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2014 Open Enrollment:October 21 – November 10,2013You must actively make benefit elections duringOpen Enrollment. If you do not enroll, you willreceive default coverage, which may not suit yourneeds — and for which you will have to pay.Because you will not be able to change your 2014coverage until the 2015 Open Enrollment period(unless you have a qualifying family statuschange event), you should carefully considerwhether you want default coverage or would liketo elect other available options. For details ondefault coverage, see the “How to Enroll for Your2014 Benefits” section of this guide.Employees hired during and after the OpenEnrollment period will be given detailedinstructions from Human Resources about how toenroll for benefits. These details will be providedduring the enterprise employee orientationprogram.Enrolling for2014Benefits DuringIf you are hired during 2014, you may enroll forcoverage within the first 30 days from your hiredate.If you do not make benefit elections, you willreceive default coverage, which may not suit yourneeds — and for which you may have to pay. Youshould carefully consider whether you want thedefault coverage. If you do not want defaultcoverage, you must make your benefit electionsduring your enrollment period.After your new hire benefits enrollment periodhas ended, you will not be able to change your2014 coverage until the 2015 Open Enrollmentperiod (unless you have a qualifying family statuschange event).When Benefits BeginThe benefits you select during Open Enrollmentwill be effective on January 1, 2014.If you are a new hire enrolling for coverage onyour date of employment, your health and dentalcoverage will begin the first of the followingmonth or on your hire date; all other benefitsbegin your date of hire. Note that both ShortTerm and Long Term Disability benefits areeffective after you complete one year and a day ofservice with GRMC.Changing Your Benefits Duringthe YearDuring each Open Enrollment period at GRMC,you make benefit choices for the following year.Your benefit elections become effective January 1and continue through December 31. The InternalRevenue Code strictly limits the circumstancesunder which you may make election changesoutside the Open Enrollment period for mostbenefit plans.You may make certain election changes for thecurrent year if you have a “qualifying familystatus change event” and you contact Benefits,Human Resources within 30 days of the event toestablish, change or delete any employeeinsurance.Your benefit changes must be consistent withyour family status change. You also may makechanges to current-year elections during “specialenrollment” periods mandated by the HealthInsurance Portability and Accountability Act of1996 (HIPAA).Qualified family status events include:Change in your marital statusBirth or adoption of a childDeath of a covered dependentChange in employment status for you or yourspouseA covered dependent losing eligibility statusAn unpaid leave of absence9

2014 BENEFITS SUMMARYCoverage for GRMC CouplesIf both legally married husband and wife areGRMC employees, they cannot be “doublecovered” under GRMC medical, dental, life andvision benefits.Spouses choose either to enroll separately formedical, dental and/or vision coverage, or tohave one spouse cover the other as adependent.Spouses cannot elect Spousal Life coverage.Only one spouse may enroll for Familycoverage.Both spouses make their own elections forflexible spending accounts as well as dental,vision, short term disability, long termdisability and life insurance coverage.Spouses should make sure they do notcontribute too much money to the healthsavings account and/ or flexible savingsaccounts. Federal penalties apply if youexceed annual maximums.IRS rules governing health savings accountsand flexible spending accounts can be foundin Publication 969 on www.irs.gov.If your coverage ends, you and/or yourdependents may be entitled to a temporaryextension of your Health Benefits Plan coverageunder the Consolidated Omnibus BudgetReconciliation Act (COBRA). You will be notifiedabout your continuation rights and you will begiven a Certificate of Creditable Coverageaccording to the Health Insurance Portability andAccountability Act of 1996 (HIPAA). Thiscertificate outlines the period for which you werecoveredunderamedical/prescriptiondrug/dental plan with GRMC.Waiving CoverageTo decline health care coverage for 2014, youmust provide proof that you have current healthcoverage elsewhere. You will be asked to providethe insurance company information, policynumber and type of coverage when you areenrolling online during Open Enrollment. If youcannot provide this information, you will not beallowed to waive coverage. Instead, you will begiven default coverage, which may not be the bestoption for you, and for which you must pay.When Coverage EndsBenefits coverage for you and your enrolledfamily members may continue as long as you areemployed by GRMC and meet eligibilityrequirements. Coverage ends if your employmentends, if you no longer meet eligibilityrequirements, if the Group Plan ceases, or if youfail to make any required contribution toward thecost of your coverage. In any case, your coverageends with the period covered by your lastcontribution.Your dependent child is no longer eligible whenhe or she reaches age 26. Coverage of anunmarried, handicapped child over age 26 ends ifhe or she is found to be no longer totally orpermanently disabled. Coverage for your spouseends on the date of divorce or death.Your dependent’s coverage under the Plan ends ifhe or she becomes eligible for coverage under thePlan as an employee.10

