Transcription
2017 IBM Benefits andPrograms Summary
TABLE OF CONTENTS2017 IBM BENEFITS SUMMARYELIGIBILITYABOUT YOUR HEALTH, LIFE AND DISABILITY BENEFITSBUSINESS TRAVEL ACCIDENT INSURANCE PLAN333MEDICAL CHOICESMEDICAL COVERAGE (AFTER YOU LEAVE IBM)TRANSITIONAL MEDICAL PROGRAM (TMP)RETIREE MEDICAL COVERAGEMEDICARESURVIVOR HEALTH BENEFIT3IBM PREFERRED PROVIDER ORGANIZATION (PPO)3IBM PPO PLUS3IBM PPO OR IBM ENHANCED PPO WITH HEALTH SAVINGS ACCOUNT(HSA)3HEALTH MAINTENANCE ORGANIZATION (HMO)4IBM EXCLUSIVE PROVIDER ORGANIZATION (EPO)4TOBACCO SURCHARGE4PRIMARY CARE4CARE MANAGEMENT4CENTERS OF EXCELLENCE5BEST DOCTORS52017 MEDICAL BENEFITS: COMPARING PLAN FEATURES6IBM’S COMMIT TO HEALTH INCENTIVE PROGRAMWELLNESS DEVICE CREDITQUARTERLY WELLNESS DRAWINGSHEALTH SAVINGS ACCOUNT (HSA) INCENTIVESVISION CHOICESIBM VISION PLANEYEMED VISION DISCOUNT PLANFLEXIBLE SPENDING ACCOUNTSHEALTH CARE SPENDING ACCOUNT (HCSA)DEPENDENT CARE SPENDING ACCOUNT (DCSA)COMMUTER BENEFITS PROGRAMLIFE AND DISABILITY BENEFITSSHORT-TERM DISABILITY (STD) INCOME PLANLONG-TERM DISABILITY (LTD) PLANGROUP LIFE INSURANCE (GLI)GROUP UNIVERSAL LIFE (GUL) INSURANCE PROGRAMHOLIDAY PLANVACATION PLANPERSONAL TIME OFFIBM LEAVES OF ABSENCE PROGRAM (LOA)IBM PARENTAL BONDING LEAVEFAMILY AND PERSONAL SERVICESTHOMAS J. WATSON MEMORIAL SCHOLARSHIPLIFEWORKSADOPTION AND SURROGACY ASSISTANCE PLANSPECIAL CARE FOR CHILDREN ASSISTANCE PLAN (SCCAP)COLLEGE COACH PROGRAMGLOBAL WORK/LIFE FUND (GWLF)IBM MONEYSMARTSOFI STUDENT LOAN REFINANCINGEXPRESSLY SERVICE FOR TRAVELING MOTHERS78888999DENTAL CHOICESIBM DENTAL BASICIBM DENTAL PLUSCIGNA DENTAL MAINTENANCE ALTERNATIVE (DMA)TIME OFF7MENTAL HEALTH BENEFITSMANAGED MENTAL HEALTH CARE PROGRAMEMPLOYEE ASSISTANCE PROGRAM (EAP)IBM 401(K) PLUS PLAN401(K) PLUS PLAN INVESTMENT OPTIONSEMPLOYEES STOCK PURCHASE PLAN (ESPP)777PRESCRIPTION DRUG BENEFITSMAINTENANCE CHOICE GENERICSADVANTAGESPECIALTY MEDICATIONSPRESCRIPTION DRUG COVERAGECAPITAL ACCUMULATION AND INVESTMENTOTHER IBM BENEFIT PROGRAMSEMPLOYEE REFERRAL BONUS PROGRAMIBM CLUBDISCOUNTS FOR IBMERSEMPLOYEE PURCHASE PROGRAM99910CAREER DEVELOPMENT PROGRAMSACADEMIC LEARNING ASSISTANCE PROGRAM (ALAP)TALENT@IBMTHINK40101010IBM CORPORATE CITIZENSHIP & CORPORATEAFFAIRS10101010CORPORATE SERVICE CORPSON DEMAND COMMUNITYIBM COMMUNITY GRANTSIBM MATCHING GRANTS PROGRAMEMPLOYEE CHARITABLE CONTRIBUTION CAMPAIGN1111111111IMPORTANT LEGAL INFORMATIONIBM has implemented policies and practices to appropriately protect the privacy of your personal health information. Personal healthinformation you provide will be handled in accordance with IBM Corporate Instruction HR113 98/11: Protection of Employee Information andthe IBM Guidelines for the Protection of Employee Information. To obtain a copy of these documents, please contact the IBM Employee ServicesCenter. The benefits and programs described in this brochure are for IBM regular 515151515151516161616161616161616171717171717
IBM PPO PlusThe IBM PPO Plus offers the same broad network ofproviders available through the IBM PPO, along with theflexibility to seek care out-of-network at a higher cost (adeductible may apply). You may see any provider youchoose without obtaining a referral.2017 IBM Benefits SummaryIBM offers a competitive benefits program, designed tosupport employees and their families across all dimensionsof health: physical, mental, social, financial, and purpose.Key features: Health Benefits Portfolio that provides strongsupport for employee well-being and preventivecare, comprehensive coverage to meet a range ofmedical situations, and solid protection against thecost of serious injury or illness. Retirement Program that helps build futurefinancial security through a leading-edge 401(k)plan and other capital accumulation programs. Income Protection in case of serious illness, injuryor death, including life insurance and disabilitybenefits. Under PPO Plus, you'll pay a higher monthly contributionfor coverage and — with a lower in-network deductible —potentially lower overall costs for