Your Benefits at Avita Health System · Your Benefits at Avita Health System ... benefits at Avita...

2016

Your Benefits at Avita Health System

2

Choosing the right benefits for you and your family

We are pleased to provide you with this updated benefit booklet summarizing the benefits at Avita Health System. Your health and well‐being are important to us. That’s why we provide employees with high quality benefit choices. We are committed to ensuring our benefits are competitive and affordable. Therefore, Avita Health System continues to pay a major portion of employee health care expenses in 2016. This booklet describes the features of your Benefit Plan. As you look through it, you will learn how you become a Plan Member and what your benefits are. Since benefits can change each year, please read this booklet carefully and share it with your family. It is important that they are aware of their benefits. Administration has the right to change benefits as the need arises. Of course, it is important that you read all communications sent to you by Human Resources. In preparing this booklet, we’ve done our best to explain everything correctly. If you have questions about your benefits, please contact the Human Resources office. We will be pleased to help you.

3

Helping you live your best life. We understand that you don’t check your life at the door when you come to work. That’s why Avita Health System is pleased to offer high‐quality benefit choices that not only support you at work, but also enrich your personal life. Our benefits are competitive and affordable, and Avita Health System will continue to pay a major portion of your health care expenses.

About this guide This guide summarizes benefits available for the 2016 calendar year. You’ll find brief descriptions of benefit options, as well as eligibility requirements. Please note that barring a qualified event (see table below), the next opportunity to make benefit changes will be during Open Enrollment for the 2017 plan year. Also, this summary does not contain all of the provisions and limitations that apply to Avita Health System benefits. For coverage details, see the Employee Handbook and the benefit plan’s Summary Plan Description (SPD), all available on the Avita Health System intranet (411). All benefits are subject to termination or modification by Avita Health System at any time at its sole discretion.

What benefits can I add or change only during Open Enrollment?

Medical Insurance Dental Insurance Vision Insurance

Flexible Spending Accounts

What benefits can I add or change any time during the year?

Life Insurance Beneficiaries 403(b) Retirement Plan (Employee Contributions)

What if my family situation changes mid‐year?

In keeping with IRS rules, you may make mid‐year benefit changes only if you have a qualifying life event, like the following:

Marriage

Divorce

Birth, adoption or placement of a child

Loss of spouse’s insurance coverage

Loss of a loved one (spouse, dependent or other family member)

Retirement When making a change to a benefit enrollment as a result of a life event, the change must be consistent with the life event and must be made within 31 days of the life event. Proper documentation of the qualifying life event is required. Those documents may include:

Marriage License/Certificate

Divorce Decree Papers

Birth Certificate/Adoption Papers

Death Certificate

Loss of insurance coverage letter/document or Creditable Coverage Certificate

4

Benefits Eligibility Information

Benefit

Regular Full‐Time 60 – 80

hours/pay

Regular Part‐Time 48 – 59

hours/pay

Part‐Time 16 – 47

hours/pay Casual When You’re Eligible

Medical/Prescription X X 31st day of employment

Dental X X 1st day of month after 31 days

Vision X X 1st day of month after 31 days

Basic Life Insurance (Provided by Avita)

X X 31st day of employment

Voluntary Life Insurance X X 1st day of month after 31 days

Dependent Life Insurance (spouse/dependent)

X X 1st day of month after 31 days

Short‐Term Disability (Provided by Avita)

X X After one year of employment

Long‐Term Disability (Exempt

Employees only – Provided by Avita) X X 31st day of employment

Flexible Spending Account (FSA)

X X 31st day of employment

Voluntary Short‐Term Disability X X 1st day of month after 31 days

Long Term Care Insurance X X 1st day of month after 31 days

Cancer Insurance X X 1st day of month after 31 days

Critical Illness Insurance X X 1st day of month after 31 days

Education Assistance Program X X After one year of employment

403(b) Retirement Plan – Employee Contributions

X X X X 31st day of employment

403(b) Retirement Plan – Employer (Avita) Contributions

X X * * After one year of employment

* Must work 1,000 hours

Roth IRA X X 31st day of employment

Employee Assistance Program X X X X 1st day of employment

Cafeteria Payroll Deductions X X X 1st day of employment

Avita patient bills for services ‐discount for prompt payment


YMCA reduced memberships for Galion & Bucyrus

X X X 1st day of employment

Galion Country Club corporate memberships


Snow Trails in Mansfield corporate membership


Great Wolf Lodge in Sandusky corporate discount


Cedar Point corporate program discounted tickets


5

Health Plans

Medical Coverage Whether you are sick or injured, your medical coverage is one of your most valuable benefits. Avita Health System pays a major portion of the expenses for your medical coverage through the Traditional Health Plan and Health Saving Account (HSA) Plan. Both plans are self‐insured through Avita.

