Benefits Decision Guide · 2016-01-15 · responsibilities, protect your assets and plan for a...

Benefits Decision Guide

2016

Table of ContentsAbout Your Benefit Choices 1

• Eligibility 1

• When You Become Eligible 1

• Who You Can Cover 2

• Domestic Partner Coverage 2

• Your Cost for Coverage 2

• Making Benefit Changes 3

• ALEX – Virtual Benefits Counselor 4

Medical Benefits 5

Health Savings Account (HSA) 9

Prescription Drug Benefits 12

Care Management Program 13

Dental Benefits 14

Vision Benefits 15

Flexible Spending Accounts (FSAs) 16

Life Insurance 19

Accidental Death & Dismemberment (AD&D) Insurance 20

Disability Benefits 21

Retirement Benefits 22

Employee Assistance Program 23

Legal Services Benefits 24

Benefits Resources Inside Back Cover

About this GuideRochester Regional Health is committed to providing its employees with a comprehensive, affordable and competitive benefits package. Our benefits are designed to help you stay healthy, balance your work and life responsibilities, protect your assets and plan for a secure financial future.

This Benefits Decision Guide provides a summary of the Rochester Regional Health benefit plans available to you. Our plans and choices provide flexibility and value, making it easy to customize a benefits package that best meets the needs of you and your family. Please review this guide carefully, and share with others in your family who are responsible for making benefit decisions. Additional benefits information is available at myROChealth.com/benefits.

How to Enroll

3�Review your Enrollment Materials Carefully review this Benefits Decision Guide, along with the personalized benefits information and plan rates available in Workday, to better understand your benefit options and associated costs.

3�Compare Your Options and Costs with ALEXTM Making benefit decisions is easy with ALEX, your personal, virtual benefits counselor. A link to ALEX is available at myROChealth.com/benefits. See page 4 for more details.

3�Complete Your Benefit Elections in Workday Once you’ve decided which benefits and coverage levels are best for you and your family, elect your choices online in Workday. A Workday link and Knowledge Builder on how to enroll is available at myROChealth.com/benefits. Once enrolled, you can review your benefits coverage at any time in Workday.

Questions?Contact the Benefits Department

[email protected]

(585) 922-1100

ROCHESTER REGIONAL HEALTH 1

About Your Benefit ChoicesEligibility You are eligible to participate in the Rochester Regional Health Benefits Program based on scheduled weekly hours, as outlined below:

BENEFIT PLAN ELIGIBILITY

Medical Plan 20+ hours per weekDental Plan 20+ hours per weekVision Plan 20+ hours per weekFlexible Spending Account – Healthcare 20+ hours per weekFlexible Spending Account – Dependent Care 20+ hours per weekCore and Optional Life Insurance 20+ hours per weekCore and Optional AD&D Insurance 20+ hours per weekLegal Services Plan 20+ hours per weekShort-Term Disability 20+ hours per weekLong-Term Disability for Physicians and Senior Executives 20+ hours per week

Long-Term Disability for Vice Presidents and below 30+ hours per weekEmployee Assistance Program All employees403(b) or 401(k) Program All employeesPension Plan All employees*

REMEMBER: The choices you make when you enroll remain in effect until the end of the calendar year in which you enrolled, unless you have a qualifying life event. If you have a qualifying event during the year, you have 30 days to make benefit changes. For more details about qualifying events, see page 3.

When You Become EligibleMost benefits become effective on your first day of employment as outlined below. All coverage ends on the date of termination or loss of eligible status.

BENEFIT COVERAGE WHEN COVERAGE STARTS

Medical, Dental, Vision and FSA On date of hire, or at the time of a qualifying eventLife Insurance, AD&D and LTD First of the month following or concurrent with date of hire,

or at the time of a qualifying event**Short-Term Disability 6 months of continuous employment for benefit eligible employees403(b) Plan/401(k) Plan You are immediately eligible to participatePension Plan Once hours requirement is met*

*Eligibility based on 1,000 hours worked per year.**You and/or your dependent cannot be in a period of limited activity on the day coverage takes effect.

2 Benefits Decision Guide 2016

Who You Can CoverYou can enroll yourself and the following eligible dependents for benefits:

• Your legal spouse• Your domestic partner (affidavit of domestic partnership required) • Your child, up to age 26 – includes your natural-born child, legally adopted child,

stepchild, legal guardian child or domestic partner’s child• A disabled adult child age 26 and older (proof of eligibility required)

The coverage levels available to you vary by benefit plan and are noted when you log into your Workday account.

Domestic Partner CoverageRochester Regional Health provides coverage for domestic partners and their eligible dependents. A domestic partnership is defined as two people of the same or opposite sex in a relationship who satisfy the criteria below:

• Are at least 18 years old and mentally competent to consent to contract to a domestic partnership;

• Have an exclusive mutual commitment, similar to that of marriage;• Are each other’s sole domestic partners and intend to remain so indefinitely;• Neither partner is legally married;• Are not related by blood to a degree of closeness which would prohibit legal marriage in

the state in which the partners legally reside;• Reside together in the same permanent residence; and• Are jointly responsible for the common welfare and financial obligations of the

household, or where the domestic partner is primarily dependent on the Rochester Regional employee for care and financial assistance.

EnrollmentTo enroll your domestic partner, you must provide the Benefits Department with a completed Affidavit of Domestic Partnership (available at myrochealth.com/benefits).

Important Tax Information The IRS requires that if a domestic partner does not qualify as your tax dependent, you must pay the incremental cost of covering your domestic partner and his/her children on an after-tax basis. Also, the value of your domestic partner’s benefit that is provided for by Rochester Regional Health will be treated as taxable income (or imputed income) for federal and state tax purposes. You will pay federal, Social Security and other payroll taxes on this additional amount throughout the year. Rochester Regional Health will report these taxes on your form W-2 at the end of each year.

Your Cost for CoverageRochester Regional Health shares in the cost of most of your benefit plans, and allows you to pay your share of the cost through bi-weekly payroll deductions, often on a pre-tax basis. Your specific costs will vary by benefit and coverage level, and are available to review in your Workday account.


Making Benefit ChangesUnder federal law, you can only enroll in Rochester Regional health benefits as a new hire or during an annual enrollment period, unless you experience an employment status change or a qualifying life event.

Employment Status ChangeIf you move from part-time to full-time status, or from full-time to part-time, the amount you pay for some of your benefits will change. You may also be able to make changes to some of your benefit elections. To do so, you’ll need to submit your new benefit elections within 30 days of your status change date. Otherwise, your benefits will remain the same until the next annual enrollment period.

