2016 Total Rewards Program Summary - Cleveland Clinic · 2016-03-31 · the inclusive Cleveland...

2016 Total Rewards Program SummaryInformation About Your Benefits

Dear Caregivers,

At Cleveland Clinic our goal is to provide you and your family with comprehensive healthcare services. This year, we are taking great pride in the introduction of additional enhanced dental and vision options at affordable rates. We know it is important for you to consider the best coverage for you and your family. Therefore it is important to us that we provide our Caregivers with those choices:

•DentalBenefitProgramupdates:4differentplanswillbeavailablefromPreventiveto Enhanced designs.

•VisionBenefitProgramupdates:Thecurrent“Basic”visionbenefitprogramisofferedfor2016at 10%LESSthanthe2015cost.Also,anew“Enhanced”choiceforvisioncarewillbeavailablefor you to select in 2016 that covers more options at a slightly higher price.

•Dependentchildrenarenowcovereduptotheage26onthedentalandvisionplans.

•Asalways,preventivecareiscovered100%intheEmployeeHealthPlanwith$0copayswhenyou seeaClevelandClinicprimarycarephysician.Lastlyfor2016,weareintroducinga$35copayfor MRI and CAT Scan services.

The highlights above, that are designed to improve your life at work and at home, are only a fraction of theinclusiveClevelandClinicTotalRewardsbenefitprogram.Othervaluablebenefitstoconsiderincludesupplementallifeinsurance,flexiblespendingaccounts,disabilitycoverageandretirementprograms.

Withtheseupdates,wehaveworkedveryhardtominimizeanycostincreasesfortheEmployeeHealthBenefitProgramin2016.Asaresult,theincreaseinpayrolldeductionamountsfortheyeararelessthan$4perpayforFamilycoverageandabout$1perpayforIndividualcoverage.ThisleavesClevelandClinic’scontributionsproudlycoveringapproximately75%ofthepremiumofyourmedicalplan.

Your constant commitment to world class care for our patients strengthens our commitment to providing the bestexperienceforyoueveryday.ThankyouforyourcontinueddedicationtoClevelandClinic.

GuyVanTiggelen ExecutiveDirector,TotalRewards

Information About Your Benefits2

As a recognized global healthcare leader, Cleveland Clinic is dedicated to providing the same world-class care to you and your family.

We take great pride in offering a comprehensive and affordable Total RewardsBenefitsprogramthatrecognizesthevaryingneedsofadiverse workforce. Through Total Rewards, individuals and families are offered security and meaningful choices to help prepare them for unpredictable life events to come.

Thank you for your continued dedication to Cleveland Clinic where wecometogethertokeeppatientsandcaregiversfirstthroughthePower of Every One.

Toby Cosgrove, MD

Table of Contents:

1. Eligibility a.EligibilityHoursDefined b. Dependents

2. Benefit Programs a.Health/Prescription/ EHPPrograms b. Dental c.Vision d.FlexibleSpendingAccounts e. Life Insurance f. Disability

3. Additional Valuable Total Rewards a.PaidTimeOff b. Retirement c. EAP d. Tuition e.OtherBenefits

4. Enrollment

5. FAQs

6. Contact Info/Links

2016 Total Rewards Program Summary 3

EligibilityEmployeeseligibleforbenefitsinclude:

•Regularfull-timeemployeesscheduledtowork72to80hoursperpayperiod.

•Regularpart-timeemployeesscheduledtowork40to71hoursperpayperiod.

Dependent Eligibility

Dependent children (naturally born children, stepchildren, legally adopted children, or children under an officialcourt-appointedguardianship)canremainonmedical,dental&visioncoverageuptoage26.

DependentbenefitsterminateattheendofbirthdaymonthandthenareofferedCOBRA

*Yourunmarriedchildrenexceedingage26whoaredisabledasdeterminedbySocialSecurityAdministrationmayremainoncoveragewithproofofdisabilityprovideditissubmittedtoHRwithin31days of determination of disability date.


BenefitProgram

ClevelandClinic’sflexiblebenefitsprogramletsyouselectbenefitsthatmeetyouandyourfamily’sneeds.

Makeyourbenefitselectionscarefullybecauseyouonlyhave31 days from yourhiredatetoenroll.Onceyoucompleteyouronline enrollment, the coverage you select begins on your date of hire, and premium payments will be withdrawn retroactively.

Plan option changes can onlybemadeonceayear–duringOpenEnrollment,whichusuallytakesplaceinOctober.Outsideofyournewhireperiod/OpenEnrollment,theonlyothertime(s)itispermissibletomakecertain changes to benefitselectionsiswithin31daysofaqualifyinglifeeventdate.

Life Events

IRS defines life events as:

Marriage/Divorce/LegalSeparation/Annulment

Birth/Adoption/LegalGuardianshipofachild

Deathofadependent:Spouseand/orChild

Employee/Spouse/DependentwithaLossofCoverageorGainofCoverage

Employee/Spouse/Dependentwithareductionorincreaseinhoursofemployment (i.e.–switchbetweenparttimetofulltimeviceversa)

QualifiedMedicalChildSupportOrder(QMCSO)

CaregiverswhoexperienceaqualifyinglifeeventandwishtomakecertainchangestotheircoveragemustcontactONEHRat216.448.2247.Representativeswillassistyouwiththeproperform(s)tocompleteandsupportivedocumentationrequiredforupdatingcoverage.Anyadjustmentstocoveragemustbeconsistentwiththechangesresultingfromthequalifyinglifeevent.