While both plans have the covered services and feature in‐network and out‐of‐network coverage, the main difference are the structures of the plans. Both plans utilize the Medical Mutual of Ohio (MMO) network. Traditional Plan (PPO Plan) A Preferred Provider Organization (PPO) Plan gives you flexibility. You can go to any health care professional you want without a referral—inside or outside of your networks. Staying inside the Avita Health System network and in‐network provider network means that you will have smaller co‐pays and full coverage. If you choose to go outside these networks, you will have higher out‐of‐pocket costs and not all services may be covered. Health Savings Account (HSA) Plan A health savings account (HSA) combines a high deductible health insurance plan with a tax‐favored savings account created for the purpose of paying medical expenses. Avita Health System helps build this account for you by depositing money each pay period into your established savings account through United Bank. The money in this savings account can help pay for your deductible or it can be left in the account to grow. Once your deductible is met, the insurance starts paying. The money left in the savings account is yours to keep. Below are some advantages to Health Savings Accounts:

Tax‐deductible Contributions to the HSA are 100% deductible (up to the legal limit) — just like an IRA.

Tax‐free Withdrawals to pay qualified medical expenses, including dental and vision, are never taxed.

Tax‐deferred Interest earnings accumulate tax‐deferred, and if used to pay qualified medical expenses, are tax‐free.

HSA money is yours to keep Unlike a flexible spending account (FSA), unused money in your HSA isn’t forfeited at the end of the year; it continues to grow tax‐deferred.

Supplemental Hospital Confinement Policy Avita Health System provides and pays for this additional policy if you are on the HSA Plan. It pays a cash benefit directly to you for each day you are hospitalized as a result of illnesses, accidents or injuries, providing you with additional financial support in a variety of circumstances. This money can be used for anything you choose. It’s your money, your decision.

6

Annual Wellness At Avita Health System we value employee wellness especially through preventative measures. As a result, we implemented a series of tests that are based on age and gender that must be performed by the end of each year in order to avoid a 10% premium surcharge. Below is the list of annual tests.

Recommended Test Gender Frequency

Wellness Exam Male & Female > 18 Years Each Year

Cholesterol Male & Female > 18 Years 5 Years

Colonoscopy Male & Female > 50 Years 10 Years

Mammography Female > 40 Years 1 – 2 Years

Pap Smear Female > 18 Years 1 – 2 Years

Testicular & Prostate Cancer (Clinical testicular exam at each physical visit with informed decision making regarding PSA Screening depending on risk.)

Male > 45 Years Each Year

To determine if you are compliant with any or all of the above wellness criteria, you can contact MMO at (800) 367‐3762 ext. 19781 during normal business hours.

Prescription Drug Coverage You probably know from your own experience that the cost of prescription drugs continues to rise dramatically. To help keep your medical expenses as low as possible, both plans include a prescription drug program administered by Express Scripts. When you enroll in either plan, you will automatically receive prescription drug coverage. For the PPO Plan, Avita Health System uses a three‐tiered (Generic, Formulary, Brand Name) preferred drug list. Drugs are placed on a formulary based on their clinical effectiveness and safety, as well as cost. There are two retail pharmacies that are covered under the plan for maintenance drugs: Avita Ontario Pharmacy and Quay’s Drugs (Galion). If these two retail pharmacies are not used for maintenance drugs, you must use Express Scripts Mail Order. Also, of note, there is a 25% less benefit paid by Avita Health System when you utilize the Avita Ontario Pharmacy. Under the TRADITIONAL PLAN, the following Over‐The‐Counter (OTC) medications will be covered at 100%. You must receive a prescription from your physician for these medications in order to be covered at 100%. Simply, take the medication off the drugstore shelf, take it to the pharmacy along with your prescription and health insurance card to receive your medications….no money will exchange hands! The following will need to be listed on the prescription for these medications:

Date Prescription is Written;

Patient’s Full Name;

Complete Name of the Medicine;

Quantity Dispensed;

Directions for Use;

Any Refills;

Signature of Prescribing Physician.

Below is the list of OTC medications that can be used in place of “regular” prescriptions.

