2016 plan year - atlantic health...core benefits in-area 2016 plan year this section contains a...

Core Benefits

In-Area

2016 Plan Year

This section contains a detailed description of Atlantic Health System’s Core Benefit programs listed below. If you have any questions about your Core Benefits, feel free to call the Atlantic Health System Employee Resource Center at (973) 660-3521. Representatives are available Monday through Friday, between 8:00 am and 4:30 pm.

Core Benefit Section Contents

This section will give you a brief overview of the Core Benefit Programs. The overview will cover:

Page(s) Who is Eligible to Participate in the Benefit Programs? …………………………..……………… 1

When Do My Core Benefits Begin? ……………………………………………………..………….. 1

Overview of Atlantic Heath System PPO Medical Plan..……………………………..………… 2

How Much Is the Medical Insurance? ……………………………………………………………... 2

How Do I Locate a Participating Provider in the Atlantic Health System PPO Medical Plan?.. 3

Coordination of Benefits ……………………………………………………………………………… 3

In-Patient/ Out-Patient Services …………………………………………………………………….. 3

At-A-Glance Benefits Summary of the Atlantic Health System PPO Medical Plan……………. 4-9

Overview of Mental Health & Substance Abuse Services ……………………………………... 10

Overview of the Group Vision Care Plan ………………………………………………………….. 11

Overview of the Prescription Plan …………………………………………………………………... 11-14

Overview of the Dental Plan ……………………………………………………………………….… 15-19

Overview of Basic Life/AD&D Insurance Plan …………………………………………………….. 19

Overview of Flexible Spending Accounts (FSA) …………………………………………………. 19-24

Overview of Tuition Reimbursement………………………………………………………………… 25-26

Overview of Paid Time Off…………………………………………………………………………….. 26-29

Plan Year 2016

08/2015 1

Who is Eligible to Participate in the Benefit Programs? Employees hired into a budgeted position and who work a minimum of 36 hours weekly are eligible to enroll for Medical, Prescription, Mental Health/Substance Abuse, Basic Life Insurance/AD&D, Supplemental Life, Long Term Disability Insurance, Flexible Spending Accounts and Dental. Employees hired into a budgeted position who work a minimum of 22.5 hours weekly are eligible to enroll for the Medical, Mental Health/Substance Abuse, Flexible Spending Accounts and Prescription plan.

Your eligible dependent

Your spouse under a legally valid marriage.

Your biological, adopted, or step child. For Medical coverage the dependent child must be younger than the age of 26 years old. For Dental coverage the dependent child must be younger than the age of 23 years old

*When enrolling a new dependent onto benefits you will need to provide documents verifying the dependent’s eligibility. Please see the new hire packet for the Dependent Eligibility Packet, which will be mailed to your home during your enrollment period. You may also find this information on the intranet on the HR Homepage under, “Did you have a life event.”

How Do I Enroll in the Atlantic Health System Benefits? New hires and status changes will receive, from CoreSource, instructions on the enrollment process for your benefit elections. Your enrollment will be processed electronically over the internet. If you have any questions please contact the Atlantic Health System Employee Resource Center at 973-660-3521.

When Do My Core Benefits Begin? Medical The first of the month following two months of employment.

Prescription The first of the month following two months of employment.

Mental Health/Substance Abuse The first of the month following two months of employment.

Basic Life Insurance/AD&D The first of the month following two months of employment.

Flexible Spending Accounts The first of the month following two months of employment.

Vision Care Plan – Preferred Vision Care The first of the month following two months of employment.

Dental The first of the month following one year of full-time employment.

Plan Year 2016

08/2015 2

Overview of the Atlantic Health System PPO Medical Plan

Plan Design Atlantic Health System PPO Medical Plan

PCP Selection Not required however, strongly encouraged due to preventive care plan design requirements. Does not need to be designated.

Referral for Specialists

Not Required.

Preventive Care

Routine Well Child Care

Routine Physical Exam

Routine Gynecological Exam

Routine Vision Exam

Required to be done by:

Participating Pediatrician or Family Practitioner

Participating Family Practitioner or Internist

Participating OBGYN

Participating Ophthalmologist

Second Surgical Opinion (Surgical Procedures requiring Second Surgical Opinion are on the enclosed At-A-Glance Benefit Summary.)

Required for in-network benefits

Pre-Certification Call QualCare 888-340-0721. Failure to pre-certify will result in a penalty of a 20% reduction in the amount the Plan may pay for covered expenses incurred.

Required for: All Inpatient Admissions, Including Acute Care, Sub-Acute

Care, Skilled Nursing, Hospice, Rehabilitation, Extended Care Facility, and Mental Health/Substance Abuse. Hospital maternity stays in excess of 48 hours for a normal delivery and 96 hours for a cesarean section.

Home Healthcare

Home Infusion Services

Surgical Treatment of Morbid Obesity

Transplant Procedures

Therapy Services in a home setting including Physical, Occupational, Speech and Respiratory

Radiation Therapy and Chemotherapy

Dialysis Therapy and Treatment

Durable Medical Equipment in excess of $1000

How Much is the Medical Insurance? The pre-tax employee biweekly payroll deductions for the Atlantic Health System Medical Plan are listed in the following table:

Atlantic Health System Medical Plan

Level of Coverage Annual Amount Bi-Weekly Amount*

Employee Only $885.84 $34.07

Employee and Spouse $2,649.42 $101.90

Employee and Child $1,654.14 $63.62

Employee and 2 Children $2,422.44 $93.17

Employee, Spouse and 1 Child $3,417.72 $131.45

Family (Any combination of 4 or more) $4,186.02 $161.00

Plan Year 2016

08/2015 3

How Do I Locate a Participating Provider in the Atlantic Health System PPO Medical Plan?

Go to the Atlantic Health System Intranet Homepage:

1. Click on “AHS and Me” under Essential Links

2. Click on “Find an AHS PPO Physician”

3. Click “AHS PPO Directory of Physicians/Providers” under “In-Area Participants”

A spreadsheet will open that lists all the providers who participate in the Atlantic Health System PPO. It is sorted alphabetically by specialty. This is the most up to date spreadsheet. It is updated monthly.

Coordination of Benefits In order to ensure correct claim payment, QualCare needs to know if you or your eligible dependents have other medical insurance coverage. The Atlantic Health System Medical Plan will be primary for employees and all covered dependents that are not covered under any other medical plan. Atlantic Health System observes the birthday rule in determining the primary insurance plan for children covered under both parents’ insurance plans. The birthday rule identifies the primary coverage under the parent whose birthday (month and day) falls first in the year. The coordination of benefits section must be completed online when you enroll for the first time and during annual open enrollment. This must be completed yearly to ensure essential information on you and your eligible dependents is kept up to date. This information will prevent unnecessary delays in processing your claims. If the information changes at any time, you must immediately contact QualCare at 888-340-0721 to update your information.

In-Patient/Out-Patient Services Non-work related illness and injuries When registering for a non-work related illness or injury, you must show the registrar your AHS Medical Identification Card and Employee Identification Badge. Dependents must show their AHS Medical Identification Card along with any other insurance identification Card(s). Work related illness and injuries When registering for a work related illness or injury, you must show the registrar your Employee Identification Badge. Only the Atlantic Health System employee is eligible to report a work-related illness or injury. The employee should immediately report to Occupational Medicine Service or if after hours then within 24 hours of the incident.

http://intranet.atlantichealth.org/static-files/Intranet/Departments/Human%20Resources/Documents/ahs_directory.xls

Plan Year 2016

Please note that no charges will be covered over reasonable and customary. Additionally, all elective out-of-network services will be reimbursed at the out-of-network benefit level using the in-network fee schedule. 1 Non-AHS facility indicates a $500 copay each scheduled admission as well as a $1,000 out-of-network deductible will apply; 50% reimbursement up to the out-of-network out-of-pocket

maximum. 2 Non-AHS facility indicates a $250 emergency admission copay as well as a $300 in-network deductible will apply; 80% reimbursement up to the in-network out-of-pocket maximum

3 Services paid at 80% are subject to a $300 in-network deductible. Please note that at an AHS facility, physician charges are covered at 80% after the $300 in-network deductible.

