Enrollment dates oct. 19 – Nov. 9, 2015

your
Enrollment dates Oct. 19 – Nov. 9, 2015
30224-H15
Benefit
Portfolio
2016
What’s inside
In addition to important annual updates and reminders, this
enrollment guide contains information about 2016 benefits
changes.
Enrollment..............................................................................................3-4
How do I enroll?...................................................................................3
Who is eligible?....................................................................................3
When can I enroll?...............................................................................4
Medical plan and Prescription Drug Plan..........................................5-8
Vision plan............................................................................................9-10
Dental plan..............................................................................................11
Flexible spending accounts...................................................................12
Health Savings Account.........................................................................13
Life insurance benefits...........................................................................14
Disability benefits............................................................................. 15-16
Paid time off ...........................................................................................17
PTO cash-in..............................................................................................17
Purchased paid time off........................................................................18
Retirement...............................................................................................19
Other benefits.........................................................................................20
Cost sheet................................................................................................21
Important contact information............................................................22
Beneficiary form.....................................................................................23
Telemedicine options.............................................................................24
This booklet is a summary of the benefit plans effective Jan. 1, 2016 and does not cover all provisions, limitations and
exclusions. Your summary plan descriptions (SPDs) and summaries of material modifications (SMMs) can be found on the
benefits website on CAMnet.
1
Letter to employees
To the CAMC Health System Family:
As the Affordable Care Act (ACA) continues to shape the way employers offer benefits
across the country, our mission is to make CAMC the “best place to work.” CAMC’s
benefits play a pivotal role in reaching that goal. Our strategy is to offer comprehensive
and affordable benefits while educating our workforce and making incremental changes
toward compliance with the ongoing Federal Regulations.
Here are a few of the 2016 changes you’ll want to make note of:
• The medical plan and the prescription drug plan will no longer be separate plans. In order to ensure compliance with ACA out-of-pocket maximums as well as reporting requirements, the medical and prescription drug plans are combining on 1/1/2016.
• CAMC will offer two health insurance plans: a “traditional PPO” plan and a High Deductible Health Plan with the option of a Health Savings Account.
• CAMC will be a preferred provider and have a preferred network for medical services. To achieve our goal of keeping out of pocket costs to a minimum, we’re introducing a new preferred CAMC network on our health insurance plans.
To ensure you understand the new plan designs and how to get the best from your
benefits, we encourage you to attend the Benefit Fair during the week of Oct. 19. Your
benefits team, along with human resources and representatives from our benefits vendors
will be on-site to answer your questions so you can make well-informed decisions for your
2016 enrollment.
We remain dedicated to offering employees the best possible benefits package and each
year we are presented with new challenges in an ever changing environment. CAMC strives
to minimize the benefit costs that affect our eligible employees and their families. Thank
you for your continued feedback and support as we work together to make CAMC the “best
place to work.”
Annual enrollment for the 2016 benefit plan year, starts Monday, Oct. 19, and runs through
Monday, Nov. 9, 2015, at 5 p.m.
I’m proud to work with you and I look forward to another great year as we strive to
provide the best health care to every patient, every day.
Kristi Snyder
VP for Human Resources
2
Enrollment Oct. 19 – Nov. 9
How do I enroll?
You will enroll in Lawson Self Service on
CAMnet. You cannot enroll from home.
You must access from a CAMC network
computer.
n From CAMnet, click on “Lawson Self Service.”
n Use your network ID and password.
n Click on “Employee Self-Service” (located in the left column).
n Click on “Benefits.”
n Click on “Benefits Enrollment.”
n Read the Welcome Screen for important enrollment information then click “Continue.”
n Carefully review each benefit and make a selection for each one.
n For dependent benefits, be sure to check the box next to the dependents you want to cover.
n On the final benefit summary page, select “Continue.”
n On the Lawson Self Service web dialog box, select “Print” to print these benefits.
It is your responsibility to keep the
printed confirmation. This is the only
confirmation you will have of your
benefit elections.
Important Lawson enrollment tip: Once you
elect employee + child or family coverage, the
dependents you have on file with human resources
will display in Lawson Self Service. If a dependent is not
showing, please contact human resources within the
enrollment period (Oct. 19 to Nov. 9) to add your
dependent to your benefits.
Who is eligible?
For family members
Eligible dependents include*:
1.Your lawful spouse
Mandatory Spouse Enrollment Rule
Spouses who are offered employer-sponsored health
insurance must enroll in their employer’s plan as
primary coverage in order to be eligible to enroll in a
CAMC medical plan. The medical plan will audit in the
first quarter of 2016.
2.Your child until end of the month he/
she attains age 26 and is either:
•A blood descendant of the first degree
•Legally adopted child or a child who is living with the eligible employee as an adopting parent during any period of probation
•A step child
•An individual for whom the eligible employee has
been appointed legal guardian
3. Your unmarried child who:
•Is mentally or physically incapable of self-support
and is claimed as a dependent by the eligible employee for Federal Income Tax purposes and was covered in the component plan in question immediately prior to aging out as an eligible dependent
*CAMC and its medical service providers reserve the right to
audit dependent eligibility. For example, you may be asked to
provide your marriage certificate and current tax return as proof
of eligibility for a spouse. If you provide false information or
documents that do not provide credible support as verification of
dependent eligibility, then your dependents’ benefit claims may be
denied, coverage will be terminated retroactively, and premiums
will not be refunded. In addition, if you provide false information
when enrolling or verifying your dependents, you may also be
subject to disciplinary action – up to and including termination.
Wait periods
Some benefits do require wait periods for new
enrollees. Additionally, you will be required to
complete the necessary forms and provide all data
required by the insurance providers in order to
participate.
3
Enrollment Oct. 19 – Nov. 9
When can I enroll in benefits?
Annual enrollment
Employees may change their elections for benefits
during the annual enrollment period.
Normal enrollment
The normal enrollment period for an eligible employee
is defined as follows:
1. Within 30 days of becoming an eligible employee. Enrollment is completed online through Lawson Self Service.
2. Employees who become an eligible employee due to a status change have 30 days from the date of the written notification from human resources to enroll.
Special enrollment
The IRS allows for a special enrollment period due
to certain qualifying events. In order to qualify for
special enrollment, you must notify the HR office and
complete the appropriate paperwork within 30 days
after the qualifying event. If notification is not
made within the 30-day timeframe, you will not
be permitted to make changes to your benefits
until the annual enrollment period or until you
experience another qualifying event. For birth
or adoption of a child you have 60 days from the
event date to notify HR.
Under HIPAA Special Enrollment and IRS Section 125
rules, employees and/or dependents may make benefit
changes due to the following qualifying events:
• Marriage, divorce or legal separation
• Birth or adoption of a child
• A child reaching an age that removes the dependent status
• Death of an eligible dependent
• Loss or gain of eligibility for benefits of participant, spouse or child
• When employer contributions toward employee’s or dependent’s coverage terminate
• An employee or dependent becoming entitled to coverage or losing coverage under Part A or Part B Medicare or Medicaid
•
4
Benefit changes due to qualifying events will become effective the first of the month following completion of change form. Birth/adoption will be effective the date of birth/adoption.