care. If you reach theannual out-of-pocket maximum, the plan will pay 100% ofyour eligible medical expenses for the remainder of theplan year. It also offers the same strong coverage forprevention, wellness and routine medical care. There is nocharge for in-network eligible, routine preventive services.Care provided by your in-network primary care physicianwill be covered at 100%.IBM PPO or IBM Enhanced PPO with Health SavingsAccount (HSA)The IBM PPO and IBM Enhanced PPO with HSA are highdeductible options that feature a health savings account,which can be used to pay for eligible current out-of-pocketmedical costs or to save for future health care expenses.Opportunity to follow leisure pursuits throughvacation, personal leave and holiday plans.EligibilityYou are eligible for all applicable benefit programs, exceptthe IBM Employee Stock Purchase Plan, beginning withyour first day of employment. Health care coverage(medical, dental and vision) is available for you, yourspouse or eligible domestic partner, eligible children andother eligible dependents.For participants who enroll in the HSA, IBM will contribute 250 for self-only/ 500 for family (pro-rated based ondate of hire). Also, in 2017 only, IBM will also contribute 250 in a Jump Start contribution for self-only or familyelections. Participants may also earn additional Commit toHealth incentives, ranging from 300 for self-only coverageto 850 for family coverage which will be deposited intoemployees’ HSA.About your Health, Life and Disability BenefitsIBM provides a range of options, to allow employees todesign a program that meets their personal or familycircumstances. You can enroll in benefits when you firstjoin IBM, and you’ll have the opportunity to review andchange your benefits each year during the enrollmentperiod, usually held in the fall. Employees pay for theirshare of benefit coverage through payroll deductions.Employees may contribute up to the IRS annual limit of 3,400 for single coverage and 6,750 for a couple orfamily. Like the other IBM PPO options, there is no chargefor in-network eligible, routine preventive services.However, to comply with IRS regulations for HSAs, allother services (with the exception of certain preventiveprescription drugs) are subject to the deductible. The IBMPPO with HSA and IBM Enhanced PPO with HSA featuresother provisions that conform with recent IRS HSAguidelines—for example, the deductible amount itselfmeets the IRS requirement for a “high deductible” plan.The deductible also works differently under the IBM PPOwith HSA and IBM Enhanced PPO with HSA, particularly ifyou enroll dependents in these options.Medical ChoicesIBM Preferred Provider Organization (PPO)The IBM PPO has a broad nationwide network of providersthat provide care at discounted rates and offers theflexibility to receive care out-of-network at higher costs. Itoffers strong coverage for prevention, wellness androutine medical care, including in-network eligible, routinepreventive screenings and preventive office visits at nocost. In addition, care provided by your in-network primarycare physician is covered at 100%. You may see anyprovider you choose without obtaining a referral. If youreach the annual out-of-pocket maximum, the plan willpay 100% of your in-network medical expenses for theremainder of the year. This plan option has a lower monthlycost for employees and dependents, but has a higherdeductible and out-of-pocket maximum than the IBM PPO Plus.If you enroll in one of the IBM HSA plan options, anaggregate deductible applies when you enroll one or moredependents – that is, the family deductible must be metbefore the plan pays benefits for any covered individual.The family deductible must be met even if one person isincurring all of the expenses.If you enroll in self only coverage, you have to satisfy theIndividual deductible before the plan pays benefits.3