Additionally, facility and anesthesiology charges at an AHS facility are covered at 100% with deductible waived. AHS facility must be contracted with the AHS Employee Medical Plan. 4 All out-of-network services will be subject to the out-of-network deductible and reimbursed at 50% of the in-network fee schedule.

5 50% coinsurance will not be applied to the out-of-pocket maximum. All out-of-network services will be subject to the out-of-network deductible and reimbursed at 50% of the in-network fee

schedule. To best use your benefits have services performed at an AHS facility which are covered at 100%. AHS facility must be contracted with the AHS Employee Medical Plan. 6 50% coinsurance will not be applied to the out-of-pocket maximum. Lab and x-ray services done in an in-network physician’s office will be subject to the in-network deductible and reimbursed at

50% of the in-network fee schedule. To best use your benefits, have services performed at an AHS facility which are covered at 100%. AHS facility must be contracted with the AHS Employee Medical Plan. 7 Services paid at 80% are subject to a $300 in-network deductible. Outpatient emergency room visits at an AHS facility cover physician costs at 100% of the in-network fee schedule.

08/2015 4

. .

2016 - BENEFITS In-Area AHS PPO EXPLANATION In Network Out of Network

Medical Expense Deductible, per Calendar Year

Per Individual Per Family Common Accident

$300 $600 $300

$1,000 $2,000 $1,000

Applies separately for in-network and out-of-network benefits.

Per Medical Inpatient Admission Copays

Scheduled Inpatient Admission Atlantic Health System Facility Per Medical Emergency Admission

$0 $0 $0

$500

1

N/A $250

2

Deductibles and coinsurances may apply after copay. Further details can be found by reading through this grid. Precertification is required.

Calendar Out-of-Pocket Maximum Per Individual Per Family

(including co-pays and deductibles) $2,000 $6,000

(excluding co-pays and deductibles) $15,000 $30,000

Premiums, balance-billed charges, penalties, and Healthcare services this plan doesn’t cover.

Maximum Benefits Per Covered Person All Covered Expenses

Combined per Lifetime Chiropractic Care, per Calendar Year Orthotic Devices, per Lifetime

Unlimited $500 $350

Unlimited $500 $350

Medical Benefits At-A-Glance

Plan Year 2016








08/2015 5

2016 - BENEFITS In-Area AHS PPO EXPLANATION Professional Charges In Network Out of Network

Surgery 80%3 50%

4 Precertification may be required.

Extraction of Bone Impacted Wisdom Teeth 80%3

80%

3

Maternity (Pre-Natal, Delivery and Post-Natal Care)

100% Global delivery fee only for:

normal uncomplicated labor and c-section. **See note under explanation

50%4

**If you are an Atlantic Health System Hospital patient, hospital facility charges for you and your newborn are covered at 100%.

Note: Procedures and inpatient doctor visits will be subject to the deductible and covered 80%, for example, induction of labor is subject to deductible. Precertification is required for hospital stays in excess of 48 hours for a normal delivery and 96 hours for a cesarean section.

Anesthesia 80%3 50%

4

Physician Visits -Inpatient -In Physician’s Office -In Physician’s Office Procedure

80%

3

100% (after $15 co-pay) 80%

3

50%

4

50%

4

50%

4

Any surgical procedures done in an in-network physician’s office are subject to the in-network deductible and out-of-pocket maximum except for the procedures listed on page 4 that are paid at 100%.

Second Surgical Opinion

100% 100% Surgical Procedures requiring Second Surgical Opinion for employees and dependents: Ostectomy or Osteotomy, Hallux Valgus procedures and Septoplasty.

. .


Plan Year 2016








08/2015 6

2016 - BENEFITS In-Area AHS PPO EXPLANATION Facility Charges In Network Out of Network

Room and Board (semiprivate) 80%3 50%

4

Special Care Units 80%3 50%

4

Facility Ancillary Expenses

80%3

50%4

Examples of facility ancillary expenses are: admission fees, use of operating, delivery and treatment rooms; prescribed drugs; whole blood and administration of blood; anesthesia and anesthesia supplies.

Hospital Services for Mother and Nursery Services for Newborn

80%3 50%

4

Skilled Nursing Facility (up to 120 days per calendar year)

80%3

50%

4 Precertification is required.

Home Healthcare (up to 60 visits per calendar year)

80% (after $50 copay)

3

80% (after $50 copay)


Hospice Care 80%3 80%


Birthing Facility 80%3 50%

4

Outpatient Surgery / Ambulatory Surgical Center 80%3 50%

4


Plan Year 2016








08/2015 7

..

2016 - BENEFITS In-Area AHS PPO EXPLANATION Other Facility and/or Professional Charges In Network Out of Network

Diagnostic X-ray and Laboratory -Outpatient Facility -Certain Services in an In-Network Physician’s Office (See Explanation) -Other Services in a Physician’s Office

50%

5

100% 50%

6

50%

5

N/A 50%

6

Services in an in-network physician’s office paid at 100%: EKG, Spirometry, Tympanometry, Urinalysis, Hemocult, Fingerstick Hematocrit, Fingerstick Blood Sugar, Rapid Strep Test, Monospot, Urine Pregnancy, Pap Smear, Pressurized or Non-pressurized Inhalation Treatment (including Nebulizers (small volume, non-filtered pneumatic) and Albuterol (up to 2.5 mg) and Ipratropium Bromide (up to 0.5 mg (FDA-approved)), Hearing Screening (up to age 15), Routine Vision Screening done at the time of routine well child care visits for children up to age 19)

Therapy (Rehabilitative) Services (including Physical, Speech, Occupational and Respiratory (up to 60 visits per calendar year)

-Outpatient Facility

-In Physician’s Office

50%

5

50%

5

50%

5

50%

5

Therapy performed in an outpatient facility or physician’s office that cannot be performed in an Atlantic Health System Hospital will be paid at 80%, deductible and out-of-pocket maximum. Note: Habilitative services are not covered. Precertification is required.

Emergency Room Care Services -Facility Charges -Physician Charges (ER Staff Physicians Only)

100% 100%

100% 100%

Non-emergency use of emergency room services are not covered.


Plan Year 2016








08/2015 8

2016 - BENEFITS In-Area AHS PPO EXPLANATION Other Facility and/or Professional Charges

(cont.) In Network Out of Network

Chiropractic Services (Up to $500 per Calendar Year)

100% 100% Reimbursement based on reasonable and customary charges.

Private Duty Nursing -AHS Private Duty Nursing

80%3

100%

50%4

N/A

For Atlantic Health System Private Duty Nursing call either Atlantic Home Care and Hospice at (973) 379-8400 or Morris Home Care, Inc. at (973) 540-9000

Durable Medical Equipment -At Home Medical, Inc.

80%3

100%

50%4

N/A

Call At Home Medical, Inc. at (973) 538-0485 or (800) 287-0643. Precertification needed for charges over $1,000.

Orthotic Devices (up to $350 per lifetime)

80%3 50%

4

Ambulance Services

80%3

(If patient is taken to an AHS Hospital - 100%)

80%3

N/A

All Other Covered Medical Expenses 80%3 50%

5

Any medical expenses that can be performed at an Atlantic Health System Hospital will be covered at 50%. The remaining 50% coinsurance will not be applied to the Out-of-Pocket Maximum.


Plan Year 2016








08/2015 9

2016 - BENEFITS In-Area AHS PPO EXPLANATION

Preventive In Network Out of Network

Routine Well Child Care 100% Not covered Such as periodic checkups and immunizations with Pediatrician or Family Practitioner.

Routine Physical Exams 100%

Not covered Up to one visit per calendar year with Family Practitioner or Internist.

Routine Gynecological Exams 100%

Not covered Up to one visit per calendar year.

Routine Pap Test and Other Related Diagnostic Testing

100%

50% (see explanation)

**Other related diagnostic testing refers to laboratory and pathology tests done in conjunction with the routine gynecological exam, such as urinalysis and blood test. When an Atlantic Health System Hospital or in-network provider utilizes the services of an out of network laboratory for a routine pap test, the benefits will be paid at 100%.

Routine Mammogram 80%3 Not covered 100% if performed at AHS facility. Up to one visit

per calendar year.

Routine Immunizations 100%

Not covered Includes allergy shots with no age limitations.

Routine Colonoscopy 80%3 Not covered 100% if performed at AHS facility.