2014 BENEFITS SUMMARYYour Medical OptionsGRMC is offering three medical plans for 2014: Medical Choice Plan — A consumer-driven health care plan with a Health Savings Account (HSA)Medical Select Plan — A Preferred Provider Organization Option (PPO)Medical Base Plan – A Preferred Provider Organization Option (PPO)/Default PlanWith these plans, you generally save money when you use in-network providers. You are responsible for acopay or coinsurance when you visit an in-network doctor, and the plan pays the rest of the cost once youhave satisfied the deductible, if applicable. If you visit a UHC network, the plan pays a percentage of theeligible charge, and you pay the rest after a deductible is applied. In 2014, there will be no out of networkprovider option, unless for emergency events.Domestic network physicians can be found ages/Medical%20Center/Medical.aspxUHC network physicians can be found at:http://www.umr.com/oss/cms/UMR/home/Find a Provider.html. Click the link under ‘Medical’.If you require select services that are not available within our GRMC Domestic network, you must firstrequest approval from Benefits, Human Resources in advance of the date of service. Without this advanceapproval, this service will not be considered in-network.Enrollment will be effective on January 1, 2014 if you enroll during the Open Enrollment period.NEW in 2014:A 100 per month additional premium may be applied to all plans where spouses are covered. In 2014,GRMC will apply a spousal surcharge for those spouses who have the ability to obtain group healthcoverage through their own employer, but prefer to stay on a GRMC health plan.Your Pharmacy BenefitsWe are excited to see plan pharmacy costs decreasing based on the establishment of an in-houseemployee pharmacy.Going through the Employee Pharmacy will continue being the lowest cost point of sale available to you!Employees will be able to enjoy the benefits of having quality customer service, dedicated pharmacists,reduced costs, and, convenience.Although mail order isn’t available, members may obtain 90 day scripts from the Employee Pharmacy.Health plan members can obtain prescription orders without the requirement of mail order services.Members will also be able to use the in-house pharmacy or go through retail; however, we do encouragethe use of our in-house pharmacy to reduce your out of pocket costs as well as overall plan costs.The maximum cost to fill a prescription for members of the Select PPO plan and Base PPO plan willbe 450 per fill at retail pharmacies.There is no maximum cost per fill for members of the Choice Plan (HDHP).11

2014 BENEFITS SUMMARYDeductibles and Co-PaysoSelect and Base plan members will not be required to meet a medical deductible formedications, nor will copays apply to out-of-pocket maximums.oChoice plan members will only be required to meet a medical deductible for non-preventivemedications. Copays will apply toward medical deductible/out-of-pocket maximums onpreventive, but will only apply to out-of-pocket maximums on non-preventive.Specialty medications must be ordered through the Employee Pharmacy.When you enroll in a GRMC-sponsored medical plan, you automatically receive prescription drug benefitsthrough your pharmacy benefit manager. The type of prescription drug benefit you receive is determinedby your medical plan and cannot be changed.You may use any pharmacy, but we encourage use of our employee pharmacy to save you time and money.Drug TiersPrescription drugs costs are based on their tier.There are three tiers. Generally:Generic drugs are chemically the same or similar totheir brand name versions — and less costly.Formulary drugs are brand name drugs that are onyour pharmacy benefit manager’s list of preferreddrugs.Non-formulary drugs are the most costly drug tierbecause they are not on your pharmacy benefitmanager’s list of preferred drugs.FormularyA formulary is a list of preferreddrugs that are covered by the plan.Drugs on this list are lessexpensive than non-formularydrugs, but more expensive thangenerics.GenericsGeneric drugs are typically as effective as brand name drugs because they contain the same activeingredients. Like brand name drugs, they are manufactured according to standards and carry the approvalof the Food and Drug Administration (FDA) for safety and effectiveness. Because generics are usually lesscostly than their brand name versions, using generic drugs will save you money.Your Pharmacy CostsIn-Network ProviderEmployee PharmacyDaysSupplyTier 1Tier 2Tier 3SpecialtyOut-of-Network ProviderEmployee Pharmacy30 day supply / 90 day supply 30 day supply / 90 day supply 5 / 10 10 / 20 10 / 20 20 / 40 15 / 30 30 / 60 30 (30 day supply) 60 (30 day supply)Retail Pharmacy30 day supply 20 35% to a max of 450 20 50% to a max of 450Must fill at GRMC EmployeePharmacyMust fill at GRMC EmployeePharmacy12