Over‐the‐Counter Medications

Abreva

Alaway

Allegra

Allegra‐D

Claritin

Claritin‐D

Zyrtec

Zyrtec‐D

Prevacid‐24

Prilosec

Slo‐Niacin

Zaditor

Zegerid

Spousal Rule At Avita Health System, spouses may be covered under the medical and prescription plans, however, a $75 per month surcharge will apply. Exceptions for the spouse to be on the plan and not have to pay the surcharge are as follows:

Spouse is covered under Medicare;

Spouse is self‐employed or unemployed;

Spouse does not qualify for his/her employer’s health plan;

Avita Health System is not covered under the employer’s health plan as an in‐network provider. For the spouses that do not meet the exceptions, a Spousal Rule Form will need to be completed and returned to the Human Resources Department.

8

Dental Coverage – Supplemental We are pleased to offer voluntary dental coverage through Delta Dental. Currently, we offer a High and a Low plan. Both plans contain a maximum payment of $1,000 total per person per calendar year and a total $50 deductible per person per calendar year limited to a maximum deductible of $150 per family per calendar year. The deductible only applies to basic and major services. The premiums listed below reflect 75% of the full premium amount. Avita Health System contributes 25% coverage for this benefit. The High Plan consists of three levels of benefits:

Diagnostic and preventative services are covered at 100%;

Basic services are covered at 80%; and

Major services are covered at 50%. The Low Plan consists of two levels of benefits:

Diagnostic and preventative are covered at 100%; and

Basic services are covered at 80%.

Delta Dental Per Pay Rates for 2016

Low Plan

Employee $7.39

Employee + Spouse $13.79

Employee + Children $19.70

Family $29.34

High Plan

Employee $10.54

Employee + Spouse $19.99

Employee + Children $22.77

Family $35.40

Vision Coverage – Supplemental The voluntary EyeMed Vision Plan helps pay for eye exams, eyeglasses (lenses and frames) and contact lenses. This plan uses the EyeMed provider network, but you have the flexibility to receive care from any optometrist or optician you prefer. If you chose an out‐of‐network provider, your reimbursement rate of eligible expenses will be lower. If you choose vision coverage, you will need to select from one of four coverage tiers (employee only, employee + 1 and family). You can enroll in vision coverage whether or not you have medical coverage through Avita Health System.

EyeMed Per Pay Rates for 2016

Employee $4.11

Employee + 1 $7.82

Family $11.49

9

Medical Benefits At‐A‐Glance

Plan Provision Avita Network In‐Network (MMO) Out‐of‐NetworkPPO HSA PPO HSA PPO HSA

Calendar Year Deductible $0

Per Person$3,000

Max Per Family $6,000

Avita Network & In‐Network limits are blended

$0

Per Person$4,000


Avita Network &

In‐Network limits are blended

$0

Per Person$6,000


After deductible is met, coverage

is at 50%

Co‐Insurance for: Inpatient hospital care, Outpatient surgery, Diagnostic and Therapeutic Services

10% N/A 25% N/A 50% N/A

Calendar Year Out‐of‐Pocket Maximums

Medical

Per Person $3,000

Employee + More $6,000

Per Person $3,000

Per Family $6,000

Per Person $4,500

Employee + More $9,240

Per Person $4,000

Per Family $8,000

No Limit

Per Person$6,000 Family $12,000

(Also see above)

Prescription Drug

Per Person $2,100

Family $3,960 N/A

Per Person$2,100

Family $3,960 N/A N/A N/A

Physician Office Visit $15 co‐pay Cost of visit

minus network discount

$40 co‐pay Cost of visit


Cost of visit Cost of visit

Preventative Care No co‐pay

(Paid fully by Avita)

No co‐pay(Paid fully by

Avita)


Avita)


Avita) Cost of visit Cost of visit

Walk‐in Clinic $30 co‐pay Cost of visit


N/A N/A N/A N/A

Urgent Care Center N/A N/A 25% Cost of visit


Cost of visit Cost of visit

Emergency Department Visit

$50 co‐pay then 25%

Cost of visit minus network

discount


Cost of visit minus network

discount


Cost of visit

Prescription Drugs: 31 day supply Retail

Generic – $10 Formulary – 40% of charges Min $30 Max $80 Brand Name – 40% of charges Min $50 Max $125

Cost of drug until deductible

is met

Generic – $10Formulary – 40% of charges Min $30 Max $80 Brand Name – 40% of charges Min $50 Max $125


is met N/A N/A

Prescription Drugs: 90 day supply Retail – Avita Ontario or Quay’s Drug (Galion) Mail Order – ExpressScripts

Generic – $25 Formulary – 40% of charges Min $40 Max $130 Brand Name – 40% of charges Min $75 Max $200


is met

Generic – $25Formulary – 40% of charges Min $40 Max $130 Brand Name – 40% of charges Min $75 Max $200


is met N/A N/A

10

2016 Health Insurance Premiums Traditional Plan

Health Savings Account (HSA) Plan

FULL TIME (60+ hours)

