2017RUSH

BENEFITS

EMPLOYEE CONTRIBUTIONS BOOKLETfor Employees of Rush University Medical Center

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2017 RUSH BENEFITS EMPLOYEE CONTRIBUTIONS BOOKLET

This booklet provides detailed information about how much you will pay for your Rush benefits in 2017. To learn more about your benefit options and to enroll, log into www.rushbenefits.HRintouch.com. Remember, your base cost of benefits is determined by your pay (for medical, supplemental life insurance and disability buy-up benefits), and the level of coverage you choose.

The following benefit cost information is included in this booklet:

2017 FULL-TIME RATES FOR MEDICAL BENEFITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2017 PART-TIME RATES FOR MEDICAL BENEFITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2017 RATES FOR DENTAL AND VISION BENEFITS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Dental Plan

Vision Plan

2017 RATES FOR LIFE INSURANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Employee Supplemental Life Insurance Spouse/Civil Union Partner Supplemental Life Insurance Child(ren) Supplemental Life Insurance

2017 RATES FOR DISABILITY BENEFITS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Short-Term Disability Buy-Up

Long-Term Disability Buy-Up

2017 RATES FOR ACCIDENT AND CRITICAL ILLNESS COVERAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Voluntary Accident Plan Voluntary Critical Illness Plan Child Critical Illness Coverage

QUESTIONS?Contact the Rush Benefits Center

Monday through Friday, 7:00 a.m. to 7:00 p.m.(312) 942-2222 or (855) 866-8696

rushbenefits@benefitfocus.com

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Rates per pay period (24 x a year)

<$22 $22-$27.99 $28-$46.15 $46.16 AND ABOVE

Employee only $42.75 $45.00 $47.50 $54.75 Employee + spouse $79.25 $84.50 $91.25 $108.75 Employee + children $73.75 $78.00 $87.00 $103.25 Family $96.50 $103.75 $111.75 $133.00

PREMIER PLAN

HEALTH SAVINGS ADVANTAGE PLAN

SELECT EPO PLAN

2017 RATES FOR NON-UNION MEDICAL BENEFITS FULL-TIME EMPLOYEES

Employee only $66.50 $70.00 $75.75 $91.00 Employee + spouse $138.00 $148.25 $160.75 $197.50 Employee + children $127.75 $138.50 $152.00 $186.00 Family $169.75 $182.00 $198.50 $243.25

Employee only $51.00 $54.00 $57.75 $69.25 Employee + spouse $103.00 $110.75 $120.75 $147.75 Employee + children $95.25 $102.50 $114.00 $138.75 Family $125.75 $135.75 $147.75 $180.50

Employee only $87.50 $94.00 $103.50 $125.50 Employee + spouse $175.75 $197.25 $218.75 $269.00 Employee + children $138.75 $177.25 $198.50 $244.25 Family $195.75 $236.00 $264.75 $327.50

EMPLOYEE HOURLY RATE

BASIC PLAN

<$22 $22-$27.99 $28-$46.15 $46.16 AND ABOVEEMPLOYEE HOURLY RATE

BASIC PLAN

PREMIER PLAN

SELECT EPO PLAN

HEALTH SAVINGS ADVANTAGE PLAN

Employee only $52.25 $55.50 $59.25 $69.50 Employee + spouse $103.00 $109.75 $119.50 $143.75 Employee + children $95.00 $101.50 $113.75 $136.25 Family $126.00 $135.50 $147.25 $177.00

Employee only $86.75 $92.00 $99.50 $121.00 Employee + spouse $186.75 $200.75 $218.50 $269.25 Employee + children $172.50 $187.50 $206.00 $253.75 Family $231.25 $248.00 $270.25 $333.50

Employee only $66.00 $70.25 $76.00 $91.50 Employee + spouse $139.25 $149.75 $163.25 $200.75 Employee + children $128.50 $138.75 $154.50 $189.25 Family $171.00 $184.50 $201.25 $247.50

