A Guide to Your Benefits - LifeBridge Health · 2019-09-23 · 2 Welcome to your benefits Your benefits are an important part of your employment at LifeBridge Health, and we are

2019

A Guide to Your Benefits

Sinai, Northwest, Levindale (Non-Union)

2

Welcome to your benefitsYour benefits are an important part of your employment at LifeBridge Health, and we are committed to offering exceptional benefits to you, our valued team members, and your families.

Please use this Benefits Guide as a resource for the benefits plans offered by LifeBridge Health this year. We want you to get the most value from your benefits and ensure you understand the plans and how to use them. You will find more details on our plans, important contact information and much more in the “Benefits” section on BridgeNet.

We’re dedicated to providing medical, dental and other benefits – through our network of providers to cover you and your family. We also have a very rich offering of optional benefits and want you to be covered no matter what life brings your way.

We encourage you to take the time to review your options and select coverage that works best for you and your family. Generally, unless you have a change in your family status, the elections that you make stay in place for the calendar year.

If you have questions, please contact Employee Services at 410-601-8000 or [email protected].

As a member of the LifeBridge Health family, your health and well-being are important to us. Take good care of yourself, so that we can continue to care for our communities together.

Best regards,

Neil M. Meltzer President & Chief Executive Officer

Table of Contents

3 Benefit Basics

5 Medical Plan

6 Prescription Drug Coverage

8 Health Savings Account

9 Flexible Spending Accounts

10 Dental Plan

11 Life Insurance & Disability

13 Additional Benefits

16 403(b) Retirement Savings Plan

17 Dependent Verification Process

18 Glossary of Terms

19 Contact Information

Enrolling in Your Benefits

Pay close attention to your first paycheck

with your new payroll deductions

Review and print your benefits confirmation

statement

Make your 2019 Benefit elections and

enroll in GHR

Collect any dependent/spouse

documentation required and

submit to Employee Services

Review this guide and the information on

BridgeNet

New Hires You have 30 days to enroll in your benefits. If you do not enroll during this time, you will not be eligible to enroll until the next annual enrollment period unless you experience a qualified life event.

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Benefit Basics

Your 2019 Benefits Are Effective January 1 Through December 31

You and the Affordable Care Act

If you work full-time, as defined by the Affordable Care Act (ACA) requires that LifeBridge Health offer you affordable medical coverage. If you are a part-time or variable hour employee, the number of hours you work may flex between full-and part-time employment which may impact your medical coverage eligibility each year. Full-time, as defined under the ACA, is working on average 30 hours per week during the applicable review period.

Making Changes During the Plan Year

You may only change your benefit elections during the year if you experience a qualified life event such as:

• Marriage, divorce or legal separation • Birth or adoption of a child • Death of your spouse or dependent child• Change in employment status of team member, spouse

or dependent child

To make changes, contact Employee Services within 30 days of a qualifying life event. You may need to provide proof of the event, such as a marriage license. If you don’t take action, you’ll have to wait until the next enrollment period to make changes unless you experience another qualifying life event.

Covering Yourself and Your Family

Medical, prescription, dental and Spending Account benefits are effective the first of the month following date of hire. All other benefits are effective the first of the month following 30 days of employment.

The following dependents are eligible:

• Your legal spouse

• Children up to age 26 (regardless of their student status or if they are claimed as a dependent for income tax purposes), or your disabled children if disabled before age 26*

*Note: Voluntary benefits may have different age requirements so please review the materials carefully.

Are You Providing Coverage to a

New Dependent?

If you enroll a new dependent for benefits, you will be required to provide documentation to confirm their eligibility. All documentation should be submitted to Employee Services at [email protected] or via fax at 410-601-8001. If you do not provide the required documents within 30 days, your dependents will not have coverage. View page 18 for detailed requirements.

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Benefit Basics

LifeBridge Health pays the full cost of many of your benefits. For others, LifeBridge Health and you share the cost or you pay the full cost. Pretax means the cost comes out of your pay before taxes are deducted. After-tax means your cost comes out of your pay after taxes are deducted. The chart shows who pays for each benefit and the related tax treatment.

Benefit Who Pays Tax Treatment

Medical LifeBridge Health/You Pretax

Dental LifeBridge Health/You Pretax

Basic Life and Accidental

Death & Dismemberment

(AD&D) Insurance

LifeBridge HealthN/A, except on

Life Insurance greater than $50,000

Supplemental Life and

Accidental Death &

Dismemberment (AD&D)

Insurance

You After-tax

Disability Coverage You (STD)LifeBridge Health (LTD)

After-tax

Buy-up Long Term

DisabilityYou After-tax

Flexible Spending

AccountsYou Pretax

Employee Assistance Plan LifeBridge Health N/A

403(b) Retirement

Savings PlanLifeBridge Health/You Pretax

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LifeBridge Health offers two medical plan options - administered by CareFirst BlueCross BlueShield (CareFirst). Each plan offers comprehensive health care benefits, including free preventive care services and coverage for prescription drugs. Here’s how the plans compare.

