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YourBenefitsat a GlanceCHI Franciscan HealthEmployeesCHIEffective January 1, 2017HealthySPIRITPhysical and financial health and wellnessSM
Taking care of patients is what you do.Taking care of you — it’s what we do!You want to come to work every day knowing you’re entering a healthy andsafe environment. We want you to go home every day with the same peaceof mind — knowing you and your family’s total well-being is protected.Your benefits, from affordable health care to a robust retirement plan, helpto take care of you — physically, mentally, financially, socially and spiritually.Use this guide to better understand all the benefits available to you and yourfamily. If you’d like to see more of the details about the plans, refer to yoursummary plan descriptions located at Inside CHI HR/Payroll Connection Find An Answer Menu. Under Browse Policies, click on the Health andWelfare Plan Documents folder.Table of ContentsClick on the links below to godirectly to each section.What You Need to KnowCandidateNew HireCurrent EmployeeWho’s Eligible for Benefits?Plan EligibilityQuestions? We Can HelpCall the HR/Payroll Connection Support Center1-844-450-94508 a.m.-8 p.m. EST, Monday-FridayVisit My Healthy SpiritMy Healthy Spirit is a robust website which supports the well-being of youand your family. It’s also the place to go to learn about and manage the variousaspects of your benefits — from retirement, medical, dental and vision tospending accounts, life insurance, wellness and time off. Go online ur mission to create healthier communities extends to our workplaceand you!Your Benefits.at a GlanceCHI Integrated Medical PlanOpt-Out CreditHealthy Spirit Wellness ProgramCHI Dental PlanVision PlanCHI Spending AccountsEmployee Basic Life and AccidentalDeath and Dismemberment(AD&D) InsuranceBusiness Travel Accident InsuranceEmployee Supplemental Life andAD&D InsuranceSpouse and Child Life InsuranceExtended Illness Bank (EIB) orSick Leave ProgramLong-Term DisabilityPaid Time Off (PTO) or Annual LeaveCHI 401(k) Retirement Savings PlanCHI 457(b) PlanTuition AssistanceAdoption AssistanceEmployee Assistance ProgramPay in Lieu of BenefitsCHI Franciscan Health Employees/TacomaBenefits at a Glance 2017
What You Need to KnowCandidateJust Imagine Yourself at CHITaking Care of Your Health and Well-beingWith our medical plan, great benefits await you! We work with an extensive network ofdoctors, hospitals and pharmacies across the country to make comprehensive medicaland prescription drug coverage readily available to you. Even better, if you use our CHIfacilities, you receive an enhanced benefit.We also offer comprehensive dental and vision plans that cover an array of services —ensuring optimal health for you and your family’s well-being.Going a Step FurtherYour health is about more than routine trips to your doctor — it’s also about the smalleveryday choices you make. We have a Healthy Spirit Wellness Program to guide andsupport you as you make those choices.Having Peace of MindWhile no one can prevent bad things from happening, you can be prepared. We offerlife and disability plans to help protect your family if the unforeseen happens. We alsothink about your financial future. So we offer a 401(k) retirement savings plan withcompany-matched funds and an additional company contribution.Finding Time to RechargeSometimes you need a break. Maybe you’re taking your family on vacation, or youhave the flu and need time to rest. We know that time away from work is important.That’s why we provide paid time off so you can balance your personal needs withyour work life.Flip through this guide to see what awaits you at CHI.New HireYou Have Choices Here at CHIYour Benefits Provide Valuable Protection for You and Your FamilyEvery day you make important decisions. Decisions that help you protect and care foryou and your family. Together we can help you choose the right benefits to meet yourneeds. Review this guide to learn about your benefits and the options available to you.Act Quickly So You’re CoveredIf you’re benefits eligible, you have 31 days from your date of hire to enroll for coverage.Please don’t miss this opportunity so you and your family have the benefits that you need.New hire continues on next page.CHI Franciscan Health Employees/Tacoma Benefits at a Glance 2017 (Revised October 2016)3
