2018-2019 Benefits and Enrollment Guide - UNC Medical Center

 
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
2018-2019 Benefits and Enrollment Guide

                              UNC Hospitals
               Graduate Medical Education

Health | HSA | Dental | Life | Disability | FSA | Deferred Compensation | Legal | Home & Auto
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
Benefits Overview
Being part of UNC Hospitals Office of Graduate Medical Education (GME) is more than just a job. UNC Hospitals GME is focused on
your health, your wealth and your career. UNC Hospitals GME realizes your benefits are an important part of your workplace journey.
UNC Hospitals GME proudly offers residents, physicians, staff and their families a comprehensive benefits program that is flexible in
design, provides for varying levels of coverage, offers voluntary supplemental programs and provides personal tax advantages
whenever possible. The benefits contained in this guide are designed around improving your health, wealth and career, as well as
providing quality, affordable benefits that are highly competitive within the healthcare industry.

    Contents                                                                        Open Enrollment: Open enrollment is your opportunity to
                                                                                     make changes to your benefit elections. Once you have
                                                                                     made your elections you may not make changes for most
2           Benefits Overview                                                        coverages until our next annual Open Enrollment, unless you
                                                                                     experience a qualifying change in status.        These include
3           Eligibility                                                              marriage, separation or divorce, birth or adoption or change in
                                                                                     custody of a child, death of a dependent, change in your
4-9         Medical Insurance Plans                                                  employment status or loss of spouse’s work-related coverage.
                                                                                     You may make changes to your benefit elections within 30 days
10-11       UNCHCS Pharmacy Services                                                 of a qualifying change in status.

12-13       UNC Personal Health Advocate                                            Medical: Our medical plans are administered by UMR and
                                                                                     UNC Hospitals GME offers three medical plans for you to choose
14          UMR Resources
                                                                                     from. UNC Hospitals GME contributes substantially toward the
                                                                                     cost of this coverage for you and your dependents. You will
15          Urgent Care vs ER                                                        receive a member ID card if you enroll. Your card will have a
                                                                                     sticker on it for you to call UMR and register the ID card upon
16-17       Preventive Care                                                          receipt. Please complete the registration process and have “other
                                                                                     coverage” information for dependents available for the call.
18          Health Savings Account

19          Flexible Spending Accounts                                              Dental: Our dental plans are with MetLife and we offer two
                                                                                     dental plans for you to choose from. Please refer to the dental
20          Medical Insurance Rates &                                                plan page for details.

            UNC Urgent Care 24/7 Virtual Care                                       Life: UNC Hospitals GME provides eligible employees with
                                                                                     Basic Life insurance through MetLife at no cost. You may
21-23       Dental Insurance and Rates                                               purchase additional supplemental life insurance for yourself and
                                                                                     your dependents.
24-26       Basic and Voluntary Life Insurance

27          Long Term Disability Insurance
                                                                                    Disability: UNC Hospitals GME                        provides       Long      Term
                                                                                     Disability coverage through Guardian.
28          Deferred Compensation
                                                                                    Flexible Spending Accounts: UNC Hospitals GME offers
29          Legal Plan                                                               Medical Care, Dependent Care and Limited Purpose Health Care
                                                                                     Flexible Spending Accounts. These accounts are administered
30          Home & Auto Insurance                                                    by P & A Group.

31-33       Additional Resources for OGME                                           Online Enrollment: You will enroll for your benefits online at
                                                                                     www.ebenefitsnow.com Please update your personal
            Residents
                                                                                     information. For website assistance call (866) 239-1055.
34          Professional Liability Coverage

35          Physician Recruitment

36-53       Important Disclosures

54          Contact Information

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In the
case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

