2018 Benefits Open Enrollment Guide - Trinity Healthmybenefits.trinity-health.org/documents/Muskegon...

2018 Benefits Open Enrollment GuideNovember 20 - 30, 2017

Now is the Time to Enroll in BenefitsEach year, you are given the opportunity to choose the benefits that work best for you and your family situation. This enrollment guide from Trinity Health provides the information youll need to enroll for next years benefits.

We encourage you to use this guide to learn about your benefit plan options, decide on the levels of coverage that are right for you and your family, and compare costs before you enroll.

In addition to details about the 2018 benefit plan options, this enrollment guide provides other important information, such as colleague and dependent eligibility requirements, step-by-step instructions on how to enroll, and how to get answers to your questions.

Be sure to take a few minutes to review the premium contributions for each benefit option before making your selections for 2018.

If you have more questions after reading this guide, refer to the For more information section to determine where you can go to get answers.

Welcome to Open Enrollment Mercy Health Muskegon!Trinity Health and Mercy Health Muskegon are pleased to provide you with the information you will need to enroll in benefits for nextyear. Throughout the rest of this communication, you will see Trinity Health and Mercy Health Muskegon referred to as simplyTrinity Health. If you have more questions after reviewing this guide, refer to the For More Information section to learn where youcan get answers.

Whats Inside

Whats New for 2018 2

How to Enroll 3

About the Medical Plans 4

Medical Coverage 5

Medical and Pharmacy

Plan Highlights 6

Paying for Medical and

Pharmacy Coverage 8

More About the Health

Savings PPO 9

Live Your Whole Life 10

More About the Medical

Plans 12

Dental Coverage 13

Vision Care Coverage 14

Flexible Spending

Accounts 15

Life Insurance 16

Time Away from Work 18

Legal Plan and

Voluntary Benefits 19

Who is Eligible 20

For More Information 21

Important Reminders 22

Additional Notices

Your Top Three Tasks for Open Enrollment

1 Make your benefit elections by Nov. 30, 2017.

2 Review the Live Your Whole Life or the BCN Healthy BlueLiving HMO section of this guide to learn about resources thatwill help you maintain your health and incentives on yourmedical contributions throughout the year.

3 Submit your Personal Health Application for supplemental lifeinsurance to The Hartford, if applicable.

Its also a good time of year to:

Check the eligibility rules if you, your spouse/eligible adult and/or dependent childboth work at Trinity Health at http://mybenefits.trinity-health.org.

Make copies of your benefit elections for proof of enrollment.

Open Enrollment is Mandatory for 2018. You must enroll by Nov. 30, 2017 in orderto have benefits in 2018.

If you want to participate in the Essential PPO Assist Plan for 2018, you mustapply each year and meet specific income and eligibility guidelines. For moreinformation on the Essential PPO Assist Plan, refer to page 8.

Open enrollment is mandatory for medical coverage for 2018

This means that you must enroll in medical coverage by Nov. 30, 2017. Even if youare going to waive medical coverage, you still need to complete your openenrollment medical coverage election and select Waive.

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Whats New for 2018

Complete your benefits enrollment by using the manualform in the back of this booklet and submit to HumanResources no later than Nov. 30, 2017.

You have the opportunity to choose from four all newmedical plan options for 2018: the Traditional PPOPlan, the Health Savings PPO Plan (which includes ahealth savings account), the Essential PPO Plan andthe BCN Healthy Blue Living HMO. See the MedicalCoverage section for more information on these planoptions. Keep in mind, because these medical planoptions are all new for 2018, you must make a medicalplan election, including if you want to waive coverage.If you dont make a medical election, you will not havemedical coverage.

Beginning in 2018, there will no longer be a credit forwaiving medical coverage.

As part of the medical plan designs for 2018, you willnow share in the cost of services when you utilize Tier1 providers: Trinity Health facilities and alignedproviders. Keep in mind, even with the newcost-sharing structure, you will have a lower deductible,coinsurance and out-of-pocket maximum when you useTrinity Health facilities and aligned providers.

We are pleased to introduce our clinically integratednetwork (CIN) structure for our medical plan options.The CIN joins local physicians and health careproviders with our Regional Health Ministry (RHM) intoa single care management system using a common setof quality measurements to ensure high quality,cost-efficient care.

Beginning January 1, 2018, we are transitioning ourEmployee Wellness program to the Trinity Healthprogram for all medical plans. Participation in thisprogram will help you maintain your 2018 medicalinsurance premiums.

Beginning in 2018, you have new vendors for dentaland vision. You will not receive an insurance card forthese plans. Keep in mind, because these plan optionsare all new for 2018, you must make a plan electioneven if you want to waive coverage. If you do not makea dental or vision election, you will not have coverage in2018.

If you enroll in benefits this year, you will receive a newmedical ID card. If you enroll in one of the three PPOplans, you will also receive a new pharmacy cardthrough CVS/Caremark.

This year, certain vaccinations will be covered throughthe pharmacy benefit as well as the medical benefitwith a $0 copay if enrolled in the Traditional, HealthSavings Account or Essential Plans. Under thepharmacy benefit, you must use your prescription cardat a participating CVS network pharmacy that offers thespecific vaccine. These vaccines may include:seasonal flu vaccine, shingles vaccine and thepneumonia vaccine.

We are pleased to introduce the Trinity HealthMyBenefits internet site for 2018. You can log on atwww.mybenefits.trinity-health.org to find informationabout the 2018 Open Enrollment process and to learnmore about your Trinity Health benefits.

Beginning Jan. 1, 2018, you and your covereddependents are required to select a primary carephysician (PCP) online if you elect a BlueCrossBlueShield of Michigan Plan.

If an eligible adult qualifies as a tax dependent, youmust complete the Non-Spouse Eligible AdultDependent Certification form posted on MyBenefitseach year in order to receive pre-tax deductions.

Starting in 2018, you may elect to cash-out up to 80hours of PTO. Keep in mind you must maintain aminimum of 40 hours in your PTO bank at the time ofthe cash-out in 2018. PTO cash-out payments will beincluded in your first pay in November 2018.

Trinity Health is updating its pharmacy formulary withCaremark effective Jan. 1, 2018. A drug formulary is alist of prescription drugs both generic and brand namethat offer the greatest overall value for both colleaguesand the plan. To learn more about the new pharmacyformulary, please visit MyBenefits or contact Caremark.

We are continuing to harmonize who is covered underTrinity Heatlh benefits and programs. For 2018, anEligible Adult may now be coverd. See the Who isEligible section for more information.

Beginning January 1, 2018, colleagues can nowreceive financial assistance for adoption expenses.

Your Enrollment RequirementsOpen enrollment is mandatory for 2018. This means that you must enroll between Nov. 20 - 30, 2017 if you want tochoose your own benefit options. If you wish to participate next year you must complete your enrollment by Nov. 30, 2017at 11:59 p.m. EST.

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How to EnrollTo enroll in benefits for 2018, complete the four page form at the back of thisbooklet, sign the Colleague Acknowledgement section, and return the originalform to your Human Resources by Nov. 30, 2017 by 5:00 p.m. EST.

If you do not change or correct your benefit elections, IRS regulations requireyou to remain in your elections throughout 2018 or until you experience aqualified status change. For more information on qualified status changes,visit http://mybenefits.trinity-health.org.

Open Enrollment ismandatory for 2018This means that you must enrollby Nov. 30, 2017 if you want tochoose your own benefit optionsfor 2018. Even if you are goingto waive coverage, you still needto complete your openenrollment elections and selectWaive.

Adding Family MembersIf youre adding family members to your benefit plan during this years open enrollment, youre required to provide writtendocumentation (for example, marriage certificate or birth certificate) verifying their dependent status to Human Resources nolater than Dec. 4, 2017. If you dont submit the required documentation by the deadline, your dependents will not beenrolled in coverage for 2018, and youll be required to wait until next years open enrollment period to add them tothe plan provided they remain eligible, and you provide documentation verifying their dependent status at that time. To seewho is eligible to be added to coverage, please see the Who is Eligible section on page 20.

You are required to provide a Social Security Number for each of your dependents over the age of one in order for them to becovered.

Please note, you have the option to purchase coverage for your spouse/eligible adult and dependents. If you and yourspouse/eligible adult or dependent(s) both work for Trinity Health, and are benefits eligible, you cannot elect dual coverage(enrolled as a colleague and a dependent). In addition, only one of you will be able to elect coverage for your child(ren).


About the Medical PlansIntroducing the Clinically Integrated Network (CIN) in 2018Trinity Health is pleased to introduce our Clinically Integrated Network (CIN) structure for our medical plan options in 2018.

A CIN joins local physicians and health care providers that have made a decision to partner with a Regional Health Ministry(RHM) to deliver services focused on high quality and cost-efficient care designed to improve the health of those we serve.

Seeking care within the CIN can help you and your physician make health care decisions that ensure that you are accessing theright care, at the right time, in the right setting. In addition, by utilizing our CIN you will pay less out-of-pocket for the care youreceive, because all of the CIN providers are in our Tier 1 network.