Qualifying Life EventsCertain life events allow you to change your benefit elections within 30 days of the qualifying event. You can do so by logging in to Workday and submitting the change request. Your requested change in coverage must be consistent with your change in status. For example, if you have a child, you can add a dependent to your coverage, but you cannot remove a dependent.

Typical qualifying life events include:• Marriage• Divorce, legal separation or annulment• Birth or adoption of a child• Change in legal custody of a child• Child reaches maximum age for coverage • Death of a spouse/domestic partner or dependent• Change in spouse’s/domestic partner’s employment• You or a family member loses or obtains coverage elsewhere• Your spouse’s/domestic partner’s employer’s Annual Enrollment period

For instructions on how to submit a benefit change request for a qualifying life event, refer to the Knowledge Builder in Workday (Benefits > Benefits How Do I?).

If you or your dependents lose Medicaid or CHIP eligibility, or first become eligible for state premium assistance, you may change your benefits within 60 days.


ALEX, an online virtual benefits counselor, is now available to make it as easy as possible to choose benefits. You can find ALEX at myROChealth.com/benefits.

ALEX is a smart, friendly benefits expert that can walk you through your medical, dental, vision and flexible spending account options using simple language – without all the benefits jargon. ALEX starts the conversation with some basic questions about you and your family, and your personal situation (all confidential, of course*). Based on your answers, ALEX helps you evaluate your options by showing helpful cost and coverage comparisons. The chat is surprisingly easy, and takes only a few minutes – plus, it will give you peace of mind knowing you made the right choices.

ALEX is available on any computer with internet access, so you can use it at home with your family. Meet ALEX today and get the conversation started.

INTRODUCING

*ALEX does not create, receive, maintain, transmit, collect or store any identifiable end-user information.

GENERIC$$

Benefits Decisions Made Easy

To compare your medical plan options, provide ALEX with an estimate of your anticipated healthcare needs

for 2016, using your past experience as a guideline.



Rochester Regional Health provides comprehensive medical insurance options through Excellus BlueCross BlueShield (Excellus BCBS).

Your Options:• No Coverage• Copay Plan• Consumer-Driven Health Plan (CDHP)

with Health Savings Account (HSA)

Rely on our Rochester Regional Health Network for the highest quality care at the lowest cost.

To find a provider or facility in the Rochester Regional Health Network, visit myROChealth.com/benefits.

Medical Benefits

Medical Plan Comparison of Your Costs The Copay Plan and CDHP offer different ways to manage your healthcare budget. With the Copay Plan, you spend more for your insurance premiums, and less for services and prescriptions when you need them. With the CDHP, it’s the opposite – you spend more when you need care, and save more when you don’t. Log in to your Workday account to compare your bi-weekly premium costs for each plan.


Medical Plan Comparison of Your Costs PLAN FEATURE COPAY PLAN CDHP

HSA Contribution from Rochester Regional Health

NoneNot available to Copay Plan

participants due to IRS rules

Single: $ 375 Two-Person: $ 750 Employee+Children: $ 750 Family: $ 750

NETWORK

ROCHESTER REGIONAL

HEALTHEXCELLUS

BCBSOUT-OF-

NETWORK

ROCHESTER REGIONAL HEALTH*

EXCELLUS BCBS*

OUT-OF-NETWORK*

Annual DeductibleSingle:

Two-Person: Employee+Children:

Family:

$0 $0 $0 $0

$0 $0 $0 $0

$1,800 $3,600 $5,400 $5,400

$1,500 $3,000 $3,000 $3,000

$1,500 $3,000 $3,000 $3,000

$1,500 $3,000 $3,000 $3,000

Out-of-Pocket MaximumSingle:

Two-Person: Employee+Children:

Family:

$ 5,000 $10,000 $10,000 $10,000

$ 5,000 $10,000 $10,000 $10,000

$ 9,000 $18,000 $18,000 $18,000

$3,000 $6,000 $6,000 $6,000

$ 6,000 $12,000 $12,000 $12,000

$ 9,000 $18,000 $18,000 $18,000

Preventive Care $0 $0You pay 40%

(after deductible is met)

$0 $0You pay 40%

(after deductible is met)

AFTER DEDUCTIBLE IS MET:

Primary Care Visit $30 copay$90 copay adults$30 copay peds

You pay 40% You pay 10% You pay 20% Peds pay 10% You pay 50%

Specialist Visit $50 copay$110 copay adults$50 copay peds


Urgent Care $75 copay$125 copay adults$75 copay peds


Inpatient Hospital $500 copay$2,000 copay adults$500 copay peds


Outpatient Facility $250 copay$2,000 copay adults$250 copay peds


Emergency Room $150 copay$350 copay adults$150 copay peds

$350 copay (not subject to

deductible)You pay 10% You pay 20%

Peds pay 10% You pay 20%

Ambulance $150 copay $150 copay$150 copay

(not subject to deductible)

You pay 20% You pay 20% Peds pay 20% You pay 20%

Routine Eye ExamAdults 1 exam per every 2 calendar years; Peds 1 exam per every calendar year

Covered in full You pay 40% You pay 10% You pay 20% Peds pay 10% You pay 50%

Routine EyewearAdults every 2 years; Peds every year

$60 allowance You pay 40% $60 allowance You pay 50%

Non-Maintenance PrescriptionsTier 1 – Generics Tier 2 – Brand Preferred Tier 3 – Brand Non-

Preferred

$10 $30 $50

$25 $50 $90

Not

covered **

$10 $30 $50

$25 $50 $90

Not

covered**

Maintenance MedicationsTier 1 – Generics Tier 2 – Brand Preferred Tier 3 – Brand Non-

Preferred

$10 $30 $50

Not

covered**

Not covered**

$10 $30 $50

Not

covered**

Not covered**

* Coinsurance percentages noted for CDHP are what you pay after your annual deductible is met. Prescription drug copays noted for CDHP are what you pay after your deductible is met. For more information about prescription drug coverage, see page 12.

** You pay the full cost for prescriptions when filled out-of-network, and these costs do not apply toward your annual deductible. For more information about prescription drug coverage, see page 12.


Lower your costs by staying in the Rochester Regional Health Network.

Talk with ALEX to pick the plan that’s right for you and your family. Available at myROChealth.com/benefits.

More About Our Medical PlansAbout the Copay Plan

• You pay set copays for healthcare services and prescription drugs received in the Rochester Regional Health Network or the Excellus BCBS Network until you reach the plan’s out-of-pocket maximum.

