2016 Benefits at a Glance - Southeast Georgia Health Systems

Transcription

2016 Benefits at a Glance - Southeast Georgia Health Systems
2016 Benefits at a Glance
Dear Team Member,
We’ve come through a year that was filled with both challenges and victories. How reassuring it has been
to know that we can count on all of you regardless of what faces us. Please allow me to extend my personal
and genuine appreciation to each and every one of you for your valuable contributions to Southeast Georgia
Health System.
The Benefits at a Glance guide outlines the various benefits Southeast Georgia Health System offers to our
team members, the cost associated with each benefit and the pay period premiums. I encourage you to
review your current benefits and attend the Benefits Fair to meet with the carriers to address your questions
and concerns. The Benefits Fair will be held Monday, November 2 on the Brunswick Campus, in the Linda
S. Pinson Conference Center (8 a.m. to 8 p.m.). Tuesday, November 3, on the Camden Campus, cafeteria
conference room (from 8 a.m. to 2 p.m.); and also on Tuesday, November 3 at the Senior Care Center-St.
Marys (from 2:45 p.m. to 4 p.m.). Benefit elections made during open enrollment will be effective
January 1, 2016.
Open Enrollment will be held Monday, November 2 through Sunday, November 15, 2015. Enrollment is
mandatory each year if you are in a benefit eligible position. If you do not enroll, your current benefits
coverage will be cancelled effective December 31, 2015.
During Open Enrollment, you will:
„„ Meet with an experienced benefit counselor to review the available benefits in order to help you
determine the best selections for you; or
- Call a benefit enroller at 1-877-605-7441; or
- Self enroll via the online benefits system at https://harmonyenroll.coloniallife.com;
„„ Make changes or maintain existing coverage (effective January 1, 2016);
„„ Verify and update dependent information.
Please read the benefits summary before signing to ensure coverage selected and all personal and family
information is correct.
As always, it is our goal to provide you with the best benefits available. We appreciate the role you play in
making a difference in the lives of our patients.
Sincerely yours,
Michael D. Scherneck
President and Chief Executive Officer
2015 BENEFITS AT A GLANCE
2016 BENEFITS AT A GLANCE
1
Contents
New for 2016...................................................................................................................... 3
Eligibility...................................................................................................................... 4
Enrollment
Before You Enroll ~ Adding a Dependent to your Coverage ......................................................... 5
How to Enroll ~ New Hires, Status Change, Qualifying Events....................................................... 5
Annual Open Enrollment Process........................................................................................ 6
GROUP BENEFITS
Health Plan (including Prescription Drug Plan features).............................................................. 7
Disease management – Wellness Program............................................................................... 9
Dental Plan.................................................................................................................. 10
MetLife.................................................................................................................... 11
Vision Plan................................................................................................................... 12
Flexible Spending Accounts.............................................................................................. 13
Basic Term Life and AD&D Insurance.................................................................................... 14
Supplemental Term Life and Voluntary Portable Life................................................................ 14
Short-term Disability....................................................................................................... 16
Long-term Disability....................................................................................................... 17
Retirement Plan............................................................................................................ 18
529 College Savings Plan.................................................................................................. 19
Employee Assistance Program........................................................................................... 20
VOLUNTARY BENEFITS
Accident Insurance.......................................................................................................... 21
Portable Whole Life Insurance............................................................................................ 21
Children’s Term Insurance Rider
Long Term Care Ride
Cancer Insurance............................................................................................................ 22
Critical Illness Insurance................................................................................................... 23
Additional Benefits............................................................................................................. 24
Pre-paid Legal/Identity Theft................................................................................................. 25
Legal Notices.................................................................................................................... 26
Contact Information........................................................................................................... 27
The Benefits at a Glance guide is designed to provide you with an overview of the benefits options we offer. The actual benefits
available to you and the descriptions of these benefits are governed by the relevant Summary Plan Document (SPD) and our contacts.
For more detailed plan information for all lines of coverage listed in the booklet call the Human Resource Department. Southeast
Georgia Health System reserves the right to modify, change, revise, amend or terminate these benefit plans at any time.
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SOUTHEAST GEORGIA HEATH SYSTEM
New for 2016
2015
Health Insurance
Bi-weekly Premium increase
Team Member Only $ 72.69 Team Member + Child(ren) $141.33
Team Member + Spouse $177.73
Family $223.82
Part-Time Team Member $159.96
(Team Member Coverage Only)
2016
$ 70.04*
$134.90*
$169.65*
$213.64*
$152.11*
Team Member Only $ 76.32 $72.69*
Team Member + Child(ren) $148.40 $141.33*
Team Member + Spouse $186.62 $177.73*
Family $235.01 $223.82*
Part-Time Team Member $167.96 $159.96*
(Team Member Coverage Only)
*HRA/Biometric Analysis Compliance Discounted Rate
Health Insurance Third Party Administrator
Health Insurance
*Deductible (individual/family)
*Out of Pocket Maximum
(individual/family) **now includes deductible, co-­‐insurance, medical and prescription co-­‐pays
Prescription
*Co-­‐pay
Disease Management
*Co-­‐pay
Dental Insurance
*Bi-­‐weekly Premium Increase
Life and AD&D Insurance
team member
*Bi-­‐weekly Premium Increase
Life and AD&D Insurance
spouse
*Bi-­‐weekly Premium Increase
Life and AD&D Insurance
child
*Bi-­‐weekly Premium Increase
Retirement Plan
Plan options
2015
2015
Group Resources, Incorporated
Super Preferred (SGHS owned/operated)
Preferred
$0 $400/$1,200
2016
2016
Non-­‐Preferred
$1,000/$3,000
$2,000/$4,000
$2,000/$4,000
$3,000/$6,000
Generic
$ 7.50
$30.00
Brand -­‐-­‐ Preferred
$50.00
Brand -­‐-­‐ Non-­‐Preferred
Specialty Drugs -­‐-­‐ 20% co-­‐pay with a $100 maximum
$ 2.50
Generic
$20.00
Brand -­‐-­‐ Preferred
Brand -­‐-­‐ Non-­‐Preferred
$40.00
Team Member Only
$14.55
Team Member + Child(ren)
$30.99
Team Member + Spouse
$26.21
Family
$42.54
Age
Rate/$1,000
$0.040
<30
$0.050
30 -­‐-­‐ 34
$0.070
35 -­‐-­‐ 39
$0.100
40 -­‐-­‐ 44
$0.150
45 -­‐-­‐ 49
$0.230
50 -­‐-­‐ 54
$0.360
55 -­‐-­‐ 59
$0.440
60 -­‐-­‐ 64
$0.610
65 -­‐-­‐ 69
$0.970
70 -­‐-­‐ 74
74 +
$1.320
$.35 per $1,000 of coverage
Meritain Health
Super Preferred (SGHS owned/operated)
Preferred
$0 $400/$1,200
Non-­‐Preferred
$1,000/$3,000
$6,850/$13,700
$6,850/$13,700
$7,450/$15,500
$ 8.00 Generic
$30.00 Brand -­‐-­‐ Preferred
$50.00 Brand -­‐-­‐ Non-­‐Preferred
Specialty Drugs -­‐-­‐ 20% co-­‐pay with a $100 maximum
$ 4.00 Generic
$20.00 Brand -­‐-­‐ Preferred
Brand -­‐-­‐ Non-­‐Preferred
$40.00 Team Member Only
$15.72
Team Member + Child(ren)
$33.47
$28.31
Team Member + Spouse
Family
$45.94
Age
Rate/$1,000
$0.046
<30
$0.058
30 -­‐-­‐ 34
$0.081
35 -­‐-­‐ 39
$0.115
40 -­‐-­‐ 44
$0.173
45 -­‐-­‐ 49
$0.265
50 -­‐-­‐ 54
$0.414
55 -­‐-­‐ 59
60 -­‐-­‐ 64
$0.506
$0.702
65 -­‐-­‐ 69
$1.116
70 -­‐-­‐ 74
74 +
$1.518
$.403 per $1,000 of coverage
(Birth to age 25)
$5,000 Option = $.50
$10,000 Option = $1.00
(Birth to age 25)
$5,000 Option = $.58
$10,000 Option = $1.15
403(b), 457 and Roth 403(b)
403(b) and Roth 403(b)
Exchange Notice: In 2014, the health care reform law created an online marketplace for purchasing health insurance coverage referred
to as a Health Insurance Marketplace or an Exchange. You are not required to purchase insurance coverage through the Marketplace.