Choose your Primary Care Physician (PCP)Maintaining a relationship with your PCP is important because they are trained to recognize any health problems you may have.A PCP is the doctor you see for most services, including annual check-ups. Your PCP can also help you identify and meet yourhealth goals and help you prevent serious, long-term health conditions. And, by following their preventive recommendations,they can help keep your health care costs low. Trinity Health encourages you to select a PCP and develop a relationship withthem. Therefore, beginning January 1, 2018, you and your covered dependents will be required to have a PCP onrecord. Be sure to indicate your PCP through the medical vendors online portal. If no PCP is indicated, the Plan willauto-assign based on:

1. Claim history

2. Tier 1 physician within 10 mile radius of your home

3. Tier 2 physician within 10 mile radius of your home

To find an in-network physician or provider, visit http://mybenefits.trinity-health.org, select the My Service Providers tab.

Understanding your out-of-pocket medical costsYou may be wondering how Trinity Health and you share medical and pharmacy costs each year. The graphic belowshows how costs are shared for both premiums and coverage. Keep in mind, your costs will vary depending on the planand the network you access at the time of service.

You pay 10%/20%*Coinsurance

Plan pays 90%/80%* of costs

How Trinity Health & You Share Medical & Pharmacy Costs

Your Cost

Trinity Health

&You

SharedCost

PlanCost

Employee Premium Contributions

Copays

100% of Medical Costs up to the deductible

Plan pays 100% of Medical Costs once out-of-pocket is met

Trinity Health and you pay costs as you receive care throughout the year.

Trinity Health and you pay for your Medical and Pharmacy premiums throughout the year.

* Dependent on the Trinity Health Medical Plan selected and the cost share for Tier 1 facilities or physicians.


Watch this Videoto Learn More

Scan the tag with yoursmartphone to downloadand view a video aboutyour 2018 medical planchoices. Get the freemobile application athttp://www.scanlife.com/get-the-app. If you dont have asmartphone, visit theMyBenefits website to viewthe video.

Medical CoverageTrinity Health is offering you four medical plan choices for 2018 which support ourefforts to provide a common experience for all colleagues and provide meaningfulchoices. Three plans are administered by BlueCross BlueShield of Michigan andone plan is administered by Blue Care Network.

The PPO plans - Traditional, Health Savings and Essential - offer these three tiersso you can pay less by receiving care from network providers.

Tier 1, or the Trinity Health network providers, are facilities or physiciansaligned with our organization that provide you with the most cost-effectivecare. For services unavailable through Trinity Health network providers, selectBlueCross BlueShield providers will be available at the Tier 2 benefit level.

Tier 2 includes select BlueCross BlueShield Providers (facilities andphysicians) not listed under Tier 1. Using Tier 2 providers can save youmoney, but not as much as using our Tier 1 network.

Tier 3 providers are out-of-network providers and this Tier provides the lowestlevel of coverage. You can use these facilities and physicians for care, but youwill pay the most out of your pocket when you do.

How the medical plan works

Traditional PPOIf you elect coverage under the Traditional PPO, you pay for a portion of the medical services you receiveuntil you meet the annual deductible. Then, coinsurance begins up to the annual out-of-pocket maximum.

Health Savings PPOWith the Health Savings PPO, you pay less per pay period for coverage leaving more money in yourpaycheck and you have access to a Health Savings Account (HSA) to help pay for current and futuremedical expenses. Heres how it works:

1. You pay the full cost of medical and prescription expenses until youreach the annual deductible (Note: preventive care services andcertain preventive 90-day generic prescriptions do not require you tomeet the deductible).

2. Once you meet the deductible, you pay coinsurance until you reachthe out-of-pocket maximum.

3. Once you reach the out-of-pocket maximum, Trinity Health pays100% of all remaining eligible expenses during the year.

To learn more about the Health Savings PPO, see page 8 of thisenrollment guide.

If you enroll in the Health SavingsPPO, you will automatically havean HSA. Trinity Health and MercyHealth Muskegon contribute toyour HSA to help you pay forexpenses toward your annualdeductible and out-of-pocketmaximum. You can alsocontribute to this account to buildsavings for current and futuremedical expenses. Weencourage you to consult with atax advisor for IRS rules and taximplications related to HSAs.

Essential PPOThe Essential PPO works the same as the Traditional PPO where you pay for a portion of the medicalservices you receive until you meet the annual deductible. Then, coinsurance begins. If you elect theEssential PPO, you pay less in premium contributions than in the Traditional PPO, however, yourout-of-pocket costs are higher.

Healthy Blue Living HMOThe Healthy Blue Living plan offers many of the features typically found in an HMO, such as the selection of aprimary care physician who coordinates all of your care, and the requirement to use specific providers. But itsalso an innovative wellness program that rewards members with lower costs for pursuing their health goals.


Medical and Pharmacy Plan HighlightsFor more information about your medical and pharmacy plan options, visit http://mybenefits.trinity-health.org.

Medical Plan Network Tier Traditional PPO Health Savings PPO1 Essential PPO1

Highlights

Trinity Health-funded account All Tiers N/A HSA: $650 / $1,300 HRA: $850 / $1,700(Individual / Family) If you qualify during

open enrollment

Tier 1 $250 / $500 $1,500 / $3,000 $1,000 / $2,000

Annual deductible Tier 2 $750 / $1,500 $2,500 / $5,000 $2,500 / $5,000(Individual / Family)

Tier 3 $1,500 / $3,000 $3,500 / $7,000 $4,000 / $8,000

Tier 1 10%* 10%* 20%*

Coinsurance Tier 2 20%* 20%* 30%*

Tier 3 40% R&C* 40% R&C* 40% R&C*

Tier 1 0% no deductible 0% no deductible 0% no deductible

Preventive care Tier 2 0% no deductible 0% no deductible 0% no deductible

Tier 3 40% R&C* 40% R&C* 40% R&C*

Tier 1 $20 / $30 10%* 20%*

Office visit Tier 2 $30 / $40 20%* 30%*(PCP / Specialist)

Tier 3 40% R&C* 40% R&C* 40% R&C*

Urgent care visit All Tiers 0% after $35 copay 10%* 20%*

Emergency room All Tiers 0% after $100 copay 10%* 0% after $100 copay

Tier 1 None** None** None**

Inpatient Tier 2 $500** $500** $750**admission

Tier 3 $1,000** $1,000** $1,000**

Tier 1 $50** None** $50**

Outpatient Tier 2 $100** $100** $100**surgical services

Tier 3 $200** $200** $200**

Tier 1 $2,500 / $5,000 $2,600 / $5,200 $3,500 / $7,000Out-of-pocketmaximum Tier 2 $4,750 / $9,500 $5,000 / $10,000 $5,500 / $11,000(Individual / Family)

Tier 3 $9,500 / $19,000 $7,000 / $14,000 $9,000 / $18,000Trinity Health Retail Trinity Health Retail Trinity Health Retail

Owned Pharmacy Pharmacy Owned Pharmacy Pharmacy Owned Pharmacy Pharmacy

Generic $8 $10 $8 $10Prescription drug Brand formulary 16% ($24 min, 20% ($30 min, 16% after 20% after 20% ($24 min, 25% ($30 min,34 day supply $64 max) $80 max) deductible, 0% deductible, 0% $64 max) $80 max)

after out-of-pocket after out-of-pocketBrand 32% ($48 min, 40% ($60 min, max max 40% ($48 min, 50% ($60 min,non-formulary $80 max) $100 max) $96 max) $120 max)

Trinity Health Mail Trinity Health Mail Trinity Health MailOwned Pharmacy Order Owned Pharmacy Order Owned Pharmacy Order

Generic $24 $25 $24 $2590 day supply Brand formulary 16% ($72 min, 20% ($75 min, 16% after 20% after 20% ($72 min, 25% ($75 min,

$192 max) $200 max) deductible, 0% deductible, 0% $192 max) $200 max)after out-of-pocket after out-of-pocket

Brand 32% ($144 min, 40% ($150 min, max max 40% ($144 min, 50% ($150 min,non-formulary $240 max) $250 max) $288 max) $300 max)

Out-of-pocket maximum based on Deductible and out-of-pocket Out-of-pocket maximum based onTier 2 based on Tier 1 Tier 2

1The individual deductible only applies to those enrolled in colleague-only coverage for the Health Savings PPO and Essential PPO Assist Plans. For allother coverage levels, the full family deductible must be met even if only one person in the family is receiving care.

*Reasonable and Customary (R&C), subject to deductible.**Subject to deductible and coinsurance.Select, generic preventive drugs are covered at 100% and are not subject to the annual deductible. See the MyBenefits website for thecomplete list of eligible drugs.


