A Step-by-Step Guide to Your 2018 Benefits Benefit Guide.pdf · A Step-by-Step Guide to Your 2018...

FOR HEALTH | FOR WEALTH | FOR LIFE

A Step-by-Step Guide to Your 2018 Benefits


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How to Enroll

Benefits Self-Service Website

Medical Plan Choices

Dental Plan Choices

Other Benefits

Who to Contact

This guide provides an overview of the Choices for Health program. Although we expect that the

information contained is accurate, if there is a discrepancy between this guide and the legal plan documents

that govern the benefit plans described, the plan documents will apply. Nothing in this booklet should be

construed as a guarantee of future employment.

Cottage Health (CH) includes Santa Barbara Cottage Hospital (SBCH),

Goleta Valley Cottage Hospital (GVCH), Santa Ynez Valley Cottage Hospital (SYVCH)

and Pacific Diagnostic Laboratories (PDL).

GRANDFATHERED STATUS NOTICE

Cottage Health Employee Benefit Plan believes this Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that this Plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of pre-existing condition exclusions. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator.

Covered persons may also contact the Employee Benefits Security Administration, U.S. Department of Labor at (866) 444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

http://www.dol.gov/ebsa/healthreform


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An Overview of Choices …for health …for wealth …for lifeAlthough this booklet is focused on your Choices for Health, the Choices employee benefits program offers more than just health benefits. Here’s an overview of all of the programs and benefits you have as a CH employee.

Benefits available to all employees

• 529 College Savings Plan

• Cash Balance Retirement Plan*

• CH Commuter Program

• CH-Sponsored Events

• Coastal Housing Partnership

• Employee Discount Program — Abenity

• Employee Assistance Program (EAP)

• Everyday Heroes — Employee Recognition Program

• Free onsite yoga and fitness classes

• Onsite Child Care at SBCH (limited availability)

• Onsite seated massage

• PDL Empower 401(k) Retirement Plan**

• Santa Barbara County Federal Credit Union

• SBCH Employee Pharmacy Discount

• Tax-Sheltered Annuities — 403(b)*

* Pacific Diagnostic Laboratories (PDL) employees are not eligible for these benefits; instead, PDL employees have a 401(k) retirement savings plan into which they are automatically enrolled.

** This program is for PDL employees only.


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Additional benefits available to full-time and part-time benefit-eligible employees

• Basic Life and Accidental Death and Dismemberment

(CH-paid)

• Long-Term Disability (CH-paid)

• Certification bonus

• Dental benefits

• Flexible Spending Accounts (FSAs)

• Healthcare Student Loan Program

• Long-Term Sick Leave

• Medical, prescription drugs and vision benefits

• Mortgage Assistance Program (MAP)

• Paid Time Off

• Prepaid Legal Plan

• SBCH Parking Cash-Out Incentive

• Travel assistance

• Tuition reimbursement

• Voluntary benefits through AFLAC

• Voluntary Life and Accidental Death and Dismemberment

• Voluntary Short-Term Disability

• Wellness program

• Workforce Housing — Bella Riviera

Additional information on your benefits can be found online.

• From home: go to www.choicesforhealth.org

• From work: go to the Employee Portal > Human Resources > Benefits & Compensation

www.choicesforhealth.org


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IntroductionChoices for Health provides you the following plan options to help meet your benefit needs:

• Three medical plans

• Vision coverage (with the High and Medium medical plans)

• Two dental plans

• Health Care Flexible Spending Account with Benny Card

• Dependent Care Flexible Spending Account

• Basic life and accidental death & dismemberment (AD&D) insurance and several options to increase life and AD&D coverage for yourself and your family

• Long-term disability insurance coverage

• The opportunity to purchase short-term disability coverage

• The opportunity to purchase prepaid legal coverage

• The opportunity to purchase additional voluntary coverage through AFLAC

Most benefit plans, except the prepaid legal plan and voluntary AFLAC products, are designed to provide a basic benefit and the option to buy up to higher levels of coverage or, in some instances, to choose less costly options or opt out of coverage altogether and receive taxable income in return.

Choices for Health offers a wellness program that includes a wide variety of resources, such as health assessments, health coaching, fitness and self-care programs and unlimited access to online health tools and information.

The Step-by-Step Guide is Only a Summary

More detailed information is available in the Medical Summary Plan Description which can be found on the Employee Portal or www.choicesforhealth.org. Benefits are not provided to leased temporary or agency employees, nor are they a guarantee of employment.

http://www.choicesforhealth.org


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Who’s Eligible | 2018 Employee Premiums | Choose Carefully | Mid-Year Changes

How to EnrollWho’s EligibleIn accordance with the Affordable Care Act requirements, Choices for Health benefits are offered to:

• full-time employees; and

• part-time employees.

Actual hours scheduled are based on department need. For more information please refer to the Summary Plan Description or contact Benefits Administration at (805) 879-8777.

If you’re eligible, you can elect medical, dental and life insurance coverage for your:

• legal spouse or legally married domestic partner

• registered domestic partners (Refer to the Summary Plan Description for important information about domestic partner COBRA and Medicare rights.)

• dependent children through the end of the month when they turn age 26

• dependent children of any age who are physically or mentally incapable of caring for themselves, who are chiefly dependent on you for financial support and for whom you are entitled to an income tax exemption.


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Proof of Dependent Status When you cover dependents, CH requires proof of dependent status. Dependents are not covered until the Benefits department has verified the proof of dependent status. Examples of the proof that is required include:

• certified copies of birth certificates for children

• certified copies of your marriage certificate, if you’re adding your spouse or legally married domestic partner

• affidavit of domestic partnership and the state registration, if you’re adding a domestic partner (not legally married).