The out-of-pocket maximums are “embedded”accumulators so they work differently than the HSAdeductibles, which are “aggregate” accumulators. If oneindividual meets their out-of-pocket maximum, the planwill start to pay at 100% for that individual. Each familymember’s out-of-pocket costs are applied to the familyout-of-pocket maximum. Once the family out-of-pocketmaximum is met, the plan will pay 100% for all eligible coveredservices.the surcharges you pay if you satisfy the requirements ofyour health plan administrator’s tobacco cessationprogram within six months or by December 31, 2017,whichever comes first. (Note: Although you may choose toparticipate in other tobacco cessation programs, you willnot be eligible to receive a refund unless you complete theprogram offered by your IBM health plan).Primary CareCare provided by your in-network primary care physicianwill be covered at 100% under the IBM PPO, IBM PPO Plusand IBM EPO options. Under the IBM PPO with HSA andIBM Enhanced PPO with HSA, primary care will be coveredat 100% after the appropriate deductible has beensatisfied. A primary care physician is a physician (MD orDO), nurse practitioner*, or physician assistant* who has aprimary designation of family medicine, internal medicine,or pediatric medicine. Keep in mind the doctor mayperform tests or request other services (e.g. lab) that willhave a separate charge that may be subject to thedeductible and applicable coinsurance. *Please note:Nurse practitioners or physician assistants billing underphysicians will be designated as a PCP or specialist basedon the designation of the physician.A HSA is different from a Health Care Spending Account inthat it is your own personal account and you do not forfeit unusedcontributions. It is important to note that you may notenroll in the IBM Health Care Spending Account if you areenrolled in one of the Health Savings Account planoptions.Health Maintenance Organization (HMO)A HMO provides comprehensive, coordinated health careservices for a fixed prepaid fee through a network ofproviders. Participants are typically responsible forcopayments and/or coinsurance for physician visits andother services.Generally, you aren’t covered for services outside thenetwork, except for emergencies. When you enroll in anHMO, you select a primary care physician (PCP) tocoordinate your care.Care ManagementEach of the regional health plan administrators have CareManagement and Disease Management programs,designed to provide expert help in managing employees’(and their family’s) health conditions and risks.IBM Exclusive Provider Organization (EPO)The IBM EPO offers the same broad network of providersthat is available through the IBM PPO and IBM PPO Plusoptions, along with the same coverage for routine preventivecare, routine screenings and primary care provider services, all atno cost to you. The EPO option is similar to an HMO in that it is an“in-network-only” option which means that (except for trueemergency situations) you must use network doctors, hospitalsand other facilities to receive benefits. The EPO option has acopay-based cost structure for high cost services such as inpatienthospital stays and ER visits along with along with thecoinsurance-based cost structure found in most PreferredProvider Organizations (PPOs) for most other services. Youmay see any network provider that you choose without areferral but many high cost services do require prior authorizationto be covered.These programs include one-on-one outreach and supportto those with serious illness and other complex medicalsituations. These care coordinators are registered nursesemployed by each of the regional health plans and willassist with precertification for inpatient hospitaladmissions and high cost medical procedures (listedbelow), medical consulting services and support to IBMmedical plan participants and their families. Access toexpert assistance in managing chronic conditions is alsoavailable through the program.Precertification is required for major diagnostic services innon-emergency situations or the service will not becovered include: CT Scans, PET