What You Need to KnowContinuedNew Hire ContinuedKeep an eye out for Annual Enrollment each fall. This is your next chance to enroll or makechanges to your coverage unless you have a qualifying life event, such as a marriage orbirth of a child.It’s Easy to Enroll!You enroll online at HR Payroll Connection Workday. If you’re looking for moreinformation, the My Healthy Spirit website is available 24/7 for you to learn all about yourbenefit options.After you enroll, you can:nUse the interactive tools, including a prescription-pricing tool and retirementplanning tool, to help you make the most of your benefits and save money.Participate in well-being challenges, workshops and lifestyle coaching to earnincentives to help pay for medical expenses.Designate a primary care provider for you and your family.Things to ConsiderAlong the WayIf your life changes, your benefitsmay need to changeIf you have a major life event, suchas a marriage, you can change somebenefits and add your new spousewithin 31 days after the life event.When the life event includes thebirth or adoption of a child, you canmake benefit changes and add thechild within 60 days after the event.Current EmployeeFor a list of qualifying life events,go to My Healthy Spirit HR/Payroll Connection MyBenefits. You can also contact theHR/Payroll Connection SupportCenter at 1-844-450-9450.Considering Your Benefits duringAnnual Enrollment?Don’t forget to namea beneficiary and keep it up to dateAnnual Enrollment is the time of year to review your current coverage and the optionsavailable. Make sure your coverage still provides the best possible care at the best valuefor you and your family.Be sure to name a beneficiary forthe following:nnGet Started: My Healthy SpiritDuring Annual Enrollment, you will learn about any changes to your benefits for thecoming year and start the enrollment process on the My Healthy Spirit website. You canalso find resources and tools to help you make the most of your benefits. It’s secure,easy-to-use and available 24/7.Your Next Step: Take ActionReview your online enrollment materials. This is the best way to make sure you and yourfamily understand your benefit options. If you choose to keep your current plans, your onlyother opportunity to make changes throughout the year is if you have a qualifying life event.Don’t forget, you have to take action and enroll every year to contribute to a flexiblespending account or a health savings account.Questions? We Can HelpCall the HR/Payroll Connection Support Center1-844-450-94508 a.m.-8 p.m. EST, Monday-FridayVisit My Healthy Spirit at http://home.catholichealth.net/myhealthyspiritCHI Franciscan Health Employees/Tacoma Benefits at a Glance 2017 (Revised October 2016)n401(k) retirement savings plan —go to NetBenefits.com/atworknLife insurance — go toMy Healthy Spirit HR/Payroll Connection MyBenefitsnHealth savings account — goto healthequity.com/ed/chiWe are paperless!You can access your summaryplan descriptions and annual legalnotices online at Inside CHI HR/Payroll Connection Find AnAnswer Menu. Under BrowsePolicies, click on the Health andWelfare Plan Documents folder.Just one more way we aresimplifying benefits for you.4
Who’s Eligible for Benefits?Great benefits await you and your family. Read below to find out which benefits you’re eligible for and when coverage begins.nnnnnnnCHI Medical PlanCHI Dental PlanVision PlanHealth Care FlexibleSpending Account (FSA)Dependent Care FSAAdoption AssistancePay in Lieu of BenefitsIf eligible and you’re regularly scheduled to work 32 hours per two-week pay period, your coveragebegins on the first day of the month following 30 days of employment.You can also enroll your eligible family members, including:n One adult family member — Your spouse or a legally domiciled adult (LDA). You can onlypurchase supplemental life insurance for you and your spouse.n Dependent children up to age 26n Disabled children of any age who are unmarried and financially dependent on you and werecovered under the plan prior to age 26Adding a new dependent to the CHI medical, dental or vision plans? If so, you’ll need toprovide documentation (e.g., birth certificate, signed LDA affidavit) confirming eligibility. You willbe notified if documentation is needed. Unconfirmed dependents will not have coverage.Note: Medical and dental rates are based on regularly scheduled hours.Opt-out Credit for Medicaland DentalEmployee Basic Life andAccidental Death andDismemberment (AD&D)InsuranceEmployee SupplementalLife and AD&D InsuranceSpouse and Child LifeInsuranceIf eligible and you’re regularly scheduled to work 48 hours per two-week pay period, your eligibilitybegins on the first day of the month following 30 days of employment.If eligible, your eligibility begins on your date of hire. You and your spouse can start using thewellness program tools and resources once your medical benefits begin.nHealthy Spirit WellnessProgramCHI 401(k) RetirementSavings PlanEmployee AssistanceProgramMilitary LeavenCHI 457(b) PlanIf eligible and you’re a highly compensated employee whose current annualized base pay exceedslast year’s compensation guidelines of 120,000 (as defined by the IRS), your eligibility begins onyour date of hire. (IRS compensation guidelines are subject to change.)nFamily and Medical LeaveAct (FMLA)You’re eligible after 12 months of service if you worked at least 1,250 hours in this time period.nnnnnnnPlease refer to the appropriate plan documents or contracts for full benefit details, exclusions and limitations. This Benefits at a Glance document only provides a summary of theapplicable provisions of the benefit plans described herein. The plans are governed by the terms of written plan documents. If the terms in this Benefits at a Glance conflict withor are inconsistent with the plan documents or contracts, then the plan documents or contracts will prevail.CHI Franciscan Health Employees/Tacoma Benefits at a Glance 2017 (Revised October 2016)5