Per Pay Per Pay with Surcharge

Avita’s Deposits to the H.S.A. Account Per Pay

COBRA Cost Per Month

Employee $73.00 $80.30 $50 $1,012.29

Employee + Spouse $144.17 $158.59 $75 $1,988.38

Employee + Dependent(s) $128.11 $140.92 $75 $1,754.12

Family $163.32 $179.65 $100 $2,964.46

FULL TIME (60+ hours)

Per Pay Per Pay with Surcharge COBRA Cost Per Month

Employee $76.17 $83.79 $1,012.29

Employee + Spouse $150.30 $165.33 $1,988.38

Employee + Dependent(s) $133.56 $146.92 $1,754.12

Family $172.39 $189.24 $2,964.46

PART TIME (48 – 59 hours)

Per Pay Per Pay with Surcharge COBRA Cost Per Month

Employee $107.91 $118.71 $1,012.29

Employee + Spouse $211.65 $232.82 $1,988.38

Employee + Dependent(s) $188.07 $206.88 $1,754.12

Family $242.71 $266.98 $2,964.46

PART TIME (48 – 59 hours)

Per Pay Per Pay with Surcharge

Avita’s Deposit to the H.S.A. Account Per Pay

COBRA Cost Per Month

Employee $106.33 $116.96 $50 $1,012.29

Employee + Spouse $208.58 $229.44 $75 $1,988.38

Employee + Dependent(s) $185.34 $203.87 $75 $1,754.12

Family $224.57 $247.03 $100 $2,964.46

11

Retirement Savings To help employees prepare for retirement, Avita Health System provides a 403(b) retirement plan which allows for employer and employee contributions. The plan is administered by OneAmerica. Employee contributions are voluntary and are made via payroll deduction on a pre‐tax basis.

Avita Health System Contributions: All employees are eligible if they work a minimum of 1,000 hours or more in a year. Employees must have completed one full year of continuous employment before employer contributions will begin. Avita will contribute 3% of an employee’s wages automatically. If the employee contributes 1%, then Avita will contribute another ½ %. If the employee contributes 2%, then Avita will contribute another 1%. Avita Health System could potentially contribute a maximum of 4% to an employee’s 403(b) account. The enrollment periods for the contributions are January and July.

Employee Contributions: All employees are eligible to participate regardless of position or length of employment. Employees can make voluntary contributions through salary reduction up to the annual allowable maximum which are set by the IRS. All taxes are deferred until the funds are withdrawn.

Flexible Spending Accounts (FSA) Flexible spending accounts help you pay for certain health care and dependent care expenses that are not covered by the medical, dental or visions plans – co‐pays, coinsurance and amounts above benefit maximums to name a few. The FSA is administered by Mutual Health Services (MHS). The FSA provides tax advantages by letting you set aside pre‐tax dollars to pay certain health care expenses. When you participate in this account, you do not pay Social Security taxes federal or state income taxes on the money you contribute or are reimbursed. FSA debit cards allow easy access to your saved pre‐tax FSA dollars, which are automatically drawn from your account as purchases made.

Employer Paid Life‐Insurance Avita Health System pays the full cost of Basic Term Life Insurance and Accidental Death and Dismemberment insurance for employees who work regular full‐time or part‐time hours after 30 days of continuous employment for nonexempt (hourly) staff at one times the employee’s annual base pay up to a maximum of $100,000. For exempt (salary) staff at two times the employee’s annual base pay up to a maximum of $100,000.

Additional Income Protection For those employees considering additional insurance protection, Avita Health System offers several options to help prepare for life’s unexpected costs.

Roth IRA Plan

Additional Life Insurance (for employees)

Additional Life Insurance (for spouses and dependents)

Critical Illness Insurance

Cancer Insurance (for employee and/or dependent)

Disability Insurance

Accident/Sickness Insurance (for employee and/or dependent)

12

Short Term Disability Insurance Avita Health System provides employees with self‐funded short term disability coverage. Employees must be a regular full‐time or part‐employee (minimum of 24 hours/week) and be employed for one continues year to be eligible. The maximum benefit paid is 12 weeks in a rolling year. Nonexempt (hourly) employees who are eligible will receive 65% of average hours worked (straight time hours worked, including PTO, holidays, furlough hours, bereavement leave, jury duty) using the six full bi‐weekly pay periods prior to the date of illness or injury. This benefit commences on the 1st day of hospitalization (inpatient) or 8th day for illness, injury, or outpatient surgeries/procedures. Exempt (salary) employees who are eligible will receive 100% of their weekly earnings as a result of illness injury for the first 22 days. After the 22 days, weekly payments will be paid at 66 ⅔% of average weekly earnings. This benefit commences on the 1st day of hospitalization (inpatient) or 8th day for illness, injury, or outpatient surgeries/procedures.