Scans, MRIs, nuclearmedicine, sleep studies, cardiac catheterization,echocardiogram (including stress echocardiogram),electrophysiology implants, Arterial ultrasound,Percutaneous coronary intervention (Stents, Balloonangioplasty, Atherectomy). Contact your health plan fordetails regarding precertification.Tobacco SurchargeA 50 per month surcharge will apply if you and/or yourenrolled spouse/domestic partner have used any tobaccoproducts within six months of the date your IBM medicalcoverage begins. This surcharge helps offset the additionalhealthcare costs typically incurred by tobacco users. Forpurposes of this surcharge, a tobacco product is defined as“any product derived from tobacco that is intended forhuman consumption” and includes cigarettes, cigars, pipetobacco, smokeless tobacco and e-cigarettes.However, you will have an opportunity to earn a refund of4
Centers of ExcellenceIBM's health plan administrators have Centers ofExcellence (COEs), facilities and providers that meetcertain quality standards of care. In general, theseproviders' outcomes are better than others. Contact yourhealth plan if you are seeking care for any of the followingservices or you may receive lower (or no) coverage for theservice. These services include: Best DoctorsWhen it comes to medical decisions, making informeddecisions is key to maintaining good health and wellbeing.Best Doctors can help you by providing expert medicaladvice, at no cost to you. All IBMers enrolled in one of theIBM medical plan options will have access to Best Doctorsin 2017.Services are provided confidentially and from the comfortof your own home over the phone or online. Reach out to:TransplantsInfertility services, including but not limited to,artificial insemination or in vitro fertilization(enrollment in a care management program isalso required.)Orthopedic surgery, including, but not limited to,knee or hip replacement or spinal fusion Bariatric surgeryIf you are currently undergoing any of these services, youmay qualify for transition of care. Confirm a diagnosis or treatment plan throughan expert review of your medical records Receive support when making treatmentdecisions Ask an expert about a diagnosis or healthcondition Find a local leading physician or specialistGet help collecting and organizing your medicalrecordsOncology services available through Best Doctors includeaccess to Watson technology including: Watson for OncologyWatson for Clinical Trials MatchingWatson for GenomicsIBMers in HMOs or other medical plans are not eligiblebecause those plans evaluate and contract for these typesof services separately.5
2017 Medical Benefits: Comparing Plan FeaturesPlan FeaturesIBM PPOIBM PPO PlusIBM PPO with HSAIBM Enhanced PPOwith HSAIBM EPOTypical HMOHigh Deductible PreferredProvider Organizationwith HSAYou may obtain care fromIn- and Out-of-networkproviders; HSA lets youuse tax-free dollars to payfor current or save forfuture health care needs;IBM will contribute 500self-only coverage or 750family coverage (prorated based on date ofhire) in 2017. No chargefor eligible In-Networkroutine preventiveservices. No charge forprimary care office visitsafter deductible issatisfied.You file claims for out-ofnetwork care only 2,700 / 5,800(combined in- and out-ofnetwork) Deductibleapplies to pharmacycoverage (exceptpreventive medications)In-network:No chargeOut-of-network:45%, no deductibleIn-Network: No charge forPCP after deductible; Youpay 25% for SCP afterdeductibleOut-of-Network:You pay 45% afterdeductibleIn-Network: You pay 25%after deductibleOut-of-Network: You pay45% after deductibleHigh Deductible PreferredProvider Organization withHSASame structure and flexibility asIBM PPO with HSA. You pay highercost for coverage in exchange forlower in-network deductible.Exclusive ou may obtaincare through anetwork ofproviders toreceive benefits;no coverage if yougo out of network.Primary CarePhysician Referralrequired tocoordinate all care.You file claims for out-ofnetwork care only 1,500 / 3,000(combined