• The cost you pay is determined by: ― Type of service ― Where service is received

» Lowest discounted copays for Rochester Regional Health Network providers

» Standard copays for Excellus BCBS Network providers

» Limited Coverage for out-of-network providers – you pay the highest cost for care

― Who receives the service » Copays for children up to age 19 are lower

than adult copays in the Excellus BCBS Network. Pediatric copays in the Excellus BCBS Network are the same as copays in the Rochester Regional Health Network. This gives families the flexibility to choose the provider best suited to their child’s needs – without paying higher copays.

About the Consumer-Driven Health Plan (CDHP)• Your healthcare and prescription drug costs are paid

as follows: ― You pay the full cost* for care and prescriptions until you reach the annual deductible:

» Single: $1,500 » Two-Person/Employee+Children/Family:

$3,000

― Once your deductible is met, you pay a percentage of the cost for your care (called coinsurance) and set copays for prescriptions until you meet your out-of-pocket maximum.**

― Both medical and prescription drug costs for all covered family members are applied to your annual deductible and out-of-pocket maximum.

» Once your out-of-pocket maximum is met, the plan pays the total cost for covered services for all family members in the plan for the rest of the year.

» Employees who enroll in the CDHP may be eligible to set up a tax-advantaged health savings account (HSA), administered by HSA Bank®, to pay for qualified medical, dental, vision care and prescription drug expenses. See page 9 for information about IRS limitations regarding health savings accounts.

NOTE: Pediatric care provided in the Excellus BCBS Network for dependents under age 19 is subject to the lower Rochester Regional Health Network deductible and coinsurance amounts noted on page 6.

* The “full cost” you pay will reflect a discounted contract rate if you use in-network providers.**Coverage for maintenance medications outlined on page 12.


Your Annual Healthcare Expenses

The plan pays the total cost of care for the remainder of the year

OUT-OF-POCKET MAXIMUM

You and the plan share the cost of care until OUT-OF-POCKET MAXIMUM is met:• You pay 10% (plan pays 90%) for care

in the Rochester Regional Health Network

• You pay 20% (plan pays 80%) for care in the Excellus BCBS Network

ANNUAL DEDUCTIBLE

You pay the total cost of care until ANNUAL DEDUCTIBLE is met: • $1,500 for single coverage

• $3,000 for all other coverage

CDHP: How It Works

1

2

3SINGLE COVERAGE:

• $3,000 in Rochester Regional Health Network

• $6,000 in Excellus BCBS Network

ALL OTHER COVERAGE:

• $6,000 in Rochester Regional Health Network

• $12,000 in Excellus BCBS Network

AFTER DEDUCTIBLE IS MET:For maintenance prescriptions, you pay: • Rochester Regional Network:

Tier 1: $10/Tier 2: $30/Tier 3: $50• Excellus BCBS Network:

Tier 1/Tier 2/Tier 3: NOT COVERED

For non-maintenance prescriptions, you pay:

• Rochester Regional Network: Tier 1: $10/Tier 2: $30/Tier 3:$50

• Excellus BCBS Network: Tier 1: $25/Tier 2: $50/Tier 3:$90

OUT-OF-POCKET MAXIMUM PRESCRIPTION DRUG COSTS

IMPORTANT TO REMEMBERCDHP premiums (payroll deductions) are lower than Copay Plan premiums resulting in annual savings that can be combined with Rochester Regional Health’s HSA contribution. These combined amounts can be put toward your healthcare expenses during the year, significantly lowering your out-of-pocket costs.

To get an estimate of your out-of-pocket costs for an anticipated medical service or procedure within the Rochester Regional Health Network, call (585) 922-COST.For services performed at other facilities, work with your provider directly, or contact Excellus BCBS (see Benefits Resources on inside back cover).


About the Health Savings Account (HSA)

2

Tax-Free Money Out

You won’t lose what you don’t use – the money remains in your HSA and can grow through interest and investment opportunities.

Tax-Free Savings

1

How an HSA WORKS

FREE MONEY from Rochester Regional Health + YOUR Tax-Free CONTRIBUTIONS.

3Use to pay for vision, dental and

qualified medical expenses.

Contributions

What is an HSA?• An HSA is an interest-earning savings and spending

account with no “use or lose” rule. You own your account, your balance can be carried over from year-to-year, and the account stays with you if you leave Rochester Regional Health. Plus, the HSA offers investment options, similar to a 403(b), for even greater potential account growth over time.

• Tax advantages of the HSA: ― Account contributions are pre-tax. ― Account interest and any investment earnings are not federal or state taxable in New York.

― Withdrawals for qualified healthcare expenses for you and your spouse/IRS eligible dependents are not federal or state taxable in New York.

Does Rochester Regional Health contribute to the HSA?• Yes. If you enroll in the CDHP and want to open an HSA,

Rochester Regional Health will make the following contributions to your account:

― Single: $375 ― Two-Person/Employee+Children/Family: $750

• The Rochester Regional Health contribution will be deposited into your account at the beginning of each quarter. If you enroll in the plan following a quarterly contribution, you will receive a make-up contribution with the next quarterly deposit for each full month you are enrolled in the plan. A detailed contribution schedule is available at myROChealth.com/benefits.

• Even if you do not wish to contribute to the HSA yourself, you still receive the free contribution from Rochester Regional Health, if you elect CDHP coverage. The contribution from Rochester Regional Health will be automatically deposited in your account as described above. Once in your account, the money may be used immediately to pay for qualified expenses incurred on or after the date your account was opened.

• Rochester Regional Health will pay the administrative fees associated with the health savings account for 2016.

• The employer contribution and covered account fee expenses are subject to change in future years.

How much can be contributed to the HSA?In 2016, maximum IRS contribution limits are:

• $3,350, if you have single CDHP coverage• $6,750, if you cover one or more dependents through

the CDHP • These are combined annual contribution limits from

all sources (contributions made by you, Rochester Regional Health and any other source). These are not total account balance limits – any rollover balances from previous years are not subject to the maximum annual contribution limits.

• If age 55 or older (or will be in 2016), you can make an additional $1,000 “catch up contribution” to your HSA.

• If you are only eligible for the HSA for a portion of the year, your limits will be adjusted accordingly.


You are responsible for determining if you are eligible to open and contribute to an HSA. For complete eligibility rules, see Publication 969 on the IRS website at irs.gov.

What else do I need to know?• The HSA is administered by HSA Bank® and is Federal

Deposit Insurance Corporation (FDIC) insured.• In order for Rochester Regional Health to open an

HSA on your behalf and make contributions to your account, you must confirm in Workday that you are eligible to participate in an HSA and will remain eligible through the remainder of the calendar year. To do so, you must either Elect or Waive HSA participation in the “Additional Benefits Plan” section in Workday under “HSA Enrollment – HSA Bank.”