Healthy Choice Program

What Is It? TheHealthyChoiceProgramwascreatedtoencourageClevelandClinicHealthPlanmembersandtheirspousetotakeaproactiveapproachtowellness.ByparticipatinginHealthyChoiceyouhavetheopportunitytoreduceyourEmployeeHealthPlanpremiumseachyear.Participationiscompletelyvoluntaryandtherearenopenaltiesfornotparticipating.Ifyouchoosenottoparticipate,yousimplywon’tgetthediscountedEmployeeHealthPlanrate.

How Do I Participate?

1. Visit a primary care provider to determine your health status. YouwillneedtohavethemfilloutanEHPHealthVisitForm(foundatwww.clevelandclinic.org/ healthplan).TheHealthVisitFormdeterminesthenextstepsforyouandyourspouse.Itwill indicateifyouhaveanyofthesixtargetedconditionsofourwellnessprograms(hypertension, diabetes,hyperlipidemia,asthma,overweight/obese,orcurrenttobaccouse).Thisformmustbe returneddirectlytotheHealthPlanOffice(emailaddress/faxnumbercanbefoundontheform).

2. The Health Plan Office will send you a letter. You and your spouse will both receive a letter indicating your health status and what programs you mustparticipateintoqualifyforthediscountedratesforthefollowingcalendaryear.

3. Meet the goals that were set for you in your program. Meetingtheparticipationrequirementsandthegoalssetforyouwillallowyoutogetthebiggest discountonyourEmployeeHealthPlanpremiumsinthefollowingcalendaryear.Ifyouandyour spouse actively participate and you do not meet your goals, you are still eligible to receive a smaller discount.

4. Comply with the annual flu vaccination program. Membersmustcomplywiththeannualfluvaccinationprogramtobeeligibletoreceivediscounts throughparticipationintheHealthyChoiceProgram.Additionalinformationregardingtheannual fluvaccinationprogramcanbefoundontheOccupationalHealthintranetpage (http://portals.ccf.org/occupationalhealth/Home/tabid/301/Default.aspx).

How Do I Find More Information? YoucanfindmoreinformationabouttheHealthyChoiceProgrambyvisitingtheHealthPlanwebsiteat www.clevelandclinic.org/healthplanorbycallingtheHealthPlanOfficeat216.448.2247,option2, option 1, option 1.


Health Plan Program

Electing medical coverage is one of the most important benefitdecisionsyouwillmake.Tomakethedecisionsimple,the Employee Health Plan offers a comprehensive network ofmedicalprovidersandvaluablefinancialassistanceforthecostsassociatedwithseriousillness,injury&preventivecarefor maintaining good health. The Employee Health Plan does not exclude coverage for pre-existing conditions.

Cleveland Clinic’s Employee Health Plan (EHP)

Tier 1 Providers www.CHNetwork.com

Tier 2 Providers www.SuperMednetwork.com www.USAMCO.com

The Employee Health Plan Prescription Drug Benefit Program

ThePrescriptionDrugBenefitisadministeredthroughCVSCaremark,thenation’slargestproviderofprescriptionsandrelated health care services.

•$100foreachmember,maximumAnnualdeductible of$300perfamily

•Deductiblewaivedifmembersfillprescriptionswith generic medications from Cleveland Clinic Pharmacies

•Enhancedbenefitsforotherprescriptionsfilledat Cleveland Clinic pharmacies

Additional EHP Programs

The following programs can help you reachyourHealthyChoicegoals.

EHP Wellness Program – helps members focus on three areas: smoking cessation, weight management and physical activity. If the member completes the application at sign-up, these services are offered free of charge. The Wellness Program application requiresanoriginalsignaturethatauthorizestheEHPDept.tocollectspecifichealthdataalongwithyourparticipation rates for tracking success.

EHP Medical Management – offers robust coordinated care and pharmacy programs that help members address chronic conditions such as diabetes, high blood pressure, asthma. Medical Management provides reimbursement for officevisitco-payments&prescriptionco-insurance as long as members complywithspecificcarecriteria.

Participation in either program over the course of a year can help you earn a lower medical premium for the followingyear’senrollment.

Fordetails,visit: clevelandclinic.org/healthplan/wellness


2016EmployeeHealthPlan

BENEFIT PROGRAM FEATURES TIER 1 Cleveland Clinic Quality Alliance Provider Network

TIER 2MMO1 and USAMCO Networks1

Annual Deductible Individual: None Family: None Individual: $500 Family: $1,500

Out-of-Pocket Maximum Individual: $1,500 Family: $3,000 Individual: None Family: None

MEDICAL BENEFIT PROGRAM FEATURES

PCP Office Visit – Family Practice, Gynecology, Internal Medicine, Obstetrics and Pediatrics 100% of Allowed Amount $25 co-pay (after deductible)

Specialist Office Visits 100% of Allowed Amount after $35 co-pay (no referral required) $50 co-pay (after deductible)

Maternity Care 100% of Allowed Amount after one-time $50 co-pay

One-time $100 co-pay 70% of Allowed Amount (after deductible)

Routine (Annual) Physical Examination by PCP 100% of Allowed Amount Not Covered

Routine (Annual) Vision Examination 100% of Allowed Amount after $35 co-pay (no referral required) Not Covered