When Choices for Health Benefits Become EffectiveGenerally, Choices for Health benefits begin on the first day of the month after you complete 30 continuous days of CH employment.

We Need Social Security Numbers

The Affordable Care Act requires that we collect Social Security numbers (SSNs) for all employees and dependents who are covered under the medical plan.

We already have SSNs for employees; if you have not yet provided your covered dependents’ SSNs, please log in to the benefits system at https://benefits.sbch.org and provide this information.

https://benefits.sbch.org


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2018 Employee Premiums EFFECTIVE APRIL 1, 2018

The following outlines your per paycheck cost for the Choices for Health dental and medical plans effective April 1, 2018. If you choose to decline coverage for these benefits you will receive additional taxable income. The cost for your Choices for Health benefits are deducted on a pre-tax basis 26 times per year.

Dental Plan

Plan Employee Only Employee + SpouseOr Employee + Domestic

Partner

Employee + Child/ren Employee + FamilyOr Employee + Domestic

Partner + Child/ren

Full-Time Part-Time Full-Time Part-Time Full-Time Part-Time Full-Time Part-Time

High 5.66 11.31 22.44 28.43 17.96 25.43 29.92 35.88

Basic 0.00 5.66 16.47 23.94 11.95 20.95 20.95 26.94

Decline (10.40) (5.20)


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Medical PlanIf you and/or your covered spouse or domestic partner make the healthy choice not to use tobacco products you will receive a discount on the premiums, which is reflected in the chart below. You will be asked to disclose your tobacco status at enrollment. Keep in mind that you will be held accountable to Cottage Health’s core values and Standards of Behavior.

Plan Employee Only Employee + SpouseOr Employee + Domestic

Partner

Employee + Child/ren Employee + FamilyOr Employee + Domestic

Partner + Child/ren

Full-Time Part-Time Full-Time Part-Time Full-Time Part-Time Full-Time Part-Time

High Tobacco-free

14.72 60.72 124.67 175.74 114.49 165.52 161.43 212.54

High Tobacco user

20.68 83.29 165.57 217.96 151.55 203.89 219.44 271.87

Medium Tobacco-free

9.19 46.01 102.19 153.28 89.91 141.01 116.50 167.54

Medium Tobacco user

16.99 64.61 140.50 192.91 124.50 176.93 170.46 222.83

Basic Tobacco-free

0.00 40.50 73.56 124.67 65.39 116.56 93.99 145.08

Basic Tobacco user

16.35 56.85 109.78 162.22 98.14 150.63 143.69 197.88

Decline (31.20) (10.40)


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Dental Plan Choices

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Choose Carefully To elect the Choices for Health benefits that work best for you, you need to enroll online at https://benefits.sbch.org. When you enroll depends on whether you are enrolling for the first time or changing your elections.

New Employees: Enrolling for the First TimeAs a new employee, you need to enroll for your Choices for Health benefits before your eligibility date. The benefits you elect will remain in effect for the remainder of the plan year (April 1 – March 31) during which you enroll.

If you don’t enrollIf you don’t enroll by your eligibility date, you will receive default benefits for the remainder of the plan year.

The default benefits consist of Employee-Only Basic Medical, Basic Dental, Basic Life Insurance, Basic Accidental Death & Dismemberment Insurance and Long-Term Disability Insurance.

Active Employees: Changing Your ElectionsEach year, CH has an open enrollment period, during which you can make benefit elections for the next plan year (April 1 – March 31).

Enroll By Your Eligibility Date

New employees must enroll for benefits by their eligibility date. Your eligibility date can be found in your offer letter of employment or due to a change in status the Employee Benefit Plan Enrollment letter.



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Becoming Tobacco-Free During the Year

Unfortunately, IRS rules do not allow premiums to change mid-year unless there is a qualified life event.

You will have to wait until the next annual enrollment to declare your new status and receive the medical premium discount.

If you wish, during the open enrollment period you can:

• change your benefit elections,

• add or drop dependent coverage,

• increase or decrease coverage levels, and

• re-enroll for Flexible Spending Accounts (FSAs) for the next plan year. (You must re-enroll for FSAs each year for the subsequent plan year.)

You are not required to make any changes during open enrollment; however, remember that you are required to declare your tobacco status. If you do not make changes to your benefit elections, the benefits you have for the prior plan year will remain in effect and you will not have FSAs.

If you do make changes to your benefits and/or re-enroll in FSAs, the Choices for Health elections that you make during annual open enrollment will remain in effect for the following plan year (April 1 – March 31).

Mid-Year Changes For All Employees Due to federal tax law, the only reason you can make benefit changes during a plan year is because you experience a major life event, such as getting married, getting divorced, adding a child through birth or adoption, or gain or loss of coverage.

If you experience a major life event, you may make benefit changes that reflect the nature of the change. For example, if you get married, you may add your spouse to your medical coverage within 30 days of the marriage, but you cannot change medical plans. You must notify Benefits Administration and complete the required paperwork within 30 days of your major life event in order to make changes to your benefits. Contact Benefits Administration at [email protected] or (805) 879-8777 if you have any questions.

mailto:chbenefits%40sbch.org?subject=


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Logging On | Getting Around the Site | Making Your Choices for Health

The Benefits Self-Service WebsiteThe Benefits Self-Service Website is a system that allows you to quickly access the benefits and compensation information you need and carry out transactions online.

You will have access to the information you need from work or at home, which makes it easy to enroll, make changes to your benefits or update your personal data at any time.