Medical and Pharmacy Plan Highlights

Medical Plan Healthy Blue Living HMO

Highlights Trinity Health BCN

Provider Network Provider Network

Annual deductible2Individual/Family $250 / $500 $750 / $1,500

Coinsurance2 10% or 50% of approved amount for select services 20% or 50% of approved amount for select services(Colleague responsibility,after deductible is met)

Preventive services $0 $0(See Summary PlanDescription for definitionof covered preventiveservices)

Office visits $20 copayment $30 copayment$30 copayment $40 copayment

(specialist) (specialist)

Urgent care visits $35 copayment $35 copayment(Non-life threatening)

Emergency room2 $100 copayment $100 copayment(Life threatening)

Inpatient $500 copaymentadmissions1 10% after deductible 20% after deductible

Outpatient surgery1 $50 copayment $100 copayment10% after deductible 20% after deductible

Out-of-pocketmaximums3Individual/Family $2,500/$5,000 $4,750/$9,500

Prescription drug Trinity Health Provider Networkcopayment/ $8coinsurance3 20% ($24 min./$64 max.)Generic (incentive applies) 40% ($48 min./$80 max.)Brand formularyBrand non-formulary

BCN Provider Network$10

20% ($30 min./$80 max.)40% ($60 min./$100 max.)

1Applies to facility fee only; does not include professional fees.2In-network deductibles apply for non-emergency use of a Trinity Health emergency room.3Copayments, coinsurance amounts, prescription drug costs, and deductibles will apply toward your out-of-pocket maximums.


Paying for Medical and Pharmacy CoverageContribution levels for the medical and pharmacy plans are based on the Social Security taxable wage base ($127,200 for2017, indexed annually) to ensure our benefit plan cost-sharing model is appropriately aligned with our colleagues incomelevels. The amount you pay for medical and pharmacy coverage is based on your annual base salary (your base rate of paytimes your budgeted hours) and your participation in the Well-Being programs. If at any time during the 2018 plan year, youearn $127,200 or more, you will pay a higher premium contribution per pay period for your medical insurance.

Traditional PPO Health Savings PPO Essential PPO Healthy Blue Living HMOFull TimeYour per pay Full 1 - Person No Full 1 - Person No Full 1 - Person No Full 1 - Person Noperiod cost Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive

For colleagues earning less than the 2017 SSTWB - Level 1Colleague only $64.52 N/A $79.52 $59.92 N/A $74.92 $54.40 N/A $69.40 $70.52 N/A $85.52

Colleagueplus spouse/

$141.95 $156.95 $171.95 $131.83 $146.83 $161.83 $119.68 $134.68 $149.68 $155.14 $170.14 $170.14

eligible adult

Colleagueplus child(ren)

$100.01 N/A $115.01 $92.88 N/A $107.88 $84.32 N/A $99.32 $109.30 N/A $124.30

Colleagueplus family

$177.44 $192.44 $207.44 $164.79 $179.79 $194.79 $149.60 $164.60 $179.60 $193.92 $208.92 $208.92

For colleagues earning the 2017 SSTWB or more - Level 2Colleague only $77.43 N/A $92.43 $71.91 N/A $86.91 $65.28 N/A $80.28 $84.62 N/A $99.62


$170.35 $185.35 $200.35 $158.20 $173.20 $188.20 $143.62 $158.62 $173.62 $186.16 $201.16 $201.16

eligible adult


$120.02 N/A $135.02 $111.46 N/A $126.46 $101.18 N/A $116.18 $131.16 N/A $146.16


$212.93 $227.93 $242.93 $197.75 $212.75 $227.75 $179.52 $194.52 $209.52 $232.70 $247.70 $247.70

Traditional PPO Health Savings PPO Essential PPO Healthy Blue Living HMOPart TimeYour per pay Full 1 - Person No Full 1 - Person No Full 1 - Person No Full 1 - Person Noperiod cost Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive

For colleagues earning less than the 2017 SSTWB - Level 1Colleague only $129.05 N/A $144.05 $119.85 N/A $134.85 $108.80 N/A $123.80 $141.03 N/A $156.03


$283.91 $298.91 $313.91 $263.67 $278.67 $293.67 $239.36 $254.36 $269.36 $310.27 $325.27 $325.27

eligible adult


$200.03 N/A $215.03 $185.77 N/A $200.77 $168.64 N/A $183.64 $218.60 N/A $233.60


$354.89 $369.89 $384.89 $329.58 $344.58 $359.58 $299.20 $314.20 $329.20 $387.84 $402.84 $402.84

For colleagues earning the 2017 SSTWB or more - Level 2Colleague only $141.95 N/A $156.95 $131.83 N/A $146.83 $119.68 N/A $134.68 $155.14 N/A $170.14


$312.30 $327.30 $342.30 $290.03 $305.03 $320.03 $263.30 $278.30 $293.30 $341.30 $356.30 $356.30

eligible adult


$220.03 N/A $235.03 $204.34 N/A $219.34 $185.50 N/A $200.50 $240.46 N/A $255.46


$390.38 $405.38 $420.38 $362.54 $377.54 $392.54 $390.38 $344.12 $359.12 $426.62 $441.62 $441.62

The 2017 Social Security taxable wage base (SSTWB) is $127,200.

Need help with your health care costs?You may be eligible for the Essential PPO Assist plan (Assist Plan) if you meet certain incomerequirements. It is the same as the Essential PPO, but includes a Trinity Health-funded HealthReimbursement Account (HRA) to help you pay for your health care costs at the time of service. Toparticipate in the Assist Plan, you must apply and meet specific income and eligibility guidelines. Tolearn more, see the application form on the MyBenefits website orhttp://mybenefits.trinity-health.org. Apply by submitting a completed application form with a copy ofyour most recent Federal Income Tax Form 1040 or 1040EZ to Human Resources by Dec. 4, 2017.

NOTE: If you think you qualify for the Assist Plan, you should elect the medical plan you think will bebest for you which could be the Traditional PPO, the Health Savings PPO, the Essential PPO orthe Healthy Blue Living HMO. If you qualify for the Assist Plan, you will be moved to the Assist Plan.Otherwise, you will remain in the plan you elected during open enrollment.

How do theIncentives work?For more informationon how to achieveFull and 1-Personincentives, see theLive Your Whole Lifesection on page 10.


More about theHealth SavingsPPOThe Health Savings PPOis a consumer-drivenhealth plan which givesyou the opportunity toparticipate in a plan whereyour health care costs aremore closely determinedby your decisions. Hereare some reasons toconsider choosing theHealth Savings PPO in2018:

I liked that I savedmoney in premiumcontributions spending moneyonly when I usedmedical care.

I can really savefor my health careexpenses when Iuse the HSA.

Its great that TrinityHealth makes its fullcontribution to my HSAin January.

For certain genericpreventive drugs anddiabetes and asthmadrug classes, I didnthave to pay mydeductible before theplan started payingthose expenses.

How thedeductible worksThe Health SavingsPPO Plan includes acombined deductible.A combineddeductible means thefull family deductiblemust be met even ifonly one person inthe family is receivingcare. Coinsurancebegins once thecombined deductiblehas been met.

How the Health Savings Account (HSA) worksWhen you enroll in the Health Savings PPO plan, you automatically have a Health SavingsAccount (HSA) through Health Equity to help you pay for current or future health care costs.Trinity Health will make a full contribution to your account in January based on the coveragelevel you elect. In addition, you can also contribute to this account up to IRS limits:

Coverage Level Trinity Health Your Voluntary Total IRS AllowedContributions Contributions* HSA Contributions

Colleague only $650 $2,800 $3,450

All other coverage levels $1,300 $5,600 $6,900

*If you are 55 or older, you can contribute an additional $1,000 in catch-up contributions to your HSA.May be subject to state taxation.

Questions about the HSAHow do I get an HSA? To be eligible for the HSA, you must enroll in the Health SavingsPPO. In addition, you cannot have coverage under another non-high deductible health plan,such as Medicare, TRICARE, or coverage through a spouses health plan.

Who can use funds in my HSA? You and your dependents can pay for medical, dental andvision expenses with funds in your HSA. Dependents must be claimed on your tax return.

Why would I contribute to my HSA? Contributions to the HSA are a great way to save ontaxes. With the HSA, you do not pay taxes on the amount you contribute through payrolldeductions, the amount you withdraw for medical expenses, and the interest you earn in theaccount (up to amounts set by federal law). Keep in mind that you can change the amountyou contribute to your HSA at any time during the plan year.

How can I use the money in my HSA? You may use the HSA to pay for qualified medicalexpenses now and during retirement for you and your qualified dependents.

How do I pay for medical expenses with my HSA? When you receive eligible health careservices, you can pay for those services with your HSA debit card, or through several onlineand smartphone app options. Youll receive more information about your payment options ifyou enroll in the Health Savings PPO with the HSA.

What happens if I dont use all the money in my HSA each year? Any money you donot use during the year is carried over, without any limits. Remember, you own the money inyour HSA and it is yours to keep even when you change jobs or retire.

Can I enroll in the Health Care Flexible Spending Account (HCFSA) if I have anHSA? When you enroll in the Health Savings PPO which includes the HSA, you will not haveaccess to the health care flexible spending account (HCFSA). However, the HSA may be seenas having more advantages over the HCFSA including:

The opportunity to carry over savings from year to year you do not forfeit any amount inyour HSA at the end of the plan year (if you are currently enrolled in the HCFSA for 2017and you elect the HSA for 2018, you must utilize your HCFSA funds by Dec. 31, 2017);

Contributions of up to $6,900 in tax-free HSA dollars each year (the HCFSA maximum is$2,600);

Your HSA dollars are saved in a bank account that may earn interest.How do I know if the Health Savings PPO, including an HSA, may be right for me?Your medical plan choice depends on your personal situation. If you answer yes to some ofthese questions, the Health Savings PPO plan may be right for you:

Would you like to have lower per pay period contributions deducted from your paycheck? Do you want to save on taxes by contributing to the

HSA for your health care costs?