• Please refer to Publication 969 on the IRS website at irs.gov to confirm your eligibility prior to making your election in Workday.

• Funds must be in the account in order to use them. Expenses incurred before you open your account are not eligible for HSA reimbursement. Funds in your account can be used to pay for qualified healthcare expenses, even if you are no longer eligible to add new funds to the account.

• Be sure to understand account and investment fees before opening an HSA. Investment options are not reviewed by Rochester Regional Health.

• Consult a tax advisor if you have any questions about your eligibility to open an HSA, or any tax consequences that result from opening or contributing to an HSA. You will receive annual reports from HSA Bank to use when completing your personal income taxes.

Save your receipts…You are responsible for ensuring that all

purchases paid out of your HSA are qualified expenses as defined by the IRS. Be sure to

save your receipts in the event you are asked to substantiate an expense.

• If you elect to contribute through payroll deductions, the total annual amount you elect will be deducted in equal amounts each pay period throughout the year. You cannot elect to deduct your total annual contribution in a single pay period. The maximum bi-weekly deduction allowed is $114.42 for single coverage and $230.77 for two-person/ employee+children/family coverage. These limits ensure that the total contributions from you and Rochester Regional Health do not exceed the IRS limits.

• You can contribute to your HSA through payroll deductions, online transfers, personal checks or money orders.

What kind of expenses can be paid for with an HSA? • You can use your HSA to pay for a wide range of

qualified healthcare expenses (as defined by the IRS) for yourself, your spouse or your IRS-eligible tax dependents. Some examples include: acupuncture, ambulance services, chiropractic care, dental treatments, doctors’ fees, hearing aids, laboratory fees, prescription drugs, behavioral health services, surgery, vaccines, vision care, wheelchairs and x-rays. For a complete list of qualified healthcare expenses, visit myROChealth.com/benefits.

• You are responsible for only using your HSA funds to pay for qualified expenses. If used for other reasons, the ineligible amount will be subject to income tax and may be subject to an additional 20% tax penalty.

• Qualified healthcare expenses must be incurred after the HSA has been opened and funded (on or after January 1, 2016).

• At age 65 or older, your account balance can be withdrawn and used for any reason without penalty, subject to income tax.

Are there rules that make me ineligible for an HSA?Certain IRS restrictions limit HSA eligibility. For instance:

• You are covered by another health plan that does not meet the IRS definition of a high-deductible health plan, including a spouse’s non-high-deductible plan.

• You are enrolled in certain types of coverage such as Medicare, Medicaid or TRICARE. Consult a tax advisor for more information.

• You are covered by a general purpose Healthcare Flexible Spending Account (including coverage during a grace period), or a similar account such as a Health Reimbursement Arrangement (HRA), even if the account belongs to your spouse or a parent (for example, if your parent’s FSA covers you until age 26).

• You can be claimed as a dependent on another person’s tax return.


Comparing an HSA with a Healthcare Flexible Spending Account (FSA)An HSA and a Healthcare FSA both offer ways to save money by paying for healthcare expenses using pre-tax dollars. The following chart shows how the two types of accounts compare:

ACCOUNT FEATURES HSAHEALTHCARE

FSA

Eligible for account if enrolled in the CDHP 4

Eligible for account if enrolled in the Copay Plan 4

Contribute pre-tax money 4 4

Free account contribution from Rochester Regional Health 4

Immediate access to total annual contribution amount 4

Can use account to pay for qualified healthcare expenses 4 4

Debit card for easy payment of expenses 4 4

Money earns tax-tree interest 4

Tax-free investment opportunities 4

Balance rolls over year-to-year 4

Can change contribution amount at any time for any reason 4

Balance can be withdrawn and used at age 65 or older for any reason without penalty, subject to income tax 4

Maximum Annual Family Contribution $6,750 $2,550

Catch-Up Contribution for those 55 and older $1,000 $0

Learn more about the Healthcare Flexible Spending Account starting on page 17.

HSA Bank Makes It Easy to Start, Grow and Manage Your HSAHSA Bank gives you everything you need to make the most of your account:

• WELCOME KIT This valuable “starter package” contains your 8-digit account number, important disclosures and a privacy statement.

• DEBIT CARD Arrives separately from the Welcome Kit and is delivered in a plain, blank envelope for security reasons. Activation instructions are included.

• INTERNET BANKING AND HSA BANK MOBILE APP Provides secure 24/7 account information, including activity and balance information, electronic statements, tax documents, email notifications and electronic funds transfers – conveniently available from any computer or smartphone.

• AUTHORIZED SIGNER FORM Lets you authorize someone else to access your HSA funds and information.

• BENEFICIARY DESIGNATION FORM Lets you designate a beneficiary for your HSA.

Learn more at hsabank.com


Maintenance Medication Requirement

AVOID UNNECESSARY COSTS: USE GENERIC PRESCRIPTIONSIf you get a brand-name prescription when a generic is available,

you’ll pay the cost for the brand prescription, plus the cost difference between the brand and generic medication.

Prescription drug benefits are included in your medical plan coverage, as described previously in the Medical Benefits section. Prescription drug benefits are different for the CDHP and the Copay Plan. So when making a decision about which medical plan to choose, it’s important to understand how each plan covers prescription drugs, and what your estimated out-of-pocket cost might be under each plan.

One-time fill prescriptions may be filled at any retail pharmacy; however, your out-of-pocket cost will be higher at pharmacies outside of the Rochester Regional Health Network.

Refer to the Maintenance Medication List available at myROChealth.com/benefits for the most up-to-date

list of maintenance medications.

IMPORTANT NOTE: If you enroll in the CDHP and get a maintenance medication and it is NOT filled at a Rochester Regional Health Apothecary OR through Express Scripts Home Delivery Pharmacy or Wegmans Home Delivery, the cost you pay WILL NOT be applied to your deductible or your out-of-pocket maximum.

Maintenance Medication In-Network Pharmacies:

• The General Apothecary

• Park Ridge Apothecary

• Unity St. Mary’s Apothecary

• Express Scripts Home Delivery Pharmacy

• Wegmans Home Delivery Program

For contact information, see the Benefits Resources listing on the inside back cover.

Prescription Drug

Benefits

To get coverage for a prescription on the Maintenance Medication List, you must fill the prescription at an in-network pharmacy (see box to left for listing). If not, you will pay the full cost for the medication and the cost will not be applied to your deductible or out-of-pocket maximum.