Logging OnFrom home: go to https://benefits.sbch.org

From work: go to the Employee Portal > Human Resources > Benefits & Compensation > Benefits Self-Service

After you log in, you will see a screen that asks whether you and/or your spouse/domestic partner use tobacco products. If you do not log in to disclose your tobacco status, you will receive the tobacco user’s premium rates, which are substantially higher. You must disclose your tobacco status in order to get the discount on the medical premiums. Your response is your certification and is considered binding. You will also need to answer whether or not you and/or your covered dependents are covered under another medical plan.

Questions about Benefits Self-Service?

You can find a list of frequently asked questions and their answers on the Benefits Self-Service Website.

You can also either email CH Benefits Administration at [email protected] or call us at (805) 879-8777.

We Need Social Security Numbers

The Affordable Care Act requires that we collect Social Security numbers (SSNs) for all employees and dependents who are covered under the medical plan.

We already have SSNs for mployees; if you have not yet provided your covered dependents’ SSNs, please log in to the benefits system at https://benefits.sbch.org and provide this information.





mailto:chbenefits%40sbch.org?subject=



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New in 2018—Designate your primary care physicianWe have changed the first tier of our wellness program to encourage you to designate Primary Care Physicians for yourself and all covered dependents.

Those who complete this requirement and get an annual physical between April 1 and December 31 of each plan year will satisfy Tier 1 of the wellness program and each earn $250 in wellness dollars.


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Getting Around the SiteTo view the self-service options available to you, look at the top menu on the screen and you will see the following sections:

Here’s what you can find in each section:

New Hire EnrollmentEnrollment instructions and online enrollment tool for new employees and those who are first-time benefits eligible

Open Enrollment (only available during open enrollment period)Enrollment instructions and online enrollment tool for existing employees

My Current BenefitsYour beneficiary and dependent designations and your personalized benefits information

Benefit FormsMedical, dental, wellness and vision claim forms, Choices Change Form and much more

PPO Providers Medical, dental and vision providers can all be found here

Plan Benefit GuidesSummary plan descriptions for each of the benefit programs and Summary of Benefits and Coverage documents for medical, prescription drug and dental programs

Personal Your address and other personal information

Payroll Your direct deposit information and your W4 forms and State DE-4 form

In Box Messages to you from Benefits Administration about the transactions you make on the site

ContactsA list of Human Resources staff and who to contact for what

To enter one of these sections, simply click on the menu option at the top of the page. This will lead you to additional options within each section where you may be able to access and update information.


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Choosing Your BenefitsOnce you decide what your Choices for Health will be for the plan year (April 1 through March 31), you may enroll online by following these easy steps:

Step 1: Read the Enrollment Instructions — EveryoneRead the instructions to familiarize yourself with the site and enrollment process.

• If you are making changes during the annual open enrollment, click “Open Enrollment” on the top menu. From the drop-down menu, click “New Hire Enrollment” on the top menu. Then click “New Hire Instructions”.

Step 2: Verify Your Personal Information — Everyone• If you are making changes during the annual open enrollment, you will want to verify that

your dependent, beneficiary and personal information is correct. To view your dependents and beneficiaries, click “Dependents/Beneficiaries”, under the Open Enrollment section. If the information needs to be corrected, make those changes directly on the page. It is mandatory for CH to collect Social Security Numbers on dependents covered under the Choices for Health medical plan. Please add the Social Security numbers for your covered dependents if they are not already in the self-service system. Add the Social Security number where it says “Tax ID#.”

It’s also a good idea to check your personal information. Click “Personal” on the top menu and verify that your address is correct. If it needs to be changed, make those edits directly on the page and click “Submit.”

You Must Re-enroll in FSAs Each Year

If you don’t go online to enroll, the benefits you have now will automatically continue, with the exception of FSAs. You must re-enroll in FSAs each year.

A Note about Opting Out

If you wish to opt out of a medical and/or dental plan you will need to click the “Medical Waive/Decline” or the “Dental Waive/Decline” option for medical and dental benefits.

Do not click “Not Selected” or the system will show that you did not make any elections.


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• If you are enrolling for the first time, you will need to enter your dependent and beneficiary information. To enter this information, click “Dependents/Beneficiaries,” under the New Hire Enrollment section. It is mandatory for CH to collect Social Security numbers on dependents covered under the Choices for Health medical plan.

Please add the Social Security numbers for your covered dependents where it says “Tax ID#.” Your address will already be in the system, but you should verify that your address is correct. Click “Personal” on the top menu, make any changes you need to make directly on the page and click “Submit.”

Step 3: Make your Choices for Health Selections at Open EnrollmentYou only need to make elections for the benefit plans you want to change and/or enroll in the Flexible Spending Accounts (FSAs). If you are not making changes or re-enrolling in an FSA, then your elections will carry forward to the new plan year.

To view your current elections, click “My Current Benefits” on the top menu. You will see a screen that lists all of your current elections. Page down to view all of them.

If you don’t make elections, your choices for 2018/2019 will default to what you currently have (except that you won’t be enrolled in FSAs — you need to enroll in those every year).

Step 2: Verify Your Personal Information — Everyone continued


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Step 4: Submit your Choices for HealthWhen you have entered all of your new elections, be sure to click the “Submit” button at the bottom of the page to save your Choices for Health selections in the system.

If you’d like to save your elections for later and complete them at another time, you can click “Save as a Draft” at the bottom of the page. Remember that if you save your elections as a draft, your enrollment is not final. You will need to log back in to the system to submit your elections before the deadline date.

After accepting your elections, you will be able to print a confirmation summary.

IMPORTANT

To confirm that your elections have been submitted, check your In Box for a message from the Benefits staff.

Your benefits are only considered “official” when you receive this confirmation message.

Important: “Save as Draft” will only save your selections. Your enrollment will not be submitted if you hit this button. You must hit “Submit” to finalize your enrollment.

Click “Submit” when you are ready to enroll. Your enrollment is not complete until you click this button.


