Welcome to Open Enrollment Mercy Health System! Your …mybenefits.trinity-health.org/documents/2018...

Welcome to Open Enrollment Mercy Health System!Trinity Health and Mercy Health System 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 System referred to as simply TrinityHealth. If you have more questions after reviewing this guide, refer to the “For More Information” section to learn where you can getanswers.

What’s Inside

What’s New for 2018 2

How to Enroll 3

About the Medical Plans 4

Medical Coverage 5

Medical and PharmacyPlan Highlights 6

Paying for Medical andPharmacy Coverage 7

More About the HealthSavings PPO 8

Live Your Whole Life 9

More About the MedicalPlans 10

Dental Coverage 11

Vision Care Coverage 12

Flexible SpendingAccounts 13

Life Insurance 14

Time Away from Work 15

Voluntary Benefits 16

Who is Eligible 17

For More Information 18

Important Reminders 20

Additional Notices

Your Top Three Tasks for Open Enrollment

1 Review and make changes to your benefit elections byNov. 15, 2017.

2 Review and update your beneficiaries.

3 Print copies of your benefit elections for proof of enrollment.Confirmation statements will not be mailed to homes.

It’s also a good time of year to:

Update your personal information through Workday or by contacting the HRHeadquarters.

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

Review the Live Your Whole Life section of this guide to learn about resourcesthat will help you maintain your health and incentives on your medicalcontributions throughout the year.

Print copies of your benefit elections for proof of enrollment.

If you want to contribute to the Health Savings Account or the Health Care orDependent Care Flexible Spending Accounts you must make an election. Lastyear’s election will not carry forward.

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 7.

Mercy Health System - SEPA 1

What’s New for 2018

• Complete your benefits enrollment online usingWorkday, the new benefits enrollment web-based tool.Follow the step-by-step instructions provided in thisguide to help you navigate your benefit options for2018.

• For updates to Health Savings PPO deductibles, pleasesee the Medical and Pharmacy Plan Highlights page.

• This year, certain vaccinations will be covered throughthe pharmacy benefit as well as the medical benefitwith a $0 copay. Under the pharmacy benefit, you mustuse your prescription card at a participating CVSnetwork pharmacy that offers the specific vaccine.These vaccines may include: seasonal flu vaccine,shingles vaccine and the pneumonia vaccine.

• You will have the opportunity to contribute $50 moreper year to your HSA, up to a maximum of $2,800 in2018, if you have colleague only coverage. The IRSHSA contribution limit for all other coverage levels hasincreased to $5,600. Trinity Health’s contributionamount to your HSA will remain the same as in 2017.

• 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.

• For 2018, individual short-term disability will no longerbe offered as a voluntary benefit through Trinity HealthPlus Benefits. You may elect individual short-termdisability during the open enrollment period when youelect other Trinity Health benefits.

• 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.

• For 2018, all Main Line Health Hospitals, including BrynMawr, Paoli, Riddle hospitals and Lankenau MedicalCenter, will automatically be processed as Tier 1 forlabor and delivery for you and your covereddependents. OB/GYN professionals will continue to becovered as Tier 1 as they are today. If your claim fromone of these locations is processed as Tier 2, reviewthe Explanation of Benefits (EOB), and if there is anerror, contact IBC to have the claim reviewed.

Your Enrollment RequirementsIf you don’t make benefit elections on or before Nov. 15, 2017, you will automatically receive a default package of benefits,which includes the same elections you had last year for medical, dental, vision, life insurance, AD&D and disability. Keep inmind:

• If you want to contribute to the Health Savings Account or the Health Care or Dependent Care Flexible SpendingAccounts, you must make an election. Last year’s election will not carry forward.

• If you want to participate in the Essential PPO Assist Plan for 2018, you must apply each year and meet specificincome and eligibility guidelines. For more information on the Essential PPO Assist Plan, refer to page 7.