Routine Vision Exam by Ophthalmologist 100% (after $15 co-pay)

Not covered Up to one visit per calendar year.


Plan Year 2016

08/2015 10

Please Note: Coverage for Mastectomies and Breast Reconstruction For individuals covered under the Atlantic Health System Medical Plan receiving plan benefits for a mastectomy, the Atlantic Health System Medical Plan will provide coverage for any necessary surgery and reconstruction of the breast on which a mastectomy was not performed in order to produce a symmetrical appearance. This coverage will be subject to the same deductibles and co-payments that apply to mastectomies under the Atlantic Health System Medical Plan’s current provisions. Please refer to the summary plan description (SPD) for the Atlantic Health System Medical Plan for details of the Atlantic Health System Medical Plan’s deductible and co-payment requirements for mastectomies. If an employee or eligible dependent has any questions, please call QualCare at 888-340-0721.

Overview of the Mental Health & Substance Abuse Services

Outpatient Care

CONCERN PLUS (800) 242-7371 must approve all services, in advance. CONCERN PLUS must be notified within 24 hours of emergency admissions

Inpatient Care

CONCERN PLUS (800) 242-7371 must approve all services, in advance. CONCERN PLUS must be notified within 24 hours of emergency admissions.

Mental Health Parity Act

In accordance with the Mental Health Parity and Addiction Equity Act, which was signed into law October 3, 2008, Atlantic Health System has made changes to its Mental Health & Substance abuse benefits. The mental health parity law was effective January 1, 2010. The law does not mandate coverage of mental health and/or substance use disorders. However, Atlantic Health System has chosen to maintain the plan and has made changes to ensure compliance with new Mental Health Parity Act regulations. What does this mean to Atlantic Health System employees and their dependents enrolled in either the Atlantic Health System PPO Medical Plans?

When utilizing a provider within the Concern Plus network professional (MD, PHD, MSW, CNS) outpatient services will have a $15 co-pay.

Maximum lifetime benefits and number of allowable annual visits will not be restricted.

Concern Plus will continue to manage all care including pre-certification of all treatment both in and out-of-network.

Providers outside of the Concern Plus Network can be utilized, however they will be considered out-of-network and paid as such.

Out-of-network benefits are subject to an annual mental health & substance abuse deductible of $1000; this is in addition to the out-of-network deductible on the medical/surgical benefits.

Out-of-Network Mental Health and Substance Abuse will have an annual out-of-pocket maximum of $15,000 for an individual, and $30,000 per family. This is in addition to the out-of-pocket maximum on the medical/surgical benefits.

The Plan will never pay more than 100% of our in-network fee schedule even when the annual out-of-pocket maximum has been met.

If you have any questions or need further clarification please call the Employee Information Line at 973-660-3521 or Concern Plus at 1-800-242-7371

Plan Year 2016

08/2015 11

Overview of the Group Vision Care Plan Employees covered under the Atlantic Health System Medical Plans are covered by “Preferred Vision Care”, a unique Preferred Provider Organization that offers its members corrective vision eye wear at wholesale cost plus a small dispensing fee. Savings can range up to 50 percent or more. The cost of this program will be fully paid by Atlantic Health System. Covered employees will receive a program booklet with two membership cards. This booklet will also provide a program explanation as well as an extensive list of local Preferred Providers. To find other providers in other areas go to www.preferredvisioncare.com and select ‘Preferred Vision Care’. Select the option for ‘Directory of Providers’. The member’s entire household is entitled to benefits, including all dependents. The member presents their ID card to the preferred provider which entitles the member to specially reduced prices. There are no restrictions; select the eyewear of your choice - and no claim forms to file or fill-out. Members can use this benefit as often as they wish. *Please note eye exams are covered for you and your eligible dependents under the Atlantic Health System PPO Medical Plan under an in-network ophthalmologist. Preferred Vision Care does not cover eye exams. See page 9 for further details.

Overview of the Prescription Plan Employees have choices for filling prescriptions for themselves and their covered dependents.

Employee In-house Pharmacy As a new hire, once you are enrolled in the Atlantic Health System Employee Medical Plan, you and your dependents will be eligible to use the Atlantic Health System Employee In-house Pharmacy. Our Employee In-house Pharmacy is safe, confidential and a convenient way to fill all your maintenance medications! Your prescription will be returned to your work site within 72 business hours. You’ll feel at ease knowing our trained pharmacists will look for drug interactions and safety precautions. The prescription cost will be deducted from your paycheck.

Any new prescription filled at the Employee In-house Pharmacy must first be filled with a 30 day supply. In most instances, a prescription needs to be tried for appropriate effectiveness before continued quantities can or should be filled. In the past, we found that many initial 90 day scripts, filled at both the Employee In-house Pharmacy and Express Scripts mail order, ended up needing to be changed before the 90 day supply was finished. This plan rule saves both the employee and the prescription plan any unnecessary costs. 90 day prescription fills of any kind CANNOT be obtained at either the Employee In-house Pharmacy or through Express Scripts mail order, without having first had a 30 day prescription fill of that same medication.

If you currently take maintenance medications on a regular basis and use the generic equivalent, each individual prescription will be filled for a $0 co-pay for the first 30 day supply as well as a $5 co-pay for your first 90 day fill of that same prescription. Thereafter, you will pay the flat co-pay of $7.50 for a 30 day supply or $10.00 for a 90 day supply on all maintenance (generic) prescriptions. This only applies to the Employee In-house Pharmacy. Costs are higher if filled at a retail pharmacy or through Express Scripts Mail Order, just another way to save!

FORMULARY brand prescriptions cost $35 for a 90 day supply at the Employee In-house Pharmacy. The cost of the NON-FORMULARY brand prescriptions are $125.00 for a 90 day supply if filling at the Employee In-house Pharmacy and $160.00 through Express Scripts Mail Order.

http://www.preferredvisioncare.com/

Plan Year 2016

08/2015 12

Overview of Prescription (cont.) The chart below illustrates how the Employee In-house Pharmacy will save you money when filling generic maintenance medications or any other generic medication:

30 DAY SUPPLY

Important Note If you receive a brand name drug for any reason when a generic substitution is available you will pay the difference in cost between the brand and the generic drug, plus the minimum co-pay. Now, see how you can save even more money by using the Employee In-house Pharmacy. You will save on all generic medications as well as formulary brand and non-formulary brand when using the Employee In-house Pharmacy:

31-90 DAY SUPPLY

PRESCRIPTION TYPE

EXPRESS SCRIPTS

MAIL ORDER

CO-PAY

EMPLOYEE IN-HOUSE PHARMACY

CO-PAY

Generic $20 First 90 day maintenance supply $5 co-

pay; thereafter $10 co-pay.

Formulary (Preferred) Brand $65 $35

Non- Formulary

(non-preferred) Brand $160 $125

Important Note If you receive a brand name drug for any reason when a generic substitution is available you will pay the difference in cost between the brand and the generic drug, plus the minimum co-pay.

PRESCRIPTION TYPE

RETAIL OR EXPRESS

SCRIPTS MAIL ORDER CO-

PAY

EMPLOYEE IN-HOUSE PHARMACY

CO-PAY

Generic $14

First 30 day maintenance supply free; thereafter $7.50 co-pay.

Non-maintenance $14.

Formulary (preferred) Brand $35 $30

Non- Formulary

(non-preferred) Brand $63 $60

Plan Year 2016

08/2015 13

Employee In-house Pharmacy Instructions If you would like to participate in the Employee In-house Pharmacy plan, complete a Patient Profile Form for yourself and your covered dependents. The Patient Profile Form is located at your designated drop off box, or online under the HR Home Page > Benefits > Employee In-house Pharmacy (in the middle) > Employee In-house Pharmacy Patient Profile Form. This form only needs to be completed once.

Place both the prescription and Patient Profile form in an envelope

Place the sealed envelope in the proper location for your site:

If you are a repeat customer:

You will not need to fill out another Patient Profile Form

On the back of your prescription, please print: o Employee name o Name of who the prescription is written o Date of birth of who the prescription is written o Employee’s work number (with area code and extension) o Site location

Place your prescription into an envelope

Place the sealed envelope in the proper location for your site For refills on a prescription initially filled at the Employee In-house Pharmacy, complete the Employee In-house Pharmacy Refill Request form found on the HR Homepage under Employee In-house Pharmacy, or contact the Employee In-house Pharmacy at 973-422-7983 to request a refill. The fax number is 973-535-3920. The Employee In-house Pharmacy is open Monday – Friday, 7:00 am – 3:00 pm.

