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Benefit Guide 2015-2016

Information on Benefits and Enrollment – Alpine Home Medical Equipment Medical :: SelectHealth www.selecthealth.org Life :: Mutual of Omaha www.mutualofomaha.com800.538.5038 800.775.8805801.442.5038 Stratus.hr :: Benefits Assistance [email protected] :: Health Equity www.healthequity.com 801.984.1326866.346.5800 Stratus.hr :: Human Resources Laura Lancaster: 801.676.8051 [email protected]

STRATUS.HR ONLINE BENEFIT ENROLLMENT Electing your benefits has never been easier. Whether you are a new hire or it’s Open Enrollment, you can now enroll in benefits, change options, compare plans, add or remove dependents and more, all online! Visit https://stratus.hr/tech-center/ to sign in.

STRATUS.HR BENEFITS DEPARTMENT Please contact Stratus.hr for any benefit-related questions, including benefit coverage, contributions, enrollment, benefit change forms, notification for changes in status, provider directories, and general carrier information.

IRS REGULATIONS Failure to meet IRS deadlines will affect your insurance coverage! IRS regulations govern how and when an employee may make cafeteria plan elections and changes to those elections. These rules require that employers enforce firm deadlines with respect to employee benefit enrollment forms and the related cafeteria plan elections. This means that we cannot accept forms turned in after open enrollment ends. Furthermore, if you experience a qualifying event allowing you to add, drop or modify your coverage and related cafeteria plan election mid-year, we must be notified of such event and the required forms must be completed generally within 30 days of such event, or you cannot make the change. In addition, please be aware that with the exception of birth, adoption or placement for adoption of a child, any cafeteria plan election changes can only be implemented prospectively, i.e., on the first paycheck or period of coverage following our receipt of the form. Therefore, if you are making a change based on a qualifying event other than a new child, and you want changes implemented as of the date of the event, you must inform us of the change and turn in your form before such event occurs. If you do not turn in your form on time, you will not receive coverage or be able to change your elections mid-year unless you have a special enrollment opportunity.

SOCIAL SECURITY NUMBERS Federal law requires you to provide a valid Social Security number for each person to be covered by any medical plan sponsored by your employer (yourself, your spouse, and all dependent children.)

MEDICARE PART D If you have Medicare or will become eligible for Medicare in the next 12 months, Federal law gives you more choices about your prescription drug coverage. Contact Stratus.hr for more information.

VOLUNTARY BENEFITS Voluntary benefits are not sponsored or endorsed by your employer, including for purposes of Federal and State law, so Federal ERISA law is inapplicable.

Page 1 of 6 12.10.2015

Information


Information on Benefits and Enrollment – Alpine Home Medical Equipment (continued)

WHY IS OPEN ENROLLMENT SO IMPORTANT? Benefits Open Enrollment for Alpine Home Medical Equipment is held each year. You may change your benefit elections as you desire until the enrollment deadline ends. All employee medical, dental, and vision premiums can be deducted from payroll on a pretax basis. Once the Enrollment Period has ended, you may not make new, or change existing benefit elections. If you believe you can make or change an election due to a change in employment or family status, you have 30 days to complete a new enrollment.

WHO IS ELIGIBLE TO PARTICIPATE IN THE BENEFITS PLAN? Please see your benefits representative for eligibility requirements Employees will receive coverage for dependents; see your summary plan description’s definition of dependent, (children who are less than 26 years of age) Employees hired after the plan year begins will select their coverage choices for the remainder of that plan year at the time of eligibility. All the necessary enrollment and

change forms are available online through the Tech Center - https://stratus.hr/tech-center/

IS IT POSSIBLE TO MAKE CHANGES DURING THE YEAR? After the enrollment deadline, your election is generally irrevocable, meaning you cannot add, modify, or drop coverage for the plan year. You may have a special enrollment right allowing coverage changes for certain losses of coverage eligibility under another plan or if you gain a new spouse or dependent. You also may be entitled, or required, to change your election if you, your spouse, or dependent(s) experience one of the Qualifying Change events below. However, you must contact Stratus.hr to determine if your plan and your circumstances allow such a change. If so, you must complete and return a change form to Stratus.hr, generally within 30 days.