     2             2018 Benefits and Enrollment Guide
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
Eligibility
UNC Hospitals Office of Graduate Medical Education offers
benefits to all eligible individuals as defined by GME.
Dependent Eligibility: If you wish, your dependents may
also be covered. Eligible dependents include:
    Legal spouse, as defined by Federal Law; and Domestic
     Partners
    MEDICAL - Your children up to the end of the month in
     which they reach age 26 regardless of marital status,
     financial dependency, residency with the Eligible
     Employee,         student status, employment status, or
     eligibility for other coverage.
    DENTAL - Your children up to the end of the month in
     which they turn 26.
     SUPPLEMENTAL LIFE - Your unmarried children to
                                                                                           Annual Elections: You have the opportunity to pay for
     the end of the month in which they reach age 19 or to
                                                                                           medical, dental and supplemental life coverage, and make
     age 26 if full-time student.
                                                                                           HSA or FSA contributions on a pre-tax basis. IRS rules
                                                                                           stipulate that once you have made your elections for the plan
    It is your responsibility to provide the GME Office with
                                                                                           year, you may not change them until the next annual
     proof of your dependents’ eligibility, in the form of: (a)
                                                                                           enrollment unless a qualifying event occurs. This restriction
     your most recent Federal Income Tax Return, (b)
                                                                                           does not apply to HSA contributions. It is important that you
     Court Order specifying your responsibility to provide
                                                                                           make your choices carefully. Changes are allowed only if
     “group health care coverage” to your dependent
                                                                                           there is a qualifying event and the change requested is
     children, or (c) Copy of birth or marriage certificate. It
                                                                                           consistent with the event. Qualifying events include, but are
     is also your responsibility to notify the GME
                                                                                           not limited to:
     Office when your dependents no longer meet the
     eligibility criteria.                                                                      Marriage, divorce, or legal separation
                                                                                                Birth or adoption (or placement of adoption) of a child
New Hire Coverage: Your benefits are effective on your                                          Death of a covered dependent
date of hire. New residents have up to 30 days after their
                                                                                                Loss or gain of eligibility for group insurance
eligibility date to enroll. If you do not enroll by that deadline,
                                                                                                 coverage for you or a covered dependent
you will not be eligible for coverage until the following annual
open enrollment period.                                                                         Change in your employment status (i.e. changing
                                                                                                 from full-time to part-time or from casual to benefits
                                                                                                 eligible and vice versa)
                                                                                                Change in dependent’s employment status, including
                                                                                                 termination or commencement of employment for a
                                                                                                 covered dependent
                                                                                                Change in health insurance eligibility due to a
                                                                                                 relocation of residence or workplace
                                                                                           If you have a family status change, you must change your
                                                                                           benefit elections within 30 days of the qualifying event, or you
                                                                                           will need to wait until the next annual open enrollment period.
                                                                                           COBRA Continuation Coverage: When you or any of your
                                                                                           dependents no longer meet the eligibility requirements for
                                                                                           health and welfare plans, you may be eligible for continued
                                                                                           coverage as required by the Consolidated Omnibus Budget
                                                                                           Reconciliation Act (COBRA) of 1986. Please refer to the
                                                                                           COBRA explanation in this guide.

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In the
case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

                                                                                                       2018 Benefits and Enrollment Guide                              3
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
Medical Plan Summary: PPO Core Plan (Rates on page 20.)