Site Lock Box Location

Morristown Medical Center Designated lock box located in the cafeteria.

Overlook Medical Center Designated lock box located outside of the pharmacy.

Newton Medical Center Designated lock box next to the time clock by the cafeteria

475 South Street- Finance, PFS, ISS & Strategic Sourcing

Designated lock box located on Pam Aloia’s desk in PFS

475 South Street- all other Corporate departments

Designated lock box located in the mailroom on the 3rd

floor

Atlantic Rehabilitation Institute Designated lock box on the ground floor.

Chilton Medical Center Designated lock box by the pharmacy.

Plan Year 2016

08/2015 14

Prescription Services (Prescription Card will be mailed)

Retail Pharmacy – up to 30 day supply Employee Co-pay

Tier 1: Generic drug $14

Tier 2: Preferred brand drug $35

Tier 3: Non-preferred brand drug $63

If you receive a brand name drug for any reason when a generic substitution available you will pay the difference in cost between the brand and the generic drug, plus the minimum co-pay.

Mail Service Program Mail Order – up to 90 days supply Employee Co-pay

Tier 1: Generic Drug $20

Tier 2: Preferred brand drug $65

Tier 3: Non-preferred brand drug $160

If you receive a brand name drug for any reason when a generic substitution available you will pay the difference between the brand and the generic drug, plus the minimum co-pay. The out of pocket maximum for pharmacy is $4,850 Individual and $7,700 Family. Your prescription cards will be mailed to you from Express Scripts. If your eligibility date has passed and you need a prescription, but you are waiting for your Express Scripts ID to arrive in the mail, you can use your Express Scripts benefits. In order for the pharmacist to find you in the system, please give the pharmacist the following information:

1. Bin #: 003858 2. Processor Control: A4 3. RxGroup #: AH6A 4. Member ID: Employee’s Social Security Number 5. Member’s 2 Digit Person Code: The pharmacist should have this information 6. The Member’s Date of Birth

If the pharmacy has any issues, please have them call Express Scripts’ Pharmacy Help Desk at 1-800-824-0898. If you have any issues please call Express Scripts at 1-866-504-8362. You may only fill prescriptions using this benefit after your effective date.

Cost Saving Tips for the Express Scripts Benefits Once your coverage is effective and before you see your doctor for a refill on a prescription, log onto www.express-scripts.com to see how much your prescription will cost. Once on the website select the heading ‘Members’ and sign in. This website allows you to view your estimated prescription cost under the ‘Price Check’ link. Remember in almost all instances you will save money by filling your prescriptions with the Employee In-house Pharmacy. The Express Scripts website also gives you the option to print or search the list of Formulary drugs. This allows you to take the list with you to your doctor, so together you can find a more cost effective medication. If you know the drug name ahead of time you can search for your prescription online and compare it to other drugs used for the same ailment to find a cheaper drug option. You can also call Express Scripts on your own at (866)504-8362 to find a cost effective prescription and to check the price of a prescription. You will need the name of the drug, the milligrams needed and how many pills will be taken per day. By calling, you can have an on the spot estimate of your cost.

Other Tools When you log onto www.express-scripts.com you can also check the status of any mail order prescriptions, order refills on active mail order prescriptions and print mail order forms online.

http://www.express-scripts.com/

http://www.express-scripts.com/

Plan Year 2016

08/2015 15

Overview of the Dental Plans

Eligible employees can elect coverage under the Atlantic Health System dental plan with Delta Dental (Group Number 3858), a provider offering 150,000 dentists nationwide with approximately 10,000 providers in New Jersey alone. Delta Dental provides Atlantic Health System with three of its Specialty Networks, which include Delta Premier, Delta Advantage and Delta PPO. Employees are entitled to access all three networks. To see if your current dental provider participates with Delta Dental, you can call toll free (800) 335-8265 or visit www.deltadentalnj.com. Participating dentists have Delta claim forms. If the dentist does not participate, the subscriber may either bring a form to the dentist or Delta will accept any ADA approved claim form the dentist’s office presently uses. Claim forms must be sent to: Delta Dental Plan of New Jersey, Inc. PO Box 222 Parsippany, New Jersey 07054 All full-time employees (exempt and non-exempt) hired into a budgeted position and regularly scheduled to work a minimum of 36 hours weekly are eligible to participate in the Delta Dental Insurance Plan effective on the first of the month following one year of full-time employment. NETWORK DESCRIPTIONS Three networks are available to Atlantic Health System Dental Plan participants. When you utilize a provider who participates in one of the three networks, you take advantage of the discounts that have been negotiated with that provider. The three networks are:

Delta Dental Premier Network – charges are based on the pre-filed negotiated fees. This network is available in all states (5,250 participating dentists in NJ)

Delta Dental Advantage Network – offers a greater discount than the Premier Network. This network is available in New Jersey only (3,600 participating dentists in NJ)

Delta Dental PPO Option Network – offers a greater discount than both the Premier and Advantage Networks. This network is available in most states (2,700 participating dentists in NJ)

If your dentist participates in more than one of the three networks described above, your dentist’s rates will automatically reflect the rate that provides the deepest discount of the networks in which the dentist participates. For example, if your dentist participates in all three networks, you will automatically receive the PPO rate. The plan design is the same in all three networks and you remain free to select any dental provider you choose. When you make your selection, please keep in mind that your choice – Delta Dental Premier Network, Delta Dental Advantage Network, or Delta Dental PPO Option Network – impacts how much coverage you’ll get from the annual maximum benefit. Dentists in the second and third tier networks (Delta Dental Advantage and Delta Dental PPO) offer greater discounts; your choice of a dentist helps you get the most for your money. If you use a provider who does not participate in one of the three networks described above, you will be reimbursed 50 percent of the PPO schedule.

To determine if your dentist is participating in any of the networks described above, or to receive a directory of network dentists, call (800) 335-8265 and a Delta Dental Customer Service Agent will assist you. You can also visit Delta’s website at www.deltadentalnj.com.

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Overview of Dental (cont.)

Dental Plan Choices Eligible employees have the option to choose from two dental plans, SmileCare and SmileCare Plus, depending on your family’s needs. Both plans allow employees and their covered dependents to use a dentist in any of the three networks: Delta Dental Premier, Delta Dental Advantage, or Delta Dental PPO. The plans are:

SmileCare Benefits Delta Dental Premier, Delta Dental’s Advantage, Delta Dental PPO

Benefits and Covered Services*

Who is Covered primary eligible enrollee and spouse as well as dependent children to age 23 (end of year)

Deductible and Annual Benefit Maximum $50 per person/$150 per family per calendar year (waived on preventive & diagnostic) The maximum benefit paid per calendar year is $1,500 per person

Diagnostic and Preventive Benefits - oral examinations, cleanings (unlimited) - x-rays: full mouth series or panoramic (either

one, once in 3 years), bitewing (twice per calendar year)

- fluoride treatment (once per calendar year, for eligible adults and children to age 19)

- sealants, for children to age 19 to the end of the calendar year (all teeth)

- space maintainers (once per space for missing posterior primary teeth, for children under age 14)

100% number of cleanings and exams per year are unlimited per person, ages 14 and older are considered adults (no deductible applies for these services)

Basic Benefits - oral surgery (extractions), fillings (composite

and amalgam), root canals (on permanent teeth once per 24 months)

80%

Crowns and Cast Restorations (once every 5 years) 50%

Prosthodontic Benefits - bridges (once every 5 years), partial dentures or

full dentures (once every 5 years), periodontal services, inlays when done in conjunction with inlay

50%

*This overview contains a general description of your dental care programs for your use as a convenient reference. Complete details of your program appear in the group contract between your plan sponsor and Delta Dental Plan of New Jersey, Inc. which governs the benefits and operation of your program. The group contract will govern if there should be any inconsistency or difference between its provisions and the information in this overview.

Out-of-Network Benefits

The same deductibles and maximums apply. All services are covered at 50% and paid at the Delta Dental PPO fee levels.