If you wish to participate in these programs next year you must complete your enrollment by Nov. 15, 2017 at11:59 p.m. EST.

2 Mercy Health System - SEPA

How to EnrollStep-by-step instructions

1. Access the Workday icon through ZENworks or by the "My Self Service"tab on MyBenefits (http://mybenefits.trinity-health.org).

2. Enter your network user ID and password and click "sign in."

For detailed enrollment instructions, please see the job aid onMyBenefits. For problems logging in, contact Trinity Resolution Center at888-667-3003.

3. Be sure to print the enrollment page for your records by clicking on the"print" button located at the bottom left hand corner of the final screen.Confirmation statements will not be mailed to homes.

If you do not change or correct your benefit elections by Nov. 15, 2017 at11:59 p.m. EST, IRS regulations require you to remain in your electionsthroughout 2018 or until you experience a qualified status change. For moreinformation on qualified status changes, visithttp://mybenefits.trinity-health.org.

Changing your electionsduring open enrollmentShould you need to change yoursubmitted elections during theopen enrollment period, use the"benefits" worklet in Workdayand select "change openenrollment". Please be sure tosubmit with your electronicsignature any time you use thisfeature whether you makechanges or not.

Job aid available to assistyou in completingenrollment throughWorkdayThrough the My Self Service tabon MyBenefits, locate the job aidfor step-by-step instructions forelecting benefits and completingyour enrollment.

Adding Family MembersIf you’re adding family members to your benefit plan during this year’s open enrollment, you’re required to provide writtendocumentation (for example, marriage certificate or birth certificate) verifying their dependent status to the HR Headquartersno later than Nov. 17, 2017. If you don’t submit the required documentation by the deadline, your dependents will notbe enrolled in coverage for 2018, and you’ll be required to wait until next year’s open enrollment period to add themto the plan – provided they remain eligible, and you provide documentation verifying their dependent status at that time. Tosee who is eligible to be added to coverage, please see the Who is Eligible section on page 17.

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 Plans

More about the Clinically Integrated Network (CIN)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.

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 don’t have asmartphone, visit theMyBenefits website to viewthe video.

Medical CoverageTrinity Health is offering you three medical plan choices for 2018 which support ourefforts to provide a common experience for all colleagues and provide meaningfulchoices. All three plans are administered by Independence Blue Cross and supportour clinically integrated network structure.

The three medical plan options are the Traditional PPO, the Health Savings PPO,and the Essential PPO. Each plan offers these three tiers so you can pay less byreceiving care from network providers.

• Tier 1, or the Trinity Health Preferred network providers, are facilities orphysicians aligned with our organization that provide you with the mostcost-effective care. For services unavailable through Trinity Health Preferrednetwork providers, select Independence Blue Cross providers will be availableat the Tier 2 benefit level.

• Tier 2 includes select Independence Blue Cross 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. Here’s how it works:

First You pay the full cost of medical and prescriptionexpenses until you reach the annual deductible (Note:preventive care services and certain preventive 90-daygeneric prescriptions do not require you to meet thedeductible).

Second Once you meet the deductible, you pay coinsurance untilyou reach the out-of-pocket maximum.

Third Once you reach the out-of-pocket maximum, TrinityHealth pays 100% of all remaining eligible expensesduring 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 System contribute to yourHSA 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.


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 / $18,000

Trinity Health Retail Trinity Health Retail Trinity Health RetailOwned 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-pocket

Brand 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.

††In-house pharmacy discount of 20% may apply.6 Mercy Health System - SEPA

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 PPOFull TimeFull 1 - Person No Full 1 - Person No Full 1 - Person No

Your per pay period cost Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive

bugColleague only

Colleague plus spouse/eligible adult Please contact the HR Headquarters for medical plan rates.

Colleague plus child(ren)

Colleague plus family

Traditional PPO Health Savings PPO Essential PPOPart TimeFull 1 - Person No Full 1 - Person No Full 1 - Person No

Your per pay period cost Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive

bugColleague only

Colleague plus spouse/eligible adult Please contact the HR Headquarters for medical plan rates.