Southeast Georgia Health System is continuing to offer health coverage as outline in the proceeding “Group Benefits” pages.
If you purchase coverage through the Marketplace, you may be eligible for a federal subsidy that lowers your monthly premiums or reduces
your cost sharing. However , to receive this federal subsidy, you cannot be eligible for health plan coverage through Southeast Georgia
Health System.
The availability of coverage through the Marketplace does not affect your eligibility for coverage through Southeast Georgia Health
System’s health plan. More information on the health are reform law and the Marketplaces is available at
www.healthcare.gov.
2016 BENEFITS AT A GLANCE
3
ELIGIBILITY
Active team members of Southeast Georgia Health System classified as:
„„ Full Time
- 1.0 (eighty hours per pay period)
- 0.9 (seventy-two hours per pay period)
„„ Part Time
- 0.8 (sixty-­four hours per pay period)*
- .75 (sixty hours per pay period)*
- 0.7 (fifty-­six hours per pay period)
- 0.6 (forty-­eight hours per pay period)
*0.8 and .75 team members are considered full time for health insurance purposes only and are not
eligible for basic term life, short-­term disability or long-term disability coverage.
Eligible Dependents are classified as:
„„ Your legal spouse who resides in the United States
„„ Child/stepchild/legal dependent child less than 26 years of age
- If your dependent child is approaching 26 and is disabled, an application for continuation
of dependent status must be made at least 30 days prior to the child’s 26th birthday.
2016 BENEFITS AT A GLANCE
4
Enrollment
BEFORE YOU ENROLL – THINGS TO KNOW
If you are ADDING a dependent to your benefit coverage, you are REQUIRED to bring a copy of the below
information/documentation to Human Resources:
„„ Dependent social security card
„„ Acceptable proof of dependent information
- Spouse: Marriage License
- Child: Birth Certificate
- Stepchild: Marriage License and Birth Certificate
- Legal Dependent: Court Documentation that confirms legal guardianship/adoption
Failure to submit the REQUIRED information/documentation by the required date will result in a delay
of enrollment, pending of claims, and/or a forfeiture of eligibility.
HOW TO ENROLL
„„ New Hires
- You will be given a specific date for your enrollment at General Orientation. You will be required to
schedule an appointment time for that specified date with Carie Chaney from Colonial Life by
calling 888-­545-­0358, option 5.
- You must enroll within 90 days from your date of hire.
(Management-­level positions and/or otherwise noted positions, must enroll within 30 days from date of hire.)
„„ Status Change (Non-­Benefit Eligible to Benefit Eligible)
- Contact Human Resources by calling 912-­466-­3100 to schedule an appointment for enrollment.
- You must enroll within 30 days from the date of your status change.
„„ Qualifying Life Events (Examples of qualifying life events: birth of baby, marriage, gain/loss of
coverage, divorce).
See your 2016 Summary Plan Document – Special Enrollment Rights for a complete list.
- Contact Human Resources by calling 912-­466-­3100 to schedule an appointment for enrollment.
- You must enroll within 30 days from the effective date of your qualifying life event.
Failure to enroll within the above given days will result in the forfeiture of your eligibility for enrollment until the
beginning of the next plan year.
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SOUTHEAST GEORGIA HEATH SYSTEM
Enrollment
ANNUAL OPEN ENROLLMENT PROCESS
The MANDATORY benefit enrollment period will begin on November 2 and continue through November 15, 2015.
Your benefit elections will be effective January 1, 2016.
There are 3 ways to enroll:
1. Meet with an enroller for a 1-to-1 enrollment session. Enrollment dates and times will be posted throughout
the Health System.
2. Call a benefit enroller at 1-­877-­605-­7441 to enroll you and answer your questions during the process.
Agents will be available for your convenience during the benefit enrollment period only, Monday through Friday,
9:00am -­6:00pm ET.
3. If you are unable to meet with an enroller, simply log in to Colonial Life’s enrollment system to apply for coverage:
https://harmonyenroll.coloniallife.com
Your User Name is SOU7C5K plus your Social Security Number. (Example: SOU7C5K-­123456789)
Your Password is the first four characters of your last name followed by the last
four digits of your Social Security Number. (Example smit6789)
Note: if your last name contains less than four characters you would enter all characters of your
last name followed by the last four digits of your Social Security Number. (Example lee6789)
For technical assistance accessing or using the system, call the Help Center at 1-­866-­875-­4772, hours of
operation 8:30am – 6:00pm, ET, Monday through Friday. Reference Account Number F-­6446637.
To use the online enrollment system, you will need the following software on your computer:
„„ Internet Explorer 5.01 or higher
„„ Adobe Acrobat Reader”
2016 BENEFITS AT A GLANCE
6
Health Plan
HEALTH PLAN
PROVIDED THROUGH GROUP RESOURCES (Full-Time & Part-Time Team Members are eligible)
Refer to the online intranet copy of the Summary Plan Description to find out more details on your health insurance.
If you have a claims question, contact Meritain Health at 1-800-925-2272.