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Overview of Dental (cont.)

SmileCare Plus Benefits Delta Dental Premier, Delta Dental’s Advantage, Delta Dental PPO

Benefits and Covered Services*

Who is Covered Primary eligible enrollee and spouse as well as dependent children to age 23 (end of year)

Deductible and Annual Benefit Maximum $50 per person/$150 per family per calendar year (waived on preventive & diagnostic) The maximum benefit paid per calendar year is $2,000 per person

Diagnostic and Preventive Benefits - oral examinations, cleanings (unlimited) - x-rays: full mouth series or panoramic (either

one, once in 3 years), bitewing (twice per calendar year)

- fluoride treatment (once per calendar year, for eligible adults and children to age 19)

- sealants, for children to age 16 to the end of the calendar year (all teeth)

- space maintainers (once per space for missing posterior primary teeth, for children under age 14)

100% Number of cleanings and exams per year are unlimited per person; ages 14 and older are considered adults (no deductible applies for these services).

Basic Benefits - oral surgery (extractions), fillings (composite

and amalgam), root canals (on permanent teeth once per 24 months)

80%

Crowns and Cast Restorations (once every 5 years) 50%

Prosthodontic Benefits - bridges (once every 5 years), partial dentures or

full dentures (once every 5 years), periodontal services, inlays when done in conjunction with onlay

50%

- Orthodontic Coverage 50%, no deductible, covered up to $2,000 per dependent up to the 19

th birthday in a lifetime.

*This overview contains a general description of your dental care programs for your use as a convenient reference. Complete details of your program appear in the group contract between your plan sponsor and Delta Dental Plan of New Jersey, Inc. which governs the benefits and operation of your program. The group contract will govern if there should be any inconsistency or difference between its provisions and the information in this overview.

Out-of-Network Benefits

The same deductibles and maximums apply. All services are covered at 50% and paid at the Delta Dental PPO fee levels.

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How much is the dental insurance plan?

The pre-tax employee biweekly payroll deductions for the Atlantic Health System Dental Plans are listed in the following table:

Level of Coverage SmileCare Dental Plan SmileCare Plus Dental Plan

Employee Only $.97 $2.65

Employee and Spouse $8.23 $8.93

Employee and 1 Child $8.23 $8.93

Employee and 2 Children $13.66 $14.81

Employee, Spouse and 1 Child $13.66 $14.81 Family (Any combination of 4 or more) $13.66 $14.81

Dental Q & A

Q. How do I contact Delta Dental? A. Representatives of Delta Dental of New Jersey are available from 8:00 am to 6:30 pm Monday through Thursday, and from 8:00 am to 5:00 pm on Friday. Call 1-877-718-3384. Most questions can be answered by following the prompts of the automated voice response system. A representative may be accessed at any time during the above hours by pressing *. As an example, a subscriber may call to find out how much of his/her maximum is left for the year or the status of a claim. Off hours messages can be left as well. Q. Can I go to any dentist? A. Yes. Dentists do not have to be pre-selected, however you will get the most of your dental dollars by using a participating provider. Note that the Delta Dental System has over 145,000 participating dentists in the nation. You may currently be seeing a Delta Dental participating dentist. When you make your selection, please keep in mind that choosing a dentist in a one of our participating networks – Delta Dental Premier Network, Delta Dental Advantage Network, or Delta Dental PPO Network - impacts how much coverage you’ll get from the annual maximum benefit. Dentists in the second and third networks (Delta Dental Advantage and Delta Dental PPO) offer greater discounts: your choice of a dentist helps you get the most for your money. Q. What is a Delta Dental participating dentist? A. In order for a dentist to participate with Delta Dental, he or she must first submit a participation agreement and pre-file dental fees for procedures routinely performed. A participating dentist cannot charge a Delta Dental subscriber an amount that exceeds the maximum plan allowance fee. If a participating dentist is visited, that dentist cannot bill you for the difference of his charges and Delta Dental’s approved fee, unless co-payments or deductibles apply. By visiting a participating dentist, you will maximize your benefit and may have lower out-of-pocket costs. Additionally a participating dentist files claims directly with Delta Dental, and Delta Dental pays the dentist directly. Q. What if my dentist does not participate? A. You may want to contact the Employee Resource Center with the name of the dentist. The name will be passed on to Delta Dental who will then contact the dentist to determine if he/she has any interest in participating. If you are comfortable with your dentist and he/she does not wish to change, that is acceptable. Delta Dental will process the claim and pay in accordance with the allowable charge for each procedure. You may be required to file the claim on your own as Delta Dental does not assign benefits to non-participating providers. You may also be responsible for paying the dentist. Delta Dental will reimburse you directly. Since Delta Dental does not have agreements with non-participating dentists you will be responsible for charges greater than the allowable, reasonable and customary charge.

Q. How do I get a list of participating dentists? A. If you would like a customized directory sent directly to your home, you may call 1-800-DELTA DENTAL-OK. You may also access Delta Dental’s Participating Provider information on the internet at www.Delta Dentalldentalnj.com.

../AppData/lcovie01/John%20Coviello/Local%20Settings/Temporary%20Internet%20Files/Content.IE5/HHAMT7RX/www.deltaldentalnj.com

../AppData/lcovie01/John%20Coviello/Local%20Settings/Temporary%20Internet%20Files/Content.IE5/HHAMT7RX/www.deltaldentalnj.com

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Q. Are claim forms necessary? A. Participating dentists have Delta Dental claim forms. If the dentist does not participate, you may either bring a form to the dentist or Delta Dental will accept any ADA-approved claim form the dentist presently uses. Delta Dental cannot accept Superbills. Q. What is the difference between the SmileCare and the SmileCare Plus choices? A. With SmileCare option you can choose your dentist from any of the three network options, each of which offers ways you can save money and a maximum annual benefit of $1,500.00 per person.

The SmileCare Plus choice offers a higher maximum annual benefit of $2,000.00 per person, plus an additional orthodontic lifetime benefit of 50 percent up to $2,000.00 per dependent up to the 19th birthday. The biweekly payroll deductions vary depending on the plan you choose. Q. My child’s orthodontic treatment began before my dental effective date; will I be eligible for orthodontic benefits under SmileCare Plus? A. No. Benefits for orthodontic care under the SmileCare Plus Program will only be payable to eligible dependents that have orthodontic treatment including any initial orthodontic visits started on or after your dental effective date. Q. Are space maintainers covered under the SmileCare and SmileCare Plus options? A. Space maintainers are a payable benefit under Preventive & Diagnostic for dependents under the age of 14. Q. Are palatal expanders covered? A. Palatal expanders are under the orthodontic benefit. The orthodontic benefit is only payable under the SmileCare Plus plan.

Delta Dental offers a program named Delta Dental Patient Direct to offer affordable dental care for those who do not have dental insurance. Eligible participants must be 18 years of age and a resident of New Jersey. Delta Dental Patient Direct is a dental membership program with an annual enrollment fee that offers access to a network of Delta Dental Patient Direct participating dentists. Payment is made directly to Delta Dental Direct Participating Dentists. There are no Atlantic Health System payroll deductions since this is an individual program. If you are interested in more information about Delta Dental Patient direct, you can call 877-TOOTH-07 (877 866-8407), or go to www.patientdirectnj.com.

Overview of Basic Life/AD&D Insurance Plan

Atlantic Health System provides Basic Life/AD&D Insurance to all full time employees hired into a budgeted position and regularly scheduled to work at least 36 hours per work week.

Full-time employees are automatically enrolled with coverage of two times the employee’s annual salary to a maximum of $400,000. Atlantic Health System pays for the premiums while you are an active employee. The insurance begins to reduce in value at age 65 and each year thereafter. At age 74, coverage is reduced to a flat $2,500. You will need to designate your beneficiary(ies) when you enroll online.