Below are a few examples of changes that you
may make as a result of a qualifying event:
• Adding or dropping a benefit
• Changing coverage levels (i.e. from single coverage to family coverage)
• Adding or removing a dependent (regardless of whether it results in a change in coverage level)
CHIPRA legal notice:
Loss or gain of eligibility for a state Children’s
Health Insurance Program (CHIP) or Medicaid
If you or your dependents are eligible for, but not enrolled
in the medical plan, you and your dependents may enroll
in the medical plan, or switch medical benefit options, if
either of the following conditions is met:
• You or your dependents are covered under CHIP or Medicaid and such coverage is terminated as a result of loss of eligibility, and you request coverage under the medical plan not later than 60 days after the date of termination of such CHIP or Medicaid coverage; or
• You or your dependents become eligible for CHIP or Medicaid premium subsidy assistance with respect to
coverage under the medical plan, if you request coverage under the medical plan not later than 60
days after the date you or your dependent is determined to be eligible for such premium assistance subsidy.
Important COBRA information:
If you lose eligibility for coverage due to a status change,
qualifying event or termination of employment, the
WV Marketplace Exchange may offer an attractive
alternative to health coverage for you as an alternative
to purchasing continuation coverage offered pursuant
to the Consolidated Omnibus Reconciliation Act of 1985
(“COBRA”). The premiums to purchase a Qualified Health
Plan in the marketplace may be less expensive than the
cost of COBRA coverage and you may qualify for a new
kind of tax credit that lowers your monthly premiums
in the Marketplace. For more information about the
Marketplace, you can refer to www.healthcare.gov or
call 1-800-318-2596, which is the federal government’s
hotline for questions about the Marketplace.
If your covered spouse or dependent child ceases to be
eligible for coverage under a CAMC group health plan
as a result of a divorce or the dependent child ceasing to
be a dependent child, either you, your former spouse, or
the child must notify HR of the event. Failure to do so in
a timely manner (60 days from the later of the date of
the COBRA qualifying event or the date the beneficiary
would otherwise lose coverage) will result in forfeiture
of their COBRA rights.
Medical plan
possible, a CAMC preferred network tier has been added. Your deductibles, co pays, and coinsurance are lower when you utilize CAMC physicians and facilities for care. Members still have full access to the Highmark network of physicians. Take some time to look over the cost shares for CAMC and Highmark networks.
While CAMC’s health plans move toward complying
with the requirements of the Affordable Care Act,
CAMC will continue to offer employees and their
families the best and most comprehensive health
coverage possible.
IMPORTANT Effective Jan. 1, 2016
To ensure we are compliant with new reporting
requirements, out of pocket maximums and to
minimize exposure to the “Cadillac tax”, the following
changes will be effective January 1, 2016:
1. Your prescription drug plan will be part of your medical plan and therefore will not require a separate election. When you elect the medical plan, you will automatically be enrolled in prescription drug coverage. You will be issued one card from
Highmark and that card will be used for both your prescription and medical insurance. The prescription drug plan will not be offered as a separate benefit.
2. The 90/10 and 80/20 plans will be combined into a single traditional Preferred Provider Organization (PPO) Plan that includes prescription drug coverage.
Due to the two new medical plan options, along
with pharmacy being combined with medical,
you must re-elect your benefits for 2016. If you
do not complete the annual enrollment process
in Lawson Self Service, you will not have medical
or pharmacy coverage.
Overview of 2016 Medical Plan Options
3. A new High Deductible Health Plan will be offered to employees. This plan will have low bi-weekly premiums and allow for the opportunity to enroll in a Health Savings Account (HSA).
4. To continue to encourage steerage to our own facilities while keeping out of pocket costs as low as 5. The mandatory spouse enrollment rule will continue to be in place for the 2016 plan year. Spouses who are offered employer-sponsored health insurance must enroll in their employer’s plan as primary coverage in order to be eligible to enroll in a CAMC medical plan. Any spouse covered on the plan as of January 1, 2016, will have eligibility verified.
The PPO Plan
If you liked the way the 90/10 and 80/20 plans covered
your medical expenses, with a low deductible up
front and then a coinsurance to pay for most services,
then the CAMC PPO Plan may be the best option for
you. Remember, the prescription drug benefit is now
covered as part of the medical plan.
PPO Plan
Preferred Network
Plan Metric
Individual
Deductible
20%
30%
60%
Individual
$5,050
$6,400
Family (may be met
$3,600
$10,100
$12,800
Individual
$2,400
$6,850
$10,000
Family (may be met
$4,800
$13,700
$20,000
$10/$40
$10/$60
60%
collectively)
Urgent Care
Emergency Room
Inpatient Co-Pay
Inpatient Services
Outpatient Lab
Pharmacy Deductible
Pharmacy Copays (CAMC)
$3,600
$1,800
collectively)
PCP/Specialist
Out of Network
$1,200
Employee Coinsurance
Out of Pocket Maximum (Incl Ded)
$1,800
Family (may be met
collectively)
Coinsurance Limit
Highmark Network
$600
$3,600
$7,200
$20
30%
60%
$150 + 20%
$150 + 20%
$150 + 20%
$200
$1,200
$1,400
20% after deductible
30% after deductible
60% after deductible
20% after deductible
30% after deductible
60% after deductible
$0 CAMC / $250 Retail and Mail Order
30% ($8 Max) Generic / 30% ($50 max) Brand / 10%($100) Specialty
5
Medical plan cont.
Important things to know about your CAMC and
Network cost shares with the PPO PLAN:
•
Your payments toward your deductible and coinsurance go toward both the CAMC and Highmark Network deductible. After you meet the
CAMC maximum out of pocket limits, you are covered 100% as long as you access care at CAMC or from a preferred network provider.
•
No individual pays more than the individual amounts listed. If you as an individual meet your $600 deductible and your $1,800 coinsurance limit ($2,400) then your medical expenses are covered at 100% thereafter at CAMC.
High Deductible Health Plan (HDHP)
CAMC is introducing a new High Deductible
Health Plan (HDHP) in 2016. The primary difference
between a PPO plan and an HDHP is how you meet
the deductible. In an HDHP, you have to pay “first
dollar” on any expenses incurred until you meet your
deductible. Expenses include prescription drugs
and all medical services, except for preventive
services. Once you meet the deductible, the plan
begins to cost share with you on expenses.
The benefits of a High Deductible Health Plan are
lower bi-weekly premiums and the ability to start a
Health Savings Account (HSA) which you can use to pay
for medical expenses (see the Health Savings Account
on Page 13 in this guide for more information). Once
you’ve met your high deductible, the CAMC High
Deductible Health plan has the same comprehensive
coverage as the traditional plan.
Important things to know about your CAMC and
Network cost shares with the HDHP PLAN:
•
Your payments toward your deductible and coinsurance go toward both the CAMC and Highmark Network deductible. After you meet
the CAMC maximum out of pocket limits, you’re covered 100% as long as you access care at CAMC or from a CAMC Physician.
•
The IRS requires that the deductible for an employee + dependent plan be at least $2600. For this reason, the deductibles differ depending on the coverage option you choose.
• In an HDHP, you have to pay “first dollar” on any expenses incurred until you meet your deductible.
• Preventive services and some medicines are covered at 100% with $0 cost share and a $0 deductible.
6
• Co pays (including prescription co pays) count toward the Federal Limit but do not count toward deductibles and coinsurance.
• Preventive services and some medicines are covered at 100% with $0 cost share.
•
Members are limited to two (2) annual fills for maintenance drugs (such as cholesterol, blood pressure or diabetes medications) at retail drug stores and mail order.