QUALIFYING CHANGES (30 DAYS UNLESS OTHERWISE STATED BELOW) Divorce or legal separation Marriage Change in number of dependents Change in employment status that causes loss of eligibility Dependent ceases to satisfy eligibility requirements Change in residence that causes loss of eligibility Significant changes in company benefit plan(s), including cost change, significant coverage curtailment, additional or significant improvement of company-offered benefits Change in coverage under another employer plan (including mandatory or optional change from your spouse’s employer and change initiated by your spouse) Loss of coverage from government plans/programs or educational institution COBRA qualifying event (termination/reduction of hours, employee death, divorce/legal separation, ceasing to be a dependent) Other changes resulting from a judgment, decree, or order; Medicare or Medicaid entitlement; or FMLA leave of absence Changes in CHIP eligibility or CHIP subsidy eligibility (60 days)

HIPAA PRIVACY NOTICE The Health Insurance Portability and Accountability Act (HIPAA) requires employers to adhere to strict privacy guidelines and establishes employee’s rights with regard to their personal health information. If you have any questions regarding this Federal regulation, contact Stratus.hr.

REMEMBER If you do not turn in your benefit choices on time, you will not receive coverage or be able to change your elections mid-year. Note: This publication is only a partial summary of benefits and is provided for informational purposes only. It does not describe all elements of the summarized programs. For complete information regarding the benefits, plan provisions, limitations and exclusions, and for a description of claims procedures, refer to the formal benefit documents that will be provided to you after enrollment. In the event of a discrepancy or conflict between the information contained in this publication and the official benefit plan provisions, the official plan documents and insurance contracts will govern. Copies of these of these documents are available for your review from your Stratus.hr Benefits Department. No rights shall accrue to you and/or your dependents because of any statement, error or omission in this publication.

Page 2 of 6 12.10.2015


Medical

The benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy, the plan documents apply.Please refer to the formal plan documents for a complete description of benefits, limitations and exclusions.

Medical :: SelectHealth – Alpine Home Medical offers the following high deductible (HDHP) medical plans select:med+ $2500 select:med+ $3000 Network Non Network Network Non NetworkDeductible (Individual/Family) $2500 / $5000 $2750 / $5500 $3000 / $6000 $3250 / $6500Out of Pocket Maximum (Medical & Pharmacy included in OOP Max) $3000 / $6000 $4500 / $9000 $5000 / $10000 $6500 / $13000Lifetime Maximum Pre-Existing Conditions (PEC) Benefit Accumulator Period

None None

Calendar Year

None None

Calendar Year Maximum Annual Out-of-Network Payment (per calendar year) None None None None Office Visits

Primary Care Specialists Preventive1,2 Chiropractic3

$15 AD$25 AD

Covered 100% Not Covered

30% AD30% AD

Not Covered Not Covered

$15 AD $25 AD

Covered 100% Not Covered

40% AD40% AD

Not Covered Not Covered

Prescriptions (Generic Required)4

Deductible (Separate – Per Person, Per Calendar Year) Retail Pharmacy (30 Days) – Tiers 1-4 Maintenance Medications (90 Days, Mail-Order or Retail90SM) Prescription Drug List (Formulary)

No Separate Pharmacy Deductible$7 AD / $21 AD / $42 AD / $100 AD

$7 AD / $42 AD / $126 AD RxSelect SM

No Separate Pharmacy Deductible$7 AD / $21 AD / $42 AD / $100 AD

$7 AD / $42 AD / $126 AD RxSelect SM

Diagnostic Lab / X-Ray

Minor (In Office)

Major Covered 100%

10% AD 30% AD30% AD

Covered 100% AD20% AD

40% AD40% AD

Inpatient Services3

Hospital, Surgical, Physician, Surgeon, Anesthesiologist Rehabilitation Therapy (Facility)5 – Physical, Speech, Occupational

10% AD10% AD

30% AD30% AD

20% AD 20% AD

40% AD40% AD

Outpatient Services3

Outpatient Surgery Home Health, Hospice, Private Nurse Durable Medical Equipment (DME) Major Office Surgery – Surgical and Endoscopic Services over $350