Super Preferred
Coverage/Plan
Preferred
Non-Preferred
$0
$400/$1,200
$1,000/$3,000
$6,850/$13,700
$6,850/$13,700
$7,450/$15,500
$20 co-pay
90% no deductible
$20 co-pay, then 100%
90% no deductible
$20 co-pay
90% after deductible
80% after deductible
60% after deductible
60% after deductible
60% after deductible
N/A
80% after deductible
80% after deductible
Preventive Care/Wellness
(annual GYN exam, mammogram, PSA, prostrate
screen)
100%
100% after $20 co-pay
Not covered
Routine Physical Exams
100%
100% after $20 co-pay
Not covered
Routine Child Care & Immunizations
(eligible child(ren) birth to 25 yrs old)
100%
100% after $20 co-pay
Inpatient Facility Charges
90% no deductible
80% after deductible
60% after deductible
Outpatient Facility Charges
100% no deductible
80% after deductible
60% after deductible
100%
80% after deductible
60% after deductible
N/A
80% after deductible
60% after deductible
100%
80% after deductible
60% after deductible
80% after $100 co-pay
80% after $100 co-pay
80% after $100 co-pay
N/A
80% no deductible
80% no deductible
100% after $25 co-pay
80% after $50 co-pay
80% after $50 co-pay
N/A
90% no deductible
80% after deductible
80% after deductible
60% after deductible
60% after deductible
(SGHS owned/operated)
Deductible (individual/family)
Out of Pocket Maximum (individual/family)
Physician Services
Office/sick visits
Hospital Visits
Surgery in office
Surgery in outpatient hospital setting
Chiropractic Service
Outpatient Diagnostic Services facility charges
(x-rays, labs)
Outpatient Diagnostic Services physician services
Physical, Occupational and Speech Therapy
Emergency Room facility
Emergency Room physician
Immediate / Urgent Care
Chemical Dependency
Inpatient
Outpatient
Prescription Drug Co-Pays**
Generic
Preferred Formulary Brand Name
Non-Preferred Formulary Brand Name
Specialty Drugs
Not covered
Co-Payment amounts for all three Medical Plans
$8.00 co-pay/$4.00 co-pay Co-pay for Disease Management Participants***
$30.00 co-pay/$20.00 Co-pay for Disease Management Participants***
$50.00 co-pay/$40.00 co-pay for Disease Management Participants***
20% to a maximum of $100 per fill
For the most current 2016 Preferred Formulary Brand name List,
log onto www.catalystrx.com
Any new specialty drugs, or prescriptions drugs/medications with a retail price of $1,000 or more MUST BE REVIEWED/APPROVED prior to fulfillment.
This process could take up to two (2) days depending upon the response time of the prescribing physician.
* Claims for physicians’ reading services will be paid at the Preferred plan rate of 80%
** At retail pharmacy: 30-day supply: 1x co-pay, 60-day supply: 2x co-pay, 90-day supply: 3x co-pay. Through mail order: 90-day supply: 3x co-pay.
*** Team Members and compliant participants in the Disease Management Program (DMP) through Southeast Georgia Health System will receive reduced copays for Disease Management related prescription drugs.
**** For Mental Health information please refer to the 2016 health insurance summary plan document.
2016 BENEFITS AT A GLANCE
7
Health Plan
Pre-certification must be completed with American Health Holdings (AHH) (1-800-242-1199) for certain procedures and all
inpatient stays; otherwise benefit coverage will decrease by 50%. Team Members must contact AHH at least 72 hours prior to
any scheduled admission for a medical condition, mental and nervous disorder, chemical dependency treatment, outpatient
surgical procedures performed outside the physician’s office, chemotherapy, purchase or rental of durable medical equipment
home healthcare, the beginning of hospice care, private duty nursing, and infusion services. In case of an emergency Hospital
admission or emergency surgery, AHH must be notified within two working days of admission.
What is the difference between physician listings under CGRHN and Aetna Choice Point of Service (POS) II? Both networks qualify
for Preferred benefits.
„„ CGRHN – local providers in the Coastal Georgia Regional Healthcare Network. A list of providers is available on the intranet
www.sghs.org/team-member portal.
„„ Aetna POS II – physicians who are outside CGRHN. A list of providers is available on the Aetna website
(www.aetna.com/docfind/custom/mymeritain/).
Health Insurance Rates
Bi-weekly
Team Member Only
$76.32
$72.69*
Team Member + Child(ren)
$148.40
$141.33*
Team Member + Spouse
$186.62
$177.73*
Family
$235.01
$223.82*
Part-Time Team Member
(Team Member Coverage Only)
$167.96
$159.96
*HRA/Biometric Analysis Compliance Discounted Rate
We are pleased to invite you and your covered dependents 18 years and older to participate in the Health Risk Assessment (HRA)
and Biometric Analysis (BA) initiative. This initiative is intended to establish a personal and organizational health & wellness
baseline, as well as provide a roadmap for you to achieve the best possible health. The Health System is committed to the health
and wellness of its Team Members, their families and the community. This offering is a natural evolution of the wellness initiatives
offered on behalf of our Wellness Team (Health Promotion & Wellness, Disease Management and Team Member Health).
The HRA/BA initiative applies to Team Members who are covered by the Health System sponsored health insurance as well as
covered dependents (spouses and adult children 18 years and older). While the HRA is an online questionnaire, the biometric
analysis will require physical presence at one of the designated areas.
If you have completed a lipid panel and blood glucose test in the last twelve months, please bring a copy of the said result to your
one-on-one meeting to avoid re-testing. You will also need to provide proof of positive identification and your health insurance
card.
Failure to complete both HRA and BA will preclude you from receiving a discount on your health insurance premium for 2016.
Online Health Risk Assessment Instructions
1. Go to sghs.extracon.com
2. Under NEW USER SIGN UP, enter your Unique Identifier and Last Name. The Unique Identifier is the 21 digit combination
of your Member ID Number off of your new insurance card and your birthday (starting with the year, and including leading
zeros before single digits). Example: If your Member ID Number is 1000000000001 and your birthday is July 5, 1975, then
your Unique identifier is 100000000000119750705
3. When you login, the homepage will ask for a Security Question and Answer.
4. From here, you can answer the Health Risk Assessment (HRA) questions.
2016 BENEFITS AT A GLANCE
8
Disease Management
DISEASE MANAGEMENT – WELLNESS PROGRAM
PROVIDED THROUGH SOUTHEAST GEORGIA HEALTH SYSTEM (Full-Time & Part-Time Team Members are eligible)
The disease management program offered by Southeast Georgia Health System is available to team members and their
dependents who are covered under the Southeast Georgia Health System’s group health insurance plan, who are taking
prescription medication(s), and are under the care of a physician for one or more of the following conditions:
Diabetes n High Blood Pressure n High Cholestero l n Asthma n GERD(Acid Reflux)
There is no cost to participate in this program. Any medication written for any of the above disease states have a reduced
co-payment for as long as the team member participates in the program, remains in compliance, and is covered under the
Health System’s health insurance.
