Benefits for 2014Considering your options

April 19, 20231

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Benefits for 2014

Health Protection• Medical and Prescription Drug Coverage• Health Reimbursement Arrangement (HRA) with

SmartHealth Plan • Socially Just Medical Benefits• Dental Care Coverage• Vision Care Coverage

Tax-Advantaged Spending Accounts• Healthcare Flexible Spending Account (FSA)• Dependent Day Care Flexible Spending Account

(FSA)

Income and Survivor Protection• Short Term Disability (STD)• Long Term Disability (LTD)• Basic Life and AD&D Insurance • Supplemental Term Life Insurance• Supplemental AD&D • Business Travel Accident Insurance• Legal Services Plan

Securing Your Retirement• Voluntary Employee Retirement Savings

Plan Contributions• Employer-Paid Retirement Benefits

(Eligible Employees)

Enriching Self and Spirit • Employee Assistance Program (EAP) • SmartHealth Wellness Program• Tuition Reimbursement • Paid Time Off (PTO)

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Let’s Discuss

Be sure to enroll by October 15, 2013

What’s changing and why?

Who is eligible for benefits?

How do my benefits work?

What do I need to do?

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What’s changing and why

Why benefits are changing

• We are adjusting to a changing healthcare environment and must work together to slow down the rising cost of benefits

• Lourdes Health Network is aligning with the Ascension Health benefit platform, along with other Health Ministries – gaining access to competitive programs while saving administrative costs

• We are continuing to offer a competitive package to meet the needs of a diverse group of associates – but a package that is more in line with benefits offered by other employers

What’s changing

• New Eligibility Classifications

• New SmartHealth medical plans offering access to new Ascension Health network as well as the BCBS network

• New Medical Plan Administrator

• Prescription Drug Program through Lourdes Rx and MedImpact

• Health Reimbursement Arrangement (HRA) to pay for medical, pharmacy, dental or vision expenses

• Employer paid Long Term Disability and Short Term Disability, EIB no longer accruing

• Basic, Supplemental and Spouse Life Coverage

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Who Is Eligible for Benefits?

Benefit Eligibility (non-union)Full Time Associates • 32-40 standard hours per week

Part Time Associates • 20-31.99 standard hours per week

Non Benefit Eligible • less than 20 standard hours per week

Dependent EligibilitySpouse • Legally married spouse

Child • Less than 26 years old (whether living with you or not, whether single or married)

• Over 26 years old (if became totally and permanently disabled while covered under the plan)

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Medical Benefits

SmartHealth Medical Benefits

including

Prescription Drug Program through MedImpact

Click icon to add SmartArt graphic

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SmartHealth Medical Benefits

SmartHealth is…

• Ascension’s system-wide medical plan for associates. 

• On the forefront of adopting all healthcare reform initiatives

• Offers both comprehensive and cost-effective health care through benefit designs and networks

• Creation of our own Ascension network of providers• Access to a National Network of Blue Cross providers

for services that are not provided by Health Ministry facilities and contracted physicians.

• While being good stewards of our healthcare spending, promotes prevention and wellness in mind, body and spirit, to further our mission of treating the whole person

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SmartHealth Medical Benefits

Our partners

•Claims administered by ABS•Coverage includes Rx through MedImpact

•Contact ABS when you have questions.

•Ascension Health network (Tier 1)•National Network (Tier 2)

SmartHealth Medical Benefits

Ascension Health Network (Tier 1)• You get the best value and

highest level of benefits when you receive care from Ascension Health Ministries and their contracted providers

• Since we are providing the care within our own system, the cost is less

• You share in the cost savings when our own facilities and physicians provide services

National Network (Tier 2)• You get preferred pricing and a

competitive level of benefits when you receive care from Blue Cross providers

Out-of Network (Tier 3)• If you use providers who are

not members of either the Ascension Health Network or the National Network…

• you will get a lower benefit level and will be responsible for higher out-of-pocket costs.