  Health Saver Plan (with HSA) Premium Health Plan

Plan Provision LBH Network

CareFirst In-Network

Out-of-Network

LBH Network

CareFirst In-Network

Out-of-Network

Company Contribution to HSA 1

Individual

Family$6001

$1,2001 N/A

Calendar Year Deductible

Individual

Family

$2,700 $5,200

$2,800 $5,600

$3,000 $6,000

$200 $400

$600 $1,200

$1,800 $3,600

Annual Out-of-Pocket Maximum

(Includes deductible, copays

and coinsurances)

Individual

Family

$4,000 $8,000

$5,000 $10,000

$6,600 $13,200

$1,000 $3,000

$4,000 $8,000

$5,600 $11,200

You Pay You Pay

Primary Physician Office Visit 20%* 40%* 50%* $10 30%* 40%*

Specialist Office Visit 20%* 40%* 50%* $35 30%* 40%*

Preventive Care – one per calendar year (includes annual physicals, immunizations, routine cancer screenings and well child visits)

$0Plan pays 100%

$0Plan pays 100%

50%* $0Plan pays 100%

$0Plan pays 100%

40%*

Diagnostic Service (includes

Advanced imaging (PET, MRI, CT),

other imaging (X-ray, sonogram),

Lab and other services)

20%* 40%* 50%* $02

Plan pays 100%30%* 30%*

Emergency Care3 20%* 20%* 20%* $100 copay per visit

$100 copay per visit

$100 copay per visit

Urgent Care 20%* 40%* 50%* $10 copay 30% 40%

Outpatient Facility and Ambulatory

Surgical Facility20%* 40%* 50%* $0* 30%* 40%*

Inpatient Hospitalization4 20%* 40%* 50%* $0* $500 copay + 30%*

$500 copay + 40%*

* After Deductible 1 If enrolling in the Health Savers Plan, the first half of funding is provided in January and the second half is provided in July as long as you are still

enrolled in the plan.2 Must be performed by LifeBridge Health Provider, designated LifeBridge health Lab or Facility.3 Emergency Room copay waived only if admitted; Emergency services available out-of-network.4 Pre-authorization required.

Important Considerations• You may use in- or out-of-network providers. You will always pay the least if you use the LifeBridge Provider Network.

Using a provider in the CareFirst network, instead of an out-of-network provider, will also help you save.

• You must meet an annual deductible before the medical plan begins to cover a portion of the cost for most care.

• Deductibles and Out-of-Pocket Maximums cross apply. Anything spent in either the LifeBridge Health Network, CareFirst In-Network or Out-of-Network levels will accumulate toward all deductibles and out-of-pocket maximums for the year.

• Out-of-pocket maximums apply to both plans. This is the maximum amount you will pay for health care costs in a calendar year. Your bi-weekly contribution rates will continue.

• You may be required to obtain pre-authorization from the plan prior to receiving certain services. If either you or your provider does not pre-authorize care when necessary, you may not have coverage for that service.

Medical Plans

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Prescription Drug CoverageThis chart provides information about your prescription drug coverage. You can save on your prescriptions by using a LifeBridge Health Pharmacy (Sinai Pharmacy, Northwest Outpatient Pharmacy or Anchor Pharmacy, the on-site location at Carroll Hospital) or Mail Order.

Did You Know? There is no cost for select generic medications used to treat high blood pressure, cholesterol, depression and diabetes if you use a LifeBridge Health Pharmacy.

NEW: Effective January 1, 2019, LifeBridge Health Pharmacy will offer mail order. More information to come during the year.

Health Saver Plan (With HSA) Premium Health Plan

Plan Provision Retail and Mail Order LBH Pharmacy1CVS/Other Retail

Pharmacies

Annual Deductible

Individual

Family

Included in Medical (see page 5)

$75 per person$225 per family

Annual Out-of-Pocket Maximum

Individual

Family

Included in Medical (see page 5)

$1,000 per person$2,000 per family

You Pay You PayRetail Prescription Drugs (30-day supply)

• Generic• Formulary• Non-formulary• Specialty

20%* 30%*40%*

50%* (LifeBridge Health Pharmacy only)

$10*2 $30*$50* $0*

$10*$40*$70*

Not Covered

Plan Provision Retail and Mail Order4 LBH Pharmacy3 CVS CaremarkMail Order4

Mail Order Prescription Drugs (90-day Supply)3

• Generic • Formulary• Non-formulary• Specialty

20%* 30%*40%*

50%* (LifeBridge Health Pharmacy only)

$20*2

$60*$100*$0*

$20*$80*$140*

Not Covered

*After deductible 1 LifeBridge Health Pharmacies: Sinai, Northwest, and Anchor Pharmacy (at Carroll Hospital Location only).2 $0 copay for generics to treat high blood pressure, cholesterol, depression and diabetes, if the prescription is filled at LifeBridge Health Pharmacy.3 Long Term Medications (Maintenance) must be filled at a LifeBridge Health Pharmacy or through CVS Mail Order.4 New: Beginning in January 2019 LBH Pharmacy will begin offering Mail Order for employees.