Need help with your health care costs?You may be eligible for the Essential PPO Assist plan (“Assist Plan”) if you meet certainincome requirements. It is the same as the Essential PPO, but includes a TrinityHealth-funded Health Reimbursement Account (HRA) to help you pay for your health carecosts at the time of service. To participate in the Assist Plan, you must apply and meetspecific income and eligibility guidelines. To learn more, see the application form on theMyBenefits website. Apply by submitting a completed application form with a copy of yourmost recent Federal Income Tax Form 1040 or 1040EZ to the HR Headquarters by Nov. 17,2017.

NOTE: If you think you qualify for the Assist Plan, you should elect the medical plan youthink will be best for you – which could be the Traditional PPO, the Health Savings PPO, orthe Essential PPO. 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 achieve Fulland 1-Personincentives, see the LiveYour Whole Life sectionon page 9.


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.

”“ It’s great that TrinityHealth makes its fullcontribution to my HSAin January.

”“For certain genericpreventive drugs anddiabetes and asthmadrug classes, I didn’thave 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 $3,450All 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 spouse’s 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. You’ll receive more information about your payment options ifyou enroll in the Health Savings PPO with the HSA.

What happens if I don’t 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 theHSA 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 keepmaking 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. It’s so important that we provide an incentive when you and your covered spouse or eligible adult complete these steps.

Here’s how this year’s 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.


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 it’s a new car or health care.

Being a smart health care consumer doesn’t 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, it’s 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.

Prescriptions available at Mercy Retail pharmacyRemember, purchasing medication at Mercy Retail pharmacy may save you money. Also, you can fill prescriptions forup to a 90-day supply of your medications at our own pharmacy. See or contact your Mercy Retail pharmacist at(1-610-237-7330) for more information.

Maintenance Choice program for your maintenance medicationsOur prescription drug plan requires that you receive your maintenance medications* in 90-day supplies through anearby Trinity Health onsite pharmacy, a local CVS pharmacy or the CVS Caremark Mail Service Pharmacy. Onceyou reach your plan limit (initial fill and 2 refills) for filling 30-day supplies at a retail pharmacy, you will pay the full costof your medications if you do 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.

Maternity Services at Main Line Health hospitalsAll Main Line Health hospitals as Tier 1 facilities for labor and delivery for you and your covered dependents. Thisincludes Bryn Mawr, Paoli, and Riddle hospitals and Lankenau Medical Center facility charges.

OB/GYN professionals will continue to be covered at Tier 1 as they are today.

The majority of claims for labor and delivery services through Main Line Health hospitals will be automaticallyprocessed as Tier 1. However, there are some situations that may result in claims processing incorrectly at Tier 2,such as entering the maternity ward through the emergency room. Carefully examine Explanation of Benefits (EOBs)and if there is an error to reach out to IBC immediately to request the claim to be reviewed.


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

Colleague plus spouse/eligible adult Please contact the HR Headquarters for dental plan rates.



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.

For more information about yourdental plan options or aboutDelta Dental, visithttp://mybenefits.trinity-health.org.


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

Colleague plus

spouse/eligible adult Please contact the HR Headquarters for vision plan rates.



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 and

saline 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) medications

For 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 you’re approved, the premium contributions will be deducted from yourpaycheck on an after-tax basis.

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

Colleague Life InsurancePlan 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 increase in colleague Supplemental life coverage will require you tocomplete a Personal Health Application form. NOTE: The Hartford willcontact you directly via email or mail if a Personal Health Application isrequired for 2018. This communication will include instructions on how tocomplete the Personal Health Application online or request a paper form.

Costs for colleague supplemental life insurance coverage are based on your age as of Jan. 1, 2018, and willbe available when you enroll online. Costs will be updated if your birthday moves you into a new age rangerate.