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Choosing Your Plan | PPO Plans | Prescription Drug Benefits | Summary of Medical Plans | Wellness Program

Medical Plan ChoicesCH offers eligible employees a choice of three Preferred Provider Organization (PPO) medical plans:

• Basic Plan (no vision coverage)

• Medium Plan

• High Plan.

Each medical plan includes the wellness and prescription drug programs. Vision coverage is also covered under the Medium and High medical plans.

If you are covered under another medical plan, you may opt out of coverage under a CH-sponsored plan and receive additional taxable income instead. Proof of other coverage will be required.

Choosing Your Medical Plan OptionAs you look at your Choices for Health medical plan options for 2018/2019, you’ll see that you have three plans from which to choose anytime you need medical care. Please note that you do not have to choose a specific medical plan option at enrollment. As the chart on pages 22–24 illustrates, most of the benefits are the same for all three medical plan options.

The only features that differ by plan are the deductibles and the amount that is allowed for vision care. The other thing that is different among the plans is the amount you pay per paycheck in premiums. All other benefits and features are the same.

The employee premiums can be found on pages 8 and 9.

Provider Directories Can be Found Online

• From home: go to www.choicesforhealth.org

• From work: go to the Employee Portal > Human Resources > Benefits & Compensation



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Preferred Provider Organization (PPO) PlansCH offers PPO medical plans because we believe that the highest level of medical care is achieved when the patient is actively involved in the decision to choose his or her medical provider.

With a PPO plan, the choice of who provides your medical care is entirely up to you. You can see whatever health care provider you want for your care and still be covered. The only difference is the amount of the provider’s charges and the amount of reimbursement you receive from the plan.

A PPO is a network of physicians and other health care providers that agree to charge lower rates to people in the CH plan than to others. Please note that you do not have to choose a specific medical plan at enrollment. If you elect medical coverage, you can decide which network to use at the time you need care. You have access to the following networks:

100% Cottage Health Facility PPO Network — a network of Cottage Health facilities for which the plan pays the entire cost of your care — you pay nothing.

85% Choices for Health Physician PPO Network — a network of providers for which the plans pay the highest level of benefits — meaning you have the least out-of-pocket expense.

80%Anthem Blue Cross PPO Network — a nationwide network for which the plans pay a lower level of benefits than for either Cottage Health PPO facilities or Choices for Health PPO providers.

60%Non-PPO — You may go to a provider who is not in any of the Cottage or Anthem PPO networks and you will receive the lowest level of benefits and have the highest out-of-pocket cost.

Please refer to the next page for more information on each medical tier.

Tobacco-Free Discount

If you and/or your covered spouse or domestic partner don’t use tobacco products you will receive a discount on the medical premiums.

You will be asked to disclose your tobacco status at enrollment. If you don’t log in to disclose your tobacco status, you will automatically receive the tobacco user’s premium rates, which are substantially higher. You must disclose your tobacco status in order to get the discount on the medical premiums.

Keep in mind that you will be held accountable to Cottage Health’s core values and Standards of Behavior.


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100% — Cottage Health Facility PPO Network — Keep it in the Family and Save Money While You’re at itIf you use Cottage Health facilities for your health care whenever possible we all benefit. You get excellent care and service and the plan pays 100% of the cost of your care — you pay nothing. Plus, you keep business here at Cottage, which helps us all control costs.

85% — Choices for Health Physician PPO Network Offers Highest BenefitsThe Choices for Health PPO Physician Network offers you a PPO network comprised of many of our attending physician staff. This gives you access to the best providers in the County at the lowest out-of-pocket costs to you. If you’re looking for excellent medical care while saving on your out-of-pocket costs, you should always look first for a provider in the Choices for Health Physician PPO network. You can find providers online at www.choicesforhealth.org

80% — Anthem Blue Cross PPO NetworkIf you choose not to receive care through either a Choices for Health PPO physician or a Cottage Health facility, you have access to a nationwide network of providers and facilities through Anthem Blue Cross. The plan will pay considerably more if you choose a provider in the Anthem Blue Cross network, however, you may also choose care outside the network.

60% — Non-PPOYou can seek care outside the Cottage Health Facility, Choices for Health Physician or Anthem Blue Cross PPO networks and the plan will pay the lowest level of benefits — meaning you will bear the most expense.

Utilization Review Requirements

To ensure that medical services are both medically necessary and cost efficient, the plan requires authorization before certain services are provided.

Call Care Coordinators at (888) 516-1511 for authorizations related to:

• Applied Behavior Analysis (ABA Therapy)

• Durable Medical Equipment (DME) Purchases and Rentals over $500

• Dialysis

• Inpatient Admissions

• Home Health Care and Services

• Hospice Care

• MRIs/MRAs and Pet Scans

• Oncology care and services (chemotherapy, radiation therapy etc.)

• Outpatient surgeries

• Skilled Nursing Facility Admissions

• Transplants: Organ and Bone Marrow



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Co-Payments for PPO Physician Visits Help You SaveCH encourages employees and their families to stay as healthy as possible and to get treatment early for illness and injuries. That’s why in any of the CH medical plans, you will pay only a low co-payment for visits to a PPO physician’s office.

Any time you or a covered family member go to a PPO physician for services, such as treatment for illness or injury, or a vision or preventive exam, you will pay only $20 for the visit, with no deductible required.

The co-payment applies only to the physician’s charges for an office visit. For diagnostic procedures, lab, X-ray, or surgery performed in the physician’s office, you will not have to pay the deductible. However, you will have to pay your percentage of the charges.

Care Coordinators are a Breath of Fresh AirWe have gotten great reviews from Cottage employees who have used Care Coordinators. The Care Coordinators serve as a single point-of-contact to help you navigate your medical/vision, dental and prescription benefits.