Do you need a way to pay for future health care costs? Can you see your HSA balance growing as you keep

making contributions each year?

We encourage you to consult with a tax advisor for IRSrules and tax implications related to an HSA.

May be subject to state taxation.

For more information about the HealthSavings PPO, including the HealthSavings Account (HSA), visitwww.healthequity.com/ed/trinityhealthor http://mybenefits.trinity-health.org.


Live Your Whole LifeStaying healthy all the way around - in body, mind, and spirit - makes us happier and more productive at home and on the job. AtTrinity Health, we believe that an annual Health Assessment and healthy activities are essential steps in understanding yourwell-being. Its so important that we provide an incentive when you and your covered spouse or eligible adult complete these steps.The Live Your Whole Life Program is available if you elect the Traditional, Health Savings or Essential PPO plan.

Heres how this years program will work:

1 All colleagues start with the Full Incentive amounts.Note: See the box to the right to understand the new optionsfor Full and 1-Person Incentives.

2 There are two Periods where you can earn LifePoints tomaintain your Full Incentive amounts.

3 To maintain these incentives throughout the year, youneed to earn 100 LifePoints in each Period by completingthe outlined activities.

Incentive StructureThere are separate incentive amounts for colleaguesand spouses/eligible adults. If both you and yourspouse/eligible adult complete the activities in eachperiod, you will maintain the Full Incentive amounts.If only one of you completes the activities in eachperiod, you will only maintain a 1-Person Incentiveamount. (See the section Paying for MedicalCoverage for contribution rates with Full and1-Person Incentives.)

Period 1 Earn 100 LifePoints by March 30, 2018

Complete your Health Assessment

The Health Assessment is an online questionnaire about your health habits. Your answers are kept secure and confidential;summary data is used to identify areas for future well-being and prevention programs.

Note: To maintain your Full Incentive amount, the health assessment must be completed by you and your covered spouse oreligible adult in Period 1 (Oct. 1, 2017 - March 30, 2018.) If you (and your spouse/eligible adult, if applicable) do not completeyour health assessment by March 30, 2018, you will not maintain the incentive of a lower per pay period cost for medicalcoverage, beginning with the pay that includes May 1, 2018.

Period 2 Earn 100 LifePoints between April 1 and June 29, 2018

To continue receiving the incentive throughout the year, you and your covered spouse or eligible adult need to earn 100LifePoints by participating in a Meaningful Choice activity that interests you within Period 2. You can choose from a variety ofMeaningful Choice Activities that fit your lifestyle. Some examples include talking with a health coach, completing a stage ofan online journey module, tracking well-being items such as hours of sleep or time spent volunteering.

If you (and your spouse/eligible adult, if applicable) do not earn 100 LifePoints by June 29, 2018, you will not maintain theincentive of a lower per pay period cost for medical coverage, beginning with the pay that includes August 1, 2018.

Need another chance to earn your Full Incentives?If you did not complete the required activities by the Period 1 deadline, you still have one morechance to regain your Full Incentive amounts. If you complete both the Period 1 and Period 2activities by June 29, 2018, you will regain the Incentive (Full or 1-Person, depending on if yourspouse/eligible adult completes the activities), beginning with the pay that includes August 1,2018.

If you feel that you are unable to complete the Live Your Whole Life incentive activities by thedeadline due to extenuating circumstances (e.g., medical hardship, military deployment), youmay request an exception. For your exception request to be reviewed, the form must becompleted and returned prior to the end of each Period. Exception forms can be found atwww.mybenefits.trinity-health/lywl or by calling 1.855.491.8781.

For more informationon dates and activities,please visit the LiveYour Whole Lifewebsite at mybenefits.trinity-health.org/lywlor call 1-855-491-8781.


BCN Healthy Blue Living HMOSMThe Healthy Blue Living plan offers many of the features typically found in an HMO, such as the selection of a primary carephysician who coordinates all of your care, and the requirement to use specific providers. But its also an innovative wellnessprogram that rewards members with lower costs for pursuing their health goals.

With this plan, you will start the year with an incentive of a lower cost per pay period for medical benefits. To continue receivingthis incentive throughout the plan year:

1. Complete a Health Assessment (HA) at BCBSM.com AND visit your PCP and have him/her complete and sign theQualification Form. The Qualification Form must be returned to Blue Care Network between Jan. 1 and Mar. 30, 2018.

If the completed Health Assessment and Qualification forms are not received by Mar. 30, 2018, you will see anincrease in your per pay period cost for medical benefits beginning with the pay that includes May 1, 2018.

If you do not meet the incentive criteria of this deadline (complete Health Assessment and submit completedQualification Form by Mar. 30, 2018), you will remain at the No Incentive rate for your medical benefits until the end of2018.

Depending on the results on the Qualification Form, you may be required to participate in additional healthimprovement activity programs to maintain the incentive of a lower per pay cost for medical benefits.

2. If, per the results of your Qualification Form, you are notified that additional action is needed to maintain the incentive;enroll and actively participate in some of the actions listed below by June 29, 2018.

If you do not complete this step (if applicable) you will see an increase in your per pay period cost for medical coveragebeginning on the pay that includes Aug. 1, 2018.

Members will have cotinine blood or urine testing conducted to verify whether you are using nicotine. Those who arepositive for nicotine have the option to enroll and participate in the "Quit the Nic" program to maintain their incentivethroughout the 2018 plan year.

Those with a Body Mass Index (BMI) of 30 or above, will have the option to enroll in WeightWatchers or theWalkingSpree Pocket Pedometer program to maintain the incentive of a lower cost for medical benefits throughout theplan year. The cost of these programs is covered by the plan for health plan enrolled colleagues.

Note: To maintain your reward of a lower premium contribution on your medical benefits each pay period, you must meet theIncentive criteria listed above by the deadline(s). If you do not complete the incentive requirements by the deadline(s) you willremain at the No Incentive rate for your medical benefits until the end of 2018. You will have another opportunity to qualify forthe incentive at the beginning of the next plan year.

To learn more about the Healthy Blue Living plan, visit http://mybenefits.trinity-health.org.


Be a smart health care consumerAs you know, the cost of high-quality health care continues to increase each year. Being a smart consumer meansgetting the best price on something you need, whether its a new car or health care.

Being a smart health care consumer doesnt mean you should avoid trips to the doctor it means making the bestdecisions about when to go to the doctor. Regular checkups can improve your health and extend your life. By gettingthe recommended exams and tests, you increase your chances of discovering problems before an illness significantlyaffects your health. Plus, preventive care is beneficial not only to your physical well-being, it also makes sense for yourfinancial health because generally, its covered by your medical plan. For more information on preventive care benefits,visit http://mybenefits.trinity-health.org.

An easy way to be a smart health care consumer is to choose a Trinity Health Tier 1 provider when you or a familymember needs medical care. Besides receiving excellent care at our own facilities, you receive the highest level ofbenefits while paying the lowest available copayment and coinsurance amounts.

Maintenance Choice program for your maintenance medications Traditional, Health Savingsand Essential PPO plans onlyOur prescription drug plan requires that you receive your maintenance medications* in 90-day supplies through yourTrinity Health owned pharmacy or through the CVS Caremark Mail Service Pharmacy. Once you reach your plan limit(initial fill and 2 refills) for filling 30-day supplies at a retail pharmacy, you will pay the full cost of your medications if youdo not move your prescription to one of the long-term options listed above.

*A maintenance medication is a long-term medication taken regularly for chronic conditions or long-term therapy.

Information about our PharmaciesWe encourage you to use one of our four pharmacies:

Mercy Health Pharmacy Glenside1631 W. Sherman Blvd., MuskegonPh 231-755-2443 Fax 231-759-4190Hours: 8:30-6:30 Monday-Friday, 9:00 - 2:00 Saturday

Mercy Health Pharmacy Hackley (Inside the Hackley Professional Center)1675 Leahy St., Suite 111, MuskegonPh 231-728-5888 Fax 231-728-4093Hours: 8:00-6:00 Monday-Friday

Mercy Health Pharmacy Lakes (located in the Lakes Village)6401 Prairie Street, Suite 1100, MuskegonPh 231-727-7968 Fax 231-727-7971Hours: 8:00-6:00 Monday-Friday

Mercy Health Pharmacy Westshore (located in the Health Pavilion)1150 E. Sherman Blvd., Suite 1400, MuskegonPh 231-672-2204 Fax 231-672-3799Hours: 8:00-6:00 Monday-Friday


Dental CoverageYou have a choice between two Delta Dental of Michigan plan options: the High plan and the Standard plan. Our plans utilizethe Delta Premier and PPO networks. Visit www.deltadentalmi.com for providers in your area.