2014 BENEFITS SUMMARY2014 Medical Plans at a GlanceAll dollar amounts and percentages reflect employee responsibility.Medical Plan FeaturesMedical Select Plan (PPO)In Network/UHC Network/OONMedical Choice Plan(HDHP with HSA)Medical Base Plan(PPO) – Default PlanIn Network/UHC Network/OONIn Network/UHC Network/OONDeductible/Individual 500/ 750/Not Covered 1,500/ 2,000/Not Covered 2,000/ 4,000/Not CoveredDeductible/Family 1,000/ 1,500/Not Covered 3,000/ 4,000/Not Covered 6,000/ 8,000/Not CoveredPreventive visits (for all servicesincluding):Colonoscopies, Mammograms, WellBaby Immunizations and Bone DensityTesting coverage* 0/* 0 /Not Covered* 0/* 0/Not Covered* 0/* 0/Not CoveredOut-of-pocket max (Includesdeductible)Individual 4,000/ 6,350 /Not Covered 4,5000/ 6,000/Not Covered 6,000/ 6,350/Not CoveredFamily 8,000/ 12,700 / Not Covered 9,000/ 12,000/Not Covered 10,000/ 12,000/Not CoveredCoinsuranceOffice visitInpatient care/surgery; OutpatientSurgery (per admit/surgery)20%/45%/Not Covered* 30/45%/Not Covered20%/30%/Not Covered20%/30%/Not Covered35%/50%/Not Covered20%/45%/Not Covered20%/30%/Not CoveredOutpatient lab/X-ray/non-hospital testsLabor & Delivery Observation Stay &any related after hours injectionsEmergency room*0%/45%/Not Covered20%/30%/Not Covered* 125/45%/Not Covered* 125/* 125/* 12520%/30%/Not Covered20%/20%/20%Urgent CareConvenience CareAmbulance ServicesRehabilitation serviceNA/* 75/Not CoveredNA/ 5020%/20%/20%* 30/45%/Not Covered20%/30%/Not CoveredNA/30%/Not Covered20%/20%/20%20%/30%/Not Covered35%/50%/Not CoveredNA/50%/Not Covered35%/35%/35%35%/50%/Not CoveredAcupuncture / Acupuncture Therapy* 30/NA/NA20%/NA/NA35%/NA/NA35%/50%/Not Covered35%/50%/Not Covered35%/50%/Not Covered35%/50%/Not Covered35%/35%/35%Nursing Services Home health (100 visitlimit), hospice, private duty (40 visitlimit), skilled nursing care (120 visitlimit).Genetic Counseling20%/20%/Not Covered* 30/45%/Not Covered20%/30%/Not Covered20%/30%/Not Covered35%/50%/Not Covered35%/50%/Not CoveredMental Health Care/Substance Abuse**InpatientOutpatient20%/20%/Not Covered* 0/* 0/Not Covered20%/30%/Not Covered20%/30%/Not Covered35%/50%/Not Covered35%/50%/Not CoveredIVIG Therapy/Home Infusion Therapy20%/45%/Not Covered20%/30%/Not Covered35%/50%/Not CoveredDurable Medical Equipments (Someexclusions apply)20%/45%/Not Covered20%/30%/Not Covered35%/50%/Not CoveredChiropractic (limit of 10 visits per year)20%/45%/Not Covered20%/30%/Not Covered35%/50%/Not CoveredRadiation Therapy/ ChemotherapyOutpatient Dialysis 30/45%/Not Covered20%/45%/Not Covered20%/30%/Not Covered20%/30%/Not Covered35%/50%/Not Covered35%/50%/Not Covered20%/30%/Not Covered35%/50%/Not CoveredHearing Aid (1 per ear per life)*** 20%/45%/Not CoveredDeductible does not apply.It is our intent to comply with required terms of federal regulations related to health care reform and mental health parity.Employee copayment/cost out-of-pocket for this service (in dollars) % Employee coinsurance payment (% of total cost of this service)13