Other benefits of the program include:
„„ Free scheduled contact with a case manager – contact must be maintained to continue the program and to receive
the following prescription drug co-pay benefits: $4.00 Generic; $20 Preferred Formulary Brand Name; $40 Non-Preferred Formulary Brand Name
„„ Free monitoring devices and free educational materials specific to the enrolled disease state(s)
Participation in the disease management program is voluntary and confidential. If you are interested in this program, a
Disease Management program application is available in the Human Resources Department at either the Brunswick or
Camden campuses.
Additional Wellness Benefits:
„„ Free wellness coach
„„ On-site fitness space
„„ Annual Biggest Loser Program
„„ Weight Watchers at work
„„ Variety of exercise programs include but are not limited to:
- Yoga
- Zumba
- Boot camp
9
SOUTHEAST GEORGIA HEATH SYSTEM
Dental Plan
DENTAL PLAN
PROVIDED THROUGH METLIFE (Full-Time & Part-Time Team Members are eligible)
Benefits
In-Network (PPO Providers)
Diagnostic & Preventive Benefits
100%
Basic Benefits / Restorative Benefits / Denture Repairs
80% UCR*
Endodontic Benefits / Periodontic Benefits / Crowns & Cast
Restorations / Prosthodontic Benefits and Orthodontic Benefits
50% UCR*
Deductible Amount Per Calendar Year
(Deductible applies to all benefits except Diagnostic & Preventive
Services or Orthodontic Services)
$50 Team Member / $150 Family
Standard Dental Annual Maximum Per Enrollee
$1,200
Lifetime Orthodontic Maximum per Enrollee
Orthodontic amounts paid will be credited on a per lifetime basis.
$1,000
Dental Rates
Bi-weekly
Team Member Only
$15.72
Team Member + Child(ren)
$33.47
Team Member + Spouse
$28.31
Family
$45.94
„„ The percent of eligible charges that the plan pays whether you use MetLife PPO (in-network) providers or out-of-network
providers is the same. However, in-network claims are processed at negotiated rates that may generally lower your out
of pocket costs.
„„ UCR = Usual, Customary and Reasonable:
- Usual – A usual fee is that fee regularly charged and received for a given service by an individual Dentist, i.e., his
“usual” fee.
- Customary – A fee is customary when it is within the range of “usual” fees charged and received by Dentists of similar
training for the same service within the geographic area determined by MetLife to be relevant.
- Reasonable – A fee is reasonable if it is usual and customary or if it falls above usual or customary or both,
but is determined to be justified considering the special circumstances.
Example of UCR applied to a claim: If your dentist charges $100 for a procedure and the plan’s Usual,
Customary and Reasonable (UCR) maximum for that procedure is $80, then you would be responsible for the
$20 difference.
Prior to receiving extensive dental care, we recommend that your dentist submit a pre-determination notice to
MetLife to determine your total estimated out-of-pocket costs.
2016 BENEFITS AT A GLANCE
10
Dental Plan
MetLife My Benefits
MetLife Benefits Information Right from Your Desktop
The MyBenefits website is a quick and easy way for you to get extensive information about your MetLife benefits – all
in one place. Log on to www.metlife.com/mybenefits to see how we’ve taken personalization and integration to a
new level. With a view to providing you with more insight to your benefits plan and enabling you to easily access your
benefits information online, MyBenefits is a dynamic tool that will prove invaluable when making important benefits
decisions.
Personalized Homepage to all your MetLife Benefits
From the homepage, you have access to personalized information, where you can link to detailed coverage
information and can perform tasks, such as:
„„ Dental PDP Plans – View your benefits and claims online, find a participating dentist, obtain information about how to
help prevent tooth decay and periodontal disease, and learn more about dental procedures in your area to help make
an informed decision about your dental care.
„„ Dental ID cards are available online for you to download and print one at your convenience. Cards contain your name,
employer’s name, and group number. Also included are MetLife’s claims submission address, website address, customer service telephone number and a service number for International Dental Travel Assistance.
Additional MyBenefits features include:
„„ Planning tools that you can use to help you make informed decisions regarding your retirement, benefits coverage as
well as other useful information for a variety of everyday topics in the Life Advice and Life Event sections.
„„ Forms and documents that you may need are located in the forms library for you to download.
„„ News & Updates allows both MetLife and your employer to communicate timely information such as enrollment dates
and new product offerings.
„„ Online claims tracking and email notifications called eAlerts, which will provide information regarding status changes to
your claims for certain benefits.
Visit MyBenefits at www.metlife.com/mybenefits today to take advantage of all the information and tools MyBenefits
has to offer you. Learn more about your benefits – so you can get more out of them!*
*Like most group benefit programs, benefit programs offered by MetLife contain certain exclusions, exceptions, waiting periods, reductions,
limitation and terms for keeping them in force. Ask your MetLife group representative for complete details.
11
SOUTHEAST GEORGIA HEATH SYSTEM
Vision Plan
VISION PLAN
PROVIDED THROUGH EYEMED (Full-Time & Part-Time Team Members are eligible)
Benefit
Preferred
Non-Preferred
Frequency
Vision Exam
$10 co-payment
Up to $35 maximum amount
Once every 12 months
Contact Lenses*
Conventional
Disposables
Medically Necessary
Allowance
Up to $135
Up to $135
$0 co-payment; Paid-in-Full
Max Amount
Up to $108
Up to $108
Up to $200
Once every 12 months
Standard Plastic
Lenses
Single Vision
Bifocal
Trifocal
Standard Progressives
Co-Payment
$25
$25
$25
$25
up to $55 allowance
Max Amount
Up to $25
Up to $40
Up to $65
Up to $40
Once every 12 months
Frames
$0 co-payment;
up to $120 allowance
Up to $60 maximum amount
Once every 24 months
* Standard Contact Lens fitting – spherical clear contact lenses in conventional wear and planned replacement. Examples include but
are not limited to disposable, frequent replacement, etc.
Vision Rate
Bi-weekly
Team Member Only
$2.43
Team Member + Child(ren)
$4.61
Team Member + Spouse
$4.87
Family
$7.14
A team member may purchase either glasses or contacts under this coverage, but not both.
Once the allowed benefit has been used, members may receive a 40% discount on purchases of complete pairs of eyeglasses
and a 15% discount on conventional contact lenses.
2016 BENEFITS AT A GLANCE
12
Flexible Spending Accounts
FLEXIBLE SPENDING ACCOUNTS
PROVIDED THROUGH STANLEY, HUNT DUPREE & RHINE (Full-Time & Part-Time Team Members are eligible)
Flexible Spending Accounts (FSA) may be used to pay for many types of health care expenses that are not covered under your
benefit plan and dependent care expenses incurred for you to go to work, with before-tax dollars. There are two spending
account available. You may choose one, both or neither depending on your situation:
„„ Unreimbursed Medical Spending Account – allow you to set aside as much as $2,550 per year for unreimbursed
expenses such as deductibles, co-payments, physicals, acupuncture, vision care, orthodontia expenses and more.
*Over-the-counter drugs are not eligible expenses.