Care Coordinators is like a “concierge” for your Choices for Health benefits that will make it easier for you to deal with your health care needs. Use the Care Coordinators to help you anytime you have a question about the Choices for Health program.

Call Care Coordinators Anytime You Have Questions Want help finding an in-network provider? Call Care Coordinators. Need to obtain precertification for an MRI? Call Care Coordinators. Confused about your Explanation of Benefits? Call Care Coordinators...you get the idea!

Get the MyQHealth App

Visit your mobile app store and search for the app name “MyQHealth.”

Download and install the app and you’ll be able to access your Care Coordinators on the go!


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Prescription Drug Benefits: More Opportunities to SavePrescription drug costs generally account for a substantial portion of health care costs. But, employees and their families who enroll in a CH medical plan have the advantage of prescription drugs offered at discounted rates, and the convenience of an employee pharmacy.

PharmacyYou can purchase up to a 30-day supply of prescription drugs at the Santa Barbara Cottage Hospital Employee Pharmacy. All you have to do is present the prescription from your physician and your hospital ID badge.

If you are enrolled in a medical plan, you also have access to most retail pharmacies. When using a participating retail pharmacy all you have to do is present the prescription and your medical ID card. Your portion of the cost for each 30-day supply is:

• Generic drugs: You pay the greater of 30% of the discounted cost or a $5 minimum per prescription

• Brand-name drugs: You pay the greater of 30% of the discounted cost or a $10 minimum per prescription.

Mail Order PharmacyYou can purchase up to a 90-day supply of maintenance prescription drugs through the mail order pharmacy program. All you have to do is have your physician write your prescription for a 90-day supply. Then, obtain a mail order prescription enrollment application from the CH Employee Portal (under the “Forms Library” tab) and send it, along with your co-payment, to the Express Scripts Mail Order Pharmacy. Your portion of the cost for each 90-day supply is:

• Generic drugs: You pay 30% of the discounted cost. The least you will pay is $13 per prescription; the most is $26 per prescription.

• Brand-name drugs: You pay 30% of the discounted cost. The least you will pay is $25 per prescription; the most is $50 per prescription.

You can order prescription refills online at www.express-scripts.com or call Member Services at (877) 243-8012.

Order Prescription Refills Online

Go to www.express-scripts.com or call Member Services at (877) 243-8012.

www.express-scripts.com



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Summary of Medical PlansThis chart shows how the Basic, Medium and High Medical Plans are different and alike. For a detailed summary of benefits please see the Medical Summary Plan Description.

Features/Benefits That Differ By Plan

High Plan Medium Plan Basic Plan

Annual Plan Year Deductible (The amount you pay for covered services each plan year before the plan pays benefits)

Per Person $200 $400 $600

Family Max $400 $800 $1,200

Annual Vision Coverage Allowance

Per Person $200 per plan year $100 per plan year No coverage

Features/Benefits That Are the Same for All Plans

Annual Out-of-Pocket Maximum (not to exceed $6,000 per person) (The most you will pay out-of-pocket each plan year for covered expenses)

Choices for Health PPO* $2,000 per person

Anthem Blue Cross PPO $4,000 per person

Non-PPO $6,000 per person

*Choices for Health Physician PPO Network


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Facility Charges (You pay a $50 co-payment for each visit to the emergency room, regardless of facility)

Cottage Health PPO Facility

Plan pays 100%; you pay nothing

Choices for Health PPO* After deductible, plan pays 85%; you pay 15%

Anthem Blue Cross PPO After deductible, plan pays 80%; you pay 20%

Non-PPO After deductible, plan pays 60%; you pay 40% plus $300 per hospital admission

Provider Charges (After you pay the annual deductible, most covered charges are reimbursed as shown below. Exceptions are shown in the following section.)

Choices for Health PPO* Plan pays 85%; you pay 15%

Anthem Blue Cross PPO Plan pays 80%; you pay 20%

Non-PPO Plan pays 60%; you pay 40%

Exceptions to Reimbursement for Provider Charges (The following services are paid differently than noted above.)

Office Visits to PPO Physicians

You pay a $20 co-payment; plan pays the rest (no deductible required)

Services Performed in PPO Physician’s Office

Charges for diagnostic procedures, x-rays, lab, surgery are reimbursed as shown in the provider charges section above, with no deductible required

Medical Plan Choices continued

*Choices for Health Physician PPO Network


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Who to Contact



Non-SBCH Outpatient Surgical Center (located in the Santa Barbara area)

After deductible and $500 copayment, plan pays 60%

Emergency Room above You pay $50 per visit to any emergency room; remaining charges reimbursed as shown

Hearing Aids After deductible, plan pays 60%, limit one pair every three years

Immunizations Plan pays 100%; you pay nothing (no deductible required)

Acupuncture year After deductible, plan pays $25 per visit, up to a maximum of 20 visits per person per

Chiropractic year After deductible, plan pays $25 per visit, up to a maximum of 20 visits per person per year

Pharmacy Prescription Drug Program (Up to a 30-day supply may be obtained at the Santa Barbara Cottage Hospital Employee Pharmacy or any network pharmacy.)

Generic drugs For each prescription drug, you pay the greater of 30% of the discounted cost or $5 for up to a 30-day supply

Brand-name drugs For each prescription drug, you pay the greater of 30% of the discounted cost or $10 for up to a 30-day supply

Mail Order Prescription Drug Program (Up to a 90-day supply for maintenance medications)

Generic drugs For each prescription drug, you pay 30% of the discounted cost (For each prescription, there is a minimum co-payment of $13; maximum co-payment of $26.)

