families

If you are eligible for health coverage, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for

employer-sponsored health coverage, but need assistance in

paying their health premiums.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance

is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay

the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, the Health Plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the Health Plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.

For more information on special enrollment rights, you can contact either:

U.S. Department of Labor Employee Benefits Security Administrationwww.dol.gov/ebsa/1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Serviceswww.cms.hhs.gov /1-877-267-2323, Ext. 61565

Medicare Part D Notice

This Notice is intended for individuals who are eligible to receive Medicare prescription drug coverage. If you are not eligible for Medicare, the content of this Notice is not applicable to you.

Please read this Notice carefully. This Notice has information about your current prescription drug coverage offered to physicians and employees at practices affiliated with The US Oncology Network or The US Rheumatology Network through the medical plans (which provides coverage through Blue Cross and Blue Shield of Texas) (“BCBS Plans”)and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this Notice is information about where you can get help to make decisions about your prescription drug coverage.

Medicare prescription drug coverage became available in 2006 to everyone with Medicare, through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

McKesson Specialty Health has determined that the prescription drug coverage offered under the BCBS “Plans” is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage. If you are enrolled in a BCBS Plan you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.

Individuals can enroll in a Medicare prescription drug coverage when they first become eligible for Medicare and each year thereafter from October 15th through November 7th or such other periods set by Medicare. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month special enrollment period to join a Medicare prescription drug plan.


You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans

offering Medicare prescription drug coverage in your area.

If you decide to enroll in a Medicare prescription drug plan, you can continue your coverage under the BCBS Plan or drop your coverage, but read below for important implications of

dropping coverage.

Please note that your current prescription drug coverage under the BCBS Plan pays for other health expenses in addition to prescription drugs. If you desire, you can retain your existing coverage under the BCBS Plan and choose not to enroll in a Medicare prescription drug plan. In the alternative, you can retain your existing coverage under the BCBS Plan (which includes medical as well as prescription drug benefits) and enroll in a Medicare prescription drug plan as a supplement to the coverage provided through the BCBS Plan – i.e., you and your eligible dependents will still be eligible to receive all of your current health and prescription drug coverage under the BCBS Plan even if you enroll in a Medicare prescription drug plan. Finally, you can enroll in a Medicare prescription drug plan in lieu of enrollment in the BCBS Plan (provided coverage under the BCBS Plan is dropped in accordance with the plan’s rules); however, if you drop coverage under the BCBS Plan, you will lose

coverage for health expenses in addition to prescription drugs.

You should also know that if you are Medicare eligible and drop or lose your coverage under the BCBS Plan and don’t enroll in Medicare prescription drug coverage within 63 days after your current coverage ends, you may pay more (a penalty) to enroll

in Medicare prescription drug coverage later.

If you decide to join a Medicare prescription drug plan, be aware that unless you have a qualifying event, you and your dependents may not elect medical coverage under the BCBS

Plan until the next open enrollment period.

If you are Medicare eligible and go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you go 19 months without coverage, your premium will always be at least 19% higher than what many other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait

until the following October/November to enroll.

Please note: More detailed information on prescriptiondrug benefits offered under the BCBS Plan is available at My Oncology Workspace> Benefits Online.

You will receive this Notice annually and at other times in the future such as before the next period you can enroll in

Medicare prescription drug coverage, and if coverage through

the BCBS Plan changes. You may also request a copy.

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. If you are eligible for Medicare, you will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For information about Medicare prescription drug plans you can also:

• Visit www.medicare.gov

• Call your State Health Insurance Assistance Program (see your copy of the “Medicare & You” handbook for their telephone number) for personalized help; or

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should

call 1-877-486-2048.

For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 1-800-772-1213 (TTY 1-800-325-0778).

Women’s Health and Cancer Rights Act of 1998 Annual Notice

This notice is to advise you of certain coverage and/or benefits provided to physicians and employees at practices affiliated with The US Oncology Network and The

US Rheumatology Network under the BCBS Plan.

This notice is required under the Women’s Health and Cancer Rights Act of 1998, which provides benefits for mastectomy and

reconstructive surgery and related services following a mastectomy.

For each covered individual receiving mastectomy-related benefits, coverage will be provided in a manner determined in

consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the

mastectomy was performed;

• Surgery and reconstruction of the other breast to achieve a symmetrical appearance; and

• Prostheses and treatment of physical complications,

including lymphedemas, at all stages of mastectomy.

Deductibles, coinsurance and copayment amounts for these services will be the same as those applied to other similarly covered Inpatient Hospital Expenses or Medical Surgical Expenses. Please refer to the deductibles and coinsurance

found in the medical plan section of this guide.

If you have questions regarding this notice, call Blue Cross and Blue Shield of Texas at 1-800-521-2227 or write to BCBSTX at

P.O. Box 655730, Dallas, Texas 75265

Newborns’ and Mothers’ Health Protection Act of 1996

This notice is to advise you of certain coverage and/or benefits provided to the physicians and employees at practices affiliated with

The US Oncology Network and The US Rheumatology Network.

This notice is required under the Newborns and Mothers Health Protection Act of 1996, which provides that each person covered for maternity/childbirth benefits be provided inpatient care for the mother and her newborn child in a healthcare facility for a minimum of:

• 48 hours following an uncomplicated vaginal delivery; and

• 96 hours following an uncomplicated delivery by

Cesarean section.