Employee only $117.25 $126.25 $140.25 $170.50 Employee + spouse $240.25 $271.50 $301.25 $371.75 Employee + children $189.50 $243.25 $272.50 $336.50 Family $268.75 $325.25 $365.00 $453.00

PART-TIME EMPLOYEESRates per pay period (24 x a year)2017 RATES FOR NON-UNION MEDICAL BENEFITS

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DENTAL PLAN Rates per pay period (24 x a year)

VISION PLAN Rates per pay period (24 x a year)

VISION PLAN

FULL-TIME EMPLOYEES PART-TIME EMPLOYEES

Employee only $4.07Employee + spouse $6.32Employee + child(ren) $6.00Family coverage $10.41

GUARDIAN: FIRST COMMONWEALTH DHMOEmployee only $5.74Employee + spouse $10.62Employee + children $12.12Family $13.74

DELTA DENTAL PPOEmployee only $10.10Employee + spouse $20.20Employee + children $17.18Family $25.26

GUARDIAN: FIRST COMMONWEALTH DHMOEmployee only $6.08Employee + spouse $11.37Employee + children $12.85Family $14.57

DELTA DENTAL PPOEmployee only $10.71Employee + spouse $21.62Employee + children $18.21Family $26.78

2017 RATES FOR DENTAL AND VISION BENEFITS

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EMPLOYEE SUPPLEMENTAL LIFE INSURANCE Monthly Rates

Supplemental life and AD&D insurance premiums are calculated based on your age, current base annual salary, and amount of coverage you desire. Rates are based on your age as of January 1 of the current year as shown in the table below.

SPOUSE SUPPLEMENTAL LIFE INSURANCE Monthly Rates

Employees may elect supplemental coverage for a spouse. Rates are based on your spouse’s age as of January 1 of the current year as shown in the table below.

How to calculate your supplemental life insurance premiumExample: To calculate the monthly premium for a 30-year-old employee whose annual salary is

$25,000 per year, and who elected supplemental coverage for twice their annual salary:

$50,000 x .08 (per rate table above) = $4,000 ÷ 1,000 = $4.00 monthly payroll deduction

AGE UNDER 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

RATE PER $.06 $.08 $.09 $.10 $.14 $.21 $.30 $.54 $1.14 $1.58$1,000

How to calculate the premium for dependent supplemental life insuranceExample: You are electing $30,000 for your 37-year-old spouse and $10,000 of coverage for each of your two children.

1) Enter the rate from the table $0.11

2) Enter the amount of insurance coverage $30,000

3) Divide line 2 by $1,000 30

4) Spouse coverage monthly premium (Multiply line 1 by line 3) $3.30

5) $10,000 of child coverage for two children +$1.54

6) Total monthly cost (add line 4 plus line 5) $4.84

CHILD(REN) SUPPLEMENTAL LIFE INSURANCE Monthly Rates

Child(ren) life coverage monthly cost (covers all eligible children)$10,000 = $1.54 per month for one or more children

AGE UNDER 25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

RATE PER $.06 $.08 $.09 $.11 $.12 $.19 $.35 $.57 $1.04 $1.77$1,000

2017 RATES FOR LIFE INSURANCE

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BUY-UP PREMIUM CALCULATION FOR 60% BUY-UP OPTION

Annual salary ÷ 100 x 0.236 = annual costAnnual cost ÷ 24 pay periods = semi-monthly deduction

Example: annual salary $50,000 $50,000 ÷ 100 x 0.236 = $118 annual cost $118 ÷ 24 = $4.92 per pay period deduction from your paycheck

SHORT-TERM DISABILITY BUY-UP Semi-Monthly Rates

Short-term disability buy-up premiums are calculated based on your age as of January 1 of the current year as shown in the table below. (Your annual salary must be at least $104,000 to be eligible for this buy up option.)