„„ Dependent Child Care Spending Account – If you are married and file a joint return, or you file a single or head
of household return, the annual IRS limit is $5,000. If you are married and file separate returns, you can each elect
$2,550 for the calendar year. *Dependent cards are funded bi-weekly with your bi-weekly payroll deductions are
available upon funding.
You MUST re-enroll each year in order for the FSA to continue the upcoming new year.
Contributions: The money you contribute is deducted from your paycheck before federal and state taxes and Social Security
are applied. In effect, you will be paying your bill with tax-free money because you pay no taxes on the money when it is
deposited or when you are reimbursed. The result can lower taxes and create more spendable income.
Tax-Free Reimbursement: You may use your debit card to pay for eligible expenses, or you may submit a claim form
for reimbursement. Dependent care expenses are reimbursed up to the total amount accumulated in your account. IRS
regulations do not allow you to change your contributions during the year, except for life qualifying events.
Special Note: “Use-It-Or-Lose-It” Rule: You will have until March 15, 2017 to spend all the 2016 funds in your Flexible Spending
Account. You will have until March 31, 2017 to file claims for reimbursement for your 2016 eligible expenses. IRS regulations
require that any remaining balance be forfeited. Therefore it is very important that you carefully estimate your expenses before
electing your annual Flexible Spending Account contribution.
For a complete listing of reimbursable health and dependent care expenses, call the IRS at 800-829-3676 and request
Publications #502 (health care) and #503 (dependent care), or access these publications through the Internet at
www.irs.ustreas.gov.
2016 BENEFITS AT A GLANCE
13
Life and AD&D Insurance
BASIC TERM LIFE AND AD&D INSURANCE
PROVIDED THROUGH AETNA (Full-Time Team Members are only eligible)
These benefits are provided by the Health System at no cost to the team member.
Eligible team members are provided life insurance at 2x annual salary to a maximum of $500,000. This employer
paid benefit is available to full-time team members and provides $1,500 for each of your eligible dependents.
Team members must designate a beneficiary for this coverage.
Base annual earnings are used to determine your benefits under the group policy. Any income you receive, such as,
but not limited to, commissions, bonuses, dividends, overtime, and differentials will be excluded from this calculation.
Accidental Death & Dismemberment insurance is included with Basic Term Life for team members’ coverage
only and can double your face value – per policy requirements.
SUPPLEMENTAL TERM LIFE AND VOLUNTARY PORTABLE TERM LIFE INURANCE
PROVIDED THROUGH AETNA (Full-Time & Part-Time Team Members are eligible)
Issue Limits
„„ Team members who are newly eligible for this benefit have a guarantee issuance of up to two times their annual
salary up to a maximum of $500,000 and do not need to complete an Evidence of Insurability (EOI) form.
„„ For those team members who did not elect this coverage when first offered at the time of hire or are making
changes to their policy face value election, an Evidence of Insurability (EOI) form must be completed. What is
Evidence of Insurability? EOI is a statement of medical history to determine if a team member is approved for
coverage when the amount of life insurance that team member desires is in excess of the guarantee issue (GI)
amount for the group.
„„ Coverage will pend EOI approval from Aetna. If approved by Aetna, coverage and payroll
deductions will begin.
„„ AGE BANDED RATES: Rates are age based and will change accordingly each year. Please refer to the table
on the right for rates per $1,000 of life coverage by age.
„„ Team members must enroll for supplemental life to become eligible for dependent life coverage.
Team Member
„„ All team members – Choice of 1x to 5x annual salary to a maximum of $500,000.
„„ New hires will be offered a guarantee issue of 2x base earnings, up to $200,000.
„„ Age Reduction: Benefit amount reduces by 35% at age 65, by 60% at age 70, and by 75% at age
75 and above.
2016 BENEFITS AT A GLANCE
14
Life and AD&D Insurance
Spouse
„„ Choice of $10,000 to $100,000 in $10,000 increments.
„„ Spouse of new team members will be offered a guaranteed issue of up to $30,000 in $10,000 increments.
Children
„„ Choice of $5,000 or $10,000.
Age
Rate/$1,000
< 25
$.046
25 – 29
$.046
30 – 34
$.058
35 – 39
$.081
40 – 44
$.115
45 – 49
$.173
50 – 54
$.265
55 – 59
$.414
60 – 64
$.506
65 – 69
$.702
70 – 74
$1.116
75 – 79
$1.518
80-84
$1.518
80 >
$1.518
Dependent Spouse Coverage
$0.403 per $1,000 of coverage
Dependent Child Coverage
(Birth to age 25)
$5,000 Option = $0.58
$10,000 Option = $1.15
*Deduction will change accordingly based on age and annual salary.
If you declined Supplemental Term Life or Voluntary Portable Term Life Insurance when first eligible you will be
expected to submit an Evidence of Insurability (EOI) form to AETNA for approval.
15
SOUTHEAST GEORGIA HEATH SYSTEM
Short-term Disability
SHORT-TERM DISABILITY
PROVIDED THROUGH AETNA (Full-Time Members only are eligible)
Short-Term Disability (STD) insurance provides you with weekly income if you are unable to work or have a reduced income
due to an illness or injury unrelated to your occupation.
„„ Team Members who are newly eligible for this benefit and elect a Buy-Up option will not need to complete an Evidence
of Insurability (EOI) form.
„„ For those team members who did not elect a Buy-Up option when it was first offered at the time of hire and are buying
up from the Core Plan, and Evidence of Insurability (EOI) form must be completed.
„„ Election of this benefit does not guarantee coverage. Coverage will pend EOI approval from Aetna.
Benefit
Core Plan
Buy-Up A
Buy-Up B
Buy-Up C
Weekly Benefit
Core- 60% to a
maximum of $1,000
per week
Core – 60% to a
maximum of $1,000
per week
Buy-up – 70% to a
maximum of $1,500
per week
Buy-up – 70% to a
maximum of $1,500
per week
Elimination (Waiting)
Period*
30 days – Accident
30 days - Sickness
15 days – Accident
15 days - Sickness
30 days – Accident
30 days - Sickness
15 days – Accident
15 days - Sickness
Benefit Duration
22 weeks after
elimination period
24 weeks after
elimination period
22 weeks after
elimination period
24 weeks after
elimination period
Contributions
100% Employer paid
Team Members pay premiums for the Buy Up option depending upon
election of Buy-Up A, B, or C.
* Elimination Period – consecutive calendar days.
Deduction amounts are subject to change in accordance with your base salary.
A Team Member can use up to 24 hours of Paid-Time Off per pay period in addition to STD collection, unless the elimination
period has not been met.
If you decline the Buy-Up option for Short-Term Disability Insurance when first eligible and you now wish to elect this option,
you will be expected to submit an Evidence of Insurability (EOI) form to AETNA for approval.