Dental Plan Highlights High Plan Standard Plan

Participating Dentist Nonparticipating Dentist Participating Dentist Nonparticipating Dentist

Annual deductible

Individual/Family $25/$50 $50/$100 $50/$100 $100/$150

Class I - Preventive services 100% covered 100% covered 100% covered 100% covered

($0 colleague cost) (Usual and Customary ($0 colleague cost) (Usual and Customary

rates apply) rates apply)

Class II - Basic services 20% after deductible 20% after deductible 40% after deductible 40% after deductible

Class III - Major restorative services 40% after deductible 40% after deductible 50% after deductible 50% after deductible

Class IV - Orthodontics 50% after deductible 50% after deductible Not covered

Maximums

Per person annual (non-orthodontics) $1,750 $1,250 $1,500 $1,000

Per person lifetime (orthodontics) $1,500 $1,500 Not applicable Not applicable

Your per pay period cost Full-time Part-time Full-time Part-time

Colleague only $6.18 $9.71 $3.74 $6.23

Colleague plus spouse/eligible adult $12.36 $19.42 $7.48 $12.47

Colleague plus child(ren) $13.91 $21.85 $8.42 $14.03

Colleague plus family $20.09 $31.57 $12.16 $20.26

NOTES: When you receive services from a non-participating dentist, you will be responsible for the difference between whatyour dentist charges and the Delta Dental non-participating dentist fee. Fluoride treatments are covered once every 12 monthsup to age 19. Bitewing x-rays are covered once every 12 months.


Vision Care CoverageYou have a choice between two United Health Care vision plan options: the High plan and the Standard plan. Visitwww.myuhcvision.com for providers in your area.

UHC Vision Plan Highlights High Plan Standard Plan

In-network Out-of-network In-network Out-of-network(reimbursement schedule) (reimbursement schedule)

Benefit frequency Calendar year Calendar year Calendar year Calendar year

Vision exam Covered in full Up to $40 $10 copayment Up to $40

Pair of lenses

Single vision Up to $40 Up to $40

Bifocal $0 copayment Up to $60 $0 copayment Up to $60

Trifocal Up to $80 Up to $80

Lenticular Up to $80 Up to $80

Frames $150 retail allowance Up to $45 $150 retail allowance Up to $45

Covered frame at retail locations at retail locations

Non-covered frame

Contact lenses

(in lieu of eyeglasses)

Elective Contact lens coverage is provided under the plan and may vary dependent on the type of contact lenses

Necessary prescribed. Please see the benefit summary on My Benefits for additional information.

Additional pair of eyeglasses

or contact lenses20% discount 20% discount 20% discount 20% discount

Additional lens options The following lens

options are covered in

full: standard scratch-

resistant coating, standard

basic and high-end

progressive lenses,

standard polycarbonate

lenses, standard anti-

reflective coating, UV,

tints, photochromic,

Transitions, edge coating

The following lens options

are covered in full:

standard scratch-resistant

coating, standard

polycarbonate lenses

Your per pay period cost

Colleague only $5.29 $3.17

Colleague plus $10.98 $5.81

spouse/eligible adult

Colleague plus child(ren) $11.52 $6.11

Colleague plus family $16.22 $8.43

For more information about yourvision care plan options, visithttp://mybenefits.trinity-health.org.


Health Care and Dependent Care Flexible Spending AccountsYou have the opportunity to set aside before-tax money to offset eligible health care or dependent care expenses. There aretwo different types of Flexible Spending Accounts a Health Care Flexible Spending Account (HCFSA) and a Dependent CareFlexible Spending Account (DCFSA).

Health Care Flexible Spending Account (HCFSA) Dependent Care Flexible Spending Account (DCFSA)

How much can I contribute? Before-tax dollars in any amount between $130 and

$2,600

Before-tax dollars in any amount between $130 and

$5,000

What expenses will it cover? Eligible health care products and services used by you

and/or your eligible dependents. Examples include:

Vision care, including eyeglasses, contact lenses andsaline solution

Dental care, both preventive and restorative Orthodontia Physical therapy, counseling, or psychological

services

Chiropractic care and acupuncture Copayments, coinsurance and deductibles Prescribed Over-the-Counter (OTC) medicationsFor a list of expenses that are eligible for HCFSA reim-

bursement, visit http://mybenefits.trinity-health.org.

Expenses for the care of your eligible dependents (child

under age 13 or qualifying adult incapable of self-care)

while you work:

Babysitting or au pair services Before and after-school programs Day care and nursery school Pre-school programs Elder care services

When do I have to spend the

money?

Contributions made to the HCFSA during the 2018

calendar year can be used for claims with dates of

service between Jan. 1, 2018 and Mar. 15, 2019.

Contributions made to the DCFSA during the 2018

calendar year can be used for claims with dates of

services between Jan. 1 and Dec. 31, 2018.

How do I access my FSA

savings?

You can use a variety of payment options to access your

FSA savings. These include the WageWorks Health

Card, Pay my Provider, Pay me Back, or by using the

Mobile application.

You can use a variety of payment options to access your

FSA savings. These include the Pay my Provider, Pay

me Back, or by using the Mobile application.

Reminders: If you choose to enroll in the Health Savings PPO medical plan option, you cannot enroll in the HCFSA. The Health

Savings Account works just like the HCFSA but offers additional benefits, such as the opportunity to carry over unusedfunds, contribute up to $2,800/individual ($5,600/family), plus an additional $1,000 in catch-up contributions if you are age 55or over, and earn interest on your savings.

You must make HCFSA and/or DCFSA elections for 2018 during open enrollment.Your prior year elections will NOT carry forward.

HCFSA and DCFSA claims for the 2018 plan year must be postmarked on or beforeMar. 31, 2019.

If you choose to contribute to the HCFSA for the first time in 2018, a new WageWorksHealth Card will be mailed to your home. Otherwise, you will only receive a newWageWorks Health Card when your current card expires.

For more information about yourFSA benefits and to obtain a listof eligible expenses, visithttp://mybenefits.trinity-health.org.

How to use your remaining 2017 HCFSA fundsIf you contributed to the HCFSA in 2017 and have funds remaining on Dec. 31, 2017, you can use the funds for claimsincurred between Jan. 1, 2018 and Mar. 15, 2018. Claims must be submitted by Mar. 31, 2018. To ensure you use yourremaining 2017 funds, you must pay for the claim at the time of service and submit your claims to WageWorks. Do notuse your WageWorks debit card to pay for claims during this period because the card will access 2018 funds.


Life InsuranceColleague life insurance optionsIf eligible, you receive employer-provided basic life/AD&D insurance at one times yourannual base salary.

In addition, you have the option to purchase supplemental coverage for yourself in theincrements shown in the table below. If you purchase colleague supplemental lifeinsurance and youre approved, the premium contributions will be deducted from yourpaycheck on an after-tax basis.

You will be eligible for will preparation services through The Hartfords EstateGuidanceWill Services at no charge. To get started, access The Hartfords EstateGuidance WillServices online at www.estateguidance.com/wills and enter the Trinity Health Web IDWILLHLF in the Promotional Code box.

Colleague Life Insurance

Plan Highlights (full- and part-time)

Basic life/AD&D One times annual base salary(employer-paid)

Supplemental life One to eight times annual base salary

Supplemental AD&D One to eight times annual base salary

Maximum amounts Basic life: $1.5 million

Supplemental life: $1.5 million

(Combined: $3 million)

Personal HealthApplications

Any new election/increase of more than one times annual base salary or morethan $1 million in colleague Supplemental life coverage will require you tocomplete a Personal Health Application form.

Costs for colleague supplemental life insurance coverage are based on your age as of Jan. 1, 2018.

Dependent life insurance optionsYou have the option to purchase coverage for your dependents (including your spouse,eligible adult or eligible children). You may elect coverage for your dependents withoutelecting coverage for yourself. If you and your spouse or eligible adult both work forTrinity Health and are benefit eligible, you cannot elect spouse/eligible adultcoverage for that individual. Also, only one of you will be able to elect coverage foryour child(ren). If your dependent child also works at Trinity Health and is benefiteligible, you cannot elect child life coverage for that individual.

Dependent Life Insurance

Plan Highlights (full- and part-time)

Spouse/Eligible Adult life1 Child(ren) life2

Coverage amount Coverage amount*

$10,000

$20,000

$50,000

$80,000

$100,000

$5,000

$10,000

$20,000

PersonalHealthApplication

Any new election/increase of more than $10,000 in spouse/eligible adult supplementallife coverage will require your spouse/eligible adult to complete a Personal HealthApplication form.

1 Costs for spouse/eligible adult life insurance coverage are based on your age as of Jan. 1, 2018.

2 Child(ren) life insurance costs cover all of your eligible children, and will be available when you enroll online.

Are yourbeneficiariesup-to-date?You may want to take amoment to review thebeneficiary(ies) you haveon file for your lifecoverage. If you haventyet designatedbeneficiary(ies), your lifeinsurance benefits willbe paid according to theplan provisions asoutlined in the SummaryPlan Description.

You may change yourbeneficiary(ies) duringthe Open Enrollmentprocess or anytimethroughout the year.

Beneficiary(ies)designated for Basic LifeInsurance apply to anyEmployee SupplementalLife Insurance elections.