in- and out-ofnetwork) ) Deductible appliesto pharmacy coverage (exceptpreventive medications)No claim form tofile 100/ 300No claim form tofileNoneIn-network:No chargeOut-of-network:45%, no deductibleIn-Network: No charge for PCPafter deductible;You pay 25% for SCP afterdeductibleOut-of-Network:You pay 45% after deductibleNo chargeVaries by HMONo charge for PCPYou pay 25% forSCPVaries by HMOIn-Network: You pay 25%after deductibleOut-of-Network: You pay 45%after deductibleYou pay 25% afterdeductibleVaries by HMOIn-network:You pay 25% afterdeductibleOut-of-network:You pay 45% afterdeductibleIn-network:You pay 25% after deductibleOut-of-network:You pay 45% after deductibleInpatient: 1,000Copay peradmission afterdeductibleVaries by HMO30%, after deductible plus 150 copay30%, after deductible plus 150 copay 210 copay 150copay (both copayswaived ifadmitted),after deductibleAfter deductible: 0 for X-rays,DME andprosthetics; 20%for other imagingservices 7,150 / 14,300Varies by HMOPlan typePreferred ProviderOrganizationPreferred ProviderOrganizationKey featuresYou may obtain carefrom in- and out-ofnetwork providers;you’ll receive thehighest level of benefitsif you use networkproviders. No chargefor eligible in-networkroutine preventiveservices or in-networkprimary care officevisits. Specialty careoffice visits “deductiblefree” for in-networkcare.Same structure andflexibility as IBM PPO,higher cost forcoverage in exchangefor lower in-networkdeductible. No chargefor eligible in-networkroutine preventiveservices or in-networkprimary care officevisits. Specialty careoffice visits “deductiblefree” for in-networkcare.Filing claimsYou file claims for outof-network care onlyIn-network: 1,500 / 4,500Out-of-network: 2,650 / 7,950You file claims for outof-network care onlyIn-network: 375 / 1,125Out-of-network: 2,650 / 7,950In-network:No chargeOut-of-network:45%, no deductibleIn-network:No charge for PCP;You pay 25% for SCP;Deductible freeOut-of-Network:You pay 45% afterdeductibleIn-Network: You pay25% after deductibleOut-of-Network: Youpay 45% afterdeductibleIn-network:You pay 20% afterdeductible (FacilityCharges)PCP: 20% afterdeductibleSCP: 25% afterdeductibleOut-of-network:You pay 45% afterdeductible20%, after in-networkdeductible plus 150copayIn-network:No chargeOut-of-network:45%, no deductibleIn-network:No charge for PCP;You pay 25% for SCP;Deductible freeOut-of Network:You pay 45% afterdeductibleIn-Network: You pay25% after deductibleOut-of-Network: Youpay 45% afterdeductibleIn-network:You pay 20% afterdeductible(FacilityCharges)PCP: 20% afterdeductibleSCP: 25% afterdeductibleOut-of-network:You pay 45% afterdeductible20%, after in-networkdeductible plus 150copayOther ServicesIn-network: You pay20% after deductibleOut-of-network:You pay 45% afterdeductibleIn-network: You pay20% after deductibleOut-of-network:You pay 45% afterdeductibleIn-network: You pay 30%after deductibleOut-of-network:You pay 45% afterdeductibleIn-network: You pay 30% afterdeductibleOut-of-network:You pay 45% after deductibleAnnual out-ofpocket maximum(includes deductible)In-network: 7,150 / 14,300Out-of-network: 16,700 / 30,050In-network: 7,150 / 14,300Out-of-network: 16,700 / 30,050In-network: 6,550 / 13,100Out-of-network: 15,750/ 28,350In-network: 6,550 / 13,100Out-of-network: 15,750 / 28,350Annual deductible(individual/family)Routine PreventiveServicesOther Office VisitsUrgent CareInpatient Hospitaland SurgeryEmergency Room(copay(s) waived ifadmitted)6You may obtaincare through anetwork ofproviders; nocoverage if you goout of network(except for trueemergencies) Nocharge for eligibleIn-Network routinepreventive servicesor primary careoffice visits.Varies by HMOVaries by HMO
1 time per program per quarter. Employees can choosefrom a wide variety of pr
with HSA and IBM Enhanced PPO with HSA, particularly if you enroll dependents in these options. If you enroll in one of the IBM HSA plan options, an aggregate deductible applies when you enroll one or more dependents – that is, the family d