Inpatient Hospital Services2 100% of Allowed Amount 70% of Allowed Amount (after deductible)

Outpatient Hospital Services Radiology — MRI/CT Scans (non-emergent)

100% of Allowed Amount100% of Allowed Amount after $35 co-pay

70% of Allowed Amount (after deductible)70% of Allowed Amount after $50 co-pay (after deductible)

Laboratory/Diagnostic Tests 100% of Allowed Amount 70% of Allowed Amount (after deductible)

Emergency Department Emergency Care Urgent Care

100% after $100 co-pay100% after $50 co-pay

100% after $100 co-pay100% after $50 co-pay

Medical Supplies and Durable Medical Equipment 80% of Allowed Amount 80% of Allowed Amount (after deductible)

Extended Care/Skilled Nursing Care2

75 Days per Benefit Year 100% of Allowed Amount 70% of Allowed Amount (after deductible)

Long-Term Acute Care2

75 Days Lifetime Maximum 100% of Allowed Amount Not Covered

Hospice Respite Care – 10 Days per Benefit Year 100% of Allowed Amount 100% of Allowed Amount

Home Health Care2 – 75 Visits per Benefit Year 100% of Allowed Amount 70% of Allowed Amount (after deductible)

Chiropractic Maximum of 20 Visits per Benefit Year

First 10 visits: 100% of Allowed Amount after $10 co-paySecond 10 visits: 50% of Allowed Amount

(Children under 16 require prior authorizationby the Medical Management Department)

Not Covered

Therapy Services: Occupational/Speech/Physical 45 Visits per Therapy

First 30 visits: 100% of Allowed Amount after $10 co-pay Second 15 visits: 50% of Allowed Amount

First 30 visits: 100% of Allowed Amount after $10 co-pay and after deductible

Second 15 visits: 50% of Allowed Amount

Dental – Surgical extractions for soft/bony impactions, or Dental implants for certain medical conditions or recent accidents/injuries

100% of Allowed Amount Not Covered

Family Planning3 100% of Allowed Amount Not Covered

Infertility – Diagnostic Only 100% of Allowed Amount Not Covered

Hearing Aids 50% of Charge up to $3,500/Ear – Limited to one aid per Ear every 3 years Not Covered

Organ Transplant Transplant Lifetime Maximum Out-of-Pocket Maximum

100% of Allowed AmountUnlimited

See above (Out-of-Pocket Maximum)

70% of Allowed Amount (after deductible)NoneNone

BEHAVORIAL HEALTH BENEFIT PROGRAM FEATURES

Outpatient Coverage Outpatient (OP) Visits4

Psychological and Neuro-Psychological Testing5100% of Allowed Amount after $35 co-pay100% of Allowed Amount after $35 co-pay

$50 co-pay (after deductible) with 100% of Allowed Amount Not covered

Inpatient Coverage2 100% of Allowed Amount 70% of Allowed Amount (after deductible)

Intensive Outpatient (IOP)2 100% of Allowed Amount 70% of Allowed Amount (after deductible)

Partial Hospitalization Programs (PHP)2 100% of Allowed Amount 70% of Allowed Amount (after deductible)

Residential Treatment2

75 days maximum per Benefit year 100% of Allowed Amount Not Covered


For Tier 1, co-payments and co-insurance listed on this chart accumulate to your out-of-pocket maximum with the exception of co-payments for hearing aids and bariatric surgery.1 MMO Traditional for the state of Ohio and USAMCO outside the state of Ohio.2 Prior authorization required.3 Marymount employees are subject to family planning exclusions including abortion, vasectomy, Norplant, Depo Provera, IUD, tubal ligation, and oral contraceptives, except if clinically appropriate.4 The Outpatient Coverage for Behavioral Health Benefit Program includes any outpatient services provided by a behavioral health practitioner for chronic pain management, sleep disorder, aftercare groups for substance abuse, and/or pre and post gastric surgery visits. There is no coverage for telephone counseling services or school meetings by outpatient behavioral health practitioners.

5 Psychological Testing: Up to six hours testing are automatically covered without prior authorization. Neuro-Psychological Testing: Up to eight hours testing are automatically covered without prior authorization.Testing is covered in Tier 1 only, by trained Behavioral Health Specialists.

Note: Prior authorization, precertification, predetermination and prior approval are often used interchangeably.

Any unauthorized programs, services, or visits will not be covered by The HBP under any circumstances and the subsequent charges will be the financial responsibility of the member. This applies to any unauthorized out-of-network and out-of-area providers and facilities, with the only exception being for emergency care.


2016PrescriptionDrugBenefit administeredthroughCVSCaremark

CATEGORIES TIER 1 Generic Rx

TIER 2Preferred Brands

TIER 3Non-Preferred

Brands (Non-Formulary)

TIER 4 Specialty Drugs

(Hi-Tech)

Drugs & Items at Discounted Rate

Non-Covered Drugs & Items

Annual Deductible $100 Individual $300 Family (Waived for generic prescriptions if obtained from a Cleveland Clinic Pharmacy) No No

Employee % Co-ins. Cleveland Clinic Pharmacies: up to 90 Day Supply

15% 25% 45% 20% Employee Pays 100% of the Discounted Price

Not Available through Rx Plan

Employee % Co-ins. CVS Caremark Retail – 30 Day Supply Mail Service Program – 90 Day Supply

20% 30% 50% 20% Employee Pays 100% of the Discounted Price

Not Available through Rx Plan

Cleveland Clinic Pharmacies including Specialty & Home Delivery:Is there a Minimum or Maximum to the Rx % Co-ins.