Who’s Eligible for Benefits? ContinuednPaid Time Off (PTO) orAnnual LeaveIf eligible and you’re regularly scheduled to work 32 hours per two-week pay period, you cangenerally begin using your time off after 90 days of employment.nExtended Illness Bank (EIB)or Sick Leave ProgramIf eligible and you’re regularly scheduled to work 32 hours per two-week pay period, your coveragegenerally begins on the first day of the month following 90 days of employment.nLong-Term DisabilityIf eligible and you’re regularly scheduled to work 48 hours per two-week pay period, your coveragebegins on the first day of the month following 90 days of employment.nBusiness Travel AccidentInsuranceTuition AssistanceIf eligible and you’re regularly scheduled to work 32 hours per two-week pay period, your coveragebegins on your date of hire.nPlease refer to the appropriate plan documents or contracts for full benefit details, exclusions and limitations. This Benefits at a Glance document only provides a summary of theapplicable provisions of the benefit plans described herein. The plans are governed by the terms of written plan documents. If the terms in this Benefits at a Glance conflict withor are inconsistent with the plan documents or contracts, then the plan documents or contracts will prevail.CHI Franciscan Health Employees/Tacoma Benefits at a Glance 2017 (Revised October 2016)6
Your Benefits at a GlanceHealth and Welfare PlansCHI IntegratedMedical PlanWe understand that your health is a priority. To help you care for you and your family, we offer threemedical plan options to choose from: Integrated Core, Integrated Basic and Integrated HDHP/HSA.Each includes an extensive network of doctors, hospitals and pharmacies across the country to giveyou exceptional medical care and prescription drug coverage.All medical plan options cover preventive care at 100%, so services like physicals and mammogramsare free as long as you see a network provider. For most other services, you pay a percentage of thecost and the plan pays its share. For some services, you have to meet the deductible before the planstarts to pay.You have options for your careThe Integrated Medical Plan has three levels of coverage: enhanced, in-network and out-of-network.The enhanced network includes our facilities throughout the country that have partneredwith local doctors to create what we call clinically integrated networks, or CINs. You receive thehighest level of benefits when you go to providers in our enhanced network listed below.n You may choose to see a provider outside of the enhanced network and still receive anin-network benefit by selecting providers from the Blue Cross Blue Shield of Illinois network.n The medical plan will cover services if you go to an out-of-network provider, but you may paymore out-of-pocket.The following pages show a comparison of the enhanced and in-network benefit levels and yourcosts. Out-of-network services are not shown in the charts. You can see the out-of-network benefitlevels and costs in the Medical Comparison Charts on the My Healthy Spirit website.nTerms to known Deductible: the amount you pay for certain covered services before the plan begins topay its share.n Copay: a fixed dollar amount you pay each time you receive certain covered services,such as emergency room visits.n Coinsurance: the percentage you pay for most other covered health care services.n Out-of-pocket (OOP) maximum: the most you pay for covered expenses in a year, includingdeductibles, copays and coinsurance.n Enhanced clinically integrated network (CIN): Rainier Health Networkn In-network: Blue Cross Blue Shield of Illinois NetworkMedical plan continues on next page.Please refer to the appropriate plan documents or contracts for full benefit details, exclusions and limitations. This Benefits at a Glance document only provides a summary of theapplicable provisions of the benefit plans described herein. The plans are governed by the terms of written plan documents. If the terms in this Benefits at a Glance conflict withor are inconsistent with the plan documents or contracts, then the plan documents or contracts will prevail.CHI Franciscan Health Employees/Tacoma Benefits at a Glance 2017 (Revised October 2016)7