Definitions

Generic – A drug that offers equivalent uses, doses, strength, quality and performance as a brand-name drug, but is not trademarked.

Formulary – A drug with a patent and trademark name that is considered “preferred” by the drug plan administrator because it is appropriate to use for medical purposes and is usually less expensive than other brand-name drugs.

Non-formulary – This type of drug is “not preferred” and is usually more expensive than generic and formulary brand drugs.

Specialty – These drugs are typically the most expensive options, may require special handling, can be difficult to administer and often require additional clinical monitoring.

Save With a LifeBridge Health Pharmacy

No Cost Preventive Medications: There is no copay ($0) for generics used to treat high blood pressure, cholesterol, depression and diabetes if the prescription is filled at a LifeBridge Health Pharmacy.

Long-term Medications: You have two options to receive a 90-day supply if you are taking a long-term medication. Long-term medications are those taken regularly for chronic conditions such as high blood pressure, asthma, diabetes or high cholesterol, and must be filled using one of these options:

• Option 1: A LifeBridge Health Pharmacy, including Sinai Outpatient Pharmacy, Northwest Outpatient Pharmacy or Anchor Pharmacy, the on-site location at Carroll Hospital.

• Option 2: Mail Order through CVS Caremark. For more information call 866-294-2110 or visit www.caremark.com.

New: Effective January 1, 2019, LifeBridge Health Pharmacy will offer Mail Order.

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Medical & Prescription Drug RatesNon-Wellness Biweekly Rate

Health Saver Plan (With HSA) Premium Health Plan

Full-Time Part-TimeFull-Time

Under $50kFull-Time

$50k-$100kFull-Time

over $100kPart-Time

Individual $35.79 $48.47 $69.97 $76.97 $84.67 $143.18

Employee/Spouse $78.73 $106.63 $153.94 $169.33 $186.27 $314.99

Employee/Child $57.26 $77.55 $111.96 $123.15 $135.47 $229.09

Employee/Family $100.20 $135.73 $195.92 $215.52 $237.07 $400.90

* Wellness rate participants, as of December 31, 2018, will be grandfathered for plan year 2019. Specific rate details can be found on BridgeNet

Potential Surcharges

If applicable, there are two potential surcharges:

• Smoker Surcharge – $30 per pay period• Spousal Surcharge – $30 per pay period, if your spouse has access to other health coverage through their

employer and that employer is not LifeBridge Health.

Note: Surcharges are applicable only to enrollments in the Medical Plans

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Health Savings Account A Health Savings Account (HSA) provides additional options for paying medical expenses with tax-free savings. LifeBridge contributes to your account to help offset some of your eligible expenses.

Account Type Health Savings Account (HSA)

Eligibility You must be enrolled in the Health Saver Plan with HSA and meet these requirements:

• Not be claimed as a dependent on another person’s tax return.• Not be covered under another medical plan that is not HSA-eligible • Not be enrolled in Medicare Part A or B, or be in receipt of VA medical or prescription benefits

within the previous three months.

Your contributions You contribute on a pretax basis and you can change how much you contribute from each paycheck. The IRS maximum annual contribution is $3,500 for individual coverage and $7,000 for family coverage. If you are age 55 or older, you may make a “catch-up” contribution of $1,000.

Company’s contributions LifeBridge Health contributes to your account (the first half is paid in January and the second half is paid in July as long as you are still enrolled in the plan).

• $600 for individual coverage• $1,200 for family coverageThe combination of your contribution and the company contribution cannot exceed the IRS maximum for 2019 of $3,500 for individual coverage and $7,000 for family coverage.

Eligible expenses Medical, dental, vision and prescription drug expenses incurred by you and your covered family members.

If you also wish to enroll in a Health Care FSA, you will only be eligible for a Limited-Purpose Health Care Flexible Spending Account (FSA).

Using your account Use the debit card linked to your HSA or submit a claim form to cover the expenses, or pay the expenses out of pocket and save your HSA money for future health care expenses.

Remaining Funds Any money left in your HSA at the end of the year will roll over to the next year — you’ll never lose your HSA dollars.

If you leave LifeBridge Health or retire, you can take your HSA with you so you can continue to pay and save for eligible health care expenses.

Fees There is a monthly fee of $2 for the HSA. As long as you are enrolled in the Health Saver Plan, at the end of the year, LifeBridge Health reimburses the fee for you.