2016 BENEFITS AT A GLANCE
16
Long-term Disability
LONG TERM DISABILITY
PROVIDED THROUGH AETNA (Full-Time Members only are eligible)
Long Term Disability (LTD) benefits provide continuing partial income replacement if your disability continues
beyond 24 weeks.
LTD is available after one year of employment.
Monthly Benefit Percentage
60% to a maximum of $8,000
Definition of Disability
Unable to work for 24 weeks with a loss of
20% of income
Duration of Benefits
Age 65, SSNRA
(Social Security Normal Retirement Age)
Elimination Period
6 months for all team members
Contributions
100% employer paid
Pre-Existing Condition
3/12*
*The pre-existing conditions limitation is 3/12. A pre-existing condition is one for which an individual has seen a medical practitioner or taken
medication in the 3 months prior to his or her coverage effective date. Benefits will not be paid for any pre-existing condition until the earlier of
3 consecutive months ending on or after the effective date of coverage during which the individual has not seen a medical practitioner or taken
medication for a condition; OR the individual remains insured under this plan for 12 consecutive months.
17
SOUTHEAST GEORGIA HEATH SYSTEM
Retirement Plan
RETIREMENT PLAN
PROVIDED THROUGH MASS MUTUAL FINANCIAL GROUP
We offer the following Retirement options: 403(b) and Roth 403(b). The plans have been streamlined in order to simplify
our retirement plan structure.
Team Member Eligibility: You are immediately eligible to contribute to the plan. You are eligible for base and matching
contributions if you meet the following criteria:
„„ are age 18 or older and
„„ have completed one year of service during which you have worked at least 1,000 hours per calendar year.
„„ Based on IRS guidelines, you may also be eligible to contribute an additional $6,000 if you are age 50 or older. In order
to receive the additional $6,000 for over 50 catch-up contributions, you must complete an election form each year.
Team Member Contributions: You may contribute as much as 100% of your annual salary up to $18,000* per year.
Employer Contributions:
„„ After 1 year of service and 1,000 hours, the Health System contributes 2.25% of your base salary each pay period.
„„ For each $1.00 you contribute, Southeast Georgia Health System will contribute:
„„ $.50 on the first 5% of your salary (2.5%) if you have less than 6 years of service
„„ $.75 on the first 5% of your salary (3.75%) if you have 6 or more years of service
Vesting: You are always 100% vested in your own contributions. You will be 100% vested in the Health System’s contribution
to your account after you have completed three years of service with at least 1,000 hours worked, per calendar year, in each of
those three years of service.
To participate in this plan, please contact our Retirement Plan Specialist, Jim Jacobs with Jacobs, Coolidge & Company LLC
(912-466-3175 or jamesljacobs@financialguide.com) who can assist you with the enrollment and education process.
You may contact Mass Mutual directly, by calling their toll-free number at 800-743-5274 Monday through
Friday 8am-9pm (EST).
*Amount subject to change per IRS guidelines.
2016 BENEFITS AT A GLANCE
18
529 College Savings Plan
529 COLLEGE SAVINGS PLAN
(Full-Time & Part-Time Team Members are eligible)
A College Advantage account may be used for tuition, room, board and other qualified expenses at any accredited college in
the U.S. If that child decides not to attend college, the account owner can leave the assets invested in the account for later use,
change beneficiaries to another family member or withdraw the assets and pay income tax and an additional 10% federal tax
on earnings.
College Advantage account owners contribute after-tax money but pay no taxes while the account accumulates. Also,
withdrawals used to pay for qualified higher education expenses are free from federal income tax. The ability to save tax-free
can make a big difference in how much college savers can accumulate over time. If interested in this plan, please contact the
Retirement Plan Specialist who can assist you with the required paperwork.
19
SOUTHEAST GEORGIA HEATH SYSTEM
Employee Assistance Plan (EAP)
PROVIDED THROUGH HORIZON HEALTH
Southeast Georgia Health System provides an EAP to protect its most valued asset – YOU. We have contracted with Horizon
Health EAP Services to provide you and each of your eligible dependents with access to professional assistance for the
challenges of everyday living.
Services Available through Horizon Health
„„ Identity Theft Consultation
- One free 60-minute telephonic consultation per
each new issue with a fraud resolution
specialist – unlimited number of issues per year
„„ Confidential Counseling Sessions to deal with
difficult periods in life
- 24/7 telephonic assessment and triage
- Face-to-face counseling sessions – up to 7 visits per
incident per calendar year
- Telephonic counseling – unlimited number of
issues per year
„„ WorkLife Benefit
- Eldercare, childcare, and dependent care
consultation and referral – unlimited number of
issues per year
- Medicare counseling – unlimited number of issues
per year
- Convenience services – unlimited number
of issues per year
„„ Financial Consultation
- One free 30-minute telephonic or face-to-face
consultation per each new issue with a financial
counselor on topics including credit counseling,
debt counseling and budgeting, mortgages,
retirement planning, and tax questions with local
referrals and web access – unlimited number of
issues per year
- Library of forms, articles, and FAQs, calculators
„„ Legal Consultation
- One free 30-minute telephonic or face-to-face
consultation with a network attorney or mediator
per each new issue – unlimited number of issues
per year
- 25% discount off usual rates for subsequent work
and network attorney or mediator.
- Free simple will preparation
- 10% discount off usual rates for telephonic and
online assistance to help prepare legal documents
such as divorce forms, estate planning forms,
immigration forms, and others
- Specialist assists employees with restoring their
identity and good credit
- Free “IDTheft Emergency Response Kit”
- Specialist advises client on how to dispute
fraudulent debts due to ID theft
- Counselor follows up with the member and
monitors progress
„„ Horizon CareLink Online EAP Services
- Free live webinars
- Child and elder care searches and resources
- School and college tools
- Adoption resources
- Veterinarian and pet care researches
- Psychological health resources
- Assessments and wellness resources
- Money and time-saving resources
It’s Confidential. As provided by law, your use of Horizon’s
services is confidential. Information related to your
participation in the EAP will not be shared with anyone
without your written permission.
It’s Convenient. Horizon’s network of professionals
are located near your home and place of employment.
Appointments are available at times convenient to your
schedule.
It’s Easy to Use. Horizon provides a national, toll-free 800
number for emergencies and crisis intervention, and to
request an initial appointment. The hotline is available 24
hours a day, 7 days a week.
Horizon Health 1-866-252-4468
www.mylifevalues.com
Username: sghs
Password: eap
2016 BENEFITS AT A GLANCE
20
Voluntary Benefits
ACCIDENT INSURANCE
PROVIDED THROUGH COLONIAL LIFE (Full-Time & Part-Time Team Members are eligible)
Accidents can happen anytime, anywhere.
Accidents are usually followed by a series of bills. Even if you have good insurance, you may still have to cover out-of-pocket
costs, such as:
„„ Doctor bills
„„ Ambulance fees
„„ Hospital expenses
Accident insurance from Colonial Life & Accident Insurance Company can help protect you, your spouse and your dependent
children from the unexpected expenses of an accident.