•
Prescription drug benefit now covered as part of the
medical plan. With the High Deductible Health Plan you will pay 100% of the cost of your medications until you reach your deductible. Once you reach your deductible the co-pays begin as outlined in
the chart (pg. 7). Members will be limited to two (2) annual fills for maintenance drugs (such as cholesterol, blood pressure or diabetes medications) at retail drug stores and mail order once the deductible is met.
•
If you elect the HDHP, you will be given the opportunity to elect a Health Savings Account (HSA) which you can use to pay for medical expenses (see the Health Savings Account page in this guide for more information) and a Limited Flexible Spending Account which you can use to pay for dental and vision expenses. Employees electing the HDHP will receive HSA enrollment instructions from the benefits department after enrollment ends.
(See chart next page)
Medical plan cont.
High Deductible Health Plan- Individual Only
Preferred Network
Plan Metric
Deductible (applies to medical and
prescription drugs)
Employee Coinsurance
Coinsurance Limit
Out of Pocket Maximum (Includes
Deductible and applies to medical and
prescription drugs)
Highmark Network
$1,500
$3,000
$5,000
20%
30%
60%
$2,500
$3,550
$5,000
$4,000
$6,550
$10,000
$10/$60, after deductible
60%, after deductible
30%, after deductible
60%, after deductible
$10/$40, after
deductible
$20, after deductible
PCP/Specialist
Urgent Care
$150 + 20% after
deductible
$200 after deductible
Emergency Room
Inpatient Co-Pay
Inpatient Services
Outpatient Lab
Pharmacy Copays (CAMC) After Deductible
Out of Network
$1,200 after deductible
$150 + 20% after
deductible
$1,400 after deductible
20% after deductible
30% after deductible
60% after deductible
20% after deductible
30% after deductible
60% after deductible
$150 + 20% after deductible
30% ($8 Max) Generic / 30% ($50 max) Brand / 10% ($100) Specialty
High Deductible Health Plan- Employee+Child, Employee+Spouse or Family
Preferred Network
Plan Metric
Highmark Network
Individual
Family (may be met
$5,200
20%
30%
60%
Individual
$2,600
$2,950
$7,500
Family (may be met
$5,200
$6,900
$15,000
Individual
$5,200
$6,550
$14,700
Family (may be met
$10,400
$13,100
$27,400
$10/$40, after
deductible
$10/$60, after
deductible
60%, after deductible
$20, after deductible
30%, after deductible
60%, after deductible
Emergency Room
$150 + 20% after
deductible
$150 + 20% after
deductible
$150 + 20% after
deductible
Inpatient Co-Pay
$200 after deductible
$1,200 after deductible
$1,400 after deductible
20% after deductible
30% after deductible
60% after deductible
20% after deductible
30% after deductible
60% after deductible
Deductible (applies to medical and
prescription drugs)
collectively)
Employee Coinsurance
Coinsurance Limit
collectively)
Out of Pocket Maximum (Includes
Deductible and applies to medical and
prescription drugs)
PCP/Specialist
Urgent Care
Inpatient Services
Outpatient Lab
Pharmacy Copays (CAMC) After Deductible
collectively)
$3,600
Out of Network
$2,600
$6,200
$7,200
$12,400
30% ($8 Max) Generic / 30% ($50 max) Brand / 10% ($100) Specialty
7
CAMC pharmacies
CAMC Pharmacy
As a participant in the medical plan you will pay the
lowest costs for your medications when you fill your
prescriptions at a CAMC Pharmacy. Please review the
new co-pay structure for 2016. Note there is no longer
a minimum payment for brand or generic drugs, the
low cost share means that you could pay less than $4
for generics at CAMC pharmacies.
90 day fills – Prescriptions written as 90 day fills will
lower the number of times you go to the pharmacy
for refills and save you a few dollars on your co-pay
maximum at CAMC pharmacies. You can request that
your physician write your prescriptions for 90 day fills.
There are three CAMC pharmacies you
can use to fill prescription drugs.
CAMC Pharmacy at Memorial Hospital Hours 7 a.m. to 7 p.m. Monday through Friday
(304) 388-9547
CAMC Pharmacy at Cross Lanes
Open 7 days a week
Hours 9 a.m. to 9 p.m. Monday through Friday
Hours 9:30 a.m. to 9 p.m. Saturday and Sunday
(304) 388-7050
CAMC Cancer Center Pharmacy
Hours 8 a.m. to 6 p.m.
Monday through Friday
(304) 388-9700
8
Delivery options:
Phone prescription refills into the Memorial Pharmacy
(304) 388-9547
Choose the delivery option
Most prescriptions can be delivered to other Charleston
area campuses.
How do I transfer prescriptions from a
retail pharmacy to a CAMC Pharmacy?
Call the pharmacy you want the prescription moved
to and provide them with the following information
(can move prescriptions among the CAMC pharmacies
without doing this):
• Your name, date of birth, address and phone numbers
• Your prescription plan ID number and person code
• Your current pharmacy’s name, location and phone number
• A list of all the medications you want transferred
Vision plan
CAMC offers a vision plan through Davis Vision. The
plan covers eye glasses, contact lenses (and fittings),
and routine eye examinations.
CAMC Network Providers – this list is subject to
change at any time, please check the CAMC Benefits
site on CAMnet for updates.
The vision plan covers an annual eye exam (once every
12 months), lenses – either lenses for your glasses or
contact lenses (once every 12 months), and frames
(once every 24 months).
Enrique E. Calderon, MD
Suite 100, 415 Morris St
Charleston, WV, 25301
(304) 388-6620
Audrey L. Hunt, MD
Suite 100, 415 Morris St
Charleston, WV 25301
(304) 388-6620
Paul Francke III, MD
1201 Washington St E
Charleston, WV 25301
(304) 343-4124
Michael Nunley, MD
1201 Washington St E
Charleston, WV 25301
(304) 343-4124
Huseyin Kadikoy, MD
Suite 100, 415 Morris St
Charleston, WV 25301
(304) 388-6620
Walter Ramsey, MD
1301 Lee St E
Charleston, WV 25301
(304) 343-3363
Muhib Tarakji, MD
418 Greenway Ave
So. Charleston, WV 25309
(304) 766-2101
Devin King, MD
1204 Hospital Drive
Hurricane, WV 25526
(304) 757-8700
Steven Hosman, MD
1301 Lee St E
Charleston, WV 25301
(304) 343-3363
Davis Network
A complete list of Davis Network providers can be
found at www.davisvision.com or dial 1-877-923-2847
option 3 - (CLIENT CONTROL NUMBER 2422)
Premiums listed on cost sheet on page 21.
9
Vision plan cont.
VISION BENEFITS
DAVIS NETWORK
CAMC NETWORK * OUT OF NETWORK
Frequency – Once Every:
Eye Examination
12 Months
12 Months
12 Months
Spectacle Lenses
12 Months
12 Months
12 Months
Frame
24 Months
24 Months
24 Months
Contact Lens Evaluation, Fitting & Follow-Up Care
12 Months
12 Months
12 Months
Contact Lenses (in lieu of eyeglasses)
12 Months
12 Months
12 Months
Spectacle Lenses
$25
$0
$0
Contact Lens Evaluation, Fitting & Follow-Up Care
$25
$0
$0
$10 co-pay (100% thereafter)
Up to $125
Up to $50
Copayments
Eye Examination
Eye Exam
Eyeglass Benefit - Frame
Davis Vision Frame Collection/2 (in lieu of Allowance):
Fashion level
100%
N/A
N/A
Designer level
100%
N/A
N/A
Premier level
$25 copay (100% thereafter)
Non-Collection Frame Allowance (Retail):
Up to $130
N/A
Up to $130 (part of $300 allow.)