Rehabilitation Therapy (Office)6 – Physical, Speech, Occupational

10% AD10% AD 10% AD 10% AD $25 AD

30% AD30% AD 30% AD 30% AD 30% AD

20% AD 20% AD 20% AD 20% AD $25 AD

40% AD40% AD 40% AD 40% AD 40% AD

Maternity3,7

Hospital, Physician Infertility – Select Services (Max plan payment of $1,500/calendar year; $5,000 lifetime)

10% AD50% AD

30% ADNot Covered

10% AD 50% AD

30% ADNot Covered

Emergency or Urgent Care

InstaCare® / KidsCare® Emergency Room – Participating and Nonparticipating Facilities

Ambulance (Air or Ground) – Emergencies Only

$35 AD / $15 AD$75 AD 10% AD

30% AD See Network Benefits See Network Benefits

$35 AD / $15 AD $75 AD 10% AD

30% AD See Network Benefits See Network Benefits

Mental Health & Chemical Dependency4

Mental Health Office Visits Inpatient Outpatient Residential Treatment1

Injectable Drugs and Specialty Medications

$15 AD10% AD 10% AD 10% AD 10% AD

30% AD30% AD 30% AD 30% AD 30% AD

$15 AD 20% AD 20% AD 20% AD 20% AD

40% AD40% AD 40% AD 40% AD 40% AD

For a complete description of benefits, limitations and exclusions, consult your Summary Plan Description available from www.selecthealth.org

1 Refer to your Certificate of Coverage for more information 2 Frequency and/or quantity limitations apply to some preventive care and Miscellaneous Medical Supply (MMS) services. 3 For assistance using your chiropractic benefit, call 1.800.678.9133. Chiropractic benefit limited to 20 visits per calendar year. Not applied to Medical out-of-pocket maximum. 4 Preauthorization is required for the following: (a) all impatient services; (b) certain injectable drugs and specialty medications; (c) certain prescription drugs; (d) certain DME items; (e) certain mental health and chemical dependency services; (maternity stays longer than two days for normal delivery or longer than four days for cesarean; (g) home health nursing; and (h)pain management/pain clinic services. Benefits may be reduced or denied if you do not preauthorize certain services. Please refer to Section 11 – “healthcare Management” in you Certificate of Coverage for details. 5 Up to 40 days per calendar year for all therapy types combined. 6 Up to 20 days per calendar year for each therapy type. 7 SelectHealth provides an adoption indemnity as outlined by the state of Utah. Medical deductible, co-pay or coinsurance listed under the benefit applies and may exhaust the benefits prior to any plan payments. All covered services obtained outside the United States, except for routine, urgent, or emergency conditions require preauthorization. All deductible/co-pay/coinsurance amounts are based on the allowed amounts and not on the providers billed charges. Nonparticipating Providers or Facilities have not agreed to accept the Allowed Amount for Covered Services. When this occurs, you are responsible to pay for any charges that exceed the amount that SelectHealth pays for Covered Services. These fees are called Excess Charges, and they do not apply to your Out-of-Pocket Maximum.

AD: After Deductible APD: After Pharmacy Deductible *Not applied to Medical out-of-pocket maximum.

Page 3 of 6 12.10.2015


Medical


Medical :: SelectHealth & NationCare – HDHP for employees outside of Utah NationCare $2500 NationCare $3000 Network Non Network Network Non NetworkDeductible (Single/Family) $2500 / $5000 $5000 / $10000 $3000 / $6000 $6000 / $12000Out of Pocket Maximum (Single/Family) $3000 / $6000 $6000 / $12000 $5000 / $10000 $10000 / $20000Lifetime Maximum None NoneOffice Visits

Primary Care Preventive Chiropractic

$15 Co-PayCovered 100%

$15 Co-Pay 1

30% AD30% AD 30% AD

$15 AD Covered 100%

$15 AD

40% AD40% AD 40% AD

Prescriptions (Generic Required)

Deductible (Separate – Per Person/Year) Retail Pharmacy (30 Days) – Tiers 1-4 Maintenance Medications (90 Days)

No Separate Pharmacy Deductible10% AD (All Tiers) 10% AD (All Tiers)

No Separate Pharmacy Deductible20% AD (All Tiers) 20% AD (All Tiers)

Diagnostic Lab / X-Ray

Minor (In Office) Major

10% AD10% AD2

30% AD30% AD

20% AD 20% AD

40% AD40% AD

Inpatient Services3 (Must Obtain PR)