Yes$3 Minimum/$50 Maximum

per Month Supply


per Month Supply

No

YesNo Minimum /

$50 Maximum per Month Supply

No No

Retail Pharmacies:Is there a Minimum or Maximum to the Rx % Co-ins.

Yes $5 Minimum/$50 Maximum

per Month Supply


per Month Supply

No NA No No

CVS Caremark Mail Service Program:Is there a Minimum or Maximum to the Rx % Co-ins.

Yes$15 Minimum/$150 Maximum90 Day Supply

Yes$15 Minimum/$150 Maximum90 Day Supply

No

YesNo Minimum /

$100 Maximumper Month Supply

No No

Is there an Annual Out-of-Pocket Max?

After deductible has been met: Individual – $1,500 / Family – $4,500 Combined Maximums for Retail, Specialty and Home Delivery No No

Components of Each Category

Generic Drugs Brand Drugs – See the Prescription Drug Benefit

and Formulary Handbook

Specialty Drugs6 See complete list of

Specialty Drugsin the

PrescriptionDrug Benefit and

FormularyHandbook

Life Style DrugsActiclate, Benzoyl,Peroxide Only Agents,Caverject, Cialis,Cosmetic Agents,Denavir Cream,Doryx, Edex,Evzio, Fertility Agents,Hysingla, Jublia,Levitra, Muse,Non-controlled Coughand Cold Agents,,Oral Allergy Medication,Penlac, Propecia,Relenza, Saxenda,Stendra, Tamiflu,Testosterone Cypionate,Testosterone Enanthate,Topical Androgen,Products, Viagra,Weight Control Products,Xartemus XR, Xerese,Zipsor, Zorvolex,Zovirax Cream,Zovirax Ointment

Over-the Counter Drugs

Alcohol Swabs DME (Durable Medical Equipment) Medical Devices Medical Supplies

Prescription Drugs Brand and Generic Brand versions of: Adoxa, Binosto, Beleodaq, Belsomra, Cyramza, Diclegis, Keytruda, Liptruzet, Monodox, Onmel, Opdivo, Oracea, Oxytrol, Solodyn, Xopenex (not covered for member over 18 years of age.) Contraceptive Coverage See page 23. Proton Pump Inhibitors (Brand Name Products)

Certain OTC Medications are covered

See the Prescription Drug Benefit and

Formulary Handbook

Prior Authorization Required See the Prescription Drug Benefit and Formulary Handbook for List ofPharmaceuticalsRequiringPriorAuthorization No NA

Diabetic Supplies,7 Asthma Delivery Devices7 and Prescription Vitamins 8

Co-Insurance 20% No No NA

Major Chains 9 in the Retail Network

ACME, Cleveland Clinic Pharmacies, Costco, CVS, Discount Drug Mart, Giant Eagle, K-Mart, Marc’s, Medicine Shoppe, Rite Aid, Target, Walgreens, Wal-Mart, plus other chains and independent pharmacies.


Note: Benefit Program Includes: generic oral contraceptives – covered for Marymount HBP participants for clinical appropriateness only under the HBP.6 There are 3 options for obtaining medications in the category listed above. The options are: 1. Cleveland Clinic Pharmacies in Cleveland and Cleveland Clinic Weston Pharmacy, 2. Cleveland Clinic Specialty Pharmacy, and 3. CVS/caremark Specialty Drug Program. Specialty Drug prescription orders (first fill and refills) are limited to a one month supply.7 Diabetic Supplies – Insulin and all diabetic supplies covered. Includes: needles purchased separately, test strips, lancets, glucose meters, syringes, lancing devices, and injection pens. Asthma Delivery Devices – Includes spacers used with asthma inhalers.8 Refers to vitamins that require a prescription from your healthcare provider.9 Members can utilize the CVS/caremark Retail Pharmacy Network for obtaining acute care prescriptions (e.g., single course of antibiotic therapy) and for the first fill of maintenance medications but must use a Cleveland Clinic Pharmacy or CVS/caremark Mail Service Program for all maintenance medications.


Dental Program Options

You can choose one of four dental options administered by Cigna:

•ThePreventiveDentalPlan–PreferredProviderOrganization(PPO)

•TheTraditionalDentalPlan–PreferredProviderOrganization(PPO)

•EnhancedDentalBenefitProgram(DPPO)

The Preventive Dental plan is designed for individuals who only want preventive and basic services. The TraditionalDentalplancoversalltypesofdentalservices.BothplansarePPOplansmeaningyoumaychooseanydentalprovider,butbyusingCignaNetworkprovidersyourco-paymentswillbelowerbecauseofthe discounted rates these providers have agreed to accept.

TheEnhancedDentalBenefitProgrambenefitprogramcoversawiderangeofdentalservices,includingpreventivecare,fillingsandextractions,majorrestorativecare,andorthodontiaforthecaregiverandalleligibledependents.TheannualmaximumbenefitishigherthantheTraditionalDentalBenefitProgram.