N/A
Up to $50
Eyeglass Benefit - Spectacle Lenses
Clear plastic single vision
100%
Up to $40
Clear plastic lined bifocal
100%
Up to $60
Clear plastic trifocal
100%
Oversize Lenses
100%
Tinting of Plastic Lenses
100%
Scratch-Resistant Coating
100%
Polycarbonate Lenses /1
$0 or $30
*CAMC providers
will be reimbursed
up to $300 for the
combined cost of
lenses and cosmetic
options listed here
with no co-pay.
Up to $80
N/A
N/A
N/A
N/A
Ultraviolet Coating
$12 co-pay (100% thereafter)
Standard Anti-Reflective (AR) Coating
$35 co-pay (100% thereafter)
Premium AR Coating
$48 co-pay (100% thereafter)
Ultra AR Coating
$60 co-pay (100% thereafter)
N/A
$20|$40 (100% thereafter)
N/A
Scratch Protection Plan: Single Vision | Multifocal Lenses
Lenticular lenses
100%
Standard Progressive Lenses
$50 co-pay (100% thereafter)
Premium Progressives (Varilux®, etc.)
$90 co-pay (100% thereafter)
N/A
N/A
N/A
*Up to $250 (part of
$300 allowance)
*Up to $125 (part of
$300 allowance)
Up to $80
Up to $60
Up to $60
Intermediate-Vision Lenses
$30 co-pay (100% thereafter)
Not included
N/A
High-Index Lenses
$55 co-pay (100% thereafter)
Not included
N/A
Polarized Lenses
$75 co-pay (100% thereafter)
Not included
N/A
Plastic Photosensitive Lenses
$65 co-pay (100% thereafter)
Not included
N/A
Up to $130
Up to $130
Up to $100
Contact Lens Benefit (in lieu of eyeglasses)
Contact Lenses: Materials Allowance
- Evaluation, Fitting & Follow-Up Care – Standard Lens Types
100%
100%
N/A
- Evaluation, Fitting & Follow-Up Care – Specialty Lens Types
Up to $60 allowance
Up to $60 allowance
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Davis Vision Collection Contact Lenses /2 (in lieu of Allowance)
- Disposable
4 boxes/multi-packs
- Planned Replacement
2 boxes/multi-packs
- Evaluation, Fitting & Follow-up Care
1/
10
100%
Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.
Dental plan
Delta Dental of West Virginia administers the
dental benefit plan. Delta Dental has three levels of
providers; PPO, Premier and Non-participating. You
will experience the lowest out-of-pocket costs if your
dentist is in the PPO network.
Effective Jan. 1, 2016
Children can be covered on the dental plan until the
end of month in which they turn 26. If you want to add
a child, age 23-25 onto the dental plan, you will need
to select employee/child or family coverage and then
click on the box beside that child’s name.
You can use your health care spending account to pay for out-of-pocket dental expenses.
BENEFITS AND COVERED SERVICES
In-PPO Network
Out-Of-PPO Network
DIAGNOSTIC & PREVENTIVE BENEFITS
Oral examinations, routine cleanings (two per year), 100 %
X-rays, fluoride treatment, space maintainers, sealants
90 %
BASIC BENEFITS
Fillings, harmful habit appliances, 80 %
occlusal adjustments
70 %
MAJOR BENEFITS
Crowns, inlays, onlays and cast restorations 50 %
40 %
ENDODONTICS
Root canals
80 %
70 %
PERIODONTICS
Gum treatment
80 %
70 %
80 %
70 %
PROSTHODONTICS
Bridges, dentures, implant abutments 50 %
40 %
ORTHODONTIC BENEFIT - after 1 yr wait period Children only to age 19
50 %
40 %
ORTHODONTIC MAXIMUM
$ 1,500 lifetime
$ 1,000 lifetime
ANNUAL PLAN MAXIMUM
$ 1,500 lifetime
$ 1,000 lifetime
ORAL SURGERY
Incisions, excisions, surgical removal of tooth including simple extractions, additional
general anesthesia (wisdom teeth are
an exception, see below)
ADDITIONAL BENEFITS AND CAMC Physicians Group Delta Dental PPO
Non-Participating
COVERED SERVICES
Facial Surgery Center and Premier Providers
Providers
IMPLANT BENEFIT
50 %
0 %
0%
IMPLANT MAXIMUM
$1,000
per person per contract year
N/A
N/A
IMPACTIONS AND EXTRACTION
OF WISDOM TEETH
60 %
0%
80 %
Premiums listed on cost sheet on page 21.
11
Flexible spending accounts
Important things to consider before
enrolling in flexible spending
accounts:
Use it or lose it rule change:
• The new rollover feature modifies the current use-it-
or-lose-it rule.
• Up to $500 of unused funds from your current plan will be allowed to rollover into your new plan year.
• This rollover does NOT count toward your plan’s maximum annual election.
•
Youmust re-elect this benefit each year. Once you authorize deposits to either account for the year, you will not be allowed to change your elections until the next annual enrollment.
• Keep all receipts. According to the IRS, documentation must be provided when additional claim verification is needed.
• You will have until March 31 to submit receipts incurred in the previous calendar year.
• If you do not provide proper documentation as
requested to myCafeteriaPlan by March 31, the amount will be added to your pay as taxable wages.
• If you terminate employment or change to a non-
benefit eligible status, participation in the plan will cease on the effective date of your termination or status change. However, claims for expenses incurred up to the termination date may be submitted up to 60 days following the termination date.
Health care spending account
Health care spending account dollars can be used to
pay for out-of-pocket medical expenses for yourself and
your dependents (children up to age 26). Examples of
eligible expenses are co-pays, deductibles, prescription
drugs, dental, orthodontia, eyeglasses and contact
lenses. A complete list of eligible expenses can be found
at mycafeteriaplan.com.
As part of the Health Care Reform legislation, nonprescription, over-the-counter medications are not
considered eligible expenses. Non-medicine over-thecounter items, such as bandages and saline solution, are
eligible expenses. The maximum contribution allowed
by the IRS is $2,500.
12
Mobile app. Now you can use your smartphone,
iPod, iPad, or Android to check your health care and
dependent care spending account balances and submit
receipts anywhere, anytime. Simply download the free
mobile app by searching for myCafeteriaPlan on-the-go
through your app store.
Dependent day care spending account
The dependent day care spending account can be used
for out-of-pocket expenses related to child care or
elder care services for your dependents. The maximum
contribution allowed by the IRS is $5,000 ($2,500 for
employees who are married but file separately).
A participant is only eligible to have a dependent day
care account if he or she pays dependent day care
expenses in order to be able to work. If married, the
participant’s spouse must also work, go to school full
time, or be incapable of self-care.
The IRS does require that you meet certain
criteria to be eligible to participate in the
dependent care spending account. For this reason,
if you are contributing to the account and experience any of the following qualifying events and notify
human resources within 30 days of the event, you may stop your contribution.
•
•
•
•
•
•
A change in the participant’s legal married status.
A change in the participant’s number of dependents.
A change in the work schedule of the participant or the participant’s spouse.
Termination or commencement of employment of the participant’s spouse.
An unpaid leave of absence taken by either the participant or the participant’s spouse.