Hospital, Surgical Physician, Surgeon, Anesthesiologist Rehabilitation Therapy (Facility)3

10% AD10% AD 10% AD

30% AD30% AD 30% AD

20% AD 20% AD 20% AD

40% AD40% AD 40% AD

Outpatient Services

Outpatient Surgery Home Health, Hospice, Private Nurse Durable Medical Equipment (DME) Rehabilitation Therapy (Office)4

10% AD10% AD 10% AD $15 AD

30% AD30% AD 30% AD 30% AD

20% AD 20% AD 20% AD $15 AD

40% AD40% AD 40% AD 40% AD

Maternity4

Hospital5 Physician (pre and postnatal)

10% AD10% AD

30% AD30% AD

20% AD 20% AD

40% AD40% AD

Emergency or Urgent Care

Urgent Care Emergency Room Ambulance (Air or Ground)

$35 AD $75 AD 10% AD

30% AD$75 AD 10% AD

$35 AD $75 AD 20% AD

40% AD$75 AD 20% AD

Mental Health & Chemical Dependency

Inpatient

Outpatient - Office 10% AD$15 AD

30% AD30% AD

20% AD $15 AD

40% AD40% AD

For a complete description of benefits, limitations and exclusions, consult your Summary Plan Description available from www.meritain.com

or by calling Meritain at 800.847.8361

1 Limit of 15 visits per calendar year. 2 Pre-Authorization Required. Inpatient services require a Prospective Review (PR). There is a penalty of $250 for failure to obtain a PR, but in no event will the penalty exceed 50% of the total charges. Penalty payments do not apply toward the OOP Max. 3 Up to 40 visits per calendar year. 4 SelectHealth provides a $4000 adoption indemnity as outlined by the state of Utah. Medical deductible, co-pay or coinsurance listed under the benefit applies & may exhaust the benefits prior to any plan payments. 5 48 hours of hospitalization for vaginal delivery, 96 hours for cesarean delivery. 4 Up to 20 visits per calendar year for each therapy type

AD: After Deductible APD: After Pharmacy Deductible *Not applied to Medical out-of-pocket maximum.

Page 4 of 6 12.10.2015


HSA


Understanding a Health Savings Account (HSA) WHAT IS A HEALTH SAVINGS ACCOUNT (HSA)? A Health Savings Account (HSA) is an account that can be funded by you with pre-tax dollars, by your employer, or both. The HSA helps pay for eligible medical expenses not covered by an insurance plan, including the deductible, coinsurance, and in some cases, health insurance premiums.

WHO IS ELIGIBLE FOR AN HSA? Anyone who satisfies all of the following: Covered by a Qualified High Deductible Health Plan (QHDHP) Not covered under another medical plan that is not a QHDHP Not entitled to Medicare benefits Not eligible to be claimed on another person’s tax return

HOW MUCH CAN I CONTRIBUTE TO AN HSA? As noted by federal law, the annual contribution limits are:

Type of Coverage 2015 Maximum

Annual Contribution 2016 Maximum

Annual Contribution INDIVIDUAL $3,350 $3,350 TWO PARTY $6,650 $6,750 FAMILY $6,650 $6,750

Catch-up contributions can be made any time during the year in which the HSA participant turns 55. Individuals over 55 may be eligible to make catch-up contributions.

WHAT IS A DEDUCTIBLE?

It is a set dollar amount, determined by your plan that you must pay out-of-pocket or from your HSA account, before insurance coverage for medical expenses can begin.

WHAT IS THE DIFFERENCE BETWEEN AN HSA AND FLEX (FSA)?

An HSA can roll-over unused funds from year to year, indefinitely An FSA cannot roll-over unused funds from year to year, and are lost if not used for

that year’s expenses.

WHEN DO I USE MY HSA?

After visiting a physician, facility, or pharmacy, request that they submit your claim to your Medical Carrier for payment. You should make sure that your provider has your most up-to-date insurance information. Once the claim has been processed, any out-of-pocket expenses will be billed. At this time you may choose the following options:

Use your HSA debit card or HSA check to pay for any out-of-pocket expenses. You may choose to write a personal check, receiving reimbursement later. You can choose to save your HSA dollars for future medical expenses.