Each option offers the same network access

How my plan works

Take time to

understand

your

medical

coverage

before you

need to use it

Preventive Care is

covered at 100%

in networkDoctor Visits go to Deductible in Tier 2 – except

Preventive Care is covered 100%

Comprehensivecovered benefits

– Prior Authorization

may be required

Check exclusions and annual maximums

Contraceptives are excluded

for 2014

The network you choose determines

how much you pay

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2014

SmartHealth

Medical

Benefit

Plans

My Plan Details

Medical Plan

$200 Deductible/0% Coinsurance

Ascension Health Network

(Tier 1)

National Network (Tier 2)

Out-of-Network (Tier 3)

Lifetime Maximum Unlimited Unlimited Unlimited

Annual Deductible All Deductibles and OOP Maximums are satisfied by Coinsurance expenses

from all Tiers.

Single $200 $400 $3,000

Family $400 $800 $6,000

OOP Max including Deductible

All Tier expenses apply to all OOP Maximums. Co-pays do not accrue toward OOP Maximum.

Single $1,450 $1,650 $9,000

Family $2,900 $3,300 $18,000

Hospital Services Co-pay/Coinsurance

Inpatient 0% 25% 50%

Outpatient 0% 25% 50%

Urgent Care $5 25%30% after Tier 2

ded

ER Services $75 + Tier 1 ded $75 + Tier 1 ded $75 + Tier 1 ded

Office Visit Co-pay/Coinsurance

Primary Care $5 25% 50%

Specialist $5 25% 50%

Specialist-Pediatrics $5 25% 50%

Mental Health $5 $5 50%

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Prescription Drug Benefits

Prescription Drugs

In-House Pharmacy

30-day SupplyCo-Pay

In-House Pharmacy 60-90 day Supply

Co-Pay

Retail Pharmacy 30-day Supply

Co-Pay

Generic $5 $12.50 $10

Preferred Brand Name (on formulary)

$15 $37.50 $25

Non-Preferred Brand Name

$35 $87.50 $50

MedVantx program discontinued, mail order through Lourdes Rx only.

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The true cost of your medical

plan includes not just your

out of pocket

expenses, but also

your payroll contributions

Biweekly Payroll Contributions

 Classification

Biweekly Medical Plan Premiums

$200 Deductible/10% Coinsurance

Full Time  

Single: Associate + One:

Associate & Child(ren): Family Plan:

$28.44$112.07$86.87

$144.23

Part Time

Single: Associate + One:

Associate & Child(ren): Family Plan:

$71.09$168.11$130.30$216.35

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Prior Authorization – New ProcessAll services received from the following providers must receive Prior Authorization:

• Kadlec Health System, Richland, WA• Kennewick General Hospital, Kennewick, WA• Tri-City Orthopedic, Richland, WA• Benton Franklin Orthopaedic Associates, Kennewick, WA• Tri-City Radiology, Kennewick, WA• Northwest Cancer Clinic, Kennewick, WA

Services will be approved for Tier 2 coverage include: • Brain• Heart• Obstetrics/Labor and Delivery• Newborn Care

No benefits will be payable by the Plan if Prior Authorization is not obtained for services received at the providers shown above.Authorization to receive care at the facilities listed above will ONLY be granted if the service is not available at Lourdes Health Network.

No benefits will be payable by the Plan if Prior Authorization is not obtained.

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SmartHealth Medical Benefits

Terms to know

Deductible: You pay this amount each year before Coinsurance starts

• Satisfied by all services, excluding Co-Pays and non-covered services• With Family Coverage, each individual satisfies their own Deductible but once the

family deductible is satisfied, benefits can start for all covered family members

Coinsurance: After satisfying the deductible, you and the Plan pay a % up to the Out-of-Pocket Maximum (OOP Max)

OOP Max: After your Coinsurance reaches the OOP Max, the Plan pays 100% for the rest of the calendar year

Co-Pay: A fixed dollar amount that you pay for non-hospital services – Co-Pays do not apply to OOP Max

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New Wellness Program – Simple & Effective

Earn Health Reimbursement Arrangement (HRA) dollars for wellness participation.

Activities & Rewards

Biometric Screening

Health Risk Questionnaire

Primary Care Provider (PCP) Visit

Total FSA Contributions/Year

$125

$125

$100

$350

HRA and FSA—what’s the difference?