Setting Up Your HSA

To set up your HSA, you must complete the Customer Identification Program (CIP) process within 90 days of enrolling. BNY Mellon will verify the information you provide, which is similar to the information you must provide when setting up any bank account. If additional information is needed, BNY Mellon will contact you via U.S. mail, and you will have up to 90 days to respond.

Once you pass the CIP process, you will receive a debit card from WageWorks in the mail. To view your balance, submit claims and more, set up a WageWorks account at www.wageworks.com.

Remember to set up your beneficiary directly with WageWorks.

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Flexible Spending Accounts

A Flexible Spending Account (FSA) helps you pay for eligible health care and dependent care costs using tax-free dollars. You decide how much money you would like to contribute to each account on a pretax basis.

Provision Health Care (FSA) Limited Purpose (FSA) Dependent Care (FSA)**

Benefits

Saves on eligible expenses not covered by insurance; reduces your taxable income

Specifically for Employees enrolled in a medical plan with an HSA. Saves on eligible expenses not covered by insurance; reduces your taxable income

Save on eligible expenses for qualified dependent care; reduces your taxable income.

Your

contributions*Maximum contribution is $2,650 Maximum contribution is $2,650

Maximum contribution is $5,000 per year $2,500 if married and filing separate tax returns

Eligible

expenses

Most medical, dental and vision care expenses that are not covered by your health plan.

Eligible expenses are limited to qualifying dental and vision expenses.

Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full-time.

Using your

account

When you incur expenses, you can access account funds in your account to pay for eligible expenses. Use the debit card linked to your FSA to cover the expenses, or pay the expenses out of pocket and submit a claim to be reimbursed by your FSA.

When you incur expenses, you can access account funds in your account to pay for eligible expenses. Use the debit card linked to your HSA to cover the expenses, or pay the expenses out of pocket and submit a claim to be reimbursed by your FSA.

When you incur eligible expenses, you can access account funds that have been contributed and submit a “pay me back” claim with WageWorks.

Use It or

Lose It

Reimbursable expenses must be incurred between January 1 and December 31. Claims for reimbursement must be submitted by March 31, of the following year. Please plan your contributions carefully. With the exception of up to $500 in the Health Care FSA rolling over from year-to-year, any money remaining in your account as of March 31, 2020 will be forfeited per Internal Revenue Service regulations. FSA elections do not automatically continue from year to year; you must actively enroll each year.

*You are not able to make changes to your annual contribution unless you experience a qualified life event. ** Due to IRS testing requirements employees designated as highly compensated employees may have their Dependent Care election limited to lower annual amount.

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Dental Plan

Regular dental care is an important part of caring for your overall health. Your dental plan is the Cigna Preferred Dental Plan, with the DPPO network.

Provision In-Network Out-of-Network*

Annual deductible (Individual/Family) $50/$150 $50/$150

Annual maximum (per Individual) $1,500 $1,500

You Pay You Pay

Diagnostic and preventive (includes cleanings,

fluoride treatments, sealants and X-rays)$0, no deductible $0, no deductible

Basic services (includes fillings, periodontics,

scaling and root planning, oral surgery)20% after deductible 40% after deductible

Major Services (includes crowns, bridges, full

and partial dentures)50% after deductible 50% after deductible

Major services (surgical) 50% after deductible 60% after deductible

Orthodontia (Child only up to age 19) 50%, after deductible, up to $1,200 Lifetime Maximum

Note: Additional cleanings are covered during pregnancy.

Dental Bi-weekly Rates Full Time Part Time

Individual $8.53 $10.10

Employee/Child(ren) $10.02 $15.03

Employee/Spouse $13.35 $20.04

Family $18.85 $28.23

* Out-of-Network may be subject to balance billing.

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Life Insurance & Disability

What would your family do if your income was lost due to death or disability? Life and disability insurance are important for you and your family’s financial security.

Company-Provided Insurance

LifeBridge Health automatically provides the following insurance benefits at no cost to you.1 You do not need to enroll.

Account Type Benefit

Basic Life

Insurance

• 1x your base annual earnings, up to a maximum benefit of $200,000

Basic Accidental

Death and

Dismemberment

(AD&D) Insurance

• 1x your base annual earnings, up to a maximum benefit of $200,000

Long Term

Disability

• 50% of your base weekly earnings, up to $10,000 per month

• 90 calendar day elimination period• Benefit begins on the 91st day of

disability and normally continues until the date that you are no longer disabled, the date you reach Social Security age or the date of your death

1 The IRS requires you to be taxed on the value of employee-provided basic life insurance coverage that is greater than $50,000. This amount appears as imputed income on your paycheck.