You should always ask that your claim be submitted to the health plan before you seek reimbursement from your HSA. This procedure will ensure that provider discounts are applied. Also, remember to keep all medical receipts and Explanation of Benefits (EOBs) to support your personal tax record. You should keep these records for at least four years.

WHEN CAN I START USING MY HSA DOLLARS? You can use your HSA dollars immediately following your HSA account activation and once contributions have been made.

CAN I CONTRIBUTE TO BOTH AN HSA & FSA IN THE SAME YEAR? Yes, a “Limited Purpose FSA” is permissible. A limited FSA only allows reimbursement of certain expenses that are not eligible for payment under the HDHP or HSA. Your employer has established a limited FSA to allow employees to contribute pre-tax dollars to an account which only reimburses expenses for dental and vision services.

WHAT IF I ENROLL IN AN HSA IN THE MIDDLE OF THE YEAR? If you enroll in an HSA at any time other than the start of the plan year when you make your other elections, you may still contribute the maximum amount allowed for the calendar year. (See the chart on the previous page.) However, the IRS requires you to participate in the HDHP during a subsequent testing period (generally through the end of the following year). Failure to do so will result in will result in adverse tax consequences.

CAN I USE MY HSA DOLLARS FOR NON-ELIGIBLE EXPENSES? Money withdrawn from an HSA account to reimburse non-eligible expenses is taxable income to the account holder and is subject to a tax penalty. An exception eliminates the taxable income issue if the account holder is over age 65, is disabled, or dies.

HOW DOES A HEALTH SAVINGS ACCOUNT WORK?

Part 1:

Qualifying High Deductible Health Insurance Plan

Part 2: Health Savings Account

Intended to cover serious illness or injury after the deductible is met

Pays for out-of-pocket qualifying medical expenses incurred before the deductible is

met

HOW IS AN HSA USED TO PAY FOR MEDICAL CARE? 1. Employee and/or employer funds the HSA account 2. Employee seeks medical services 3. A bill for medical services is submitted as a claim to your insurance carrier and paid in part according

to your QHDHP, subject to a deductible and coinsurance. * 4. Employee can pay the remaining amount with a debit card or check from their HSA. 5. This process is repeated until deductible and out-of-pocket maximum are fulfilled, after which the

employee generally should be covered for almost all in-network eligible expenses. * Subject to plan design, check Summary Plan Description. Preventive care may be covered at 100%

CAN MY HSA DOLLARS BE USED FOR RETIREMENT HEALTH CARE COSTS? Yes, for expenses eligible for reimbursement, and Medicare and other health coverage premiums after age 65.

CAN I USE THE MONEY IN MY ACCOUNT TO PAY FOR MY DEPENDENTS’ MEDICAL EXPENSES? Yes, you can use the money in the account to pay for medical expenses of yourself, your spouse, or your dependent children. You can pay for expenses of your spouse and dependent children even if they are not covered by your HDHP.

WHY SHOULD I ELECT AN HSA? 1. Cost Savings Tax benefits:

HSA contributions are excluded from Federal income tax Interest earnings may be tax free Withdrawals for eligible expenses are exempt from Federal income tax

You pay a reduced medical plan premium contribution Unused money is held in interest-bearing savings or investment accounts from year

to year Note: Many states have passed legislation to provide favorable state tax treatment for HSAs. However, in a small number of states, amounts contributed to HSAs and interest earned on HSA accounts could be included in the employee’s compensation for state income tax purposes.

2. Long-Term Financial Benefits Save for future medical expenses, including retiree medical Funds roll over year to year This is your account - you take it with you. If you leave your employer, you can do

the following: Leave your funds in the current HSA Transfer your funds to an HSA with your new employer Transfer your funds to another qualifying account within 60 days

3. Choice You control and manage your health care expenses You choose when to use your HSA dollars to pay your health care expenses. You choose when to save your HSA dollars and pay health care expenses out-of-

pocket You can choose to increase or decrease your election during the year (as allowed by

your employer)

Page 5 of 6 12.10.2015


EAP & Life Insurance


Employees will be eligible to enroll in voluntary life insurance for themselves and their eligible dependents the first of the month following 90 days of full time active employment. Supplemental Group Term Life Insurance is available on a voluntary basis. This coverage is in addition to the company provided amounts and the premiums are 100% employee paid through payroll deduction. Coverage is available only to employees eligible for benefits and covered under the basic Group Term Life Insurance provided by Stratus.hr.