A change in dependent day care provider.
Health Savings Account &
Limited Flexible Spending Account
You will not see the health savings account or limited
flexible spending account as options on the annual
enrollment screens in Lawson self service.
If you elect the high deductible health plan, you will
be sent additional information regarding the health
savings account and limited flexible spending account
options. You will be given the opportunity to elect
these benefits at that time.
What is an HSA?
An HSA is a special bank account owned by an
individual where contributions to the account are used
to pay for current and future medical expenses or
specifically, to offset the deductible of High Deductible
Health plans. Your contributions are made on a pre-tax
basis, the funds are portable and the balance rolls over
from year to year.
In order to be eligible to participate in
CAMC’s HSA:
1. You MUST BE ENROLLED IN CAMC’S High Deductible Health Plan
2. You cannot be enrolled in any medical plan other than a HDHP and an HSA, including a Flexible Spending Account. *you can be enrolled in a Limited Flexible Spending Account
3. You cannot be enrolled in Medicare
4. You cannot be claimed as a dependent on anyone’s taxes
5. You are at least 20 years old and not a full time student
After enrolling in CAMC’s HSA, CAMC will deposit $200
in your HSA if you have an Employee Only medical
plan; or $400 if you have either Employee + Child,
Employee + Spouse, or Family coverage.
How does the HSA work?
Your HSA works like a regular savings account at a
bank. You can deposit money into your HSA through
direct deposit, pre-tax deductions, or family and friends
can make post-tax contributions on your behalf. If
you are on the employee only HDHP, you can deposit
$3,350 per year and if you’re on the Employee +
Spouse, Child(ren), or Family HDHP, you can deposit up
to $6,750 per year.
How can I spend it?
Eligible expenses include medical, dental and vision
expenses with a date of service after your HSA is
active. You can pay for any medical expenses for your
spouse or your tax dependent children even if they are
not enrolled in your plan and/or have other insurance
coverage. Usage is limited to available funds.
What if my spouse has an HSA?
Your combined annual contributions cannot exceed
$6,750. Additionally, you must have separate accounts.
If your spouse has an HSA and you would like to
contribute to an HSA as well, you must have a separate
account. The maximum amount you can contribute is
based on health insurance coverage levels.
Are there any fees associated with the
HSA?
There is an administrative fee of $2.50 per month
per account. This monthly fee will be deducted from
participants’ accounts.
For more information regarding the HSA, you can visit
myCafeteriaPlan.com
Limited Flexible Spending Account
What is a Limited Flexible Spending
Account?
A limited Flexible Spending Account is a spending
account that covers expenses for vision and dental only.
However, once a participant hits the high deductible,
the limited FSA can then be used for medical expenses.
Why is a Limited Flexible Spending
Account necessary?
Due to strict HSA eligibility rules, a HSA participant
can elect a limited Flexible Spending Account, but not
a regular Flexible Spending Account. The limited FSA
is an additional way to put pre-tax savings away for
dental and vision expenses without having to use your
HSA money which continues from year to year.
For more information regarding the Limited Flexible
Spending Account, you can visit myCafeteriaPlan.com.
13
Life insurance
Life insurance gives you the opportunity to protect
your family’s dreams, ambitions and finances, should an
unexpected death occur. The employee and dependent
life insurance plans are fully insured and administered
by Lincoln Financial Group. Your employer provides
all eligible employees term life insurance at one times
their annual salary (up to $50,000) at no cost to the
employee. Employees may choose to elect additional
coverage for themselves and their family members.
Supplemental term life insurance
Employees may purchase additional coverage of one,
two, three or four times their annual salary (maximum
of $600,000). First time election at annual enrollment
of one or two times your salary does not require
evidence of insurability. First time election of coverage
greater than $450,000 or increasing coverage by
more than two levels will require completion of the
evidence of insurability form and approval from Lincoln
Financial Group. Must be enrolled in employee
supplemental term life in order to elect spouse or
child life.
Spouse term life
Employee may purchase term life insurance on their
spouse. Coverage amounts are $10,000, $20,000,
$30,000 or $50,000. First time election of $50,000,
or increasing coverage by more than two levels will
require completion of the evidence of insurability form
and approval from Lincoln Financial Group.
Child term life insurance
Employees may purchase term life insurance on their
child(ren) up to age 26. Coverage amounts are $3,000,
$5,000, $10,000, $15,000 or $20,000.
14
Accidental death and dismemberment
Employees may purchase for themselves and their
family (children up to age 26) in $10,000 increments up
to a maximum of 10 times the employee’s annual salary
(maximum $500,000)
Evidence of insurability
Lincoln Financial Group requires that you complete an
evidence of insurability form to determine if elected
coverage is approved. The evidence of insurability form
is only required for the following reasons:
• Increasing or adding coverage by more than two levels for employee supplemental term life or spouse term life
• First time election greater than $450,000 coverage for employee supplemental term life
• First time election of $50,000 for spouse term life
If any of these apply to you, complete the evidence of
insurability form online at Lincoln4benefits.com no
later than Jan. 31, 2016. You can find a link to this form
through the benefits site on CAMnet.
Read this carefully if you are enrolling for the
first time.
Short-term disability benefits (STD)
Effective date – change effective
Jan. 1, 2016
STD will become effective the first of the month
following 90 days of employment in a benefit
eligible status. You must be actively working on the
effective date of coverage, otherwise your benefit
will be effective when you return to work. If you are
currently in a one year wait period, your benefit
will start Jan. 1, 2016 provided you elect the
benefit during annual enrollment.
Short-term disability (STD) insurance is designed to pay a
benefit to you in the event you cannot work because of
a covered illness or injury. This benefit replaces a portion
of your income, thus helping you to meet your financial
commitments in a time of need. STD is fully insured and
administered by Lincoln Financial Group .
Benefit amount
n 60% of your base earnings. Available to all eligible employees.
n 75% of your base earnings. Available to employees who became benefit eligible prior to Oct. 1, 2006.
Benefit waiting period
Payments will begin after a waiting period of seven (7)
consecutive days. During the wait period, you must use
40 hours PTO or Unused Sick Bank if available. PPTO
days may be used only if available and requested by the
employee.
Benefit period
Benefits may continue during disability up to 90 days.
Your weekly benefit is based on your employment
status, i.e. full-time and pro-rata 5 through 9. The plan
maximum weekly benefit is $2,350.
Late enrollment penalty
Employees who enroll in short-term disability for the first
time during annual enrollment will be subject to a 60-day
wait period penalty for the first 12 months of coverage.
After one year of continuous coverage under the plan,
the late enrollment penalty will not apply as long as you
remain enrolled in the plan. Any claim filed as a result of
accidental injury are excluded from this penalty.
Filing a claim
To file a claim, contact Lincoln Financial Group’s claim
intake service center 1-866-783-2255 between 8 a.m.
and 8 p.m. EST Monday through Thursday and 8 a.m. to
6 p.m. EST on Fridays. You will be asked to provide the
following information (in addition to other questions
about your absence):
• Employer Name and/or Group Number: CAMC group # 000010179739
• Name, Social Security number and date of birth
• Address and phone number
• Doctor’s name, address, phone number and fax number
• Your occupation and the last day you worked
• Your condition or diagnosis
Important Information
• Disability pay will be based on your hourly rate in effect on your last day at work. Any changes in your rate while on disability will not affect your disability earnings.