Overview of Flexible Spending Accounts (FSA) Spending accounts help stretch your Healthcare and dependent care budget. That’s because spending accounts let you use pre-tax dollars to pay for eligible Healthcare and dependent care expenses. You won’t pay taxes on the money you put into the account. Please budget wisely, unused money will be forfeited if not used by the annual deadline. All employees hired into a budgeted position and regularly scheduled to work a minimum of 22.5 hours a week are eligible to participate in the spending accounts effective on the first of the month following two months of

http://www.patientdirectnj.com/

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Overview of Flexible Spending Accounts (FSA) (cont.)

employment. To fund your accounts, you make equal contributions each pay period that are not subject to Federal or Social Security taxes. There are two separate spending accounts:

The Healthcare Account – examples of eligible expenses are co-pays and prescriptions

The Dependent Care Account – example of an eligible expense is child daycare expenses For a Healthcare FSA, CoreSource will automatically send you a “benny card”. Your benny card will act as a debit card to pay for eligible healthcare expenses from your healthcare flexible spending account. The debit card is used instead of cash to pay for covered prescription co-pays, doctor office visit co-pays and more. The debit card allows more flexibility by automatically deducting your eligible purchase from your Healthcare flexible spending account and eliminating the need to submit claims. For expenses (co-pays) you incur at the Employee In-house Pharmacy, you will need to submit the paper claim to CoreFlex for reimbursement. You will need to submit paper claim forms for all Dependent Care FSA expenses. Once you sign up for a Healthcare flexible spending account, CoreSource will send to you your benny cards and information packet, including a listing of eligible expenses. If you don’t receive your debit card or have additional questions in reference to Flexible Spending Accounts, please contact CoreFlex at 877-267-3359. Q. Can I participate in both Healthcare account and Dependent Care account? A. Yes. You may participate in one, both, or neither. Q. When can I sign up for or change my Flexible Spending account elections? A. During your newly eligible enrollment period, (under the eligibility guidelines) or during the next open enrollment period. You cannot change your election for the rest of the year unless you have one of the qualifying life events listed below:

- Marriage, divorce, or legal separation - Birth or adoption of a child - Loss of, or significant change in, your spouse’s medical coverage - Your spouse begins or stops work

- Death of a spouse or child Q. What if I do not use up all of my Flexible Spending account money set aside by the claim submission reimbursement deadline? A. The IRS requires that any money you don’t spend from your Flexible Spending account will be forfeited. Q. What are the advantages of having a Flexible Spending account? A. You can lower your federal taxes and save money when you put pre-tax dollars into the spending accounts. Q. How will I know how much to set aside for Flexible Spending account? A. Before you decide how much money to put into either spending account, carefully estimate your medical, dental, vision, and dependent care expenses for the coming year. Decide if you will have predictable expenses such as replacing eyeglasses each year. Ask yourself, is anyone in my family getting expensive dental care done this year? What will my day care cost be this year? Q. Does the money come out of my paycheck pre-tax or after-tax? A. The money you set aside for Flexible Spending comes out of your paycheck on a pre-tax basis. You won’t pay federal taxes (and outside New Jersey, in most instances, no state tax) or social security taxes, on the amount you set aside. When you’re reimbursed for an eligible expense, the money is still tax-free; thus the advantage of the spending account is tax savings.

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Q. Why do I need to use all the money in my account by the end of the year? A. The federal government stipulates that any excess money you have by then end of the year will be forfeited. You will receive a statement at the end of the third quarter each calendar year, identifying unused dollars in your account, enabling you to plan how to use up your dollars. Q. How long do I have to submit a claim from the Dependent Care and Healthcare flexible spending accounts? A. You submit claims with a date of service up to and including March 15th of the following year. This means that each year employees can submit expenses that have been incurred throughout the current plan year plus an additional grace period until the following March 15th. All applications for reimbursement must be received by CoreSource no later than June 15th. Q. I don’t plan to take the individual medical coverage. Does that mean I can’t use the Flexible Spending accounts for my family? A. You can sign up for the Flexible Spending accounts for expenses for all your eligible dependents, regardless of whether you sign up for medical coverage. Q. How much can I contribute into the Healthcare Flexible Spending account? A. You can contribute from $100 to a maximum of $2,500 in tax-free dollars each year to your Healthcare account. Q. What are eligible Healthcare expenses? A. The Healthcare flexible spending account is designed to pay for medical and dental expenses that you or your eligible dependents incur over the course of a year – expenses not fully covered or reimbursed. Please see the list of eligible and non-eligible expenses on page 23.

Keep in mind, you can’t receive payment for any expenses that are covered under any other medical or dental plan, or that you claim as a deduction on your federal income tax return. Since the IRS list of eligible Healthcare expenses is subject to change each year, please contact CoreFlex at (877) 267-3359 with any questions about eligible Healthcare expenses.

Q. How much can I contribute into the Dependent Care Flexible Spending account? A. You may use this account to pay for dependent care services that are necessary for you (and your spouse, if married) to work. You can contribute from $100 to a maximum of $5,000 in the account each year. You can only contribute $2,500 if you are married and you and your spouse file separate income tax returns - but the amount you designate may not exceed your spouse’s gross salary or one-half of your salary, whichever is lower. Remember, if you and your spouse make deposits in separate accounts, the total cannot exceed $5,000. You can submit expenses for children under age 13 who you claim as dependents for tax purposes, or for any dependent, like a spouse or parent, who is physically or mentally incapacitated.

Q. What are eligible dependent care expenses? A. Expenses the IRS lets you pay through dependent care spending account include:

Government qualified day care centers, nursery schools, or summer programs

Other licensed institutions or private home caregivers

Any expense that qualifies for a federal dependent care tax credit

Dependent Care expenses are eligible if they enable you (and your spouse, if you are married) to work. The caregiver’s tax identification number (Social Security or employer identification number) must be submitted to receive dependent care reimbursement. An eligible dependent is a dependent that is younger than 13 years old and living with you. An eligible dependent may also include your mentally or physically impaired spouse or a dependent that is incapable of caring for himself /or herself and whose support you contribute more than half. Please see the list of eligible and non-eligible expenses on page 24.

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Remember to consider your tax bracket. If you choose to be reimbursed for dependent care expenses from the spending account, you cannot take advantage of federal and state dependent care income tax credits for the same expenses. Depending on your tax bracket, the account may provide an attractive alternative to the dependent care tax credit. You should consult your tax advisor as to which is best for you. Q. Do I need to complete a claim form when submitting an eligible Dependent Care FSA expense? A. Yes. The form can be located on the HR Homepage under forms or you can request a form by emailing CoreFlex at [email protected]. Q. How do I submit a claim form? A. You may file a claim each month as long as it is for $50 or more. You can be reimbursed only for expenses you’ve incurred during the plan year, in which you made contributions. When you have eligible dependent care expenses, submit your receipts and claim forms to:

CoreSource Attn: Flexible Spending Department P. O. Box 8215 Little Rock, AR 72221

Q. What if I don’t have enough money set aside in my Dependent Care flexible spending account to pay the claim? A. CoreFlex will continue to reimburse you for that claim until it is paid off. Q. Once I submit a claim form for dependent care account reimbursement, how long does it take to receive the reimbursement? A. Usually five to ten working days (plus mail time).

Q. Can I find out how much money I have in my dependent care account? A. Whenever you receive a reimbursement check, an explanation of benefits attached to your check will indicate your current balance in your spending account. Q. What if I have an expense at the end of the year and don’t receive the bill until the next year? A. As long as your expenses were incurred during the plan year, you can still be reimbursed. You may incur bills for the year’s eligible expenses until March 15 of the following year. The deadline to submit is June 15 of the following year.

Q. Is it better for me to use the Dependent Care Spending account or the federal tax credit? How do I decide? A. You should consult your tax advisor as to which is best for you.

Federal Income Tax Credit The federal income tax credit allows you to subtract a percentage of your expenses for care from the federal taxes you owe. The percentage depends on your taxable household income. IRS rules say you cannot use the same expenses under both the dependent care spending account and the tax credit. So which one to choose depends on your personal financial situation. You may need to consult an accountant or financial advisor before deciding.

mailto:[email protected]

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Know your HealthCare FSA Eligible Expenses

Please note: FSA funds can no longer be used to purchase OTC medicine and drugs unless a medicine or drug is requested by prescription. A “prescription” means a written or electronic order for a medicine or drug

that meets the legal requirements of a prescription in the state in which the medical expense is incurred and that is issued by an individual who is legally authorized to issue a prescription in that state.