Medications not on the Maintenance Medication List may be filled at any retail pharmacy; however, you will pay a lower copay if filled at an in-network pharmacy, as outlined in the chart on page 6.

IMPORTANT NOTE: Maintenance Medications for chronic conditions including asthma, diabetes and high blood pressure are subject to the deductibles and/or copays outlined on the chart on page 6.


As a Rochester Regional Health employee, you and your family members are eligible for comprehensive care management services, education and support available at no cost through the Greater Rochester Independent Practice Association (GRIPA). GRIPA is a group of more than 1,200 physicians within the Rochester Regional Health Network who are supported by a team of registered nurses, clinical pharmacists, certified diabetes educators and social workers.

The GRIPA team works closely together with patients and their doctors to help lower costs, enhance quality of care and improve overall health by providing:

• Hands-on care coordination, consultations and education to help you manage chronic health conditions such as diabetes, asthma and high blood pressure

• Assistance with navigating the health care system, including finding in-network providers and estimating out-of-pocket costs for services and procedures

• Helpful hints and personal support to save money on prescriptions

Employees and their dependents who enroll in a Rochester Regional Health medical plan are automatically enrolled in the GRIPA Care Management program. Those not covered by a Rochester Regional Health medical plan can also participate by contacting GRIPA directly.

Personal health information is securely maintained by GRIPA and all communication between you, your provider and GRIPA are strictly confidential. Under no circumstances will any Rochester Regional Health employee ever have access to your personal health information.

As a participant in the program, you and your dependents may be contacted by a GRIPA Care Manager to discuss a health condition. You may also contact GRIPA directly for immediate health management support as outlined above.

Contact GRIPA today to learn more:

(585) 922-1520 [email protected]

Care Management Support

Take advantage of the free

Care Management services available to you through GRIPA.


Dental BenefitsRochester Regional Health provides affordable dental insurance options through Excellus BlueCross BlueShield (Excellus BCBS) to encourage you and your family to maintain good oral health. Proper dental care can also help prevent more serious health issues such as heart disease, low birth weight and osteoporosis. Bi-weekly premium costs for dental plan coverage are provided in Workday.

Your Options:• No Coverage• Basic Dental Plan• Enhanced Dental Plan

Dental Plan Comparison of Your Coverage & CostsThe table below compares your out-of-pocket costs for both dental plan options. Both plans provide a fixed percentage to the BlueShield Customary Schedule of Allowances.

IN-NETWORK PLAN FEATURE

BASIC PLAN ENHANCED PLAN

SINGLE

TWO-PERSON/FAMILY SINGLE

TWO-PERSON/FAMILY

Annual Deductible $50.00 $100.00 $25.00 $75.00

Preventive ServicesOral exams, cleaning, polishing, x-rays, flouride treatments, sealants, emergency pain treatment

$0 $0

Basic Restorative ServicesFillings, extractions, root canals, oral surgery, endodontics, periodontics, scaling, anesthesia*

50% of cost after deductible is met


Major Restorative ServicesInlays, crowns, space maintainers, prosthodontics, dentures and repairs



Orthodontia(For dependents up to age 19)Teeth straightening with braces or other methods

No coverage – you pay the full cost


Annual Coverage Maximum Plan covers up to $1,000 per covered

individual

Plan covers up to $1,500 in eligible costs per covered individual

Orthodontia Lifetime Maximum Not applicable Plan covers up to $1,500 per individual

* IV sedation is a covered expense for wisdom teeth removal. For additional information regarding coverage for IV sedation or anesthesia for a planned dental procedure, ask your provider to submit a Predetermination of Benefits to Excellus BCBS.

Use providers in the Excellus BCBS Dental

Network to pay the lowest cost

for services. Visit excellusbcbs.com to find or confirm

in-network providers.

IMPORTANT NOTE: Before you receive dental services, ask your dental provider to submit a Predetermination of Benefits to Excellus BCBS. This will ensure you know what your actual out-of-pocket cost will be before treatment begins.


Vision Benefits

The Insight Network includes several retail chains such as LensCrafters and

Pearle Vision, in addition to local private practitioners. To search for a participating

provider, visit EyeMed.com and choose the Insight Network under “Find a Provider.”

* Refer to the Summary of Benefits and Coverage chart on myROChealth.com/benefits to review vision care benefits covered under the medical plan. If you elect a Rochester Regional Health medical plan and the Optional Vision Plan, the medical plan will be your primary coverage and the Optional Vision Plan will be secondary.

** Refer to the Optional Vision Plan Highlights at myROChealth.com/benefits for a detailed listing of covered services and costs.

Talk with ALEX to see if the Optional Vision Plan is right for you and your family.

Available at myROChealth.com/benefits.

Rochester Regional Health offers optional vision coverage through EyeMed to help you and your family maintain eye health and detect potential problems early. The vision benefits offer savings for eye care expenses, such as routine eye exams, eyeglass frames/lenses and contact lenses. This coverage is offered as an enhancement to vision benefits provided through your medical plan.* Bi-weekly premium costs for vision plan coverage are provided in Workday.

Your Options:• No Coverage• Optional Vision Plan

The plan offers the greatest coverage for providers in EyeMed’s Insight Network, with limited coverage for out-of-network providers, as outlined here.

Plan Coverage & Costs**

PLAN FEATUREEYEMED INSIGHT

NETWORKOUT-OF-

NETWORK

Annual Eye Exam with dilation as necessary

You pay $10 copay You receive $35 reimbursement

Frames (once every 12 mos.)

Plan pays up to $170, plus 20% of balance over $170

You receive $85 reimbursement

Single Vision Lenses (once every 12 mos.)

You pay $25 copay You receive $25 reimbursement

Contacts (once every 12 mos.)

Plan pays up to $170, plus 15% of balance over $170

You receive $136 reimbursement

OR


Rochester Regional Health offers two types of pre-tax flexible spending accounts (FSAs) to help with your out-of-pocket expenses for healthcare and dependent care. If you regularly pay out-of-pocket medical and/or dependent care expenses, a little planning can mean a lot of savings when you enroll in an FSA.

Your Options:• No Participation• Healthcare Flexible Spending Account*

― Contribute up to $2,550 • Dependent Care Flexible Spending Account

― Contribute up to $5,000 ― Contribute up to $2,500, if you are married and filing taxes separately

Flexible Spending Accounts

Big Savings with FSAsYour contributions to an FSA are deducted

from your paycheck before taxes are taken out. This means your taxable income is lowered by the amount you contribute to your FSAs, and you do not have to pay federal, state, Social Security or Medicare (FICA) on this money. By putting these dollars in an FSA, you save anywhere from 23 – 46% off your total FSA

contributions (depending on your tax bracket).