•TheDentalHMOPlan–HealthMaintenanceOrganization

TheDentalHMO10planrequiresyoutouseCignaDentalHMOnetworkproviders,andeachfamilymemberisrequiredtoselectageneraldentist.Orthodontiaisacoveredservicefornotonlydependentchildren,butalsoemployees&theirspouses.Yourout-of-pocketpaymentsforallcoveredservicesarebasedontheCIGNADentalCare(DHMO)PatientChargeSchedule(PCS)agreedtobyCIGNADentalnetworkdentists.You are not covered for any out-of-network services.

COVERED SERVICES CignaDPPONetwork

Preventive Care Oralexams,cleanings,x-rays,etc.

100% Reasonable&Customary

(nodeductible)

Basic Services Fillings,oralsurgery,extractions,etc.

80%R&C(afterdeductible)

Major Services Dentures, crowns, dental implants, etc.

NotCovered

Orthodontia NotCovered

Annual Deductible (individual/family) $50/$150

Annual Benefit Maximum $500 per covered person

Preventive Dental Plan

10 Define:HMOProvider–HMOprovidersaremainlythelargecorporate,commercialdentistrylocationsi.e.SearsDental,DeltaDental,AspenDentaletc.


COVERED SERVICES CignaDPPONetwork

Preventive Care Oralexams,cleanings,x-rays,etc.

100%R&C (nodeductible)

Fillings & Extractions 80%R&C(afterdeductible)

Major Restorative Care Oralsurgeryfornon-impactedwisdomteeth,crowns,bridges,rootcanals,dentalimplants,etc.)

60%R&C(afterdeductible)

Orthodontia(adultsandchildren) 80%R&C(after deductible, lifetime

maximumof$2,500perperson)

Annual Deductible (individual/family) $50/$150

Annual Benefit Maximum $1,500 per year

EnhancedDentalBenefitProgram

COVERED SERVICES Your Charge

Preventive Care Oralexams,routinecleanings,x-rays

NoCharge

Restorative Services Amalgam(silver)fillings Resin-based composite crown, anterior

NoCharge$85

Major Services Crown – porcelain fused to high noble metal Fullupperorlowerdenture

$460$625

Orthodontia Children – up to 19th birthday Adults – age 19 and older

$2,040$2,376

DentalHMOPlan

COVERED SERVICES CignaDPPO AdvantageNetwork

CignaDPPO Network Out-of-Network

Class 1: Preventive&diagnosticcare–oralexams,cleanings,x-rays,etc.

100%(nodeductible)

100% (nodeductible)

100%R&C(nodeductible)

Class 2: Basic/restorativecare–fillings,oralsurgery,extractions,etc.

80% (afterdeductible)


70%R&C (afterdeductible)

Class 3: Majorrestorativecare–dentures,crowns,etc. 50% (afterdeductible)



Class 4:Orthodontia(lifetimemaximumbenefitof$1,250pereligible covered dependent under age 26.




Annual Deductible(individual/family) $50/$150 $50/$150 $50/$150

Annual Benefit Maximum Class1,2,&3expenses

$1,250 per person

$1,000 per person

$1,000 per person

Balance Billing by Dentist in excess of co-insurance No No Yes

Traditional Dental Plan


Vision Program

•TheVisionplanisamaterialsonlyplanadministeredbyEyeMed

•Eyeexamsfallunderyourmedicalinsurance

•PurchaseeyewearfromanyproviderintheEyeMed*ACCESS-networkforbestcoverage

•Participantscanalsotakeadvantageofdiscountsforadditionalpairsofeyeglassesandcontactlenses

COVERED EYE WEAR EYEMED VISION CARE ACCESS NETWORK BENEFITS

OUT-OF-NETWORK REIMBURSEMENT

Frames Any available frame at provider location

$130Allowance 20%offbalanceover$130 $35

Standard Plastic Lenses SingleVisionBifocal Trifocal

Standard Progressive Lens

Premium Progressive Lens Tier 1 Tier 2 Tier3 Tier4

FullycoveredFullycoveredFullycovered

$65co-pay

$85co-pay$95co-pay$110co-pay$65co-pay

80%ofretailless$120allowance

$25$40$55

$40

$40$40$40$40

Lens OptionsUVCoatingTint(SolidandGradient) Standard Plastic Scratch Coating Standard Polycarbonate – Adults Standard Polycarbonate – Kids under 19StandardAnti-ReflectiveCoatingPremiumAnti-ReflectiveCoating Tier 1 Tier 2 Tier3 Polarized OtherAdd-ons

$15co-pay$15co-pay$15co-pay$40co-pay$40co-pay$45

$57co-pay$68co-pay

20% off Retail Price20% off retail price20% off retail price

NotCoveredNotCoveredNotCoveredNotCoveredNotCoveredNotCovered

NotcoveredNotcoveredNotcoveredNotCoveredNotCovered

Contact Lenses (Contact lens allowance includesmaterialsonly) Conventional Disposable

$110allowance 15%offbalanceover$110

$110allowance

$70

$70

Lasik or PRK from US Laser Network 15% off Retail Price or 5% off Promotional Price

Notcovered

Additional Pairs Benefit Membersalsoreceivea40%discountoff complete pair eyeglass purchases and 15% discount off conventional contact lensesoncethefundedbenefithas

been used.