Eligible Healthcare Expenses Medical Treatments/Procedures

Acupuncture

Alcoholism (inpatient treatment)

Drug addiction

Hearing exams

In vitro fertilization

Norplant insertion/removal

Physical exam (not employment related)

Reconstructive surgery (if medically necessary due to congenital defect or accident)

Rolfing

Speech therapy

Sterilization

Transplants (including organ donor)

Vaccinations/immunizations

Vasectomy and vasectomy reversal

Weight loss programs (as prescribed by your doctor)

Well baby care

Obstetric Services

Lamaze class

Midwife expenses

OB/GYN exams

OB/GYN prepaid maternity fees (reimbursable after date of birth)

Pre and post natal treatments

Lab Exams/Test

Blood test

X-rays

Cardiographs

Laboratory fees

Metabolism test

Spinal fluid tests

Urine/stool analyses

Medical Equipment Supplies And Services

Abdominal/back supports

Ambulance services

Arches/orthopedic shoes

Contraceptives, prescribed

Crutches

Guide dog (for visually/hearing impaired)

Hearing devices and batteries

Hospital bed

Learning disability (special school teacher)

Medic alert bracelet or necklace

Oxygen equipment

Prostheses

Splints/casts or support hose (requires medical necessity)

Syringes

Transportation expenses (essential to medical care)

Weight loss drugs ( to treat specific disease

Practitioners

Allergist

Chiropractor

Christian science

Dermatologist

Homeopath

Naturepath

Osteopath

Physician

Psychiatricst

Psychologist

Medication

Insulin

Prescribed birth control and vitamins

Prescription drugs

Dental Services

Physical exam

Dental x-rays (not employment related

Dentures

Exam/teeth cleaning

Extractions

Fillings

Gum treatment

Oral surgery

Orthodontia/braces Vision Services

Eye exams

Eyeglasses

Reading glasses

Contact lenses

Laser eye surgeries

Artificial eyes

Prescription sunglasses

Radial keratotomy/LASIK

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The OTC items which are no longer eligible for reimbursement without prescription include, but are not limited to, items in the following categories:

Acid controllers Baby rash ointments/creams Motion sickness

Allergy & Sinus Cold sore remedies Pain relief

Antibiotic products Cough, cold & flu Respiratory treatments

Anti-diarrheals Digestive aids Sleep aids & sedatives

Anti-gas Feminine anti-fungal/itch Stomach remedies

Anti-itch & insect bite Hemorrhoid preps

Anti-parasitic treatments Laxatives

Ineligible Healthcare Expenses Expenses not eligible for reimbursement through the Healthcare Spending Account include, but are not limited to, the following:

Anti-Baldness Drugs Electrolysis or Hair Removal Maternity Clothes, Diaper Service

Bottled Water Illegal Operations and Treatments Nursing for Newborns

Uniforms Cosmetics, Toiletries, Toothpaste, etc. Marriage Counseling

Insurance Premiums Custodial Care in an Institution Funeral and Burial Expenses

Teeth Whitening Health Club Dues (unless prescribed by Dr.)

Know your Dependent Care FSA Eligible Expenses

The Dependent Care FSA is not for healthcare expenses. It is for care for children under the age of 13 and dependents who are mentally incapacitated. Please budget all healthcare expenses for the Healthcare FSA.

Eligible Dependent Care Expenses

Before and after school care

Licensed Child Care Provider, Elderly Care Provider, or babysitter inside or outside participant’s household

Day Camps, Summer Camps, and Holiday Camps

Pre-Kindergarten/ Nursery Schools

Registration fees (but only after services are provided)

Sick-child facility

Ineligible Dependent Care Expenses

Expenses not eligible for reimbursement through the Dependant Care Spending Account include, but are not limited to, the following:

Babysitting provided by a person under the age of 19 and is the child/stepchild of the employee

Boarding schools (educational expenses)

Overnight camps

Separate charges for food, diapers, clothing, or supplies

Kindergarten (educational expenses)

Special activities

Tuition expenses

Transportation For any additional questions on eligible expenses please contact CoreFlex at 1-877-267-3359.

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Overview of Tuition Reimbursement Atlantic Health System offers a Tuition Reimbursement program as a way of encouraging personal growth and to make it possible for employees to increase their job-related skills and abilities. The Tuition Reimbursement program offers reimbursement for:

Degree programs (Associates, Bachelors, Masters, and Doctoral) for matriculating students pursuing a degree program offered by an accredited college or university.

Certification Exam Fees and Recertification Fees required for your current job or strongly recommended and approved by Department Manager to support professional growth.

An employee must attend an accredited degree-granting college or university located in the United States. Courses of study must be healthcare related, or enable the employee to develop skills, knowledge, and qualifications that will benefit the employee in their present position or in a future position within Atlantic Health System. Full-time and part-time employees will be eligible for reimbursement benefits outlined below based on biweekly hours for which an employee is hired.

Hours Worked

Biweekly

Undergraduate Degree Reimbursement

(per calendar year)

Graduate Degree Reimbursement

(per calendar year)

Full-time 72 – 75 hours 100% Tuition up to $4,800.00 100% Tuition up to $5,000.00

Part-time 55 – 71 hours 75% Tuition up to $3,600.00 75% Tuition up to $3,750.00

Part-time 37.5 – 54 hours 50% Tuition up to $2,400.00 50% Tuition up to $2,500.00

The application to apply for Tuition Reimbursement and for Certification/Recertification Reimbursement can now be completed online through Employee Self Service. To apply online via intranet:

Go to the Atlantic Health System intranet

Click on ‘Departments’

Click on ‘Human Resources’ under the ‘Corporate’ column

Click on ‘Employee Self Service’ in the left rail

Click on ‘Self Service Login’

Log in using your Atlantic Health System email login and password

Click on Self-Service

Click on ‘Learning and Development’

Click on ‘Apply for Tuition Reimbursement’

For additional information on the Tuition Reimbursement program, you can call the TR Hotline at 973-660-3175 or visit our website at: http://intranet.atlantichealth.org/Departments/Corporate/Human+Resources/Tuition+Reimbursement EdAssist Atlantic Health System employees have the opportunity to benefit from personalized educational counseling with the addition of EdAssist™ Educational and College Finance Advising, an expansion of the AHS tuition reimbursement program. Offered by Human Resources Recruitment, EdAssist provides personalized support by helping employees make better decisions regarding education. Through EdAssist, AHS employees will now have access to discounts in tuition cost with more than 200 colleges and universities. This benefit also offers free one-on-one consultation and advising to help employees:

Make well-informed decisions regarding schools and programs that can help advance their careers.

Stay on track to successfully complete their degrees in the most timely and cost-effective way.

http://intranet.atlantichealth.org/Departments/Corporate/Human+Resources/Tuition+Reimbursement

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Overview of Tuition Reimbursement (cont.)

Reduce their length of study by exploring credit by examination options, waiving required courses from

previous coursework and gaining credit for life experience and internal corporate training programs.

Identify grants, scholarships, military discounts and other external resources to lower the cost of tuition

and stretch tuition assistance dollars further.

To learn more about our new partnership with EdAssist, including our expanded list of university partnerships, virtual career fair and so much more please visit www.edassist.com/atlantichealthsystem To schedule an appointment to speak with an EdAssist Advisor, please call 855-729-5957 or e-mail EdAssist directly at [email protected]

Overview of Paid Time Off Program Our Paid Time off Program gives you more flexibility in how you use your paid time off. You get a set number of hours each year to use as you wish. Everyone needs time away from work. Sometimes you plan a vacation or personal day months in advance. Other times, you may be sick, or faced with an unscheduled emergency, and you can’t make it into work. Here, you have the flexibility to choose how to spend your time off. Each eligible employee will have:

A Time Bank for scheduled and unscheduled absences and

An Extended Illness Bank for illnesses lasting more than five days. You are eligible to participate in the Paid Time Off Program if:

You are a full-time or part–time employee;

You are regularly scheduled to work at least 18.75 hours every week; and

You have completed three months of employment. Employees earn Time Bank hours on a prorated basis, determined by the number of regularly scheduled weekly hours, position, and length of service. Extended Illness Bank hours and Legal Holiday hours are earned on a prorated basis determined by the number of regularly scheduled weekly hours. The Time Bank

The Time Bank is a pool of time you can use for scheduled absences or an occasional unscheduled day away from work. You choose how you use your paid time off. Similar to depositing your paycheck into a bank, each year Atlantic Health System advances a set number of hours into your Time Bank. The number of hours depends on:

Your position;

The number of regularly scheduled hours you work every week; and

Your length of service. Every time you take a paid scheduled or unscheduled day off, that time is ‘withdrawn” from your Time Bank account. Each day off is deducted from the total number of Time Bank hours you received at the beginning of the year. Knowing the total Time Bank hours you have for the whole year, you can keep track of how many hours you’ve used and how much time you have left.