For more information about yourlife insurance benefits or toobtain a Personal HealthApplication form, visithttp://mybenefits.trinity-health.org


Supplemental and dependent life insurance ratesThe cost of colleague supplemental life insurance coverage is based on the colleagues age and the amount of coverage youelect. To estimate your per pay contribution, use the following calculation:

X 1,000 X =Annual Base Pay Supplemental life Rate (see table Monthly contribution

(Rounded up to the insurance election below) amount

next $1,000)

X 12 26 =Monthly contribution Months Pay periods Per pay

amount contribution

The cost of spouse life insurance coverage is based on the colleagues age and the amount of coverage you elect. To estimateyour per pay contribution, use the following calculation:

1,000 X =Spouse life insurance election Rate (see table below) Monthly contribution amount

X 12 26 =Monthly contribution amount Months Pay periods Per pay contribution

The cost of child(ren) life insurance covers all of your eligible children and is based on the amount of coverage you elect. Toestimate your per pay period contribution, use the following calculation:

1,000 X $0.100 =Child(ren) life insurance election Rate Monthly contribution amount

X 12 26 =Monthly contribution amount Months Pay periods Per pay contribution

Supplemental LifeMonthly rate (per $1,000 of coverage)

Colleague age* Colleague Spouse

under 25 $0.030 $0.032

25 29 $0.034 $0.038

30 34 $0.046 $0.053

35 39 $0.051 $0.060

40 44 $0.058 $0.070

45 49 $0.088 $0.106

50 54 $0.140 $0.176

55 59 $0.257 $0.304

60 64 $0.402 $0.489

65 69 $0.742 $0.911

70 74 $1.232 $1.753

75+ $1.657 $1.392

* Use colleague age for colleague and spouse supplemental life rates.

Supplemental AD&D insurance rates

The cost of supplemental AD&D coverage is based on the amount of coverage you elect. To estimate your per pay contribution,use the following calculation:

X 1,000 X $.011 =Annual Supplemental Monthly contribution

Base Pay AD&D election amount

X 12 26 =Monthly contribution Months Pay periods Per pay

amount contribution


Time Away From WorkAt Trinity Health, we are working to harmonize time offbenefits across our Ministry. Our goal is to help strengthenand enhance our people-centered health system and provideour colleagues with meaningful benefits that are competitiveand sustainable. Here are some of the benefits you receive asyou need time away from work.

Short-term disabilityShort-term disability (STD) pays a benefit if you are unable towork because of a qualified injury or illness. NOTE: this is anemployer provided benefit. No election is required to receivethis benefit.

Amount of benefit 60% of base pay

Management :100%

When benefits

begin

After a 7 calendar day elimination period following

an injury or illness

How long benefits

continue

Up to 180 days

Use of PTO time Full- or part-time colleagues are required to

use PTO for days scheduled to work during

the first 7 calendar days.

Long-term disabilityLong-term disability (LTD) pays a benefit if you are unable towork for a long period of time because of a qualified injury orillness. You have the option to elect more LTD coveragethrough a buy-up election during open enrollment.

Amount of

employer-provided

benefit

60% of base pay, not to exceed $10,000 per month

Management: 70% of base pay, not to exceed

$15,000 per month

Amount of

available buy-up

coverage

66 2/3% of base pay

Management: This option is not available

Cost for buy-up

coverage

Based on your income level Available when you enroll online

When benefits

may begin

After 180 days of disability

How long benefits

continue

Benefits continue until you are able to return

to work, are deemed no longer disabled, or

until age 65 or older, depending on when the

disability begins.

For more information about yourdisability benefits, visithttp://mybenefits.trinity-health.org.

PTO cash-outUnder the PTO program, hourly colleagues earn PTO basedon your hours worked. You are able to cash-out a certainamount of your unused PTO each year.

How much time can

you cash-out

You can cash-out up to 80 hours.You must

maintain a minimum PTO bank of 40 hours

Electing to cash-out Election for 2018 may only be made during

open enrollment to avoid taxation on the value

of your PTO bank. Your election is irrevocable

and cannot be changed.

Payment date for

cash-out

You will receive your cash-out in the first pay

in November 2018.

You may cash-out only hours you will accrue during thecalendar year in which you plan to receive payment.Consequently, you may not cash-out PTO hours carried overfrom previous years. For example, Jane has a PTO balanceof 100 hours as of Dec. 31, 2017. During open enrollment,she elects to cash-out 40 hours in 2018. Jane cannotcash-out any of the 100 hours she earned in 2017 or earlier.She must plan her 2018 cash-out amount on only the hoursshe will accrue in 2018.

REMINDER: If you want to cash-out PTO in 2018, you mustmake a new PTO cash-out election. Your prior year electionwill NOT carry forward.

For more information aboutthe program, visithttp://mybenefits.trinity-health.org.


Legal PlanYoure eligible for the legal plan if you are a regularly scheduled full- or part-time colleague with 48 or more budgeted hours perpay period, and you have satisfied the required waiting period. You have the option of electing legal coverage through HyattLegal.

Hyatt Legal

Plan Highlights

In-network Out-of-network

All covered services are paid in full

No waiting periods

No deductibles or copayments

No claim forms

You may choose a non-plan attorney

and be reimbursed according to a set fee schedule

Following is a brief outline of personal legal services provided:

Office consultation and telephone advice Consumer protection Wills and codicils Living wills Living trusts Sale, purchase or refinancing of home Debt collection defense Personal bankruptcy Tax audits Administrative hearing representation Juvenile court defense Eviction defense (tenant only) Tenant negotiation (tenant only) Civil litigation defense

Incompetency defense Document preparation affidavits, deeds, demand letters, mortgages,

notes, powers of attorney

Document review Uncontested divorce Premarital agreement Uncontested adoption, guardianship or conservatorship Name change Protection from domestic violence Property tax assessment Traffic ticket defense (no DUI) Identity theft defense Immigration assistance


Colleague only: $5.12

Colleague plus family: $6.97

For more information aboutthe legal plan, visitwww.legalplans.com.

Voluntary BenefitsIn addition to your group benefits, Trinity Health has partnered with The Farmington Company to provide eligible colleagues theopportunity to elect personal insurance plans. Individual policy options include:

Life insurance Accidental Death and Dismemberment (AD&D) Insurance Cancer insurance Critical illness insurance Auto/home insurance Pet insurance Identity theft insurance Hospital Indemnity Accident insuranceFor more information and to enroll, call 1-866-251-9529. Be sure to tell the representative that you are a member of TrinityHealth and Mercy Health Muskegon.


Who Is Eligible

Eligible Individual Definition

Colleague Regularly scheduled full- or part-time colleague with 48 or more budgeted hours per pay period.

Spouse/Eligible Adult You may cover your spouse or Eligible Adult. An Eligible Adult is an adult who resides and has financialinterdependence with the colleague, and is not a tax qualified dependent or related by blood, adoption or

marriage to the colleague.

If an eligible adult qualifies as a tax dependent, you must complete the Non-Spouse Eligible Adult Dependent

Certification form posted on MyBenefits each year in order to receive pre-tax deductions. For 2018, you must

submit the form by Dec. 4, 2017.

Dependent Children Dependent children are eligible for coverage through the end of the Plan Year in which they turn age 26,regardless of marital status, student status, residency, financial dependency or other requirements provided

they meet all of the following criteria:

They are:

Your or your spouse/eligible adults natural children;

Your or your spouse/eligible adults legally adopted children or children placed with you or your eligible adult

for adoption; or

Children for whom you or your spouse/eligible adult are the court-appointed legal guardian.

Not otherwise covered under the Plan or any other group health plan offered by the Employer.

Note: Children of eligible adults may be covered only if their eligible adult is covered.

New HiresNew hires are eligible for benefits on the first day of the month following 30 days of employment. To view the complete

eligibility rules anddocumentationrequirements for youand your family visithttps://mybenefits.trinity-health.org


For More InformationWe hope this enrollment guide has provided you and your family with all of the information you need to make your benefitelections for 2018. In addition to completing your Open Enrollment, please remember to review and update your personalinformation, such as your address, phone number, marital status and emergency contacts as necessary. You may update yourpersonal information at any time throughout the year. If you still have questions about your options or the open enrollmentprocess, you can:

Contact the HOTLINE for benefit information and questions. Your call will be answered within 24 hours. Contact us at 231-672-3980: or

Email us at [email protected]

If you need assistance with your enrollment, Human Resources Representatives will be available on the following days andtimes.

Day Time(s) Campus Room

Monday, Nov. 20 2:00 4:00 p.m. Hackley Youngberg Auditorium

Tuesday, Nov. 21 2:30 4:30 p.m. Mercy Conference Room B & C

Wednesday, Nov. 22 2:00 4:00 p.m. Mercy Conference Room B & C


Important Reminders

Benefit elections are final for 2018Remember, the benefits you elect during open enrollment will be in effect fromJan. 1 through Dec. 31, 2018. The choices you make now are final for 2018,because open enrollment is your only opportunity during the year to switchmedical, dental or vision plan coverage.