Account Type Benefit

Supplemental

Life and AD&D

Insurance

for you

• Up to 5x your base annual salary, up to $2,000,000

• Guaranteed issue of 3x your salary, up to $500,000

Supplemental

Life and AD&D

Insurance for

your spouse

• Increments of $15,000, $25,000 or $50,000 (not to exceed the amount of the Employee’s basic and supplemental coverage)

• Guaranteed issue up to $25,000

Supplemental

Life and AD&D

Insurance for

your child(ren)

• $10,000 per child up to the age of 26, unless disabled before age 26

• Must be added within 30 days of birth or adoption, as a new hire or at open enrollment

Short-Term

Disability

for you

• 60% of your weekly earnings, up to $1,500 per week

• 21 calendar day elimination period • Benefits begin on the 22nd day of

disability due to a non-work related injury and illness, and are payable up to the 90th day, if approved

Buy-up Long

Term Disability

for you

• Covers up to 60% of your base weekly earnings up to $15,000 per month

• Pre-existing conditions apply, please reference Policy for detailed information

Reminder regarding Life Insurance: Keep your beneficiary information up-to-date in GHR.

Employee Paid Insurance

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Important Considerations For Your

Disability Plans• If approved by the carrier, your disability

payments begin after an elimination period. The elimination period is the length of time you must be continuously disabled and unable to perform your primary position (due to a non-work related injury or illness) and under the appropriate care of a physician before the disability benefits become payable.

• Benefits may be reduced by other income, such as Social Security.

• In your first 12 months of coverage, any disability that arises from a condition for which you received treatment or took medications to treat in the three months prior to your effective date will be excluded.

• To place a disability claim please contact Cigna directly.

Buy-up Long-Term Disability

You may purchase additional long-term disability (LTD) coverage that provides up to 60% of your annual salary, up to a $15,000 maximum monthly benefit. If you are interested in purchasing this coverage, you may do so, without evidence of insurability, when you are first benefits eligible.

Employee earning $80,000 per year:

• Monthly covered payroll: $6,667 (annual salary divided by 12)

• Buy Up Rate: $0.382 per $100 of monthly covered payroll

• 0.382 x $6,667/$100 = $25.47 per month or $11.76 per 26 pays

Employee earning $100,000 per year:

• Monthly covered payroll: $8,333 (annual salary divided by 12)

• Buy Up Rate: $0.382 per $100 of monthly covered payroll

• 0.382 x $8,333/$100 = $31.83 per month x 12/ 26 or $14.69 per 26 pays

Supplemental Life and AD&D Insurance

You may choose to purchase additional life and AD&D coverage for yourself and your dependents at affordable group rates. Rates are based on age and the coverage level chosen.

Supplemental Life and AD&D Insurance for you

You may purchase coverage for yourself through after-tax payroll deductions as follows:

• Up to 5x your base annual salary, to a maximum of $2,000,000.

• Guarantee issue is 3 times salary, up to $500,000.

• If you are enrolling for the first time and are not a new hire, or if you enrolled in coverage and choose to increase your covered amount by more than 3x your salary, or $500,000, Evidence of Insurability will be required. Please contact Employee Services with questions.

Supplemental Life and AD&D Insurance for your dependents

You may purchase coverage through payroll deductions as follows:

Spouse

• Increments of $15,000, $25,000, or $50,000 (cannot total more than basic plus supplemental life and AD&D insurance coverage on the Employee)

• If you are electing $50,000 coverage or increasing coverage, Evidence of Insurability will be required. Please contact Employee Services with questions.

Child(ren)

• $10,000 per child

• Must be added within 30 days of birth or adoption, as a new hire or at open enrollment

• Coverage up to age 26, or disabled children

Dependent Coverage Bi-weekly Rate

Spouse $15,000 $1.42

Spouse $25,000 $2.36

Spouse $50,000 $4.73

Child* $10,000 $1.06

*Note: Rate is the same regardless of how many children are covered.

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Additional Benefits

Employee Assistance Program – CareBridge

If you find yourself in need of professional support to deal with personal, work, financial or family issues, the Employee Assistance Program (EAP) can help. You and your immediate family (spouse, dependent children) can use the EAP for help with:

• Marriage and family problems• Job-related issues• Stress, anxiety and depression• Parent and child relationships• Legal and financial counseling• Identity theft counseling• Financial planning• Various other issues

The program is available 24/7, is completely confidential and offered at no cost. If you need help or guidance, call a CareBridge counselor at 800-437-0911 or visit www.myliferesource.com, access code: KKNH3.

Hyatt Legal

Attorney fees can be expensive. With this plan, attorney fees for the legal services listed below are fully paid for when you use a network attorney. There is no limit on the number of times you may use the plan.