COMPARISON OF TAX- ADVANTAGED ACCOUNTS

Account FSA HRA

Who owns the account Associate Ascension Health

Who funds the account Associate Ascension Health

What plans are offered with the account

Traditional PPO Traditional PPO with HRA

Limits $2,500 $350 in annual wellness rewards

Fund availability Immediate As earned

Use it or lose it Yes No

Portable No No

Interest bearing No No

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The difference a network makes: An example FT Associate with Associate + 1 coverage

Medical Care Ascension Health Network (Tier 1) Blue Cross Blue Shield (Tier 2)

Hospitalization for $10,000

I meet individual deductible…..$200And I pay 0% of the rest While the plan pays …………….$9,800

You satisfy the deductible…………. $40025% Cost-Share ……………………….$2,400Capped at OOP Max ……………… $1,650So I only owe…………………………..$1,650

2nd hospitalization $20,000

Already met deductible0% Cost-Share I already paid……………………..…..$200While the plan pays ……………$20,000I owe .………..…………………………..$0

Already met deductible25% Cost-Share = $5,000 butI met my OOP Max I already paid…………………..….…$1,650So I owe only.………..…………...…..$0

Hospitalization for spouse of $18,000

He meets deductible…..……......$2000% Cost-Share I already paid ………………......….$200While the plan pays …………….$18,000Spouse pays only……………………$200

He satisfies the deductible..…………... $40025% Cost-Share = $4,400 butCapped at family OOP Max............ $3,300And I already paid …………………...….$1,650So he pays …….……………………………..1,650

Bottom line Annual premium……………….. …$2,913Deductible………………………… $ 400Out of Pocket Max……………… …..$0I pay…………………….. $3,313Plus Doctor/ER/Urgent Care co-pays and Rx co-pays.

Annual premium……………………$2,913Deductibles………………………… ..$800Out of Pocket Max…………….. $3,300I pay…………………………. $7,013Plus Doctor/ER/Urgent Care Co-Pays and Rx Co-Pays.

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Tips to Avoid Unnecessary Costs

• Choose Ascension Health Network (Tier 1) for all care if you can and

verify network affiliation by using the Provider Directory available on

our intranet or at MySmartHealth.org (during open enrollment)

• Have all ancillary testing done at our hospitals/facilities. Remind your

physician’s office to refer your lab/pathology specimens to our

facilities – don’t assume they will

• Understand your benefits

Be a wise healthcare consumer

Verify prior authorizations• The ordering physician is responsible for obtaining the prior

authorization according to the guidelines set by the Third Party

Administrator who handles your claims• Always ask whether or not a prior authorization is needed for

services• Note: Bariatric Surgery is only covered in Tier 1 if it’s available

from a Health Ministry within 100 miles

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Women’s Preventive Services• The U.S. Department of Health and Human Services, the Department of Labor and the Internal

Revenue Service have jointly released final regulations regarding women’s preventive services

under the Affordable Care Act (“ACA”). The ACA requires group health plans to provide coverage

for "contraceptive services" as part of an array of women’s preventive services that must be

included in health plans without cost sharing to covered participants.

• The regulations contain an accommodation for eligible non-profit religious organizations that

oppose providing contraceptive coverage. As a healing ministry of the Catholic Church, Ascension

Health does not promote or condone contraceptive practices and objects to providing such

coverage. Therefore, as the plan sponsor of both our self-insured Ascension Health SmartHealth

Medical Plan (“SmartHealth Plan”) and our self-insured Ascension Health Prescription Drug

Program (“Rx Plan”), Ascension Health qualifies as an eligible organization that is entitled to the

accommodation. As a result, neither the SmartHealth Plan nor the Rx Plan will provide coverage

for contraceptive benefits that are in conflict with our Catholic Identity and the Ethical and Religious

Directives for Catholic Health Care Services.

• As part of the accommodation, third party administrators of our SmartHealth and Rx plans are

required to provide this coverage to covered members at no cost, independently of Ascension

Health and consistent with the authority given them by the final regulation. You will receive

information directly from those Administrators about the coverage that may be available to you for

those “preventative services.”