2014 BENEFITS SUMMARYMedical Choice Plan— A consumer-driven health care plan with a health savings account (HSA)You may have heard plans like the Medical Choice Plan called “consumer-driven.” This refers to the shift indecision-making power from the plan administrator to you, the consumer. You take control of your healthcare, and you decide how you spend your health care dollars. How is it that you get to make these decisions?Your HSA gives you this freedom.The Medical Choice Plan features an HSA you may use to help pay for eligible medical expenses. HSAs canhelp provide funds for out-of-pocket costs protection for years that you have high costs. But in years whenyou have lower costs, you may have funds to roll over to use in future years, when you may need them.There are no copayments, and referrals are not requiredAll dollar amounts and percentages reflect employee responsibility.In-Network ServicesUHC NetworkOut-of-Network Services 1,500 individual/ 3,000family 2,000individual/ 4,000familyNot CoveredCoinsurance20%30%Not CoveredPhysician Office Visits20%30%Not Covered 0** 0**Not Covered 4,500 individual/ 9,000 family 6,000 individual/ 12,000 familyNot CoveredDeductiblePreventive OfficeVisits for all servicesinclusive of:Colonoscopies,Mammograms, WellBaby Immunizations,Bone Density TestingAnnual Out-of-PocketMaximum(includes deductible)** Deductible does not applyWhy Choose the Medical Choice Plan?The Medical Choice Plan offers many advantages over traditional health care plans:You have control. You are empowered to make your own medical care decisions and spend yourhealth care dollars the way you see fit. By keeping yourself and your family healthy, your medical costs— and GRMC’s —can decrease.Smart costs. With the Medical Choice Plan, you pay lower payroll deductions than in the Medical SelectPlan, but you have a higher deductible. There are no copayments. Instead, when you meet the annualdeductible, the program generally pays 80% of most of your eligible in-network expenses up to the outof-pocket maximum.Tax advantages. Both you and GRMC can contribute to your HSA on a pre-tax basis. When you incur aneligible medical or prescription drug expense, you may use your HSA dollars to pay for it. You also havethe opportunity to lower your taxable income by enrolling in the Limited Purpose Health Care FlexibleSpending Account. Use this account to reimburse your eligible dental and vision expenses.14

2014 BENEFITS SUMMARYLasting savings vehicle. You own your HSA, so you take it with you when you leave GRMC. You maycontinue contributing to your HSA (following IRS rules) and use your HSA to pay for eligible medical,pharmacy, dental and vision expenses.Health Savings AccountYour HSA is a federally regulated savings account. You own your account and can take it with you when youleave GRMC employment. If you wish, you may open an HSA at a different financial institution. If you enroll inthe Medical Choice Plan, you also must enroll in the HSA and elect a contribution amount.Using Your HSA FundsYou may use your HSA to pay eligible medical, pharmacy and vision out of pocket expenses incurred by youand dependents you claim on your federal tax return.Contributing to Your AccountYou choose how much to contribute to your HSA through pre-tax payroll deductions.For 2014, the federal combined employee/employer annual contribution limit is 3,300/individual or 6,550/family. If you are age 55 or older, you may make annual catch-up contributions of up to 1,000.On the first payroll of 2014, GRMC will contribute 500 for 2014 to your individual HSA, or 875 for 2014to your family HSA. GRMC will also contribute up to an additional 500 to your HSA account based on yourcompletion of certain GRUHealthyYou activities each quarter. TIP: When determining your annualcontribution amount, remember to factor in GRMC’s contributions so you do not contribute more than thefederal maximum. Excess contributions are subject to income tax as well as a 20% penalty.GRUHealthyYou IncentivesThroughout 2014, employees in the Choice plan will be given opportunities to earn up to an additionalmaximum of 500 employer HSA contributions in to your HSA based on completion of wellness activities.The employer contributions will be added to your account on a quarterly basis during the plan year. Boththe Biometric Screening and Health Risk Assessments are required in order to obtain the employerincentive dollars. All dollars will be shown as points. 1 point 1 dollarMaximum Annual GRUHealthyYou Incentives500Screening/Assessment – required to participate in the incentive programComplete Biometric Screening performed by Employee Health & Wellness(Includes blood pressure screening, weight, lab testing for cholesterol and glucose screening)Complete Health Risk AssessmentEducationComplete approved Weight Management Program .Complete approved Diabetes Education Series Complete online Action Plans Complete GRUHealthyYou Education Class .Complete approved Smoking Cessation Program .5050251010015

2014 BENEFITS SUMMARYHealthy LifestylesExercise Log (provided by fitness center – during 2014 calendar year) .Complete GRUHealthyYou Online Challenge .Participate in and complete telephonic coaching program EAP Self-Assessment Tool .Preventive CareObtain Annual Preventive Exam*(Maximum allowed 300 per calendar year)o Routine Physical . o Mammogram for women 40 o PAP screening for women 18 .o Colorectal cancer screening over age 50 .o Coronary Artery Calcium Screeningo (Age 55 to 75 for men, age 45 – 75 for women) .o Preventive Dental Screening .o Vision S

Your benefits. Your way. ENROLLMENT GUIDE . 2 014 B E N E F I T S S U M M A R Y 2 . 2 014 B E N E F I T S S U M M A R Y 3 Susan Norton Vice President, Human Resources Welcome to Georgia Regents Medical Center's 2014 Open Enrollment Guide for the January 1, through December 31, 2014 plan year. Whether you're just starting your career or you .