For more information on qualifiedfamily status changes, visithttp://mybenefits.trinity-health.org.

If you experience a qualified familystatus change or certain employ-ment status changes and provideany required documentation to yourHuman Resources representative within 30 days of the event, you will be allowedto make certain benefit changes that are consistent with the status change. Forexample, if you get married during the plan year, youll be able to add yourspouse to your coverage within 30 days of the marriage. For more informationon family status changes, visit http://mybenefits.trinity-health.org.

HIPAA privacy notice is available onlineTrinity Health and the Trinity Health Corporation Welfare Benefit Plan (Plan) takethe security of colleagues and family members Protected Health Information(PHI) very seriously. To access a copy of the Plans Health Insurance Portabilityand Accountability Act (HIPAA) Privacy Notice, visithttp://mybenefits.trinity-health.org. If you are unable to access the HIPAA noticeonline, contact your Human Resources representative to request a paper copyby mail.

Medical plan election notificationWhen you enroll in a Trinity Health medical plan, the medical plan coverageprovides benefits through a clinically integrated network (CIN) of hospitals,physicians, and other health care providers and professionals, including carecoordinators and case managers that monitor and coordinate all aspects of yourmedical care. Trinity Health and Mercy Health Muskegon participate in the CIN.When you and your covered dependents receive health care services at facilitiesor by the colleagues of your employer or a health care provider or professionalaffiliated with your employer, colleagues of your employer or a health careprovider or professional affiliated with your employer will have access to and mayuse and disclose your and your covered dependents personal health informationto manage and coordinate your care. Any access to and use and disclosure ofprotected health information will comply with the privacy and security regulationsunder HIPAA and any applicable state privacy and security laws.

Plan documents and Summary of Benefits andCoverage (SBC) are available onlineA Summary of Benefits and Coverage (SBC) provides basic information about amedical plan, comparison examples, and a glossary of terms. To access theSBCs for the medical plan options, the Summary Plan Descriptions andcertificates of coverage for the Plan benefits available to you, visithttp://mybenefits.trinity-health.org. If you are unable to access any SBC or Plandocument online, contact your Human Resources representative to request apaper copy by mail.

Notice: Womens Health andCancer Rights Act of 1998The Womens Health and Cancer RightsAct of 1998 requires all group healthplans that cover mastectomies to providecertain reconstructive surgery and otherpost-mastectomy benefits. TrinityHealths medical benefit plan provisionsare as follows:

The Trinity Health medical benefit planwill not restrict benefits if you or youreligible dependent receives benefitsfor a mastectomy and elects breastreconstruction in connection with themastectomy.

Benefits will not be restricted providedthat the breast reconstruction isperformed in a manner determined inconsultation with your (or your eligibledependents) physician, and mayinclude: Reconstruction of the breast on

which the mastectomy wasperformed;

Surgery and reconstruction of theother breast to produce asymmetrical appearance; and

Prostheses and treatment ofphysical complications of all stagesof mastectomy, includinglymphedemas.

Benefits for breast reconstruction may besubject to appropriate plan coverageprovisions and limitations, includingannual deductible, copayment andcoinsurance provisions that areconsistent with those established forother benefits under the plan.

If you have any questions about yourmedical plan provisions relating to theWomens Health and Cancer Rights Actof 1998, contact your Human Resourcesrepresentative.


2018 BENEFITS OPEN ENROLLMENT FORMMercy Health Muskegon Pro-Med

Now that youve reviewed the information in this guide, you are ready to make your elections for 2018. Be sure to complete all four pages of this form, sign the Colleague Acknowledgement section, and return the original form to your Human Resources Representative by Thursday, November 30, 2017.

Form - 1Mercy Health Muskegon Pro-Med

Colleague informationFirst Name Last Name MI

Address City, State, Zip

Date of Birth Social Security Number

Phone Number Marital Status

Medical coverage Please select one medical plan from the options shown below. Costs shown are on a per pay period basis.

* In order to keep the full incentive you must participate in the Trinity Health Well-Being program. See the OE Guide for more information. The 2017 Social Security taxable wage base (SSTWB) is $127,200

ts Traditional PPO Health Savings PPO Essential PPO Healthy Blue Living HMO

Full Incentive*

Full Incentive*

Full Incentive*

Full Incentive*

Colleague only

Colleague plus spouse/eligible adult

Colleague plus child(ren)

Colleague plus family

$ 64.52

$141.95

$100.01

$177.44

$ 59.92

$131.83

$ 92.88

$164.79

$ 54.40

$119.68

$ 84.32

$149.60

$ 70.52

$155.14

$109.30

$193.92

Colleague only




$77.43

$170.35

$120.02

$212.93

$ 71.91

$158.20

$111.46

$197.75

$ 65.28

$143.62

$101.18

$179.52

$ 84.62

$186.16

$131.16

$232.70

For colleagues earning the 2017 SSTWB or more - Level 2

Full Time


For colleagues earning less than SSTWB - Level 1

Colleague only




$129.05

$283.91

$200.03

$354.89

$119.85

$263.67

$185.77

$329.58

$108.80

$239.36

$168.64

$299.20

$141.03

$310.27

$218.60

$387.84

Colleague only




$141.95

$312.30

$220.03

$390.38

$131.83

$290.03

$204.34

$362.54

$119.68

$263.30

$185.50

$329.12

$155.14

$341.30

$240.46

$426.62

For colleagues earning the 2017 SSTWB or more - Level 2

ts Traditional PPO Health Savings PPO Essential PPO Healthy Blue Living HMO

Full Incentive*

Full Incentive*

Full Incentive*

Full Incentive*

Part Time


For colleagues earning less than SSTWB - Level 1

Dental coverage Please select one dental plan from the options shown below. Costs shown are on a per pay period basis.

High Plan Standard PlanFull-time Part-time Full-time Part-time

Colleague only $ 6.18 $ 9.71 $ 3.74 $ 6.23Colleague plus spouse/eligible adult $12.36 $19.42 $ 7.48 $12.47Colleague plus child(ren) $13.91 $21.85 $ 8.42 $14.03Colleague plus family* $20.09 $31.57 $12.16 $20.26No dental coverage

Mercy Health Muskegon Pro-MedForm - 2

Vision coveragePlease select one vision plan from the options shown below. Costs shown are on a per pay period basis.

High Plan Standard PlanColleague only $ 5.29 $3.17Colleague plus spouse/eligible adult $10.98 $5.81Colleague plus child(ren) $11.52 $6.11Colleague plus family* $16.22 $8.43No vision coverage

Dental coverage dependent informationDependent full name SSN DOB Gender Relationship

Vision coverage dependent InformationDependent full name SSN DOB Gender Relationship

* Colleague plus family equals Colleague plus spouse/eligible adult plus child(ren)

Medical coverage dependent informationDependent full name SSN DOB Gender Relationship

Colleague supplemental life and AD&D insurance coverageRegularly scheduled full-time colleagues receive employer-paid basic life and AD&D insurance at 1 times annual pay. You may select supplemental life and AD&D insurance coverage from the options shown below. Costs for supplemental life and AD&D insurance coverage are based on your age and are available in the enrollment guide along with a formula to estimate your cost.

Life insurance beneficiary designation Please use the space below to designate one or more beneficiaries for your life and AD&D insurance coverage. PrimaryBeneficiarys full name Relationship Percent payable

Contingent**Beneficiarys full name Relationship Percent payable

** A contingent beneficiary is the person(s) named to receive your life and/or AD&D insurance benefit if the primary beneficiary is deceased.

Dependent life insurance coverage You may select dependent life insurance coverage from the options shown below. Spouse/eligible adult life insurance rates are based on the age of the colleague. Child(ren) life insurance costs per pay period cover all of your eligible children. Costs for dependent life insurance coverage are available in the enrollment guide along with a formula to estimate your cost.Spouse life $ 10,000

$ 20,000 $ 50,000 $ 80,000 $100,000

No spouse life coverage Child(ren) life $ 5,000

$ 10,000 $ 20,000

No child(ren) coverage

Form - 3Mercy Health Muskegon Pro-Med

First Name Last Name MI

Supplemental life 1 x annual base pay 2 x annual base pay 3 x annual base pay 4 x annual base pay 5 x annual base pay

6 x annual base pay 7 x annual base pay 8 x annual base pay

No supplemental coverage

Supplemental AD&D 1 x annual base pay

2 x annual base pay 3 x annual base pay 4 x annual base pay 5 x annual base pay

6 x annual base pay 7 x annual base pay 8 x annual base pay

No supplemental coverage

Mercy Health Muskegon Pro-MedForm - 4

Flexible spending accountsYou may elect a new contribution amount for the health care flexible spending account (HCFSA). Please note that your 2017 election will not carry forward to 2018. Enter your contribution as an annual amount. Your annual election must be between $130 and $2,600. Dont forget that over-the-counter drugs will not be reimbursable under the plan.

You may also elect to contribute to the dependent care flexible spending account (DCFSA). This election should be entered as an annual amount and must be between $130 and $5,000.