Brand-name drugs For each prescription drug, you pay 30% of the discounted cost (For each prescription, there is a minimum co-payment of $25; maximum co-payment of $50.)

Medical Plan Choices continued


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Other Benefits

Who to Contact


Wellness ProgramAt CH, our primary purpose is to improve the lives of our patients. We want to do the same thing for you and your family. Choices for Health offers a wellness program that includes a wide variety of resources such as health assessments, health coaching, fitness and self-care programs and unlimited access to online health tools and information.

If you are enrolled in one of the Choices for Health medical plans, your participation in this program is voluntary, confidential and provided at no additional cost to you or your covered family members.

Wellness Program at a GlanceThe chart on the next page gives you an overview of the benefits and services the wellness program offers you for preventive care, improving your health to lower your risk of certain conditions and managing diagnosed conditions to minimize their impact on your life.

If you participate in the wellness program, you can earn wellness dollars that are deposited to your wellness account. You and each covered dependent age 18 or older can earn a total of $550 that will be added to each individual’s wellness account if all three tiers are completed. (Enrolled dependents under age 18 can earn up to $400.)

To earn wellness dollars in the 2018/2019 plan year, you must complete the Tier 1 and Tier 2 wellness activities by the deadlines shown on the chart. Please note that the IRS requires wellness dollars to be taxed as ordinary income. This is called imputed (taxable) income. The wellness program has three tiers of activities, as shown on the following page.

For More Wellness Information...

Please refer to your Choices for Health Wellness Guide or our wellness portal at www.chschoices.org.

Use Your Wellness Dollars

You and your dependents can use your wellness dollars to reimburse yourself for the cost of approved lifestyle programs.

See your Wellness Guide or the wellness portal for more information.

Wellness Dollars are Taxed

Please note that the IRS requires wellness dollars to be taxed as ordinary income. This is called imputed (taxable) income and it means that the taxable income will appear on your paycheck and the actual wellness dollars you receive will be lower.

www.chschoices.org

http://www.chschoices.org

http://www.chschoices.org


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Wellness Activity Wellness Dollars

Tier 1 Getting an annual general physical exam and designating a Primary Care Physician must be completed between April 1 – December 31 of each plan year

$250 for each covered member

Tier 2 Completing the online health assessment, including biometric data must be completed between April 1 – December 31 of each plan year

$150 for each covered member 18 or over

Tier 3 Completing two approved wellness activities by March 31, 2019 $150 for each covered member

• Receive a preventive service (Mammogram, pap smear, immunization (other than the flu shot required for employees), colonoscopy, fecal occult blood test, bone mineral density test, or HIV test)

• Complete an average of 7,500 steps over a quarter period, as verified by a fitness tracker

• Get an annual preventive dental exam

• Complete an approved CH class: (smoking cessation, childbirth class, heart smart lecture, diabetes education program or financial education program (either at CH or a non-CH class led by a certified professional)*

• Complete one wellness challenge (employees only)

• Complete Advanced Medical Directive and file with CH**

• Complete a run/walk charity event sponsored by a professional organization (this includes MilesforMoms)*

• Complete the maternity program with Quantum

• Complete a non-CH prenatal/childbirth program

• Complete a non-CH smoking cessation program

• Graduate from, or complete three or more chronic condition coaching sessions with Quantum*

• Complete three or more lifestyle coaching sessions with Envolve*

Total *Eligible for dependents under age 18 in addition to online wellness activities

**Completing the Advanced Medical Directive counts as TWO activities

$550 for each person age 18 or older

$400 for each person under age 18


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Who to Contact

PPO Plans | Summary of Dental Plans

Dental Plan ChoicesCH offers eligible employees a choice of two Delta Dental Preferred Provider Option (PPO) dental plans:

• Basic Plan

• High Plan.

If you are covered under another dental plan, you may opt out of a CH-sponsored plan and receive additional taxable income instead.

Provider directories can be found online:

From home: go to www.choicesforhealth.org > PPO Providers

From work: go to the Employee Portal > Human Resources > Benefits & Compensation

What’s Different about the Plans?

The differences between the dental plans are the amount of the maximum annual benefit, orthodontia coverage and your monthly contribution.

Dental Preferred Provider Organization (PPO) PlansThe CH dental plans are Preferred Provider Organization (PPO) plans, just like the medical plans.

With a dental PPO plan the choice of who provides your dental care is entirely up to you. You can see whatever dental provider you want for your care and still be covered. The only difference is the amount of the provider’s charges and the amount of reimbursement you receive from the plan.

A dental PPO is a network of dentists that agree to charge lower rates to people in the CH plan than to others. Both of the CH dental plans offer two Delta Dental networks:

• The Delta Dental Premier network in which all Delta dentists participate and charge rates negotiated with Delta

• The Delta Dental PPO option, a smaller PPO network of Delta dentists that charge lower rates than those in the Premier Network.

You may also go to a provider who is not in the Delta Dental Premier or the PPO network and the plan will pay a lower level of benefits.



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PPO Plans | Summary of Dental Plans

Summary of Dental PlansThis chart shows how the Basic and High Plans are alike and different.

Features/Benefits That Differ By Plan

High Plan Basic Plan

Maximum Annual Benefit $1,500 per person $500 per person

Orthodontia (For adult or child) Plan pays 50% of charges, up to a lifetime maximum benefit of $1,500

Not covered

Features/Benefits That Are the Same for Both Plans

Annual Deductible $50 per person

Preventive Care (i.e. exams, cleanings)

• Delta Dental Premier and PPO

• Non-PPO

Plan pays 100%, no deductible required

After deductible, Plan pays 90%

Basic Treatment (i.e. fillings, oral surgery, extractions)


• Non-PPO

Plan pays 80%, no deductible required


Major Treatment (i.e. crowns, restorations)


• Non-PPO




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Who to Contact

Flexible Spending Accounts | Life and Accident | Disability Insurance | Prepaid Legal Plan

Flexible Spending Account (FSA) ChoicesCH offers you the chance to save on taxes through two Flexible Spending Accounts (FSAs):

• the Health Care Flexible Spending Account, which you can use to reimburse yourself tax-free for eligible out-of-pocket health care expenses

• the Dependent Care Flexible Spending Account, which you can use to reimburse yourself tax-free for eligible day care expenses.