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 InsurancePlan 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 increase in spouse/eligible adult supplemental life coverage will require yourspouse/eligible adult to complete a Personal Health Application form. NOTE: TheHartford will contact you directly via email or mail if a Personal Health Application isrequired for 2018. This communication will include instructions on how to completethe Personal Health Application online or request a paper form.

1 Costs for spouse/eligible adult life insurance coverage are based on your age as of Jan. 1, 2018, and willbe available when you enroll online. Costs will be updated if your birthday moves you into a new agerange rate.

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 haven’tyet 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


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 notan employer-paid for benefit. You pay the full cost of coverageon a post-tax basis. Rates are based on your pay and age.Pre-existing conditions apply.

Visit the MyBenefits website for more details.

Amount of benefit 60% of base pay

Option A: up to $500 maximum per week Option B:

up to $2,000 maximum per week

When benefits

begin

After a 14 calendar day elimination period following

an injury or illness

How long benefits

continue

Up to 11 weeks or until you no longer qualify for

benefits, whichever comes first

Use of time off

benefits

Full- or part-time colleagues are required to

use earned time off, i.e. Long Term Sick,

CTO, and vacation, until only 40 hours

remain.

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.

Amount of

employer-provided

benefit

60% of base pay

Up to a maximum of $10,000

When benefits

may begin

After 90 days of disability

How long benefits

continue

Benefits continue until you are able to return

to work, are deemed no longer disabled, or

until normal retirement age.

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


Voluntary BenefitsIn addition to your group benefits, Trinity Health has partnered with Trinity Health Plus Benefits to provide eligible colleagues theopportunity to elect personal insurance plans. Open enrollment for these benefits will be held in the Spring of 2018. Individualpolicy options include:

• LifeTime benefit term insurance with long-term care

• Critical illness coverage

• Legal coverage

• Group accident insurance

Additional voluntary benefits available for enrollment all year long include:

• Auto and home insurance

• Pet insurance

• Discount marketplace

• Long-term care

• Employee financial solutions

• ID theft protection

For more information, call 1-866-766-4840. Be sure to tell the representative that you are a member of Trinity Health and MercyHealth System.


Who Is Eligible

Eligible Individual Definition

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

budgeted hours per pay period for short-term disability and 70 or more budgeted hours per pay period for

long-term disability.)*

Spouse/Eligible Adult You may cover your spouse or Eligible Adult. An Eligible Adult is an adult who resides and has financial

interdependence 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 Nov. 17, 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 adult’s natural children;

• Your or your spouse/eligible adult’s 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 HR Headquarters by emailing [email protected] or calling 610-567-5483 between 8:00 a.m. and 5:00 p.m.weekdays or open the “Benefiting from Total Rewards” icon on http://mhssepa.che.org.

• Attend a colleague help session

Day Time(s) Operating Unit*Friday, Oct. 20 8:30 a.m. – 11:00 a.m. Conshohocken (System Office)Thursday, Oct. 26 9:30 a.m. – 11:00 a.m. MHH - SpringfieldThursday, Oct. 26 1:00 p.m. – 4:00 p.m. Mercy Life & Mercy Home Health - Broad St.Friday, Oct. 27 7:00 a.m. – 7:00 p.m. NazarethMonday, Oct. 30 1:00 p.m. – 3:00 p.m. LIFE - Valley ViewTuesday, Oct. 31 7:00 a.m. – 7:00 p.m. Mercy Fitzgerald (SEPA)Wednesday, Nov. 1 7:00 a.m. – 7:00 p.m. Mercy Philadelphia (SEPA)Wednesday, Nov. 1 10:00 a.m. – 12:00 p.m. LIFE - Sharon HillThursday, Nov. 2 10:00 a.m. – 12:00 p.m. MHH - Blue BellFriday, Nov. 3 10:00 a.m. – 12:00 p.m. MHH - Newtown SquareWednesday, Nov. 8 10:00 a.m. – 12:00 p.m. MHH - Nazareth OfficeWednesday, Nov. 8 1:00 p.m. – 3:00 p.m. LIFE - Assisi HouseThursday, Nov. 9 10:00 a.m. – 12:00 p.m. LIFE - North HancockThursday, Nov. 9 10:00 a.m. – 12:00 p.m. MHH - Langhorne (St. Mary)

• Attend a benefits fair, where you’ll receive additional information and have an opportunity to ask questions regarding yourbenefit options.