LONG-TERM DISABILITY BUY-UP Semi-Monthly Rates

2017 RATES FOR DISABILITY BENEFITS

RATE TABLE FOR BUY-UP OPTIONAGE UNDER 25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

MONTHLY .74 .697 .693 .591 .535 .586 .663 .749 .838 .918 RATE

How to calculate your STD buy-up premiumExample: To calculate the semi-monthly premium for a 32-year-old employee whose annual salary is $115,000 at the 75 percent benefit:

Step One: $115,000 ÷ 52 = $2,211.54 (weekly salary) times .75 equals $1,658.65

Step Two: $1,658.65 – $1,500 (core STD benefit) = $158.65

$158.65 ÷ 10 = $15.87

$15.87 x .693 (from rate table above) = $10.99

Step Three: $10.99 ÷ 2 = $5.50 semi-monthly payroll deduction

Premium rates represent the cost of each $10 of weekly salary (up to $500) above the weekly salary paid by the core STD benefit (up to $1,500). Rush employees not paid through the time and attendance system should refer to the appropriate sick leave policy for more information.

Long-term disability buy-up premiums are calculated based on a common rate for all employees: $0.236 per $100 of annual salary.

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VOLUNTARY ACCIDENT PLAN Rates per pay period (24 x per year)

VOLUNTARY CRITICAL ILLNESS PLAN Rates per pay period (24 x per year)

CHILD CRITICAL ILLNESS COVERAGE Rates per pay period (24 x per year)

Critical Illness coverage for your children is available in increments of $2,500 up to $15,000.

COVERAGE AMOUNT: $10,000 $20,000 $30,000

EMPLOYEE AGE Employee Plus spouse Employee Plus spouse Employee Plus spouse

< 25 $1.24 $1.06 $2.47 $2.12 $3.71 $3.18

25 - 29 $1.66 $1.40 $3.32 $2.79 $4.98 $4.19

30 - 34 $2.31 $2.00 $4.61 $4.00 $6.92 $6.00

35 - 39 $3.53 $3.12 $7.05 $6.24 $10.58 $9.36

40 - 44 $5.67 $5.23 $11.33 $10.45 $17.00 $15.68

45 - 49 $8.72 $8.63 $17.44 $17.26 $26.16 $25.89

50 - 54 $12.69 $13.36 $25.38 $26.72 $38.07 $40.08

55 - 59 $17.82 $19.82 $35.63 $39.64 $53.45 $59.46

60 - 64 $26.03 $29.76 $52.06 $59.52 $78.09 $89.28

65 - 69 $36.79 $73.58 $110.37

70 - 74 $52.11 $104.22 $156.33

75 - 79 $69.91 $139.81 $209.72

80 - 84 $83.80 $167.60 $251.40

85 + $92.27 $184.53 $276.80

2017 RATES FOR ACCIDENT AND CRITICAL ILLNESS COVERAGE

Employee $6.15

Employee + Spouse $10.34

Employee + Children $11.85

Employee + Family $18.93

AMOUNT OF COVERAGE $2,500 $5,000 $7,500 $10,000 $12,500 $15,000

PAY PERIOD COST $0.22 $0.43 $0.65 $0.86 $1.08 $1.29

This guide contains a summary of 2017 benefits contribution rates for medical and other benefit options available to you. For more information about any Rush benefit plan, please refer to the applicable summary plan description. Although every effort has been made to ensure that the information in this guide is accurate, if there is any conflict between this guide and the terms of a benefit plan as described in the summary plan description, the latter must control. Summary plan descriptions are available in human resources and online at www.rushbenefits.HRintouch.com.

Please note: These rates apply ONLY to non-union and ISSSA-represented employees. Teamsters-represented employee rates may be different from those listed in this booklet, and these employees are advised to consult their contract for rates. These rates do not apply to house staff. Your cost for 2017 is based on your salary (hourly rate equivalent) that is in effect on October 30, 2016.