Health Care FSAThe minimum amount you may direct into your Health Care FSA is $130 per year; the maximum is $2,650 per year. For any amounts you elect to deposit in your Health Care FSA for the 2018/2019 plan year, you will be allowed to roll over $500 into the following plan year. However, if you have an amount over $500 in your Health Care FSA, that amount will be forfeited. For more information about what health care expenses are eligible for Health Care FSA reimbursement, go to the IRS website.

The Benny CardThe Health Care FSA comes with a special-purpose MasterCard. With Benny, participants simply swipe the card, and the funds are automatically deducted from the Health Care FSA for payment. Benny eliminates most out-of-pocket expenses and some paperwork.

The major advantage of Benny is that it allows you to pay many eligible health care expenses at the point of service rather than waiting for reimbursement.

Benny draws on the value of your annual election amount. Each time you incur a qualified healthcare expense at a health-related business (like a pharmacy or doctor’s office) that accepts MasterCard, simply use your Benny Card. The amount of your qualified purchases will be deducted from your FSA account automatically.

Health Care FSA Carryover

For any amounts you elect to deposit in your Health Care FSA for the 2018/2019 plan year, the IRS allows you to roll over $500 to the following plan year. This does not apply to the Dependent Care FSA.

www.irs.gov


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Other Benefits

Who to Contact


Dependent Care FSAThe minimum amount you may direct into your Dependent Care FSA is $130 per year; the maximum is $5,000 per year. Estimate carefully! Any amount left in your Dependent Care FSA after the end of the plan year will be forfeited. Please note that the rollover described above for the Health Care FSA does not apply to the Dependent Care FSA. For more information about what dependent care expenses are eligible for Dependent Care FSA reimbursement go to the the IRS website.

How You Save with FSAsWhen you enroll in one or both FSAs, you authorize CH to direct a portion of your pay into your FSAs on a pre-tax basis — that is, before taxes are withheld. You save on taxes two ways:

• you don’t pay payroll or Social Security taxes on the amount that goes into your FSA, and

• you don’t pay taxes on the money when you reimburse yourself for eligible expenses.

If you have eligible out-of-pocket expenses during the plan year, the FSA tax savings typically results in lower out-of-pocket costs to you. Lower contributions to Social Security may result in a slightly lower Social Security benefit when you retire. Please check with your tax advisor.

Eligible FSA Expenses

See www.irs.gov for a complete list of health care expenses in IRS publication #502 and a complete list of child/dependent care expenses in IRS Publication #503.

Call 800-TAX-FORM (829-3676)or visit www.irs.gov.

www.irs.gov

www.irs.gov

www.irs.gov

www.irs.gov


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Life and Accident Insurance ChoicesLife and accident insurance provide a level of financial security for your loved ones in the event an illness or accident results in your death or serious injury. You may also purchase voluntary life insurance for your spouse and/or children.

Basic Life and Accidental Death and Dismemberment (AD&D) InsuranceCH provides you with the following basic coverage at no cost to you:

• Basic Life Insurance equal to one times salary

• Basic AD&D coverage equal to two times salary.

Life insurance benefits are payable in the event of your death. If an accident causes your death, AD&D benefits are payable to your beneficiary in addition to life insurance. If you lose limbs or senses due to an accident, all or part of the AD&D coverage amount may be payable.

Life Insurance and Your Taxes

The value of life insurance coverage over $50,000 will be taxed as ordinary income.


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Other Benefits

Who to Contact


Voluntary Life and AD&D CoverageYou may purchase the following voluntary life and AD&D insurance coverage:

• Employee Life Insurance in $10,000 increments, up to a maximum of $50,000 and not to exceed the guarantee issue amount of $100,000. As a new hire, you can elect up to $100,000 of coverage without having to provide Evidence of Insurability (EOI). Any employee can choose up to $500,000 of coverage, subject to EOI.

• Spouse Life Insurance in $5,000 increments, up to a maximum of $20,000 and not to exceed the guarantee issue amount of $50,000. As a new hire, you can elect up to $50,000 of coverage without having to provide EOI. Any spouse can choose up to $250,000 of coverage, subject to EOI.

• Child Life Insurance of $5,000, $10,000, $15,000 or $20,000 per child

• Voluntary AD&D Coverage equal to one to six times your annual base salary for you and/or your family.

Voluntary Life and AD&D Rates

The rates for voluntary life and spouse life coverage are determined by the covered employee’s age and the amount of coverage.

Life insurance for children is a flat rate. Your contributions for voluntary life and AD&D coverage are paid through pre-tax payroll deductions.


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Other Benefits

Who to Contact


Disability Insurance ChoicesDisability coverage provides a level of financial protection by replacing a portion of your salary if an illness or injury leaves you unable to work.

Basic Disability Insurance CoverageYou have state disability insurance and long-term disability coverage.

• State Disability Insurance (SDI) is provided through the State of California SDI program. Starting with the eighth day of disability, the SDI program will replace a portion of your weekly salary, up to a maximum benefit amount that is established each year. Benefits continue for up to 52 weeks, as long as you remain disabled.