If you are a new employee or you change to Paid Time Off eligible status, you will begin your Time Bank accrual the first pay period, following three months of employment. After that, on the first pay period of every year Atlantic Health System advances your Time Bank hours for the whole year! You can use time that’s been advanced but not earned except in the case of a leave of absence.

http://www.edassist.com/atlantichealthsystem

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Overview of Paid Time Off Program (cont.) You may only use hours earned in your Extended Illness Bank, however if you leave Atlantic Health System before you’ve had a chance to earn the hours you’ve taken off, the value of those hours will be subtracted from your final paycheck. If you terminate at Atlantic Health System or have a change in status (e.g., you change positions and/or regularly scheduled hours) you will be ineligible for the Paid Time Off Program, you’ll receive a lump sum check for your earned Time Bank hours. The amount of your check will be prorated to reflect how long you worked in a particular position during the year. Also, any Time Bank hours you’ve already taken will be deducted from your lump-sum payment. To calculate your paid time off for less than 37.5 regularly scheduled weekly hours, divide your regularly scheduled weekly hours by 5 days; regardless of the number of days you are regularly scheduled to work in a pay period. Then, multiply that figure by the maximum amount of Time Bank or Extended Illness Bank days you could receive, based on your position and years of service. An employee’s Time Bank advance will be used for scheduled Time Bank absences and unscheduled Time Bank absences. A scheduled Time Bank absence from work is a day(s) scheduled and approved in advance by the department head in keeping with the scheduling and approval requirements defined by each department. An unscheduled Time Bank absence is not pre-approved or scheduled in advance with the department head, and is a result of an emergency or illness. When you need to take an unscheduled absence, as a result of illness or family emergency, be sure to follow the procedures for your department. If you have not followed the correct department reporting procedure for your absence, the department head may not approve payment for that time off. Be sure to use your Time Bank days by December 31 of the current year. At the beginning of the first pay period of each year, your account is replenished with the new year’s advance of Time Bank hours. You will not be able to “cash in” your hours or carry over hours from one year to the next. Atlantic Health System gives you until the end of the current year to use your Time Bank allowance. Any unused time will be deposited in your Extended Illness Bank. If you use all your Time Bank allowance before year-end you can borrow in the month of December only, up to 5 days (37.5 hours) from your Time Bank allowance for the following year for unscheduled absences only. Examples of Positions within Each Time Bank

Time Bank 1 Provides 18 paid-time-off days. Those who might use this time bank are unit secretaries, administrative assistants, food service workers, and nurse’s aides. At the beginning of their fourth year, they receive 23 days. At the beginning of their sixth year, they receive 28 days. Time Bank 2 Provides 23 paid-time-off days. Those who might use this time bank are registered nurses, physical therapists, social workers, and respiratory therapists. These employees start with 23 days of Time Bank Advances. At the beginning of their fourth year, they receive 28 days.

Time Bank 3 Provides 28 paid-time-off days. Those who might use this time bank are managers and directors. Extended Illness Bank The Extended Illness Bank is for an illness requiring you to miss work for more than five consecutive scheduled workdays. If you have exhausted your Time Bank advance, you cannot access your Extended Illness Bank until you use five consecutive unpaid workdays. Like the Time Bank, the number of hours placed in your Extended Illness Bank is based on your regularly scheduled weekly hours. Your position or years of service do not affect it.

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Overview of Paid Time Off Program (cont.) Each year, the maximum number of hours deposited into the Extended Illness Bank is 67.5 hours or nine days. Only full–time employees who are regularly scheduled to work at least 37.5 hours every week are eligible for the maximum. Part–time employees receive their Extended Illness Bank time on a prorated basis. Unlike the Time Bank, you carry over any unused Extended Illness time from year to year, up to a maximum of 26 weeks or 975 hours. If you are out more than five consecutive days, the first five days are taken from your Time Bank and subsequently the time is then taken from your Extended Illness Bank. The time period of five consecutive scheduled workdays is based on hours and not actual calendar days or shifts. Hours are used in order to be fair and consistent to all employees. An employee’s regularly scheduled weekly hours divided by 5 determines the hours for one “work day”. A “work day” for an employee regularly scheduled for 37.5 weekly hours is 7.5 hours (37.5 regularly scheduled weekly hours divided by 5). For an employee regularly scheduled for 36 weekly hours a “work day” is 7.2 hours (36 regularly scheduled weekly hours divided by 5). Worker’s Compensation If you are unable to work because of a work-related illness or injury; you may receive Worker’s Compensation. Worker’s Compensation will pay up to 70 percent of your base pay, or a maximum weekly benefit that is subject to change per year. Instead of coming out of your Time Bank, the first seven (calendar) days of your injury or illness are paid out of your Extended Illness Bank. Starting the eighth day, you will be paid by Worker’s Compensation; payments are calculated from the first calendar day you were out of work because of a work-related injury or illness. You may request a lump sum payout of the 30 percent not paid by Workers Compensation, using your Extended Illness Bank time. If you experience a work-related illness/injury, you should immediately report the injury to the supervisor. You and your supervisor should immediately contact the site Occupational Medicine Service to schedule an appointment for the employee to be examined. If Occupational Medicine Service is closed at the time of the incident, the employee should be sent to the hospital Emergency Department for evaluation. The supervisor and employee should then leave a message at Occupational Medicine Service to notify them of the injury and the name of the person to contact to arrange for a follow-up.

Family and Medical Leave By law, Atlantic Health System must provide you the opportunity, if eligible, to take a leave of absence (up to 12 weeks) for maternity leave or if you fall sick from a serious health condition. If you choose to take a medical leave for your serious medical condition, you must use five consecutive Time Bank (PTO) days and then your Extended Illness Bank, in that order. Once you’ve exhausted your Extended Illness Bank, you should apply for state disability. A leave of absence, if eligible, provides an employee up to 12 weeks every 24 months to care for a seriously ill family member - including a child, spouse, parent, parent-in-law, domestic partner, or to care for a newborn following maternity leave. If you request a leave for any of these reasons, you will be required to take two weeks of PTO or whatever time you have remaining your bank. You may be able eligible to collect up to 6 weeks of state disability. The remaining weeks off would be an unpaid leave of absence. Employees out on a leave will not accrue Time Bank (PTO), Extended Illness Bank, or Holiday time.

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Overview of Paid Time Off Program (cont.) Legal Holidays Legal holidays are an important and enjoyable part of our Paid Time Off Program. If you are an eligible full-time or part-time employee, you will receive the following six legal holidays effective the first pay period of the year: Christmas, New Year’s Day, Memorial Day, Independence Day, Labor Day, and Thanksgiving.

If you work on a legal holiday, the hours will remain for use at another time. Unscheduled Time Bank absences preceding or following the legal holiday may forfeit payment of the legal holiday based on the discretion of your department head. Part-time employees who work 18.75 or more regularly scheduled hours every week receive these holidays on a prorated basis. Any legal holiday hours not used by the end of the last pay period in February (the grace period) will be deposited into your Extended Illness Bank. No cash-outs will be allowed for any unused legal holiday time.

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This booklet is designed to provide an overview and only includes key features of the programs. More specific information is contained in the Summary Plan Description documents. If any conflict arises between the information presented in this package and the Summary Plan Description documents that define the Program, the official documents will govern. As with all benefit programs and plans, they are subject to change. You can find copies of the Summary Plan Descriptions on the Atlantic Health System Intranet or contact the Employee Resource Center.

Welfare Benefit Plan Summary Annual Report Summary of Benefits and Coverage

http://intranet.atlantichealth.org/static-files/Intranet/Departments/Human%20Resources/Documents/WelfareBenefitPlan-SummaryAnnualReport.pdf

http://intranet.atlantichealth.org/static-files/Intranet/Departments/Human%20Resources/Documents/AHSPPOPlan-SBC2014.pdf