Covered services include, but are not limited to:

• Wills, trusts, powers of attorney, guardianship• Mortgages, home equity loans, deeds, property

tax assessments• Small claims assistance• Elder law• Identity theft• Immigration assistance• Debt collection defense/consumer protection• Bankruptcy issues• Adoption• Traffic ticket defense, restoration of driving privileges

Bi-weekly Rate

Hyatt Legal $8.54

Group Voluntary Critical Illness Coverage

Group Voluntary Critical Illness coverage through MetLife pays benefits for non-medical, critical illness-related expenses that your medical plan might not cover. Benefits are in the form of a lump sum payment, which is paid after a diagnosis is made.

You have a choice of a $10,000 or $20,000 initial benefit amount. Your total benefit amount will be 3 times the initial benefit amount you select. You can receive initial and recurring benefit payments until your total benefit amount is met.

You can enroll yourself, your spouse, and eligible dependent children (to age 26, unless disabled). To make a claim please contact MetLife.

MetLife will provide an annual benefit of $50 per calendar year for taking one of the eligible screening/prevention measures. MetLife will pay only one health screening benefit per covered person per calendar year. More details can be found on BridgeNet.

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Group Voluntary Accident Coverage

Group Voluntary Accident coverage through MetLife can pay benefits for off-the-job accidents, plus some benefits that correspond with medical care. The coverage can be used on its own or to fill a gap left by other coverage. It pays a benefit up to a specified amount for dislocation/fracture, initial hospitalization confinement, hospitalization confinement, intensive care, ambulance service, medical expenses, outpatient physician’s treatment and more.

The below chart shows a range of potential payment amounts for a given category of covered conditions. Actual payments are determined by the benefit type.

Covered Benefits Low Plan High Plan

MetLife Accident Insurance Pays You MetLife Accident Insurance Pays You

Injuries –

12 covered injury typesRanging from $25 – $5,000 per injury Ranging from $50 – $10,000 per injury

Medical Services & Treatment –

15 covered types

Ranging from $15 – $1,000 per medical service/treatment type

Ranging from $25 – $2,000 per medical service/treatment type

Hospital Coverage (Accident) $500 (non-ICU) or $1,000 (ICU) per accident $1,000 (non-ICU) or $2,000 (ICU) per accident

Admissions $100 per day (non-ICU), up to 31 days $200 per day (non-ICU), up to 31 days

Confinement $200 per day (ICU), up to 31 days $400 per day (ICU), up to 31 days

Inpatient Rehab$100 per day, up to 15 days per accident and 30 days per calendar year

$200 per day, up to 15 days per accident and 30 days per calendar year

Accidental Death$25,000 $75,000 is passenger in common carrier

$50,000 $150,000 is passenger in common carrier

Dismemberment, Loss & Paralysis $250 - $10,000 per injury $500 – $50,000 per injury

Lodging

$100 per night, up to 31 nights; up to $3,100 in total lodging benefits available per calendar year

$200 per night, up to 31 nights; up to $6,200 in total lodging benefits available per calendar year

Health Screening (Wellness)

$50 payable 1x per covered insured per calendar year, if covered insured takes a covered test

$50 payable 1x per covered insured per calendar year, if covered insured takes a covered test

Group Voluntary Accident Rates Low Plan High Plan

Employee Only $3.30 $5.46

Employee Plus Spouse $6.94 $11.63

Employee Plus Child $6.92 $11.40

Family $8.34 $14.34

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Whole Life Insurance

This benefit through MetLife provides a great supplement because it provides coverage for your entire life, not just while employed with LifeBridge. Because you own the policy, you can take it with you.

Whole Life Insurance is offered with Texas Whole Life, administered in partnership with MetLife. If you are

interested in Whole Life you are required to contact a

Benefits Counselor for enrollment options and cost. You are not able to self enroll in this benefit as there is a specific application/review process.

Identity Theft Protection

This service through InfoArmor is designed to protect your identity and assets through identity, credit and social media monitoring. InfoArmor also extends dependent coverage to any dependent who lives in the same household as the employee or who is financially dependent on them, with no age limit.

PrivacyArmor is available in two comprehensive plans to fit your needs with PrivacyArmor Essential and PrivacyArmor Plus. Both products include:

• Identity and credit monitoring• Annual credit report and monthly credit score tracking• Threshold monitoring• Social media reputation monitoring• Digital wallet storage and monitoring• Full-service identity restoration• $1,000,000 identity theft insurance policy• A digital exposure report

Learn more at MyPrivacyArmor.com

Questions? Contact InfoArmor

PrivacyArmor Essential PrivacyArmor Plus

$3.66 per Individual per Paycheck

$4.59 per Individual per Paycheck

$6.43 per Family per Paycheck $8.28 per Family per Paycheck

Feature PrivacyArmor Essential

PrivacyArmor Plus

Credit Monitoring

Tri-Bureau Credit

Monitoring

Annual Credit Report

Monthly Credit Score

Tracking

Social Media Reputation

Monitoring

Digital Wallet Storage &

Monitoring

Full-Service Identity

Restoration

Privacy Advocate

Assistance

$1,000,000 Identity Theft

Insurance Policy

Expanded Data Sources for

Transactions on Financial

Accounts

Additional Proactive Alerts

on Financial Account

Transactions

Threshold Monitoring on all

Financial Accounts

Home and Auto Discount Program

You can receive special group discounts on auto, home, and renter’s insurance through Liberty Mutual. The policies are tailored to suit your needs. Please contact Liberty Mutual to inquire and/or enroll.