Features of Colonial Life’s Accident Insurance:
„„ You are paid benefits to help you with the care and treatment of a covered accidental injury.
„„ Your benefits are paid directly to you, unless you specify otherwise.
„„ You are paid benefits regardless of any other insurance you may have with other insurance companies.
„„ You can take your coverage with you if you change jobs or retire.
Talk with your Colonial Life benefits counselor to learn more about accident insurance and how it can help protect what
you’ve worked so hard to build.
WHOLE LIFE INSURANCE – WITH CHILDREN’S TERM LIFE AND LONG TERM CARE RIDERS
PROVIDED THROUGH COLONIAL LIFE (Full-Time & Part-Time Team Members are eligible)
Life insurance that comes with guarantees … because life doesn’t
Whole life insurance from Colonial Life & Accident Insurance Company provides guaranteed features – cash value
accumulation, premium rates and death benefit (minus any loans and loan interest) – that help ensure those benefits will be
there to help protect your family’s way of life.
Guaranteed protection: Offers lifetime protection with a guaranteed death benefit that will not change as long
as premiums are paid when due.
Guaranteed premiums: Promises a level premium that stays the same from the day you purchase the policy.
Guaranteed cash value: Guarantees the cash value amount – which accumulates on a tax-deferred basis.
Features of Colonial Life’s Whole Life Insurance:
„„ Provides a benefit for the beneficiary that is typically free from income tax.
„„ Three option dates to purchase additional coverage with no proof of good health required if you are age 55 or younger
at the time of purchase.
„„ The policy’s Accelerated Death Benefit can provide a percentage of the death benefit if the insured is diagnosed with a
terminal illness.
„„ $3,000 immediate claim payment as an advance of the death benefit, paid to the designated beneficiary.
You can’t predict the future, but you can rest easier knowing you have life insurance protection with lifelong guarantees.
Talk with your Colonial Life benefits counselor to learn more.
21
SOUTHEAST GEORGIA HEATH SYSTEM
Voluntary Benefits
CANCER INSURANCE
PROVIDED THROUGH COLONIAL LIFE (Full-Time & Part-Time Team Members are eligible)
How will you pay for what your health insurance won’t?
If diagnosed with cancer, would you have the money to cover:
„„ Out-of-network treatments
„„ Experimental treatments
„„ Rehabilitation
„„ Travel and lodging
„„ Child care expenses
Cancer insurance from Colonial Life & Accident Insurance Company helps guard against financial hardship if you or a loved one
is diagnosed with cancer.
Features of Colonial Life’s Cancer Insurance:
„„ Helps pay some of the direct and indirect costs related to cancer diagnosis and treatment.
„„ Helps pay for expenses health insurance may not cover, such as deductibles and coinsurance.
„„ Pays an annual benefit for specified cancer screening tests.
Talk with your Colonial Life benefits counselor to learn more about cancer insurance and how it can help provide
financial security for you and your family.
2016 BENEFITS AT A GLANCE
22
Voluntary Benefits
CRITICAL ILLNESS INSURANCE
PROVIDED THROUGH COLONIAL LIFE (Full-Time & Part-Time Team Members are eligible)
Are you prepared for the cost of an illness?
If you were to suffer a heart attack, stroke or other critical illness, would you have the money to cover:
„„ Deductibles and coinsurance
„„ Home health care needs
„„ Travel and lodging
„„ Lost income
„„ Rehabilitation
„„ Child care
Even those of us who plan for the unexpected with life, disability and health insurance may discover that some critical illness
expenses can still remain unpaid. Without adequate protection, you could have to pull from savings or rely on other financial
sources in your time of need.
Critical illness insurance from Colonial Life & Accident Insurance Company helps preserve your lifestyle in the event of a
specified critical illness. It provides benefits that you can use however you like.
Features of Colonial Life’s Critical Illness Insurance:
„„ Pays a benefit if you are diagnosed with a covered specified critical illness.
„„ Coverage is available for you and your covered dependents.
Talk with your Colonial Life benefits counselor to learn more about critical illness insurance and how it can help provide
valuable financial protection.
Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
Coverage is subject to policy exclusions and limitations that may affect benefits payable. Products may vary by state and may not be available in all
states. For cost and complete details, see a Colonial Life benefits counselor.
23
SOUTHEAST GEORGIA HEATH SYSTEM
Additional Benefits
Paid Time Off (PTO): provides each regular full-time
and part-time team member (0.6 FTE or above) with
prescribed number of hours. PTO is accrued bi-weekly
and is based upon a team members approved FTE
status, length of service and based on prorated actual
hours worked. Team members can accrue up to a
maximum of 450 hours.
PTO Cash-In: after being employed for one year,
team members may cash in PTO two times within a
calendar year.
HOURS ACCRUED PER PAY PERIOD
NON-EXEMPT
Full-Time
(0.9 & 1.0)
Part-Time
(0.8)
Part-Time
(0.6)
Less than 2 years
7.077
2.461
1.846
2 years < 4 years
7.385
2.708
2.031
4 years < 6 years
7.692
2.953
2.215
6 years < 8 years
8.00
3.200
2.400
8 years < 10 years
8.308
3.446
2.584
10 years < 20
years
8.615
3.692
2.769
20 years and over
10.154
4.923
3.692
EXEMPT
HOURS ACCRUED
PER PAY PERIOD
Less than 2 years
8.615
2 years < 4 years
8.923
4 years < 6 years
9.230
6 years < 8 years
9.538
8 years < 10 years
9.846
10 years < 20 years
10.154
20 years and over
10.769
Additional Leaves:
„„ Family Medical Leave – is available to Team Member
for self or their eligible dependent(s). Team Member
must be employed for 12 months and have worked
1,250 hours in the last 12 months from date of onset
to be eligible. See policy SHR #75 for more details.
„„ Educational Leave – Team members who are planning on attending school and cannot work full-time
status may be eligible for this leave option. See policy
#76 for more details.
„„ Bereavement Leave – Team members who may be
in need to take leave due to a death in the family, as
defined: Immediate family is confined to the Team
Member’s or current spouse’s relationship: father,
mother, brother, sister, current spouse, child, grandparents/grandchildren, legal guardian, step-parents/
step-children/step-brothers and step-sisters. Leave
can be paid up to three (3) consecutive days of their
normal scheduled work. See policy SHR #77 for more
details.
Holiday Pay: The following holidays are recognized by
SGHS: New Year’s, Memorial Day, July 4th, Labor Day,
Thanksgiving and Christmas. For payroll purposes,
holidays are recognized on the official calendar day
(from midnight to midnight). See policy SHR #71 for
more details.
Scholarship Program: Scholarship assistance is
typically provided to allied health or nursing school
students who are willing to commit to a certain time
frame of full-time employment in their goal position with
Southeast Georgia Health System. See policy SHR #33
for more details.
Tuition Reimbursement Program: Team members
classified as full-time that have completed twelve
months of continuous full time employment.