Here’s How it Works:Let’s say your annual income is $35,000 and you are in a 30% tax bracket. If you contribute $2,000 to the Healthcare FSA and $2,500 to the Dependent Care FSA, a total of $4,500 will be deducted from your annual income on a pre-tax basis (taken from your pay in 26 bi-weekly deductions throughout the year). This will lower your taxable income from $35,000 to $30,500. So instead of paying $10,500 in annual taxes ($35,000 x 30% taxes), you’ll only pay $9,150 ($30,500 x 30% taxes) – saving you $1,350 ($10,500 – $9,150).

FSA PARTICIPATION

NO FSA PARTICIPATION

Annual Income (before taxes)

$35,000 $35,000

Pre-Tax Healthcare FSA Contribution ($ 2,000) $0

Pre-Tax Dependent Care FSA Contribution ($ 2,500) $0

Taxable Income $30,500 $35,000Estimated Taxes (30%) ($ 9,150) ($10,500)Annual Tax Savings $ 1,350

The Healthcare FSA and Dependent Care FSA are separate benefit plans administered by Lifetime Benefit Solutions. You may not use funds in your Healthcare FSA to pay for dependent care expenses and you may not use funds in your Dependent Care FSA to pay for healthcare expenses.

* Not available to those who enroll in the CDHP medical plan. See page 17 for details.


About the Healthcare FSAThe Healthcare FSA helps you save money on everyday out-of-pocket medical, prescription drug, dental and vision expenses. Qualifying dependents for FSA purposes include children through the end of the year in which they turn age 26.

Save your receipts…The IRS requires that all purchases made

with an FSA debit card be validated. Fortunately, debit card technology

automatically substantiates the vast majority of your transactions. For those

that cannot be automatically substantiated, you will be sent a Request for Information Letter requesting a copy of your receipt or

other necessary documentation.

Talk with ALEX to see if and how flexible spending accounts can save you money. Available

at myROChealth.com/benefits.

Typical Eligible Expenses:• Out-of-pocket expenses for medical, dental and vision

care not paid by insurance coverage (such as copays, deductibles, coinsurance)

• Medical devices such as glasses, contacts, hearing aids, orthopedic equipment, orthodontia equipment, dentures

• Alternative medical care, such as acupuncture and holistic treatment

• Smoking cessation programs• Weight loss programs for those diagnosed as obese• Prescription drug expenses• Some over-the-counter items like bandages, contact

lens solutions, first aid kits

For a full list of eligible Healthcare FSA expenses, visit myROChealth.com/benefits.

Who Can Enroll?• The Healthcare FSA is available to those who enroll

in the Copay Plan for medical coverage, or those who elect no medical coverage.

• Per IRS rules, if you are enrolled in an FSA, you cannot make contributions to an HSA. So, if you enroll in the Consumer Driven Health Plan (CDHP) with the Health Savings Account (HSA) for 2016, you cannot also participate in the Healthcare FSA in 2016.

• This restriction also applies to your spouse. If your spouse is covered on your CDHP, and you’ve enrolled in an HSA, your spouse cannot participate in his/her employer’s Healthcare FSA.

IMPORTANT NOTE: The Healthcare FSA does not have a rollover or grace period feature. You must incur eligible expenses by December 31 of the plan year in which you are enrolled to receive reimbursement from the FSA. These expenses must be submitted by no later than March 31 of the following year to receive reimbursement.


About the Dependent Care FSAThe Dependent Care FSA is used for daycare expenses you incur for your tax dependents while you – or, if married, you and your spouse – work outside the home or attend school full-time. It CANNOT be used for reimbursement of healthcare expenses for eligible dependents.

Who Can Enroll?• The Dependent Care FSA is available to any eligible

employee who works 20+ hours per week and would like to enroll. If you are enrolled in the CDHP medical coverage, you can also participate in the Dependent Care FSA (but not the Healthcare FSA).

Typical Eligible Expenses:• Care at a licensed nursery school, day camp or day

care center• Before- and after-school care or qualified summer day

camps for children under age 13• Your portion of FICA or other taxes you pay for a

care provider• In-home services related to the care of an elderly or

disabled adult dependent• Services from individuals who provide dependent care

in or outside your home, excluding care provided by your spouse, your own children under age 19 or any other tax dependents

• Agency or association fees required to obtain the services of a dependent care provider

For a full list of eligible Dependent Care FSA expenses, visit myROChealth.com/benefits.

Dependent Care FSA vs. Federal Dependent Care Tax CreditUnder current tax law, qualified dependent care expenses you pay on an after-tax basis may qualify as a credit against your federal income tax return. Depending on your circumstances, the tax savings may be greater if you pay for dependent care on an after-tax basis and claim the expenses on your federal income taxes rather than use a Dependent Care FSA. For others, the tax savings will be greater under a Dependent Care FSA. You cannot use both tax-saving methods for the same expense; use of the Dependent Care FSA will reduce or eliminate your tax credit. To help determine which method is best for you, consult with a financial advisor or tax professional.

IMPORTANT NOTE FOR HIGHLY COMPENSATED EMPLOYEES: Due to IRS regulations, the amount highly compensated employees can contribute to a Dependent Care FSA may be limited. You will be notified by Human Resources if your annual Dependent Care FSA election needs to be reduced as a result of IRS non-discrimination testing.

More About FSAsENROLLMENT COMMITMENT Once you make your election, you may not change your contribution amount during the year, unless you have a specific qualifying event that results in a new tax dependent (e.g., marriage, birth, adoption).

ESTIMATE EXPENSES CAREFULLY While an FSA is a “use it or lose it” plan, don’t let this scare you away. To avoid losing money at the end of the year, contribute just the amount needed to cover expenses you’re certain to purchase in 2016, like medically necessary prescription drugs, prescription glasses and contact lenses.

AVAILABILITY OF FUNDS Healthcare FSA: Your full annual contribution amount is available to pay for qualified expenses as soon as you enroll in the plan.

Dependent Care FSA: You must have a balance in your account in order to make a payment from the Dependent Care FSA.

PAYING FOR EXPENSES If you sign up for a new Healthcare or Dependent Care FSA, Lifetime Benefit Solutions will send you debit cards. The debit card provides an easy, convenient way to pay for qualified healthcare and dependent care expenses.