Please note, beginning January 1, 2019 Liberty Mutual will only be offered through direct bill and will not be available for payroll deductions.

Pet Insurance

Pet Insurance through PetFirst helps offset the cost of caring for your dog or cat, and covers everything from preventive care to accidents and illness, as well as the costs of X-rays, office visits, medications, surgeries and hospital stays.

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403(b) Retirement Savings Plan

LifeBridge Health offers 403(b) Retirement Savings Plan giving you an easy way to save for your future through payroll deductions.

Eligibility

You are eligible to participate in the plan as of the first of the month following completion of one month of service with the company.

Your Contributions

Contributions from your pay are made on a pretax basis up to the IRS annual limit of $19,000 for 2019. If you are 50 years of age or older, (or if you will reach age 50 by the end of the year), you may make an additional catch-up contribution in addition to the normal IRS annual limit of $6,000 for 2019.

LifeBridge Health Contributions

For details on your 403(b) match from LifeBridgeHealth, visit BridgeNet at lbhweb/benefits.

Vesting

Vesting refers to your right of ownership to the money in your account. You are immediately vested in all of your contributions and earnings on your contributions. You are 100% vested in LifeBridge Health contributions after three years of service. For vesting purposes, a year of service is defined as a Plan Year in which you are credited with 1,000 hours.

For More Information

For additional details about the 403(b) Retirement Savings Plan or to enroll or change your contribution rates or investment elections, please refer to Transamerica Retirement Solutions at 800-755-5801, or www.lbh.trsretire.com.

Remember: you can make changes to your 403(b) plan at anytime during the plan year.

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You are required to complete the Dependent Verification Process for any dependent or spouse that will be newly covered with LifeBridge Health Benefits. If you are not sure if you have the required dependent verification on file, please contact Employee Services. Your dependent(s) will not have coverage until you complete this process.

As part of our commitment to control health care costs, LifeBridge Health (LBH) is taking steps to ensure that only eligible dependents are covered under our medical and/or dental plans. To accomplish this, LBH has implemented a dependent verification program. This process is intended to ensure that each dependent enrolled in the LBH medical and/or dental plans is accurately listed and eligible for coverage.

There are three (3) steps to the verification program clearly detailed below. Please complete all 3 steps for the dependents you enrolled in benefits, if applicable.

1. Make sure that you provide legible copies of all required documentation.

2. Write your name and employee ID number on each piece of documentation.

3. Write “Not For Official Use” on each document and cross out the first five digits of any social security number.

Required Documentation:

Spouse:

• A copy of your marriage certificate AND• One form of documentation establishing current marital

status such as a joint household bill, joint bank/credit account, joint mortgage or lease, or front page of your jointly filed federal tax return.

Child:

• A copy of the child’s birth certificate, naming you or your legally married spouse as the child’s parent, or appropriate court order / adoption decree naming you or your legally married spouse as the child’s legal guardian.

Disabled Dependent:

• A copy of the child’s birth certificate, naming you or your legally married spouse as the child’s parent, or appropriate court order / adoption decree naming you or your legally married spouse as the child’s legal guardian AND

• A copy of a physician certification confirming the child’s disability status.

All required documentation must be received by Employee Services as soon as possible. You can submit documentation via fax at 410-601-8001 or email at [email protected]

Your dependent(s) will not have coverage until we receive the documentation. If documentation is not received within 30 days of your start date, your dependent will not be eligible for coverage until the next open enrollment period unless they experience a qualifying life event.

If you have any questions regarding this process please contact Employee Services at 410-601-8000 or [email protected]

Dependent Verification Process

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Glossary of Terms

After-tax – The contributions you make for benefits such as Life and AD&D insurance and Disability insurance are subject to Social Security tax, federal income tax and, in most cases, state and local income taxes.

Calendar Year Maximum – The benefit amount paid each year for each family member enrolled in the dental plan.

Coinsurance – The sharing of cost between you and the plan. For example, 80 percent coinsurance means the plan covers 80 percent of the cost of service after a deductible is met, and you will be responsible for the remaining 20 percent of the cost.

Copay – A fixed amount (for example $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

Deductible – The amount you have to pay for covered health care services before your health plan begins to pay.

Elimination Period – The time period between the beginning of an injury or illness and receiving benefit payments from the insurer.