This benefit does not require a covered female who is eligible for maternity/childbirth benefits to:

• give birth in a hospital or other healthcare facility; or

• remain in a hospital or other healthcare facility for the

minimum of hours following birth of the child.

If a covered mother or her newborn child is discharged before the 48 or 96 hours has expired, coverage of post-delivery care will be provided under this plan. Post-delivery care includes parent education, assistance and training in breast-feeding and bottle-feeding and the performance of any necessary and appropriate clinical tests. Care will be provided by a physician, registered nurse or other appropriately licensed heath care provider, and the mother will have the option of receiving the care at her home, the healthcare provider’s office or a healthcare facility.

Prohibitions: The BCBS Plan may not (a) modify the terms of this coverage based on any covered person requesting less than the minimum coverage required; (b) offer the mother financial incentives or other compensation for waiver of the minimum number of hours required; (c) refuse to accept a physician’s recommendation for a specified period of inpatient care made in consultation with the mother if the period recommended by the physician does not exceed guidelines for prenatal care developed by nationally recognized professional associations of obstetricians and gynecologists or pediatricians; (d) reduce payments of reimbursements below the usual and customary rate; or (e) penalize a physician for recommending inpatient care for the mother or the newborn child.

Mental Health Parity and Equity Addiction Act of 2008

This notice is to advise you of certain coverage and/or benefits provided to the physicians and employees at practices affiliated with The US Oncology Network and The US Rheumatology Network under the BCBS Plan. Pursuant to the Mental Health

Parity and Equity Addiction Act of 2008 (MHPEA), the BCBS Plan provides for parity in the application of aggregate lifetime and annual dollar limits on mental health benefits and substance abuse/chemical dependency benefits, with the dollar limits imposed under the BCBS Plan on medical and surgical benefits. This means that the BCBS Plan does not set annual or lifetime dollar limits on mental health or substance abuse/chemical dependency benefits that are lower than any such dollar limits on medical and surgical benefits. In addition, the BCBS Plan’s financial requirements and treatment limitations (such as copays and deductibles) applicable to mental health and substance abuse/chemical dependency benefits are no more

restrictive than the predominant financial requirements and

treatment limitations applied to substantially all medical and

surgical benefits provided under the Plan.

Nondiscrimination Notwithstanding anything in the BCBS Plan to the contrary,

the BCBS Plan may not discriminate against any individual or

dependent of that individual with respect to health coverage

on the basis of a health factor. Further, the BCBS Plan shall

not (a) adjust premium contribution amounts based on

genetic information, (b) request or require an individual or

family member to undergo a genetic test (except in certain

circumstances related to research), or (c) request, require, or

purchase genetic information with respect to any individual

prior to the individual’s enrollment in the BCBS Plan or

coverage in connection with enrollment in the BCBS Plan.

Genetic Information Nondiscrimination Act of 2008

McKesson Specialty Health and The US Oncology Network shall comply with GINA and, therefore, will not:

(a) Increase group premium or contribution amounts based on genetic information;

(b) Request or require an individual or family members to undergo genetic testing; or

(c) Request, require, or purchase genetic information prior to or in connection with enrollment or at any time for underwriting purposes.

“Genetic information” is information about (1) an individual’s genetic tests; (2) the genetic tests of an individual’s family members; (3) the manifestation of a disease or disorder in an individual’s family members; or (4) any request or receipt by the individual of his or her family members of genetic information. Genetic information does not include blood tests that are not

designed to obtain information relating to genotypes, mutations, or chromosomal changes; cholesterol tests; or information about the age or sex of an individual or family member. For these purposes GINA shall mean the Genetic Information Nondiscrimination Act of 2008.

The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.

CONTACT INFORMATIONThe following chart provides a quick reference to resources and contact information regarding the benefits available to plan participants.

You may also call the Benefits Help Line at 1-877-248-8518 Monday through Friday from 9am to 5pm Central Time.

Benefit(s) Carrier Name Group # Phone Web

Medical (PPO)Blue Cross and Blue Shield of

Texas57676 1-800-521-2227 www.bcbstx.com/members

Medical (Consumer’s

Choice)

Blue Cross and Blue Shield of

Texas57678 1-800-521-2227 www.bcbstx.com/members

Prescriptions Prime Therapeutics 57676 1-800-521-2227 www.myrxhealth.com

Health Savings Fidelity Investments N/A 1-800-544-3716 www.netbenefits.com

Dental Ameritas Group 350247 1-844-212-1430 www.ameritas.com

VisionDavis Vision 7256 1-800-999-5431 www.davisvision.com

VSP 1-800-877-7195 www.vsp.com

Life/AD&D MetLife 139108 1-866-492-6983 www.metlife.com/mybenefits

Short- and Long-term Disability

Total Absence Reporting (FML)

MetLife 139108

1-866-729-9200

1-877-638-8269

www.metlife.com/mybenefits

Critical Illness MetLife 1391081-800-438-6388 (ask for Critical

Illness)N/A


BPAS N/A1-866-401-5272

(Customer Service)

www.bpas.com

COBRA AonHewitt N/A 1-877-248-8518http://upointhr.com/ thenetworkbenefits

Perks Program Beneplace N/A 1-800-683-2886 www2.beneplace.com/uson

Employee Assistance Program

ComPsych USON123 1-877-477-8766 www.guidanceresources.com

401(k) Fidelity N/A 1-800-890-4015 www.401k.com

2016 BENEFITS GUIDE - Alight · 2020-06-30 · If you (and/or your dependents) have Medicare or...

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