Notcovered

Frequency Lenses or Contact LensesFrame

Onceevery12monthsOnceevery12months


BasicVisionBenefitProgram


COVERED EYE WEAR EYEMED VISION CARE ACCESS NETWORK BENEFITS

OUT-OF-NETWORK REIMBURSEMENT

Frames Any available frame at provider location

$160Allowance 20%offbalanceover$160 $35

Standard Plastic Lenses SingleVisionBifocal Trifocal

Standard Progressive Lens

Premium Progressive Lens Tier 1 Tier 2 Tier3 Tier4

FullycoveredFullycoveredFullycovered

$65co-pay

$85co-pay$95co-pay$110co-pay$65co-pay

80%ofretailless$120allowance

$25$40$55

$40

$40$40$40$40

Lens OptionsUVCoatingTint(SolidandGradient) Standard Plastic Scratch Coating Standard Polycarbonate – Adults Standard Polycarbonate – Kids under 19StandardAnti-ReflectiveCoatingPremiumAnti-ReflectiveCoating Tier 1 Tier 2 Tier3 Polarized OtherAdd-ons

FullycoveredFullycoveredFullycoveredFullycoveredFullycoveredFullycovered

$12$23

20% off Retail Price20% off retail price20% off retail price

$8$8$8$20$20$23

$23$23$23

NotCoveredNotCovered

Contact Lenses (Contact lens allowance includesmaterialsonly) Conventional Disposable

$160allowance 15%offbalanceover$160

$160allowance

$70

$70

Lasik or PRK from US Laser Network 15% off Retail Price or 5% off Promotional Price

Notcovered

Additional Pairs Benefit Membersalsoreceivea40%discountoff complete pair eyeglass purchases and 15% discount off conventional contact lensesoncethefundedbenefithas

been used.

Notcovered

Frequency Lenses or Contact LensesFrame



EnhancedVisionBenefitProgram


Flexible Spending Accounts

Therearetwodistinct,FlexibleSpendingAccounts(FSA),andbothareadministeredbyPayFlex.

YoucanusetheFSAaccountstosetasidepre-taxmoneytoreimburseyourselfforqualifiedexpensesincurred during the calendar year.

The Medical FSA is for you andyourdependents’out-of-pockethealthcareexpenses.

•minimumelection:$100peryear

•maximumelection:$2500peryear

•annualamountyouelectisavailableimmediately

The Dependent Care FSAisforadult/childdaycareexpensesonly.

•minimumelection:$100peryear

•maximumelection:$5000peryearifyouaresingleoryouaremarried&filingajointtaxreturn ($2500ifyouaremarriedandyou&yourspousefileseparatetaxreturns)

•annualamountyouelectaccumulatesperpay

•Eligible dependents include:Childrenunderage13who youclaimasdependentsonyourFederal IncomeTaxreturn.Spousesphysicallyormentallyunableto care for themselves. •Individuals(suchasparentsorchildrenage13orolder)who reside with you, are physically or mentally incapable of caring for themselves, and can be claimed as dependents on your Federalincometaxreturn

•For advantages/disadvantages consult with your tax advisor

*ForacompletelistofEligible/IneligibleexpenseitemsforeitherFSAaccount visit www.HealthHub.com;click“Employees”tab

ThingstoconsiderwhenmakingdecisionsaboutFSAcontributions:

•Youcanmakepretaxcontributionstoeitherorbothaccounts

•Youcannottransferfundsfromoneaccounttotheother

•Youshouldcarefullyconsidertheamountsyouplanto contribute because you will forfeit any account balances that are not claimed for reimbursement at the end of the calendar year

•YouhaveuntilMarch15thofthefollowingyeartouseup the remaining prior year balance. Claims for reimbursement mustbesubmittednolaterthanMarch31st.

•Accountsdonotcarryoverfromyear-to-year. Mustre-electedeveryOpenEnrollment.


Life Insurance Program

ClevelandClinicprovidesbenefiteligibleemployeeswithnocosttermBasic Life insurance coverage at onetimestheirannualbasepay,uptoamaximumof$500,000.YoualsoreceiveAccidentalDeathandDismembermentcoverageequaltotheamountofthetermlifecoverageatnoadditionalcost.

Supplemental Life Insurance Plan At an additional cost, you may elect term11 Supplemental Life insurance.

•Optiontoelectonetotentimesbasepay,notexceeding$1,500,000

•Premiumisdeterminedbyyoursalaryandyouragebracket

•Newlyeligibleemployeeshaveopportunitytoelectuptosixtimesbasepay($1millionmaximum) without providing evidence of insurability

•Ifyoudecidetoelectatalaterdate,youwillbeaskedtoprovideevidenceofinsurability

IRS Requirement.Iftheamountofyourlifeinsuranceexceeds$50,000,ClevelandClinicisrequiredtoreportthepremiumontheexcessamountastaxableincometoyou(knownasimputedincome).

Please designate your beneficiaries on your HRConnect Portal account

Dependent Life Insurance Plan BenefiteligibleemployeesalsohavetheoptiontoelecttermdependentLifeInsurancecoveragefortheirlegalspouse&eligiblechildren(underage23).

•Flatbenefit:$25,000/Spouseand$10,000/eligiblechild

•You,astheemployee,aretheautomaticbeneficiary

•Grouprateatanannualcostof$65post-taxinaccordancewithIRSregulations

•Fornewlyeligibleemployees,evidenceofinsurabilityisnotrequired

Disability Insurance Program

Regular, full-time employees with one continuous year of uninterrupted service are eligible for both Short and Long Term disability at 60% of their base salary.