Flexible Spending Accounts (FSA) – FSAs allow you to pay for eligible health care and dependent care expenses using tax-free dollars. The Health Care Account can be used to pay for services not covered by your medical, dental or vision plan such as copayments, coinsurance deductibles, prescription expenses, lab exams and tests, contact lenses, and eyeglasses. The Dependent Care Account is used to pay for day care expenses associated with caring for elder or child dependents that are necessary for you or your spouse to work or attend school full-time. The money in the account is subject to the “use it or lose it” rule which means you must spend the money in the account before the end of the plan year.

Health Savings Account (HSA) – An HSA is a personal health care account for those enrolled in an HDHP. You may use your HSA to pay for qualified medical expenses such as doctor’s office visits, hospital care, prescription drugs, dental care, and vision care. You can use the money in your HSA to pay for qualified medical expenses now, or in the future. Your HSA can be used for your expenses and those of your spouse and dependents, even if they are not covered by the HDHP.

High Deductible Health Plan (HDHP) – A qualified High Deductible Health Plan (HDHP) is defined by the Internal Revenue Service (IRS) as a plan with a minimum annual deductible and a maximum out-of-pocket limit. These minimums and maximums are determined annually and are subject to change.

In-network – A designated list of health care providers (doctors, dentists, etc.) with whom the health insurance provider has negotiated special rates. Using in-network providers lowers the cost of services for you and the Company.

LifeBridge Health (LBH) Network – LifeBridge Health Provider Network

Out-of-network – Health care providers that are not in the Plan’s network and who have not negotiated discounted rates. The cost of services provided by out-of-network providers is much higher for you and the Company. Additional deductibles and higher coinsurance will apply.

Out-of-pocket maximum – The most you will pay of your own money before services are 100 percent covered by the medical plan. Your annual deductible is included in your out-of-pocket maximum.

Pretax – The contributions you make for medical, dental, HSA, FSA health care spending and FSA dependent care spending are not subject to Social Security tax, federal income tax or, in most cases, state and local income taxes.

Reasonable & Customary Charges (R&C) – Prevailing market rates for services provided by health care professionals within a certain area for certain procedures. Reasonable and Customary rates apply to out-of-network charges.

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Contact InformationPlan Provider Phone Number Website

Medical CareFirst 866-595-6245 www.LifeBridgeHealthPlans.com

Prescription Drugs CVS 866-294-2110 http://caremark.com/wps/portal

Dental Cigna 800-244-6224 www.cigna.com

Flexible Spending Accounts WageWorks 877-924-3967 www.wageworks.com

FMLA/LOA Requests FMLA Source 877-462-3652 www.fmlasource.com

Credit Union

Levindale Central Credit Union of Maryland

410-828-4500 www.ccumd.org

NorthwestDestinations Credit Union

410-663-2500 www.destinationscu.org

SinaiFirst Financial Credit Union

800-903-3328 www.firstfinancial.org

Health Savings Account

(HSA)WageWorks 877-924-3967 www.wageworks.com

Life Insurance and AD&D MetLife 800-438-6388 www.mybenefits.metlife.com

Disability Cigna 800-781-2006 www.cigna.com

Employee Assistance

ProgramCarebridge

800-437-0911 Company Access Code:

KKNH3www.myliferesource.com

Critical Illness/Accident

Insurance/Whole Life

Insurance

MetLife 800-438-6388 www.mybenefits.metlife.com

Legal Assistance Hyatt Legal 800-438-6388

Company Access Code: 571687

www.mybenefits.metlife.com

Identity Theft Protection InfoArmor 800-789-2720 www.InfoArmor.com

Home and Auto Insurance Liberty Mutual 800-295-3549 www.libertymutual.com

Pet Insurance PetFirst 866-937-7387 www.petfirst.com/lifebridge

403(b) Retirement

Savings Plan

Transamerica Retirement Solutions

800-755-5801 www.lbh.trsretire.com

Additional Resources Service Phone Number Website

Employee Services For HR/Benefit/Payroll inquires 410-601-8000 [email protected]

Mobile Wallet Card

Provides you access to plan contact information and group

numbers as well as 2019 benefit guides anywhere from your

computer or mobile phone

— http://mymobilewalletcard.com/lifebridge

Enrollment CounselorsAdditional support in

understanding your benefits and/or to make enrollment elections

855-736-1446 —

About this Guide: This benefit summary provides selected highlights of the LifeBridge Health employee benefits program. It is not a legal document and shall not be construed as a guarantee of benefits nor of continued employment at the company. All benefit plans are governed by master policies, contracts and plan documents. Any discrepancies between any information provided through this summary and the actual terms of such policies, contracts and plan documents shall be governed by the terms of such policies, contracts and plan documents. LifeBridge Health reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The authority to make such changes rests with the Plan Administrator.