You can also file a reimbursement claim for qualified expenses, and can elect to have your reimbursements direct deposited into your bank account. Claim forms are available on the Lifetime Benefit Solutions website at lifetimebenefitsolutions.com.

CLAIM PERIOD To be eligible for reimbursement, expenses must be incurred, between January 1 – December 31, 2016, while you are a participant in the FSA. There is no grace period for reimbursing 2017 expenses from your 2016 FSA. You must file all claims for expenses incurred in 2016 by March 31, 2017. Any money that remains in your FSA after this deadline will be forfeited, per IRS rules. If you terminate employment, you have 90 days from your termination date to submit for reimbursement of claims. Any money remaining in your account after this deadline will also be forfeited.


Core Life InsuranceEmployees regularly scheduled to work 20+ hours per week are automatically enrolled in Core Life Insurance in the amount of 1 x annual salary (minimum of $25,000; maximum of $1,500,000) – at no cost and with no evidence of insurability required (EOI).* Benefits are paid out in the event of your death while employed by Rochester Regional Health. This insurance does not provide any cash value during your lifetime.

Optional Employee Life and Dependent Life InsuranceYou can also purchase additional life insurance for yourself, your spouse and your children. Your rates for the coverage levels outlined below are provided in Workday.

Coverage Levels and Insurability RequirementsTYPE COVERAGE GUARANTEED ISSUE AMOUNT**

Optional Employee Life 1x to 5x annual salary up to $1,500,000

Total of Core and Optional Insurance coverage cannot exceed $3,000,000

Lesser of 3x annual salary or $1,500,000 when combined

with Core Life Insurance

Optional Spouse/Domestic Partner LifeCoverage amount cannot exceed 50% value of your Optional Employee Life amount.

$25,000 increments up to a maximum of $125,000

Rates based on employee’s age, not spouse’s/domestic partner’s age

$50,000

Optional Child Life***Covers children to age 26Rate is the same regardless of number of children covered

$5,000$10,000

No EOI required

* EOI refers to the underwriting process our insurance carrier, Liberty Mutual, uses to determine if you can be insured for the coverage you have requested, based on your current health status. If evidence of insurability is required, Liberty Mutual will contact you to complete a health questionnaire.

** The guaranteed issue amount is only available during your first eligibility window, typically within the first 31 days of your eligibility period for electing life insurance.

***Must purchase Optional Employee Life to purchase Optional Spouse/Domestic Partner Life and Child Life.

Life Insurance


Core AD&D InsuranceEmployees regularly scheduled to work 20+ hours per week are automatically enrolled in Core AD&D coverage in the amount of 1x annual salary (minimum of $25,000; maximum of $1,500,000) – at no cost. AD&D provides coverage for accidents that result in death or dismemberment. AD&D covers both work and non-work-related accidents.

If you have an accident that results in death, the coverage amount is payable to your beneficiaries. If the accident results in your dismemberment, a pro-rated portion of the coverage amount is payable to you (refer to the schedule of benefits available on myROChealth.com/benefits for details).

Optional AD&D InsuranceYou can also purchase additional AD&D insurance for yourself, your spouse and your children. Your rates for the coverage levels outlined below are provided in Workday.

Coverage LevelsTYPE COVERAGE

Optional Employee AD&D 1x to 5x annual salary up to $1,500,000Total of Core and Optional AD&D Insurance cannot exceed

$3,000,000Optional Spouse/Domestic Partner AD&D

$5,000 increments, up to 50% of Employee Optional AD&D amount, not to exceed $125,000

Optional Child AD&D $2,000 increments, up to 50% of Employee Optional AD&D amount, not to exceed $40,000

If you and your spouse/domestic partner are both covered by Rochester Regional Health benefit plans, you may not purchase Dependent Life or AD&D coverage on your spouse/domestic partner, if your spouse/domestic partner is enrolled as an employee. Only one of you may elect Dependent Life and AD&D coverage for your eligible children.

Accidental Death & Dismemberment (AD&D) Insurance

BeneficiariesYou can designate any number of primary and contingent beneficiaries for your life insurance and AD&D policies, and you can change these beneficiaries at any time in Workday.

Primary beneficiaries receive the life insurance benefit in the event of your death. You designate the percentage of the total benefit each beneficiary would receive – these percentages must add up to 100%.

Contingent beneficiaries receive the benefit if no primary beneficiary is living at the time of your death. These designations must also total 100%.


Disability Benefits

Short-Term DisabilityShort-Term Disability (STD) provides partial income protection if you are unable to work due to your own medical condition.

Employees regularly scheduled to work 20+ hours per week are automatically enrolled in STD benefits at no cost. The benefit provided is 60% of weekly salary. You are eligible to receive STD benefits after six months of continuous employment.

Here’s How STD Benefits Work:• If you qualify for STD, the first

seven consecutive calendar days of your absence are unpaid. You may use accrued PTO or vacation time, if available, to be paid during this absence.

• The next 25 weeks of your approved STD leave are paid at 60% of your base salary. A qualified short-term disability is covered for up to 26 weeks.

If you do not meet the eligibility requirements for short-term disability coverage, you may be eligible for New York State mandated Statutory Disability benefits.

Long-Term Disability Long-Term Disability (LTD) coverage enables you to continue to receive income when an extended disability prevents you from working. Rochester Regional Health offers Core and Optional LTD benefits for eligible employees with a minimum of six months of service, as outlined below.

LTD Eligibility & Coverage ELIGIBILITY TYPE COVERAGE

Vice Presidents and below regularly scheduled to work 30+ hours per week

Core LTD40% of base earnings

up to $1,500 per month

Optional LTD60% of base earnings


Physicians and Senior Executives regularly scheduled to work 20+ hours per week

Core LTD50% of base earnings


Optional LTD66.7% of base earnings up to

$20,000 per month

LTD benefits begin when STD benefits exhaust at 26 weeks. LTD benefits continue for as long as you are totally disabled, up to age 65. Benefits may be extended beyond age 65 for a disability that begins at age 60 or after.


At Rochester Regional Health, we recognize that saving for retirement is important, but it’s not always easy. So we offer convenient and valuable retirement plan benefits, including a Defined Benefit Pension Plan, along with Retirement Savings Plans, to help you secure your financial future. Combining the Pension Plan with a Retirement Savings Plan allows you to supplement any Social Security benefits you may receive, and diversifies your sources of retirement income.

Retirement Benefits

Defined Benefit Pension PlanThe Defined Benefit Pension Plan is a company-funded retirement plan. Employees are automatically enrolled in the plan after completing one year of credited service, and will be vested after five years of credited service. Per diem employees may work enough hours to participate in the pension plan.