Long Term Disability Insurance Avita Health System provides exempt (salary) employees with long term disability coverage. Employees are eligible for this coverage after the completion of the 30th day of employment. This coverage consists of 60% of basic monthly earnings after four month disability. The maximum benefit is $12,500 per month based on monthly earnings.

Paid Time‐Off (PTO) Program Avita Health System provides an all purpose paid time‐off program. Regular full‐time and part‐time employees are eligible to sue this accrued time off for vacation, holiday, illness, injury or personal business. It combines traditional vacation and sick leave plans. In the event that available PTO is not used by the end of an employee’s anniversary hire date, the employee may carry over the maximum amount allowed to the next year or have the option to cash‐out up to 40 hours of PTO. PTO is accrued by the following schedules:

Non‐Exempt (Hourly) EmployeesFull‐Time

(70 – 80 Hours Bi‐Weekly)

Years of Service Rate Per Hour Maximum Carryover

Hours Per Year Maximum

Days Per Year Maximum

0 – 5 0.08466 96 176 22

6 – 14 0.10388 136 216 27

15 – 24 0.12315 176 256 32

25 – 29 0.12693 180 264 33

30 – 34 0.13077 188 272 34

36 – 40 0.13462 196 280 35

41+ 0.13847 204 288 36

13

Non‐Exempt (Hourly) EmployeesPart‐Time





0 – 5 0.05388 72 112 14

6 – 14 0.07313 112 152 19

15 – 24 0.09238 152 192 24

25 – 29 0.09616 154 200 25

30 – 34 0.10000 158 208 26

35 – 40 0.10385 162 216 27

41+ 0.1077 166 224 28

Exempt (Salary) EmployeesFull‐Time





0 – 5 0.10388 136 216 27

6 – 14 0.12315 176 256 32

15 – 24 0.12693 180 264 32

25 – 29 0.13077 188 272 34

30 – 34 0.13462 196 280 35

36+ 0.13847 204 288 36

Exempt (Salary) EmployeesPart‐Time





0 – 5 0.07313 112 152 19

6 – 14 0.09238 152 192 24

15 – 24 0.09616 154 200 25

25 – 29 0.10000 158 208 26

30 – 34 0.10385 162 216 27

36+ 0.10770 166 224 28

14

Bereavement Leave Avita Health System understands the need to have some personal time to mourn the loss of family member. As a result, we provide paid bereavement leave to eligible regular full‐time and part‐time employees. Bereavement pay will be based on scheduled days missed during the leave. In order to receive bereavement pay, the days missed must be consecutive and used within an appropriate amount of time consistent with the death. Avita Health System will pay for the following for immediate family members:

Up to 4 consecutive days for: o Spouse o Mother/Father o Step Mother/Father o Son/Daughter o Step Son/Daughter o Guardian o Legal Dependent

Up to 3 consecutive days for: o Brother/Sister o Step Brother/Sister o Grandmother/Grandfather o Mother/Father In‐Law o Brother/Sister In‐Law o Son/Daughter In‐Law o Grandchild

Education Assistance Program Avita Health System recognizes that the skills and knowledge of its employees are critical to the success of the organization. Therefore, Avita provides personal and professional development opportunities for full‐time and part‐time employees. Education Assistance is to be used for relevant degrees in accredited programs. Course work taken must be related to the employee’s present job, or one to which the employee could reasonably aspire within the Avita Health System. A maximum of $3,000 per employee per calendar year will be available under this policy unless there is a significant need for a particular specialty/degree, this amount will be determined by Administration on an individual basis.

Other Benefits Discounted corporate Galion County Club Memberships payable through payroll deduction

Discounted corporate rates for Snow Trails ski resort in Mansfield

Discounted corporate rates for Great Wolf Lodge in Sandusky (some restrictions apply)

Supplemented Memberships for Galion and Bucyrus YMCAs payable through payroll deduction

Discounted Verizon Wireless accounts and accessories

Annual Company Events o Healthcare Week Celebrations o Summer Family Company Picnic

15

o Years of Service Employee Banquet o December Holiday Celebrations

Discounted Avita Health System patient bills of 25% off if bill is paid off within specified period of time as well as the capability of paying through payroll deduction

Cafeteria discounts

Discounted Cedar Point tickets

Date post:	10-Apr-2018
Category:	Documents
Upload:	phamdat
View:	217 times
Download:	1 times

Your Benefits at Avita Health System · Your Benefits at Avita Health System ... benefits at Avita...

Documents