Your Benefits.at a Glance ContinuedHealth and Welfare Plans ContinuedCHI IntegratedMedical PlanContinuedThese charts show the enhanced network and in-network amounts. For out-of-network coverage,see the Medical Plan Comparison Charts on the My Healthy Spirit website.Integrated CoreThese are theamounts you pay.Employer AccountFundingAnnual DeductibleIndividualFamilyCalendar YearOut-of-Pocket(OOP) MaximumIndividualFamilyPreventive CareServicesPrimary CarePhysicianOffice VisitSpecialistOffice VisitEmergencyRoom Visit(waived if admitted)Urgent CareAmbulance(medically necessary)Enhanced(CIN)NetworkIn-NetworkNo employer fundingIntegrated BasicEnhanced(CIN)NetworkIn-NetworkNo employer funding 0 0 1,500 3,000 0 0 2,500 5,000 3,000 6,000 6,000 12,000 4,000 8,000 6,600 13,200100% coveredIntegrated HDHP/HSAEnhanced(CIN)NetworkIn-NetworkEmployer HSA Funding*(spread across all pay periods): 500 Individual/ 1,000 FamilyEmployee may also deferbefore-tax dollars into thisaccount up to IRS limits 2,600 5,200 4,000 8,000100% covered 6,450 12,900100% covered 10 copay(nodeductible)20%coinsurance(nodeductible) 20 ductible) 25 copay(nodeductible)25%coinsurance(nodeductible) 35 ductible) 175 copaythen 100%covered 175 copaythen 100%covered 200 copaythen 100%covered 200 copaythen 100%covered 200 copaythen 100%covered(afterdeductible) 200 copaythen 100%covered(afterdeductible) 50 copay(nodeductible) 75 copay(nodeductible) 75 copay(nodeductible) 100 copay(nodeductible) 75 copay(afterdeductible) 100 copay(afterdeductible)100% covered100% covered(after deductible)100% coveredInpatient Care/ServicesOutpatient Care/ServicesHome Health CareHospiceDurable MedicalEquipmentChiropractor(20 visit limit perperson per year)10%coinsurance(nodeductible)for uctible)15%coinsurance(nodeductible)for nce(afterdeductible)* The Integrated HDHP/HSA Plan includes the health savings account feature which lets you save before-tax dollars towardyour medical expenses. You can learn more about the health savings account later in this document.Medical chart continues on next page.Please refer to the appropriate plan documents or contracts for full benefit details, exclusions and limitations. This Benefits at a Glance document only provides a summary of theapplicable provisions of the benefit plans described herein. The plans are governed by the terms of written plan documents. If the terms in this Benefits at a Glance conflict withor are inconsistent with the plan documents or contracts, then the plan documents or contracts will prevail.CHI Franciscan Health Employees/Tacoma Benefits at a Glance 2017 (Revised October 2016)8
Your Benefits.at a Glance ContinuedHealth and Welfare Plans ContinuedCHI IntegratedMedical PlanContinuedThese charts show the enhanced network and in-network amounts. For out-of-network coverage,see the Medical Plan Comparison Charts on the My Healthy Spirit website.Integrated CoreThese are theamounts you pay.Therapy —Physical,Occupational,Speech andMassage(30 visit limit perperson per year,does not apply toenhanced network)Mental andNervous(inpatient oroutpatient)Other CoveredServicesLifetime ible)for oinsurance(afterdeductible)UnlimitedIntegrated le)for facilityandphysicianchargesIntegrated UnlimitedUnlimitedMedical chart continues on next page.Please refer to the appropriate plan documents or contracts for full benefit details, exclusions and limitations. This Benefits at a Glance document only provides a summary of theapplicable provisions of the benefit plans described herein. The plans are governed by the terms of written plan documents. If the terms in this Benefits at a Glance conflict withor are inconsistent with the plan documents or contracts, then the plan documents or contracts will prevail.CHI Franciscan Health Employees/Tacoma Benefits at a Glance 2017 (Revised October 2016)9
Your Benefits.at a Glance ContinuedHealth and Welfare Plans ContinuedCHI IntegratedMedical PlanContinuedPrescriptionDrugsThese are theamounts you pay.Integrated CoreIntegrated BasicNo deductible,applies to in-network OOP maxIntegrated HDHP/HSAAfter deductible, appliesto in-network OOP maxCHI PHARMACY* (if available) Retail 30-day PrescriptionGenericPreferred BrandFormularyNon-PreferredBrand NonFormulary 5 copay15% coinsurance( 20 min/ 55 max)25% coinsurance( 32.50 min/ 80 max)CHI PHARMACY* (if available) Mail Order 90-day PrescriptionGeneric 12.50 copayPreferred BrandFormulary15% coinsurance( 50 min/ 87.50 max)Non-PreferredBrand NonFormulary25% coinsurance( 80 min/ 162.50 max)CVS/CAREMARK PHARMACY NETWORK* Retail 30-day Presc
CHI Spending Accounts Employee Basic Life and Accidental Death and Dismemberment (AD&D) Insurance Business Travel Accident Insurance Employee Supplemental Life and AD&D Insurance Spouse and Child Life Insurance Extended Illness Bank (EIB) or Sick Leave Program Long-Term Disability Paid Time Off (PTO) or Annual Leave CHI 401(k) Retirement .File Size: 1MBPage Count: 17Discover on this pageWhat is the maximum 401(k) contribution for a 50 year old?When can you use FSA for 2017?When is FMLA eligible?