You earn a year of credited service for each calendar year in which you work at least 1,000 hours. If you work 1,000 hours or more each year for five consecutive years, you are fully vested in the pension plan. Vesting means you are entitled to receive a benefit from the plan at retirement. Benefits are based on the average of your annual compensation in the five highest earning years out of the last ten years prior to retirement or termination.

Normal retirement age is the later of age 65 or your fifth anniversary of plan participation; however, you may elect to retire early under the plan. If you have completed at least five years of benefit service, you can retire as early as age 55. If you retire early, your benefit will be reduced.

More details about the plan are available at myrochealth.com/benefits.

403(b)/401(k) Retirement Savings PlansAll employees are immediately eligible to participate in either our 403(b) or 401(k) retirement savings plans, depending on work location (ask your Human Resources representative which plan you are eligible to participate in).

These plans allow you to set aside pre-tax dollars through automatic payroll deductions into a retirement program. You may direct your contributions into one or more investment options to create a diversified portfolio for your retirement savings. Options include a mix of money market/stable value, bonds and stocks.

In addition to assisting with saving for retirement, these accounts lower your current taxable income. Your Human Resources representative will provide you with further details about your retirement savings plan eligibility, specific plan features and enrollment options.


Rochester Regional Health is proud to offer a comprehensive Employee Assistance Program (EAP), called BalanceWorks®, at no charge to all employees. The BalanceWorks EAP is available through Employee Network, Inc. (eni) and provides confidential assistance with everyday work and family issues, as well as more challenging personal concerns, 24-hours a day, 7-days a week. In addition to providing confidential consultations with licensed mental health professionals, the program also offers you and eligible family members:

• Personal assistant to conduct research, coordinate events or plan tasks and projects

• Counseling referrals• Financial and legal consultations• Child/elder care resources• Online access to work/life tools, articles, videos

and interactive courses

To learn more, visit mybalanceworks.com using Member #: 43842073 and Group #: 8982.

You are automatically enrolled in the

BalanceWorks EAP and can begin using

services on date of hire.

Employee Assistance Program


Rochester Regional Health offers optional Legal Services benefits, called MetLaw®, administered by Hyatt Legal Plans. You may enroll yourself, your spouse or domestic partner and your children up to age 26. MetLaw is a legal services plan that provides affordable legal representation for you, your spouse/domestic partner and dependents. MetLaw gives you unlimited access to a nationwide network of over 11,000 experienced attorneys, including several throughout Monroe and the surrounding counties.

Legal Services Benefits

NOTE: Pre-existing matters for which you’ve already hired an attorney before enrolling in MetLaw are not covered in order to protect attorney-client relationships. However, if you haven’t hired an attorney, pre-existing matters are covered and you can use the plan as much as necessary to support your needs.

2016 enrollment rates for the Legal Services Plan are available in Workday. For more information, visit myROChealth.com/benefits.

With MetLaw, you receive unlimited legal advice, fully covered legal services and representation for a wide range of personal legal matters, such as:

COURT APPEARANCES Traffic ticket defense, personal property protection, administrative hearings, consumer protection matters

DOCUMENT REVIEW & PREP Mortgages, elder law, review of personal legal documents, deeds

FAMILY LAW Prenuptial agreements, adoption, guardianship

REAL ESTATE MATTERS Home sale, purchase or refinance, zoning applications, boundary disputes, property tax assessments

DEBT COLLECTION DEFENSE Identity theft defense, tax audits, creditor negotiation

WILLS Preparation of living wills, powers of attorney, trusts


Benefits Resources BENEFIT RESOURCE CONTACT INFORMATION

Rochester Regional Health Benefits Information

Human Resources Department/Benefits Team

(585) 922-1100 [email protected]

Benefits Decision-Making Support ALEX – Personal, Virtual Benefits Counselor

myROChealth.com/benefits

Medical Plans Excellus BlueCross BlueShield (877) 668-7636 excellusbcbs.com

Health Savings Account HSA Bank (800) 357-6246 hsabank.com [email protected]

Prescription Drugs The General ApothecaryMonday – Friday 8 am – 8 pmSaturday 10 am – 4 pm

(585) 922-3970Rochester General Hospital Campus Medical Office Building 1415 Portland Ave, Suite 125

Park Ridge ApothecaryMonday – Friday 7 am – 7 pmSaturday 7 am – 12 pm

(585) 723-7340Rochester Regional Health Unity Campus Professional Office Building 1561 Long Pond Road

St. Mary’s ApothecaryMonday – Friday 9 am – 5:30 pm

(585) 368-3928Rochester Regional Health St. Mary’s Campus 89 Genesee Street

Express Scripts Home Delivery Pharmacy

(888) 327-9791 Express-Scripts.com

Wegmans Home Delivery (800) 586-6910 wegmans.com/pharmacy

Care Management Support GRIPA (585) 922-1520 gripa.org

Dental Plans Excellus BlueCross BlueShield (800) 724-1675 excellusbcbs.com

Optional Vision Plan EyeMed (866) 800-5457 eyemed.com

Flexible Spending Accounts (FSA) Lifetime Benefit Solutions (800) 327-7130 lifetimebenefitsolutions.com

Disability Benefits Liberty Mutual (888) 778-9217 mylibertyconnection.comCompany Code: RRHLIBERTY

Legal Services Plan Hyatt Legal Plan (800) 821-6400 info.legalplans.comAccess Code: 7870010

Employee Assistance Program eni (800) EAP-CALL mybalanceworks.comMember ID: 43842073 (effective 1/1/16)Group ID: 8982 (effective 1/1/16)

Retirement Savings Plans 403(b)/401(k)

RGH Plan:MetLife

(800) 543-2520(585) 922-3521 (local representative)mlr.metlife.com

Unity/ACM Plan:Transamerica Retirement Solutions

(888) 676-5512(585) 723-7116 (local representative)tsretire.com

This enrollment guide describes certain benefit plans as they apply to eligible Rochester Regional Health employees. Complete details about the plans are in the legal plan documents. You may receive a copy of the plan documents by contacting the Benefits Department or the Plan

Administrator. The Plan Administrator may request payment of a reasonable charge for the copy. If there is any discrepancy between the information contained in this guide and the provisions of the legal plan documents, the plan documents govern. Rochester Regional Health

reserves the right to terminate, suspend, withdraw, amend or modify any of the plans at any time for any reason.

HUMAN RESOURCES Riedman Campus

100 Kings Highway SouthRochester, NY 14617

1-2016

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