• Long-Term Disability (LTD) Insurance is provided by CH at no cost to you and insured by Reliance Standard Life Insurance Company. After you have been disabled and unable to work for 180 days, the LTD plan will replace 60% of your monthly salary, up to a maximum benefit of $10,000 per month. As long as you remain disabled, benefits will continue until age 65, at which time retirement benefits can begin.

Voluntary Short-Term Disability Insurance CoverageIf you wish, you may purchase additional disability insurance to supplement the benefits provided by SDI. Voluntary Short-Term Disability (STD) pays a benefit equal to 20% of your weekly earnings, up to a maximum weekly benefit of $1,000. This benefit, which is in addition to benefits provided by the SDI program, begins after you have been disabled for 30 days and continues for up to 22 weeks, as long as you remain disabled.

Rates for Voluntary STD are determined by formulas based on the amount of benefit. Your contributions for voluntary STD coverage are paid through after-tax payroll deductions.

CH Provides a 60% LTD Benefit

If you become disabled and are unable to work for 180 days, CH provides a benefit of 60% of your monthly salary up to $10,000.

Call to File a Short-Term Disability Claim

To file a claim for Short-Term Disability call the toll-free hotline number (877) 203-0549 and a Reliance Standard claims representative will assist you.


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Prepaid Legal PlanFrom time to time we all need legal support — whether it is to create a will or living trust, when we are buying or selling a home or even if we need help to protect our identities. Sometimes we don’t know who to call for help with these issues or we are concerned about the cost of legal services.

That’s why CH offers a prepaid legal plan through Hyatt Legal Plans to all employees and their dependents who are eligible for the CH medical plan. The plan is voluntary and gives you the opportunity to purchase a variety of prepaid legal services.

The plan is designed to give you telephone and office consultations for an unlimited number of legal matters. For reduced fees, you can also be represented by an attorney in the Hyatt Legal Plan’s network. In most cases, your legal services are covered in full when you use a network attorney. If you use an attorney who is not in the Hyatt network, your legal fees will be reimbursed up to the amount that is shown in the Hyatt schedule of benefits.

During the consultation, the attorney will review the law, discuss your rights and responsibilities, explore your options and recommend a course of action.

Prepaid Legal Benefits Roll Over

If you elect prepaid legal coverage it will roll over from one year to the next.

To discontinue coverage you have elected at a prior enrollment, you need to check “Not Selected” in the box next to “Prepaid Legal Plan” on the Benefits Self-Service Website.



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Among other services, the prepaid legal plan covers:

• Creating a will

• Buying or selling a home

• Neighbor disputes

• Personal injury

• Defense of civil lawsuits

• Driver’s license suspension and revocation

• Personal property issues

• Identity theft protection

It is important to note that if you enroll in this plan, you must stay in it for the entire plan year, which would be until April 2019 — you cannot discontinue your prepaid legal plan benefits mid-year.

Please also note that the prepaid legal plan only covers new litigation; the plan will not cover any legal issue where you have already begun litigation.

To enroll in the prepaid legal plan, select the coverage on the Benefits Self-Service Website. Remember, you must hit the “Submit” button (and NOT the “Save as Draft” button) in order to submit your enrollment.

Want More Info on Prepaid Legal?

For more information, go to the Hyatt Legal Plans website at www.info.legalplans.com or call them at (800) 821-6400.

Prepaid Legal Plan continued


www.info.legalplans.com


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Choices Contact ListBenefits Phone Website

Benefits Self-Service Website Your CH benefits portal for all things health related including summary plan descriptions, provider directories, benefit claim forms and more. Access this site from home, work or any computer with an internet connection.

(805) 879-8777 Benefits Administration

Monday – Friday 8:00 a.m. – 4:30 p.m. Pacific Time


CH Employee Portal This is your main CH employee portal and it can only be accessed from a work computer.

N/A Click on the employee portal from your work station and navigate to the following locations:

• Human Resources > Benefits & Compensation

Here you will find benefit summary plan descriptions, provider directories and additional information on CH benefit programs.

• Policies & Procedures > Human Resources Policies

Policies regarding many employee benefits including Paid Time Off (PTO), Tuition Reimbursement and the SBCH Parking Cash-out Program.

• Forms Library

Here you will find benefit claim forms, tax withholding forms and many other CH forms.



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Benefits Phone Website

Care CoordinatorsServes as your team of patient services representatives, nurses and benefits experts; processes pre-authorizations for certain medical procedures such as inpatient admissions, home care and outpatient procedures.

(888) 516-1511



If you have a Smartphone, you can also download the mobile app — just search for the name “Your Care Coordinators” at the app store.

Go to this website or use the app to:

• Find providers

• Get copies of forms

• Retrieve documents

• Get information on claims

• Order ID cards

• Print temporary ID cards

Delta Dental Processes dental claims and offers network of dental providers.

Group #2879

(800) 765-6003 www.deltadentalins.com

Express Scripts Processes pharmacy claims.

(877) 243-8012 www.express-scripts.com

Hyatt Legal Plans Voluntary prepaid legal provider.

(800) 821-6400 www.info.legalplans.com


www.deltadentalins.com


www.info.legalplans.com


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Benefits Phone Website

EnvolveProvides the health assessment and offers lifestyle coaching.

(866) 896-8353

Coaching Hours


Saturday 8:00 a.m. – 5:00 p.m. Pacific Time

www.chschoices.org

Reliance StandardProvides life insurance, AD&D, long-term disability, and voluntary short term disability coverage.

(800) 351-7500 N/A

How to reach CH Benefits Administration:

Address: P.O. Box 689 Santa Barbara, CA 93102-0689

Email: [email protected]

Phone: (805) 879-8777

Fax: (805) 879-8738

02/2018 • Some photos by Glenn Dubock, Cottage Health Media Services

www.chschoices.org

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