• You will be responsible for maintaining your benefit premiums by paying benefits by check to the Benefits department.
• All other benefits, critical illness, cancer and whole life
insurance must also be maintained by contacting the vendors directly to discuss payment options.
•
Lincoln Financial Group does not automatically withhold income taxes. If you want income taxes withheld, you must complete a W-4 and a State Tax
withholding form. You can find forms on CAMnet or request them from Lincoln Financial Group.
• Retirement Loans: If you have a retirement loan, contact Sonja Putnam at (304) 388-7555 to discuss your options while off on disability.
15
Long-term disability benefits (LTD)
Effective date – change effective
Jan. 1, 2016
LTD will become effective the first of the month
following 90 days of employment in a benefit
eligible status. You must be actively working on the
effective date of coverage, otherwise your benefit
will be effective when you return to work. If you are
currently in a one year wait period, your benefit
will start Jan. 1, 2016 provided you elect to
continue the benefit during annual enrollment.
Long-term disability is fully insured and administered by
Lincoln Financial Group.
Benefit amount
n 60% of your base earnings.
Elimination period
Evidence of insurability
Lincoln Financial Group will determine if coverage is
approved or denied.
If you are enrolling in long-term disability for the
first time during annual enrollment, you need
to complete the Evidence of Insurability form
online at lincoln4benefits.com no later than Jan.
31, 2016. You can also find a link to this form
through the benefits site on CAMnet.
Medical Underwriting
Lincoln Financial Group
PO Box 21008
Greensboro NC 27420-1008
What happens if you don’t complete and
return the form?
90 consecutive calendar days of total disability.
If electing for the first time you will not have coverage.
Benefit period
You will need the following information to
complete the Evidence of Insurability form.
LTD benefits continue as long as you remain totally
disabled from any occupation up to age 65 or older
if certain guidelines are met. It is the employee’s
responsibility to provide Lincoln Financial Group with all
required information in order to receive LTD benefits.
Coordination of coverage
LTD income is coordinated with other income including
Social Security disability.
Continuation of benefits
If you are approved for LTD, you may continue your
benefits for up to 12 months, provided you continue
to make the required monthly contributions. At the
end of 12 months, employment will be terminated and
COBRA coverage for benefits will be offered. COBRA
benefits include health, pharmacy, vision, dental and
flexible spending accounts.
16
• Group Number: CAMC
• Group Policy #: 000010179739
PTO (paid time off)
Your Paid Time Off (PTO) plan is designed to recognize
the diverse needs of employees in regards to time
off from work. PTO is inclusive of hours for sick
days, vacation time, holidays, bereavement (beyond
bereavement policy), doctor appointments and other
personal time off from work.
PTO Accrual Schedule
Regular full-time
Years of Service
Days accrued per year
Hours per pay (26)
0-4 216.46
5-9
26
8.00
10-14
28
8.62
15-19
29
8.92
20+
30
9.23
Regular Part-time; Prorata 50-60-70%
Years of Service
Days accrued per year
Hours per pay (26)
0-10
11+
5
10
1.54
3.08
Prorata 80%
Years of Service
Days accrued per year
Hours per pay (26)
0-4
17
5.23
5-9
21
6.46
10-14
22
6.77
15-19
23
7.08
20+
24
7.38
Prorata 90%
Years of Service
Days accrued per year
Hours per pay (26)
0-4
19
5.85
5-9
24
7.38
10-14
25
7.69
15-19
26
8.00
20+
27
8.31
Managers (Designated Administrative Employees-status 21)
Years of Service
Days accrued per year
Hours per pay (26)
0-4
26
8.00
5-9
30
9.23
10-19
33
10.15
20+
35
10.77
PTO cash-in
Eligible employees may cash in a portion of the PTO
time which will be accrued during the upcoming
calendar year. The cash-in will be paid at the base pay
rate in effect at the time the payout occurs.
Criteria to participate:
• A balance of at least 80 PTO hours on Oct. 10, 2015.
• No attendance disciplines within one year prior to Oct. 10, 2015.
•
Employees may cash in a minimum of 16 hours. Full-time, pro-rata 8 and 9 employees may cash in a maximum of 40 hours and part-time, pro-rata 5, 6, and 7 may cash in a maximum of 30 hours.
Employees who are at max may make a conditional
election; however, they must accrue the number of
hours elected by the payout date the following year.
The number of hours elected will be set aside in a
separate PTO plan to ensure that these hours are
available for payout as elected. The 2016 payout is
scheduled to be paid out on Oct. 14, 2016 as part of the
employee’s regular paycheck.
PTO cash-in is an annual benefit that does not
roll over, therefore, you must elect this benefit
each year.
17
Purchased paid time off (PPTO)
Each year during annual enrollment, eligible employees
have the option to purchase additional time off
through the Purchased Paid Time Off plan. Below are
a few key points employees should keep in mind when
electing to purchase additional days off:
n The 2016 PPTO will be available to use from 12/20/2015 through 11/19/2016.
n PPTO is a no-risk plan in which the employee pays
100% of the premium. This means that every dollar paid in will be paid out either when you
use PPTO or when remaining balances are paid out to you at the end of the year.
PPTO is an annual benefit that does not roll
over, therefore, you must elect this benefit
each year.
n The 2016 PPTO payout is scheduled to be paid on Dec. 9, 2016 as part of the employee’s regular paycheck.
n The premium is calculated on the number of hours
elected and at 104% of your base rate. The premium is withheld over the first 24 pay periods of the year.
n If you terminate employment or change to a non-
PPTO eligible status prior to the 24th pay period
of the year and you have used more hours than you have paid into the plan, you will owe the difference between what you have paid into the plan and the total you used for the year.
Annual purchased days of PTO available based on an eight-hour work day
Employee status
0-8 years of service
9-18 years of service
19+ years of service
Regular full-time
5 days per year
10 days per year
15 days per year
Pro-rata 9 (72-79 hours)
5 days per year
9 days per year
14 days per year
Pro-rata 8 (64-71 hours)
4 days per year
8 days per year
12 days per year
Pro-rata 7 (56-63 hours)
4 days per year
7 days per year
11 days per year
Pro-rata 6 (48-55 hours)
3 days per year
6 days per year
9 days per year
Pro-rata 5 (40-47 hours)/ Part-time
3 days per year
5 days per year
8 days per year
18
Retirement – CAMC Health System 401(k) Plan
Don’t fool yourself into thinking you can’t save for your
future. Your workplace savings plan helps make it easy,
convenient and affordable to accumulate the money
you need for retirement. Your benefit at retirement
depends on how much you contribute, your employer’s
matching contributions and the results from the
investments you select.
Take these easy steps to ensure your
future today:
Enroll
The 401(k) Plan allows you to contribute pretax
contributions through payroll deductions. If you are not
enrolled in the CAMC Plan, enroll today at netbenefits.
com/camc and select Enroll Now or call 1-800-343-0860.
If you do not actively choose an investment option(s),
your contribution will be defaulted to a JPMorgan
SmartRetirement Institutional Class Shares Fund that has a
target retirement date closest to the year you might retire
based on your current age and assuming a retirement
age of 65. However, we encourage you to take an active
role in the Plan and choose investment options that are
appropriate for you. To learn more about investment
options available, see Investment Options & Plan Basics
at netbenefits.com/camc. Through payroll deduction,
you may contribute up to 100% of your eligible pay on a
pretax basis, up to the IRS dollar limits.