Employees may select any amount up to $500,000 in increments of $10,000. Spouse coverage is up to 100% of the employee’s Supplemental Coverage amount up to $250,000 in increments of $5,000. Unmarried, dependent children under the age of 26 are eligible for $10,000 of coverage.

All Supplemental Insurance amounts can be purchased at any time and are subject to evidence of insurability. Each applicant must complete a Group Life Health Form. Insurance will become effective on the first of the month following underwriting approval by Mutual of Omaha. Supplemental Life benefits will reduce by 35% at the insured’s age 65; by 60% at age 70; and by 75% at age 75. Benefits terminate upon retirement. Supplemental Life offers a Right of Conversion. Enrollment forms are available from Stratus.hr.

Please see Certificate of Coverage summary for more detailed benefit information.

Basic Life :: Mutual of Omaha – 100% Company Paid Employees will receive basic life insurance for themselves the first of the month following 60 days of full time active employment. Benefits reduce by 35% at the insured’s age 65; by 60% at age 70; and by 75% at age 75 and terminates at age 80. AD&D benefits match this reduction schedule. Life and AD&D benefits terminate upon retirement. Benefits – Employee Only Coverage Annual Deductible $10,000 Maximum Annual Benefit $10,000 Accidental Death and Dismemberment (AD&D) $10,000 Please see Certificate of Coverage summary for more detailed benefit information.

Enhanced Basic EAP :: Mutual of Omaha – 100% Company Paid Your company can suffer when an employee is faced with a personal or professional issue that gets in the way of maintaining productivity at work. Offering a robust Employee Assistance Program can be the answer for both your employee and their family. And, it can help your company’s bottom line, too.

EXPERIENCED EAP STAFF Master’s level professionals can provide assistance for a variety of personal and professional matters, including: Emotional Well-being Family and Relationships Legal and Financial Healthy Life Styles Work and Life Transitions

NETWORK A robust network of licensed and/or certified mental health professionals

TOLL FREE NUMBER – (800) 316-2796 Confidential consultation and resource services. Visit http://www.mutualofomaha.com/eap/ for more information.

EAP BENEFITS Unlimited telephonic access to EAP Professionals 24 hours a day, seven days a week Telephone assistance and referral Service for employees and dependents Three face-to-face sessions with a counselor (per calendar year)

Face-to-face visits can also be used toward legal and financial consultations Legal Assistance Financial Assistance Substance Abuse Assistance Connect employees with resources for:

Dependent Care Assistance & Referral Services Elder Care Assistance & Referral Services

Access to a library of educational articles, handouts and resources via Web site

Voluntary Supplemental Life :: Mutual of Omaha – 100% Employee Paid

MONTHLY RATES PER $1,000 OF COVERAGE Age Non Tobacco User Tobacco User Under 30 $0.05 $0.12 30 to 34 $0.06 $0.13 35 to 39 $0.08 $0.18 40 to 44 $0.12 $0.30 45 to 49 $0.18 $0.49 50 to 54 $0.27 $0.94 55 to 59 $0.45 $1.43 60 to 64 $0.63 $1.61 65 to 69 $1.10 $2.60 70 to 74 $2.50 $5.69 75 & Over $5.80 $21.50 Monthly Dependent Life $2.00 per $10,000 of Coverage

GUARANTEED ISSUE (NEW HIRES ONLY) Employee $250,000* Spouse $50,000 Dependent Children $10,000 *This includes the $10,000 employer sponsored amount. The maximum Guaranteed Issue amount you can elect is 5 times your annual salary, up to $240,000.

Page 6 of 6 12.10.2015

859 W. South Jordan Parkway, 2nd Floor

South Jordan, UT 84095

801.984.0252 ph

801.984.0254 fax

https://stratus.hr

ONLINE ENROLLMENT Enrollment in Benefits for you and your family has never been easier! Simply log in to Tech Center (stratus.hr/tech-center) to begin. Click on the Benefits link to enter the online enrollment system. Once logged in, you can see your current enrollments, compare plans, choose new elections and waive current ones, view employer contributions and more. Stratus.hr’s Online Benefits Enrollment System has all the tools you need to get informed about your benefits and choose the options that will best protect you and your loved ones. Get started today!

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