HCFSA contribution $___________for 2018 or No HCFSA contribution DCFSA contribution $___________for 2018 or No DCFSA contribution

Health Savings PPO AccountFor those who have elected the Health Savings PPO only, you may elect to contribute, on a pre-tax basis, up to $3,450 for individual and $6,900 for family per calendar year. Contributions will be deducted over 26 pay periods per plan year. Enter election as an annual amount per the above guidelines.

HSA contribution $____________ for 2018 or _____ No HSA contribution

Legal planYou may select legal coverage from the options shown below.

Colleague only $5.12Colleague plus family $6.97No legal coverage

Colleague acknowledgementI understand that the benefits I elect with this form will become effective January 1, 2018 and will continue through December 31, 2018. I authorize Trinity Health to make the necessary deductions from my pay for the benefits I elected.

Colleague signature Date

Colleague printed name

LYWL 1

NOTICE REGARDING WELLNESS PROGRAM

The Live Your Whole Life Colleague Health Plan Well-Being Incentive Program (the Well-Being Program) is a

voluntary wellness program available to all colleagues and their spouses/eligible adult dependents, if applicable, who

are enrolled in a participating medical and prescription drug program (a group health plan) offered by the colleagues

Trinity Health employer. The Well-Being Program is administered according to federal rules permitting employer-

sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with

Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and

Accountability Act, as applicable, among others. If you choose to participate in the Well-Being Program you will be

asked to complete a voluntary health risk assessment or HRA that asks a series of questions about your health-related

activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart

disease). In addition, certain other activities that are intended to help colleagues improve their health or prevent disease

(referred to as meaningful choice activities) are offered under the Well-Being Program. You are not required to

complete the HRA or participate in any of meaningful choice activities.

However, colleagues who are enrolled in a group health plan offered by their Trinity Health employer and who choose to

complete a voluntary HRA and meaningful choice activities will receive an incentive of a lower per pay cost for the group

health plan coverage. If a colleagues spouse/eligible adult dependent, is also enrolled in the Trinity Health group health

plan, the colleague will receive an additional incentive of lower per pay cost for the coverage if the spouse/eligible adult

completes an HRA and meaningful choice activities. Although you are not required to complete the HRA or the

meaningful choice activities, only colleagues (and their spouses/eligible adult dependents, if applicable) who do so will

receive the incentive of a lower per pay cost for group health plan coverage throughout the plan year.

Additional incentives of up to $500 may be available for colleagues and their spouses/eligible adult dependents, if

applicable, who submit a claim for non-surgical weight loss reimbursement under a Trinity Health group health plan.

If you (or your spouse/eligible adult dependent, if applicable) are unable to participate in any of the health-related

activities required to earn an incentive, you (or your spouse/eligible adult dependent, if applicable) may be entitled to a

reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative

standard by contacting the Live Your Whole Life consumer support line (powered by RedBrick Health) at 855-491-8781.

The information from your HRA will be used to provide you with information to help you understand your current health

and potential risks, and may also be used to offer you services through the Well-Being Program, such as condition

management, medical management, case management and health and well-being coaching. You also are encouraged

to share your results or concerns with your own doctor.

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable health information. Although

the Well-Being Program and Trinity Health may use aggregate information they collect to design a wellness program

based on identified health risks in the workplace, the Wellness Program will never disclose any of your personal

information either publicly or to your employer, except as described in the paragraph below, as necessary to respond to

a request from you for a reasonable accommodation needed to participate in the Well-Being Program, or as expressly

permitted by law. Medical information that personally identifies you that is provided in connection with the Well-Being

LYWL 1

Program will not be provided to your supervisors or managers and may never be used to make decisions regarding your

employment.

All Trinity Health group health plans provide care coordination, care management, utilization review and referral services

to help manage the healthcare provided to covered members. By enrolling in a Trinity Health group health plan you

understand that the plan will provide services to manage each covered members care. These services may be

provided through independent third-party administrators, a clinically integrated network of hospital, physicians and other

health care providers and professionals (CIN) and other healthcare providers. Your participation in a Trinity Health

group health plan means that the persons contracted to provide these services will have access to your personal health

information, including health information you disclose through an HRA or other Well-Being Program activities. Trinity

Health facilities and healthcare providers and professionals affiliated with Trinity Health facilities participate in certain

CINs. Information about your medical treatment at any facility and from any healthcare provider or professional may be

accessed and used by individuals who work at a Trinity Health facility or provider (including your employer) participating

in a CIN or the group health plan not only for treatment but also to manage and coordinate your healthcare.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by

law to carry out specific activities related to the Well-Being Program, and you will not be asked or required to waive the

confidentiality of your health information as a condition of participating in the Well-Being Program or receiving an

incentive. Anyone who receives your information for purposes of providing you services as part of the Well-Being

Program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally

identifiable health information is (are) third-party administrators, members of a CIN and other healthcare providers and

professionals such as registered nurses, doctors, case managers, medical managers, health coaches, condition

managers and the Well-Being Program administrator in order to provide you with services under the Well-Being

Program.

In addition, all medical information obtained through the Well-Being Program will be maintained separate from your

personnel records, information stored electronically will be encrypted, and no information you provide as part of the

Well-Being Program will be used in making any employment decision. Any access to, use or disclosure of your medical

information obtained through the Well-Being Program will comply with the privacy and security regulations under the

Health Insurance Portability and Accountability Act and any applicable state privacy and security laws. Appropriate

precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you

provide in connection with the Well-Being Program, we will notify you as soon as possible.

You may not be discriminated against in employment because of the medical information you provide as part of

participating in the Well-Being Program, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation,

please contact the Live Your Whole Life consumer support line (powered by RedBrick Health) at 855-491-8781.

HBL

NOTICE REGARDING WELLNESS PROGRAM

The Healthy Blue Living (HBL) Wellness Incentive Program (the Wellness Program) is a voluntary wellness program

available to all colleagues who are enrolled in a participating HBL medical and prescription drug program (a group

health plan) offered by the colleagues Trinity Health employer. The Wellness Program is administered according to

federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent

disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008,

and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in

the Wellness Program you will be asked to complete a voluntary health risk assessment or HRA that asks a series of

questions about your health-related activities and behaviors and whether you have or had certain medical conditions

(e.g., cancer, diabetes, or heart disease). You will also be asked to complete a biometric screening, which will include

measuring blood pressure, measuring Body Mass Index (BMI) through height and weight measurements, a waist

circumference measurement and a blood test for nicotine, total cholesterol, high density lipoproteins (HDL), low density

lipoproteins (LDL), triglycerides, and blood glucose. In addition, certain other activities that are intended to help

colleagues improve their health or prevent disease (referred to as health improvement activities) are offered under the

Wellness Program. You are not required to complete the HRA, biometric screening or participate in any of health

improvement activities.

However, colleagues who are enrolled in a HBL group health plan offered by their Trinity Health employer and who

choose to complete a voluntary HRA, biometric screening and health improvement activities will receive an incentive of

a lower per pay cost for the group health plan coverage. Although you are not required to complete the HRA, biometric

screening or the health improvement activities, only colleagues who do so will receive the incentive of a lower per pay

cost for group health plan coverage throughout the plan year.

Additional incentives of up to $500 may be available for colleagues and their spouses/eligible adult dependents, if

applicable, who submit a claim for non-surgical weight loss reimbursement under a Trinity Health group health plan.

If you are unable to participate in any of the health-related activities required to earn an incentive or achieve any of the

health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative

standard. You may request a reasonable accommodation or an alternative standard by contacting the Healthy Blue

Living (HBL) Customer Service line at 800-662-6667.

The information from your HRA and the results from your biometric screening will be used to provide you with

information to help you understand your current health and potential risks, and may also be used to offer you services

through the Wellness Program, such as condition management, medical management, case management and health

and wellness coaching. You also are encouraged to share your results or concerns with your own doctor.

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable health information. Although

the Wellness Program and Trinity Health may use aggregate information they collect to design a wellness program

based on identified health risks in the workplace, the Wellness Program will never disclose any of your personal

information either publicly or to your employer, except as described in the paragraph below, as necessary to respond to

a request from you for a reasonable accommodation needed to participate in the Wellness Program, or as expressly

HBL

permitted by law. Medical information that personally identifies you that is provided in connection with the Wellness

Program will not be provided to your supervisors or managers and may never be used to make decisions regarding your

employment.

All Trinity Health group health plans provide care coordination, care management, utilization review and referral services

to help manage the healthcare provided to covered members. By enrolling in a Trinity Health group health plan you

understand that the plan will provide services to manage each covered members care. These services may be

provided through independent third-party administrators, a clinically integrated network of hospital, physicians and other

health care providers and professionals (CIN) and other healthcare providers. Your participation in a Trinity Health

group health plan means that the persons contracted to provide these services will have access to your personal health

information, including health information you disclose through an HRA, biometric screening or other Wellness Program

activities. Trinity Health facilities and healthcare providers and professionals affiliated with Trinity Health facilities

participate in certain CINs. Information about your medical treatment at any facility and from any healthcare provider or

professional may be accessed and used by individuals who work at a Trinity Health facility or provider (including your

employer) participating in a CIN or the group health plan not only for treatment but also to manage and coordinate your

healthcare.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitte

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