Increase your Contribution
Most experts recommend a contribution rate of 10
to 15% annually to reach retirement goals. Increase
your contribution percentage at any time by logging
on to netbenefits.com/camc , under quick links drop
down, choose Contribution Amount. Having trouble
remembering to increase your percentage? Sign up for
the Annual Increase Program to automatically increase
your contribution each year. Click Annual Increase
Program to choose the increase percent and the date of
the increase!
Catch-up Contributions
If you have reached age 50 or will reach 50 during
the calendar year and are making the maximum
IRS pretax contribution ($18,000 for 2015) you may
make an additional “catch-up” contribution ($6,000
for 2015). The IRS annual limits are subject to cost of
living adjustments. Contact the Benefits Department
at (304) 388-7555 if you are electing the “catch-up”
contribution for the first time.
Beneficiaries
Your beneficiary or beneficiaries will inherit your
account in the event of your death. Designate
your beneficiary when you enroll, and update the
information if you experience a life-changing event
such as marriage, divorce, death, etc. Fidelity’s Online
Beneficiaries Service, available through NetBenefits
offers a quick and convenient process. Simply click on
“Beneficiaries” in the “About You” section of Your
Profile on NetBenefits. You may also download the
form from the Benefits webpage on CAMNet under
401(k), complete and send to Fidelity Investments.
Stay on Track
Manage your account by using the tools on NetBenefits.
Fidelity Workplace Planning & Guidance Consultants
provide free one-on-one guidance for participants.
Schedule an in-person or phone consultation at fidelity.
com/atwork/reservations. Visit the Benefits web page on
CAMNet for the on-site consultation schedule.
On the go? The NetBenefits® apps give you access to
your Fidelity workplace accounts, anytime, anywhere,
right on your mobile device.
Download your FREE NetBenefits mobile app today.
Visit the App StoreSM (iPod touch®/ iPhone® and iPad®),
Google PlayTM Store or browse NetBenefits.com on the
mobile Web.
Education
Financial Basics – fidelity.com/backtobasics.com
Let’s get down to basics
To build a solid financial foundation, a good first
step is starting with the basics. From budgeting and
debt management to reducing health care costs and
understanding Social Security, we can help to break
it all down – and provide next steps to help you get,
and stay, on track. Visit fidelity.com/backtobasics to
get started. You’ll find tips and resources in multiple
formats – from videos and graphics to articles. If you
have questions after navigating the site, or would like
to partner on a strategy specific to your situation, talk
with a Fidelity representative at 1-866-630-9720 to
help you get started.
It’s never too early to start planning for your financial
future. But where do you begin? At Fidelity’s e-Learning
site on Fidelity NetBenefits® you will find workshops
that provide the education you may need to help you
reach your retirement goals. Visit Fidelity e-Learning®
today! The workshops are entirely self-directed, so
you can learn at any time and proceed at your own
pace. And it’s web based, so you can access it from
any computer that has an Internet connection. The
workshops cover a variety of subjects to help you plan
your financial future.
19
Other benefits
Free Parking – Parking facilities are provided
on company property for the convenience of all
employees.
CAMC Federal Credit Union – Credit Union
membership offers employees access to a full range of
financial products and services.
CAMC Pharmacy – The company provides a pharmacy
at CAMC Memorial Hospital, CAMC Cancer Center and
Urgent Care Cross Lanes for all CAMC employees. Your
out-of-pocket costs are less than at a retail pharmacy.
Pride Card - CAMC has established relationships
with external local and national vendors to give our
employees discounts on many products and services
including the following discounts to name a few:
• Sprint - 23% monthly service discount
• Dell – special pricing on select products
• Charleston and Teays YMCA – Membership fee waived
• Uniforms Plus – 20% discount
Employee Health Services – The company provides
all employees access to employee health services
which include employment physicals, immunizations,
and treatment of illness or injury at no cost to the
employee.
My Health Wellness Program – CAMC’s Wellness
Program has been recognized as a Fit Friendly
Worksite Gold Achievement from the American Health
Association and has received the National Excellence
in Worksite Wellness Award. It is a voluntary program
open to all employees that offers a choice of rewards
including medical premium discounts, membership
discount at CAMC Nautilus, activities and events, classes
and more.
Employee Emergency Fund
A few cents is all it takes to help each other. Together,
through the CAMC Employee Emergency Fund, we
have the power to make a difference for fellow
employees when the unexpected happens. Since the
program’s inception in 2001, the CAMC Foundation
has awarded more than $800,000 to 1,262 employees
who experienced financial hardship during personal
emergencies such as:
•
•
•
•
20
Replacement of personal items due to theft, flood, fire or other disaster
Dangerous living conditions
Family bereavement
Medical expenses
You don’t know when the unexpected might
happen, and this fund is there to help! For
more information, call (304) 388-9860 or email
camcfoundation@camc.org.
CAMC Family Resource Center
We understand that life can be complicated, that’s
why we are here to help you with issues that hit
close to home. Our staff is trained to help you and
your family deal with parenting, relationships, same
gender concerns, loss and crisis, depression, anxiety,
substance abuse issues, obesity, women’s issues,
infertility, adjustment to chronic illness or pain, and
specialized testing for children- all in the comfort of
a safe and confidential environment. Call the FRC at
(304) 388-2545.
Employee Assistance Program
As an employee of CAMC, you have a wonderful
benefit known as the Employee Assistance Program.
This program offers four, free counseling sessions per
person, per issue, per year. To learn more about this
FREE benefit, please call the Family Resource Center
and ask for the intake coordinator, or contact ComPsych
directly at 1-888-628-4824 for prior authorization.
CAMC PatientLink - Your information on your
time.
CAMC PatientLink is a secure patient portal that allows
you 24/7 access to information about your care at
CAMC. It’s a convenient way to manage your health
information on your own time.
You’ll be able to see test results and other documents
related to your health care more quickly, instead of
waiting on a call from your doctor’s office. Many test
results will be available within 36 hours of testing.
If you’ve been an inpatient, your visit summary and
discharge information will also be available.
Available results include:
• Lab tests
• Imaging reports
• Continuity of care/discharge summary documents (inpatient)
• Patient Plan (select CAMC Physicians Group practices)
Learn more and sign up at camc.org/patientlink.
2016 benefit cost worksheet
This worksheet is for calculation purposes only. To make benefit elections, you must enroll
through Lawson Self Service between Oct. 19 and 5 p.m. on Nov. 9, 2015.
Annual salary calculation : _____________ X ____________ = _______________
hourly rate
status hours
annual salary
Status hours: full-time =2080; pro-rata 9=1872; pro rata 8=1664; pro rata 7=1456;
pro-rata 6=1248 pro rata 5 and part-time regular=1040
PPO Plan (Medical and Prescription Drug)
HDHP (Medical and Prescription Drug)
$ 66.00 PPO plan employee
$ 31.00 HDHP plan employee
$138.00 PPO plan employee + child(ren)
$ 79.50 HDHP plan employee + child(ren)
$194.00 PPO plan employee + spouse
$130.00 HDHP plan employee + spouse
$218.00 PPO plan family
$159.00 HDHP plan family
Premiums do not include $25 tobacco surcharge. Add if applicable.