Short Term Disability Plan–Ifanemployeeisonanauthorizedleaveofabsence,theShortTermbenefitmay provide up to 26 weeks of income at 60% of base salary through the disability period.

Long Term Disability Plan – If a medical condition continues beyond the short term disability period, an employeemaybeeligibletoreceivetheLongTermbenefit.Thelongtermbenefitreplaces60%ofbasepay,upto$15,000permonth.

Thesebenefitsarepaid100%byClevelandClinic.

Part time employees are also provided an opportunity to purchase Voluntary Long Term Disability. Voluntarycoveragepaysabenefitofupto60%ofbasemonthlypayanditcanbepurchasedduringtheinsurancecompany’sannualenrollment.

11 Define:Termlifeinsurance–lifeinsurancethatpaysabenefitintheeventofthedeathoftheinsuredduringaspecifiedterm.


AdditionalValuableTotalRewards

Retirement Program

TherearetwoplansthathelpyousaveforretirementandbothareadministeredthoughFidelityInvestments.

The Investment Pension Plan (IPP) is the ClevelandClinic’scontribution toward your retirement at no cost.

•Aslongasyouare21yearsold,youareautomaticallyenrolledintheplanonyourdateofhire.

•Eachpayperiod,employeesenrolledwillreceiveanEmployerPensionContribution,basedonyears of service.

•EmployeesareresponsibleformanagingtheirIPPaccount.

* Ineligible employees include: Students, residents/fellows and research associates.

The Savings & Investment Plan (SIP) is yourpre-taxcontribution toward your retirement.

•Newlyhiredfull-time,part-time&PRNemployeesareautomaticallyenrolledat3%

•Youmayoptout/adjustatanytimeduringtheyear

•ClevelandClinicwillmatch50centsforeverydollaryousave,upto6%ofyourpaythatyou contribute to the plan

•QualifyfortheEmployerMatchingContributionsafterthreeyearofservice.*Students, residents/ fellows, research associates and Lakewood Hospital employees participating in Public Employees Retirement System are not eligible for matching contributions

Paid Time Off (PTO)

Thisprogramcombinesvacation,holidays,personaldaysandsickdaystoprovideyouwithflexibilityindetermining your individual time-off schedule.

•Allowancesbasedonpositionandlengthofservice

•AfternewhireperiodyoucanbeginutilizingPTOyou’veaccrued

•Non-benefiteligibleemployeesandresidents/fellowsarenoteligibletoaccruePTO

PTO Trade-in DuringOpenEnrollmentemployeescantrade-intheirPTOtooffsetbenefitcosts.

Please note:

•Trade-inmustbeinincrementsof8;minimum8hoursandmaximum80hours

•YoucannotchangeyourPTOtrade-inamountduringthecalendaryear

•PTOtrade-indoesnotcarryoverfromyear-to-year

•PTOtrade-incanonlybeelectedduringOpenEnrollment

•Ifyouterminate,retire,changestatustoPRNortemporaryorexperienceaqualifyinglifeevent mid-year,yourPTOcannotbereturnedtoyou


Employee Assistance Program (EAP)

EAPisaconfidential,outsideprogramthathelpsyouandyourfamilymemberswithdifficultpersonalissues. Assistance comes in forms of:

•Confidentialconsultations

•WorkLifeServices/FamilyDependentCareProgram

•Adoptionservices

•Professionalassistancewithchild/eldercare

Employeescancall24hoursaday,7daysaweekat800.989.8820totakeadvantageoftheprogram’sconfidential,short-termcounseling.

Tuition Assistance Program

After completing twelve months of employment, you are eligible to receive tuition reimbursement after satisfactorilycompletingapprovedcourses.EdAssistHelpDeskat877.410.6927

Reimbursement is based on:

•Status(full-orpart-time)

•Nursingornon-nursing

•Typeofdegree

Other Benefits

•CollegeAdvantage529SavingsProgram

•ComputerPurchaseProgram

•RetireeMedicalPlan

•AdoptionAssistance

•VoluntaryAutoandHomeInsurance

•VoluntaryMetLawGroupLegalPlan

•VoluntaryVeterinaryPetInsurance

DEGREE TYPEANNUAL MAXIMUM TUITION REIMBURSEMENT

NursingMajor Full-time

NursingMajor Part-time

Non-NursingMajorFull-time

Non-NursingMajorPart-time

Graduate/Doctorate/PhD Degree $7,500 $3,750 $4,500 $2,250

Bachelor Degree $5,000 $2,500 $3,000 $1,500

Associate Degree $2,500 $1,250 $1,500 $750

Tuition Reimbursement


EnrollmentNewHireEnrollmentiscompletedthroughyourHRConnectPortalaccountwithin31daysofyourhiredate.Beginbyloggingontohttp://hrconnect.ccf.orgusingyourNetworkID(ActiveDirectory)andNetworkPassword.FollowtheinstructionsincludedonyourBuzzcardforaccessingtheenrollmentforthefirsttime.

Things to consider:

•Ittakes4-6weeks,afterenrollmentiscompleted,toreceiveyourIDcardsinthemail

•Yourcoverageisretro-effectivetoyourdateofhire,soyourelectionpremiumpaymentsare withdrawn retroactively

•Youareonlyauto-enrolledinBasicLifeandAccidentalDeath&Dismembermentcoverage

•Ifyoudonotelectbenefitswithin31daysofyourhiredate,youwillnotbeentitledtoother benefitsuntilthenextOpenEnrollmentperiodunlessyouexperienceanIRSqualifiedlifeevent.