Upon satisfactory completion of each course of an
approved curriculum, the team member is eligible for
reimbursement up to a maximum of $3,000 per fiscal
year. See policy SHR #79 for more details.
For further information about any of these benefits or
policies, call Human Resources at 912-466-3100.
2016 BENEFITS AT A GLANCE
24
Pre-paid Legal/Identity Theft
PREPAID LEGAL/IDENTITY THEFT SHIELD
PROVIDED THROUGH LEGAL SHIELD (Full-Time & Part-Time Team Members are eligible)
Pre-Paid Legal Services: Local attorneys participate in the program (see HR for details).
Toll-free phone consultations on legal issues are available Monday through Friday from 8 am – 5 pm.
Identity Theft Shield Highlights:
Credit Report – Evaluation of current credit standing with detailed analysis.
Credit Monitoring – Suspicious activities will be brought to your attention, providing you with early identity theft detection.
Identity Restoration – Complete assistance with the devastating and overwhelming process of restoring your name and credit.
Eligible dependent children: Up to age 23 and a full-time student (12 credit hours per semester).
25
Individual or Family Rates
Bi-weekly
Pre-Paid Legal Only
$6.81
Identity Theft Only
$5.98
Pre-Paid Legal and Identity Theft
$11.40
SOUTHEAST GEORGIA HEATH SYSTEM
Legal Notices
LEGAL NOTICES
NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS:
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health
plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other
coverage (or if the employer stops contributing towards you or your dependents’ other coverage). However, you must request enrollment
within 30 days after you or your dependents’ other coverage ends (or after the employer stops contribution toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll
yourself or your dependents.
In addition, if you have a new dependent as a result of marriage, birth adoption, or placement for adoption, you may be able to enroll
yourself or your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement
for adoption.
SECTION 125 PRE-TAX BENEFIT AUTHORIZATION NOTICE:
Before-tax deductions will lower the amount of income reported to the federal government. This may result in slightly reduced Social
Security benefits. If you do not enroll eligible dependents at this time, you may not enroll them until the next open enrollment period. You
may not drop the coverage you elected until the next open enrollment period. You may only make a change or drop coverage elections
before the next open enrollment period under the following circumstances:
„„ A change in marital status, or
„„ A change in the number of dependents due to birth, adoption, placement for adoption or death of a dependent, or
„„ A change in employment status for myself or my spouse, or
„„ Open enrollment elections for my spouse, or
„„ A change in a dependent’s eligibility, or
„„ A change in residence or worksite.
„„ Any change being made must be appropriate and consistent with the event and must be made within 30 days
of when the event occurred.
WOMEN’S HEALTH and CANCER RIGHTS ACT OF 1998 Annual Notice:
The Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction
and surgery to achieve symmetry between the breast, prostheses, and complications resulting from a mastectomy, including lymph
edema. Call Meritain Health at 800-925-2272 for more information.
NEWBORNS’ ACT DISCLOSURE:
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of
stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than
96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending
provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as
applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan
or the insurance issuer for prescribing a length of stay not in excess of 48 hours(or 96 hours).
EXCHANGE NOTICE:
In 2014, the health care reform law created an online marketplace for purchasing health insurance coverage, referred to as a
Health Insurance Marketplace or an Exchange. You are not required to purchase insurance coverage through the Marketplace.
Southeast Georgia Health System Incorporated is continuing to offer health coverage as outlined in the preceeding “Group
Benefits” pages.
If you purchase coverage through the Marketplace, you maybe eligible for a federal subsidy that lowers your monthly premiums
or reduces your cost sharing. However, to receive this federal subsidy, you cannot be eligible for health plan coverage through
Southeast Georgia Health System Incorporated.
The availability of coverage through the Marketplace does not affect your eligibility coverage through Southeast Georgia Health
System’s health plan. More information on the health care reform law and the Marketplaces is available at www.healthcare.gov.
2016 BENEFITS AT A GLANCE
26
Contact Information
Name
Contact
Phone
Website / E-Mail
Fax
Accident
Colonial Life
888-545-0358
claim opt. 1
wellness claim opt. 2
www.coloniallife.com
888-612-0026
Basic Life and AD&D &
Supplemental Life
AETNA
800-523-5065
www.aetna.com
Life Claims
800-238-6239
Benefit Administrator
Diana Mathena
912-466-3102
dmathena@sghs.org
912-466-3113
Benefits Compensation
Coordinator
Renee Harris
912-466-3179
rharris@sghs.org
912-466-3113
Cancer
Colonial Life
888-545-0358
www.coloniallife.com
888-612-0026
Credit Union
Marshland Federal Credit Union
912-466-3150
www.marshlandfcu.coop
912-466-3153
Critical Illness
Colonial Life
888-545-0358
www.coloniallife.com
888-612-0026
MetLife
800-438-6388
www.metlife.com/dental
859-389-6505
Michelle Atkinson
912-466-3180
matkins@sghs.org
912-466-3113
Employee Assistance Program
Aetna Resources for Living EAP
866-252-4468
24 hours a day
www.mylifevalues.com
Login: sghs
Password: eap
Flexible Spending Accounts
Stanley, Hunt, Dupree & Rhine
800-768-4873
https://shdr.Ih1ondemand.com
252-293-9049
HR Manager – Camden
Sharon Zawislak
912-576-6412
szawislak@sghs.org
912-576-6404
Human Resources
Main Number
Toll Free Number
912-466-3100
800-678-9250
www.sghs.org
912-466-3113
Dental
Disease Management
Medical
Pharmacy
PPO Provider Network
Precertification for Medical
Pre-paid Legal & Identity Theft
Retirement Plan Specialist &
College Savings Plan
Short-Term & Long-term
Disability
Vision
Whole Life & Long Term Care
Workers’ Compensation
27
Meritain Health
Incorporated
Optum RX
Main –800-925-2272
7 am - 6:30 pm CST
www.mymeritain.com
888-727-5560
www.catamaranrx.com
CGRHN
Refer to www.sghs.org/team-memberportal
Aetna POS II
www.aetna.com/docfind/custom/mymeritain/
Catamaran is now
Optum Rx
AHH
800-242-1199
Legal Shield
800-654-7757
www.legalshield.com
Mass Mutual
800-743-5274
www.massmutual.com/retire
Jim Jacobs
Jacobs & Coolidge
912-466-3175
jamesljacobs@financialguide.com
912-466-3113
AETNA
800-488-2386
www.aetna.com
Claims
866-667-1987
EyeMed Customer Service
866-723-0514
www.eyemedvisioncare.com
Claims
866-293-7373
Colonial Life
888-545-0358
www.coloniallife.com
888-612-0026
AMTRUST
877-528-7878
submissions@amtrustgroup.com
800-487-9654
SOUTHEAST GEORGIA HEATH SYSTEM
Notes: Notes
ColonialLife.com
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underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
10-15 | NS-14117-1