Employee Vision Plan (includes exam and materials)
$1.00 Employee only
$2.27
Employee + child(ren)
$2.02
Employee + spouse
$5.05Family
Dental Plan
$9.75
Employee
$18.75 Employee + spouse
$19.25 Employee + child(ren)
$27.75 Family
Purchased Paid Time Off (PPTO)
1.04 x hourly rate x number of hours purchased ÷ 24
Short-Term Disability
60% Plan - Annual salary x .0053 = _________ ÷ 24 pay periods
75% Plan* - Annual salary x .0094 = _________ ÷ 24 pay periods
*(Must have become benefit eligible prior to Oct. 1, 2006 to be eligible for 75%)
Long-Term Disability
Annual salary x .003 = _______ ÷ 24 pay periods
Health Care Spending Account
Annual Contribution ÷ 24 pay periods
Dependent Day Care Spending Account
Annual Contribution ÷ 24 pay periods
Employee Term Life Insurance
You may purchase additional life insurance in the amount of 1, 2, 3 or 4 times your
annual salary.
Annual Salary x _________ = _________ round up_______÷ 1,000 x ________ = ________
(1, 2, 3 or 4) (next $1,000) (age bracket cost)
Cost by Age Bracket 29 under
.02 45 – 49
.085
30 – 34
.025
50 – 54
.140
35 – 39
.035
55 – 59
.215
40 – 44
.055
60 – 65
.265
Spouse Term Life Insurance $0.40 ($10,000) $0.80 ($20,000) $1.20 ($30,000)
(must have employee term life)
$2.00 ($50,000)
Child Term Life Insurance $0.29 ($3,000) $0.50 ($5,000) $1.00 ($10,000) (must have employee term life)
$1.50 ($15,000) $2.00 ($20,000)
Accidental Death & Dismemberment
$0.13 per $10,000 – Employee only
Desired coverage ÷ 10,000 x .13 =
$0.20 per $10,000 – Family
Desired coverage ÷ 10,000 x .20 =
TOTAL BENEFIT COST PER PAY PERIOD:
My Cost
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_____________
$_____________
21
Important contact information
PLAN
Medical Plan
24-Hour Nurse Line
Wellness
Disease Management
Prescription Drug Plan
ADMINISTRATOR
PHONE NUMBER
WEB ADDRESS
Highmark Blue
Cross Blue Shield
Customer service 1-877-770-6991
24-hr. Nurse Line 1-888-258-3428
mybenefitshome.com
Vision Plan
Davis Vision
Dental
Customer service 1-800-999-5431
Network providers 1-877-923-2847
memberhelp@davisvision.com • code 2422
Delta Dental
1-800-932-0783
(Group 1022)
Short-Term Disability
1-866-783-2255
and
Lincoln Financial Group
(8 a.m. to 8 p.m. Monday through Thursday
Long-Term Disability
8 a.m. to 6 p.m. Friday
davisvision.com
deltadentalins.com
lincoln4benefits.com
Employee Assistance
Lincoln Financial Group
1-888-628-4824
eapadvantage.com
Program
Employee Connect
Term Life Insurance 1-866-783-2255
(8 a.m. to 8 p.m. Monday through Thursday
lincoln4benefits.com
Lincoln Financial Group
8 a.m. to 6 p.m. Friday
www.lfg.com
Life Insurance Claims 1-800-487-1485
Life Keys: 1-855-891-3684
Travel Connect: 1-800-527-0218
Flexible Spending AccountsmyCafeteriaPlan
1-800-865-6543
mycafeteriaplan.com
401K/RetirementFidelity 1-800-343-0860
fidelity.com/atwork
COBRA
Business Plans, Inc.
1-800-865-4485
CAMC Benefits Department
(304) 388-7555
Exchange and
Medicaid enrollment
(304) 388-3913
1-888-779-7076
Voluntary Benefits
Lincoln
Critical Illness
Whole Life
1-800-423-2765
Voluntary Benefits
Unum
Old Critical Illness
Old Cancer Insurance
New Accidental Insurance
1-800-635-5597
CAMC Financial Counselor
mycobraplan.com
For all other benefit related questions, please contact your human resources associate or the benefits
department directly.
Benefits Department...............................................................(304) 388-7555
Human Resources - General Hospital....................................(304) 388-7638
Human Resources - Memorial Hospital.................................(304) 388-5400
Human Resources - Women and Children’s Hospital..........(304) 388-2287
Human Resources - Teays Valley Hospital.............................(304) 757-1891
This booklet is a summary of the benefit plans effective Jan. 1, 2016 and does not cover all provisions, limitations and exclusions. Your summary plan
descriptions (SPDs), summaries of material modifications (SMMs) and summary of benefits insert (SOBI) for each plan can be found on the benefits
website. In addition, you can access forms, links to providers, and other important details related to your benefit portfolio. From CAMnet, click on
the benefits link.
22
Beneficiary form
Policyholder - CAMC Health System, Inc
Policy Number – CAMC
Beneficiary Designation for CAMC Life Insurance
Unless otherwise noted below by the employee, the person(s) named below as beneficiary will be
considered beneficiary for all CAMC benefits with the exception of Retirement Funds. Additionally, unless
otherwise noted in the “%” column, if two or more beneficiaries are named, the proceeds will be paid in
equal shares to the named beneficiaries surviving the insured. The beneficiary designation can be
changed at any time. If you are married and/or divorced, you should consult with your legal counsel prior
to changing your beneficiary. The designation takes effect as the date the completed form is received and
accepted by your employer. Lincoln Financial Group is the underwriter for the following
coverage: Life, Long Term Disability, and Accidental Death and Dismemberment.
Step One: Designate at least one primary beneficiary
Beneficiary
Designation
(List at least
one)
Primary
Name and Address
(Please print)
% You wish
paid to this
beneficiary
Relationship
Social
Security #
Beneficiary
Date of
Birth
Primary
Primary
Total = 100%
Step Two: Designate at least one secondary beneficiary in the event something would happen to you and your
primary beneficiary
Beneficiary
Designation
(List at least
one)
Secondary
Name and Address
(Please print)
% You wish
paid to this
beneficiary
Relationship
Social
Security #
Beneficiary
Date of
Birth
Secondary
Total = 100%
I have been given the opportunity to enroll in CAMC’s Group LTD, Supplemental Life Insurance & Voluntary
AD&D plans. I understand that if I decline now, but later decide to enroll, I will be required to provide
evidence of good health that is satisfactory to Lincoln Financial Group and understand my
request for coverage may be declined. I authorize my employer to make the appropriate payroll
deductions from my wages. I am not now disabled and I am performing all the duties of my occupation
for the number of hours my employment status indicates. I understand that if there is a discrepancy
between the enrollment form and the policy, the terms of the policy apply.
Signature: ____________________________ Employee Number: ________ Date: _______
23
Telemedicine options – Local providers
Your PCP should be your first option, but if your PCP is
unavailable, try a “virtual” doctor visit:
Telemedicine service
• Doctor staffed 24/7
• Limited services
• Minor illnesses (cold, flu, sinus infection, UTI, sore throat, pink eye, headache)
• Online registration
• No appointment
Telemedicine co-pay $30.00
It’s as Easy as 1-2-3
1.Request a consult via web or app
-amwell.com
-doctorondemand.com
-dermatologistoncall.com
•Register/create a profile
- Medical history
-Medications
-Allergies
•Select your location
- Doctors will be licensed in the state in which the patient is located
2.Select a doctor
•For DermatologistOnCall, a doctor will reply within 72 hours
3.See the doctor
24
your
Enrollment dates Oct. 19 – Nov. 9, 2015
30224-H15
Benefit
Portfolio
2016