Day Time(s) Operating Unit*Wednesday, Oct. 25 6:30 a.m. – 6:30 p.m. Mercy Philadelphia (SEPA)Thursday, Oct. 26 9:30 a.m. – 11:00 a.m. MHH - SpringfieldThursday, Oct. 26 1:00 p.m. – 4:00 p.m. Mercy Life & Mercy Home Health - Broad St.Monday, Oct. 30 6:30 a.m. – 4:30 p.m. NazarethWednesday, Nov. 1 6:30 a.m. – 6:30 p.m. Mercy Fitzgerald (SEPA)Thursday, Nov. 2 9:00 a.m. – 3:00 p.m. Conshohocken (System Office)

* More details about location will be announced and posted online.


For More Information – Continued

Benefits contact Information:

Plan Type Contact Phone Website

Benefits/Eligibility and HR Headquarters 610-567-LIVE Email: [email protected] Questions (5483)Enrollment Workday https://idp.trinityhealth.orgTrinity Health IT Help 610-492-3839Desk(to reset password)Medical IBC Member Services 800-ASK-BLUE

(800-275-2583)www.ibx.com/trinityhealth

Health Savings Account Health Equity Partners 866-212-4721 www.healthequity.com/ed/trinityhealthPrescriptions Caremark 866-243-7526 www.caremark.comPrescriptions Mercy Retail Pharmacy 610.237.7330Dental Delta Dental of Michigan 800-524-0149 www.deltadentalmi.comVision United Health Care 800-638-3120 www.myuhcvision.comFlexible Spending WageWorks 877-924-3967 www.wageworks.comAccounts andCommuter BenefitsLife Insurance The Hartford 888-563-1124 www.thehartford.comCredit Union Franklin Mint 610-534-6360 www.fmfcu.orgCredit Union Philadelphia Federal 215-934-3500 www.pfcu.comDisability The Hartford 855-532-7880 www.thehartford.comEmployee Assistance Carebridge 800-437-0911 www.myliferesource.comProgram access code: BKKR5Voluntary Benefits TH Plus Voluntary Benefits 866-766-4840 www.cheplusbenefits.comEmployment Verification The Work Number 866-604-6572 www.theworknumber.com

company code: 14229


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 tothe HR Headquarters within 30 days of the event, you will be allowed to makecertain benefit changes that are consistent with the status change. For example,if you get married during the plan year, you’ll be able to add your spouse to yourcoverage within 30 days of the marriage. For more information on family statuschanges, 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 Plan’s Health Insurance Portabilityand Accountability Act (HIPAA) Privacy Notice, visithttp://mybenefits.trinity-health.org. If you are unable to access the HIPAA noticeonline, contact the HR Headquarters to request a paper copy by 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 System 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, visit your benefitswebsite. If you are unable to access any SBC or Plan document online, contactthe HR Headquarters to request a paper copy by mail.

Notice: Women’s Health andCancer Rights Act of 1998The Women’s Health and Cancer RightsAct of 1998 requires all group healthplans that cover mastectomies to providecertain reconstructive surgery and otherpost-mastectomy benefits. TrinityHealth’s 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 eligibledependent’s) 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 theWomen’s Health and Cancer Rights Actof 1998, contact the HR Headquarters.


Welcome to Open Enrollment Mercy Health System! Your …mybenefits.trinity-health.org/documents/2018...

Documents

Transcript of Welcome to Open Enrollment Mercy Health System! Your …mybenefits.trinity-health.org/documents/2018...