FAQsWhen does my coverage begin once I sign up?

Coverage is retro effective to your date of hire.

When will my insurance cards arrive?

4-6weeks

Can I switch to different plans during the year?

No,planoptionchangescanonlybemadeduringOpenEnrollment.

When is open enrollment?

TypicallyOpenEnrollmentisheldeverymid-October.

Who do I contact to make changes to my benefits?

ContactONEHRat216.448.2247.

When signing up for the Employee Health Plan do I need to choose a Tier?

Youdonotneedtochooseatier.BothtiersareofferedundertheEmployeeHealthPlan.The tiers determine where your provider falls and how much coverage you will have.

Can I roll over another retirement plan to my new SIP?

Yes,obtainareleaseformfromyourpreviousprovidertorolloveryouraccounttoFidelity

How does Cleveland Clinic match my SIP contribution?

TheClevelandClinicwillmatch.50centsforeverydollaryousave,onthefirst6%ofyourpaythat you contribute to the plan.

When will I be fully vested?

Youarealwaysvestedat100%inyourcontributions.Thematchvestsafter3yearsofservice.


ContactEnrollment site

http://hrconnect.ccf.org

Medical

MutualHealth 800.451.7929 www.MutualHealthServices.com

Tier 1 providers ClevelandHealthNetwork www.CHNetwork.com

Tier 2 providers ClevelandHealthNetwork www.CHNetwork.com

MedicalMutualTraditionalNetwork www.SuperMedNetwork.com

USAManagedCareOrganization www.usamco.com

EHP Programs

www.clevelandclinic.org/healthplan

Prescription

Caremark 866.804.5876 www.Caremark.com

https://myrefills.clevelandclinic.net

www.ClevelandClinic.org/pharmacy

HomeDelivery 216.328.6076

Dental

Cigna 800.244.6224 www.MyCigna.com

Vision

EyeMed 866.723.0513 www.EyeMed.com

Flexible Spending Accounts

PayFlex 800.284.4885 www.HealthHub.com

Life Insurance

Consumers Life 855.544.2542 www.ConsumersLife.com

Retirement

FidelityRetirement 888.388.2247 www.Fidelity.com/atwork

COBRA Continuation Services

PayFlex 800.359.3921

Employee Assistance Program

216.445.6970 800.989.8820 www.ConcernEAP.org

Tuition Assistance

EdAssist 877.410.6927

Voluntary Long term Disability

UNUM 800.858.6843

Other Benefits

College Advantage 800.233.6734

Computer Purchase Program 866.670.3479

MetropolitanInsurance(Auto/Home/Legal/Pet) 800.438.6388


ONE HR Service Center216.448.CCHR (2247)877.688.CCHR (2247)

ONE HRTHE POWER OF EVERY ONE

For HR self service you can continue to use HR Connect and AskHR.To provide feedback concerning the new ONE HR Service Center please email [email protected]

1 Current HR Initiative 2 Benefits 3 Payroll 4 Occupational

Health 5 HR General Line 6 Caring for Caregivers

(EAP)

1 Current HR Initiative Seasonal use for hot topics such as Open Enrollment, Summer fun discounts, etc.

2 Benefits

Press 1: For Healthy Choice or EHP Wellness programs

Press 2: For the Medical plan, pharmacy, billing statements, or the Willis Audit

Press 3: For the Dental and Vision plan, change of status, life events, Flexible Spending, Voluntary Benefits, or Employee Discounts

Press 4: For COBRA

Press 1: For COBRA PayFlex

Press 2: For COBRA CCF

Press 5: For Leave of Absence, including Disability and FMLA

Press 6: For the Retirement Program

Press 1: To transfer to Fidelity 888-388-2247 Press 2: To discuss plans for retirement Press 3: For Retirement Account questions

For questions related to Benefits, including Healthy Choice, EHP Wellness, Leave of Absence, and Retirement

3 Payroll Press 1: to speak with a Payroll Representative for Short Term DisabilityPress 2: to speak with a Payroll Representative for Regional Hospitals and Las VegasPress 3: to speak with a Payroll Representative for Main Campus Press 4: to speak with a Payroll Representative for Children’s Rehab/Home CarePress 5: to speak with a Payroll Representative for Tax DepartmentPress 6: to speak with a Payroll Representative for Time & AttendancePress 7: to speak with a Payroll Representative for Florida

For questions about your paycheck, PTO, Tax withholdings, or Direct Deposit

4 Occupational Health Press 1: To schedule an Occupational Health visit

Press 2: To speak to a nursePress 3: To be connected to the ReadySet Help Desk for technical problems For questions

related to OccHealth

5 Other HR Services

Press 1: For Recruitment

Press 1: To check on the status of your application, withdraw, or reset your password Press 2: For Physician recruitment

Press 3: To speak with a Military recruiter

Press 4: For international assignments

Press 5: For Student Experience

Press 2: For HR Connect Support Press 1: For system access issues from work or home and computer password reset

Press 2: For HR Connect

Press 3: For employment verification

Press 4: For general HR questions

For questions related to recruitment, HRConnect, employment verification, and general HR questions

6 Caring for Caregivers Program

A confidential Staff and Employee Assistance Program (EAP) for personal, family or work place concerns

HR-COMP-10-7-2015


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