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Socially Just Health Benefits Subsidy

• Offered to FT associates

• Income must be less than 200% of the Federal Poverty Level based on family size

• If eligible, associates must enroll in the PPO $200 deductible/ 0% cost-share plan

• Associates may be eligible for 100% waiver or a discount of 25%, 50% or 75% on associate premiums, inpatient and outpatient service co-pay/cost-share at our facilities only

Ensuring access to care for all

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Non-Medical Benefits

Flexible Spending Accounts (FSAs)

Delta Dental Coverage

Vision Service Plan (VSP)

Life, Disability, and More

Click icon to add SmartArt graphic

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Flexible Spending Accounts

Administered by ADP

Be sure to elect your contribution amount before deadline

Remember: if you don’t use it, you lose it

Healthcare FSAMinimum $ 260

Maximum $2,500

Your Health Ministry deposits your annual contribution amount in your FSA debit card at first of year

You will receive new debit card the for 2014

Dependent Day Care FSAMinimum $260

Maximum $5,000 for married associates $2,500 for single associates

You pay bills, then submit them for reimbursement

Dental PlanYour Delta Dental plan provides comprehensive coverage

Delta Dental of Missouri

Service Comprehensive Plus Traditional

Deductible $50 per person$150 family maximumDoes not apply to Preventative services.

Preventative 100%

Basic 80%

Major 50%

Orthodontia 50% child coverage to age 19; $1,500 lifetime maximum

No adult coverage unless you are currently enrolled in adental plan that covers adult orthodontia, the banding isapplied by December 31, 2013, and you are enrolled in this Delta Dental plan after January 1, 2014

Annual Maximum $1,500 - Excludes Preventative (w/MAXAdvantage) and Orthodontia

Watch for a new Delta Dental card coming in the mail before 1/1

Vision Services PlanYou may elect Full Coverage with VSP

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Vision Service Plan – Full Coverage Service VSP Network Out-of-Network

Exam 100% 1 in 12 months after $10 Co-Pay Up to $45Prescription Glasses

Lenses

Single vision

Lined bifocal

Lined trifocal

Lenticular Lenses

100% 1 in 12 months, after $25 Co-Pay

100% 1 in 12 months, after $25 Co-Pay

100% 1 in 12 months, after $25 Co-Pay

100% 1 in 12 months, after $25 Co-Pay

Up to $45

Up to $65

Up to $85

Up to $125

Frame OR

Contacts Elective*

*If you choose contact lenses instead of glasses, you will be eligible for a frame 12 months from the date the contact lenses were obtained.

$130 after $25 Co-Pay, plus 20% off any out-of-pocket costs, every 12 months

$130 allowance after $25 Co-Pay, every 12 months

Up to $47

Up to $105

Diabetic Eyecare Program 100% supplemental services for Type 1 diabetics after a $5 Co-Pay

Lasik Surgery For details about benefits for laser vision correction surgery contact VSP directly

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Disability Coverage

STD and LTD benefits are offset by any other income you may receive

EIB plans will stop accruing at the first of the year – balances may be used through June 2015

Short Term DisabilityEligibility Lourdes Health Network pays the full cost for

FT and PT non-union associates

Elimination Period 7 days

Coverage Covers a percentage of weekly base pay for 180 days

• Workers’ Compensation injuries are excluded from STD benefits. • After qualifying for EIB and STD due to illness or injury, you must exhaust EIB

before STD benefits begin.

Long Term DisabilityEligibility Lourdes pays the full cost for FT and PT

associates.

Coverage Covers a percentage of monthly base payfrom the 181st day until recovery or age 65

LTD benefits for Mental Health conditions are limited to 24 months.

Other protection

Legal Services Plan • Low-cost legal assistance is available to you through Hyatt Legal,

including assistance with adoption services, wills, trusts, living wills, and identity theft, etc.

• You may enroll during any open enrollment period if you think you’ll need a lawyer in the year ahead.

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Enriching Self and Spirit

• Lourdes Health Network provides additional benefits to support associates in meeting goals for personal development and well-being, including:

• Employee Assistance Program – support is available to you and covered dependents through LifeWorks for assistance with managing stress, relationships, and financial issues. You can talk to someone 24/7 by phone or in person by appointment.

• Educational Assistance – please see newly revised policy on Ellucid.

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Open Enrollment Resources

Available on our Intranet – click on

• 2014 Benefits Handbook

• Benefit FAQs

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Next Steps

Take time to consider your options

• Open enrollment begins October 1, 2013

• Remember: This is an “active enrollment” – all benefits eligible associates must re-enroll in all benefits for 2014

• Enroll before October 15, 2013

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Thanks for listening!