Healthcare is one of the most important and necessary parts of your benefit package. The following is a summary of our benefit plan.
For a more detailed explanation of benefits, please refer to your Summary Plan Description and Summary of Benefits and Coverage
(SBC).
                                         PPO CORE PLAN- BENEFIT PLAN 008
                                                                                                           NON-NETWORK SERVICES
                                        DOMESTIC NETWORK                IN-NETWORK SERVICES
 SUMMARY OF BENEFITS                                                                                          Out-of-Network
                                         UNC Providers                UHC Choice Plus Providers
                                                                                                                Providers
DEDUCTIBLES & M AXIMUMS
Lifetime Benefit Maximum                      Unlimited                          Unlimited                          Unlimited
                                             $250 Single                       $1,000 Single                      $2,000 Single
Annual Deductible
                                             $500 Family                       $2,000 Family                      $4,000 Family
Member Coinsurance                              10%                                30%                                40%
Out-of-Pocket Maximum –                     $1,000 Single                      $2,000 Single                      $4,000 Single
Includes Coinsurance.                       $2,000 Family                      $4,000 Family                      $8,000 Family
                            THE DEDUCTIBLE AND OUT-OF-POCKET M AX AMOUNTS FOR THE
               DOMESTIC NETWORK (UNC PROVIDERS) AND UHC CHOICE PLUS PROVIDERS CROSS-FEED.
                        THE DOMESTIC DEDUCTIBLE APPLIES TO UNC FACILITY SERVICES ONLY.
PREVENTIVE CARE & OFFICE VISITS
Physician Office Visit                                                                                        Covered at 60% after
                                        $10 Copay then 100%                $35 Copay then 100%
Primary Care providers                                                                                            deductible
                                                                                                              Covered at 60% after
Specialist Office Visit                 $20 Copay then 100%                $50 Copay then 100%
                                                                                                                  deductible
Preventive Office Visit
                                          Covered at 100%                    Covered at 100%                       Not Covered
Primary Care or Specialist
Well Baby Office Visit                    Covered at 100%                    Covered at 100%                       Not Covered
Routine Lab & X-rays                                                                                          Covered at 60% after
                                          Covered at 100%                    Covered at 100%
Primary Care or Specialist                                                                                        deductible
Outpatient Preventive                                                                                         Covered at 60% after
                                          Covered at 100%                    Covered at 100%
Mammography                                                                                                       deductible
Prenatal Care
                                          Covered at 100%                    Covered at 100%                       Not Covered
Does not include Sonograms
                                        Covered at 90% after               Covered at 70% after               Covered at 60% after
Postnatal Care
                                            deductible                         deductible                         deductible
Routine Eye Exam                        $10 Copay then 100%                $35 Copay then 100%                $35 Copay then 100%
    Lenses and Frames                                       Covered up to $80 at 100%, then 90% for all 3 Tiers
INPATIENT & OUTPATIENT SERVICES
Inpatient Facility & Physician          Covered at 90% after               Covered at 70% after               Covered at 60% after
Services                                    deductible                         deductible                         deductible
Outpatient Hospital & Surgery
                                        Covered at 90% after               Covered at 70% after               Covered at 60% after
Services including Physician &
                                            deductible                         deductible                         deductible
Surgeon Charges
DIAGNOSTIC SERVICES
                                    Hospital Services: $20 Copay      Hospital Services: Covered at
Outpatient Hospital Lab
                                             then 100%                     70% after deductible               Covered at 60% after
Charges when performed
                                        Physician Services:           Physician Services: Covered at              deductible
alone
                                         Covered at 100%                   70% after deductible
Outpatient Hospital X-rays                                                 Covered at 70% after               Covered at 60% after
                                        $20 Copay then 100%
Charges                                                                        deductible                         deductible
Independent Clinical Lab                Covered at 90% after               Covered at 70% after               Covered at 60% after
Facilities                                  deductible                         deductible                         deductible
Outpatient Advanced Imaging                                                Covered at 70% after               Covered at 60% after
                                        $20 Copay then 100%
(MRI, MRA, CT, CAT Scan)                                                       deductible                         deductible
                                                                           Covered at 70% after               Covered at 60% after
PET Scans                               $20 Copay then 100%
                                                                               deductible                         deductible

   4          2018 Benefits and Enrollment Guide
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
Medical Plan Summary: PPO Core Plan (Rates on page 20.)

                                            PPO CORE PLAN- BENEFIT PLAN 008 CONTINUED
                                                                                  IN-NETWORK SERVICES               NON-NETWORK SERVICES
                                                 DOMESTIC NETWORK
     SUMMARY OF BENEFITS                                                            UHC Choice Plus                    Out-of-Network
                                                  UNC Providers
                                                                                       Providers                         Providers
URGENT CARE & EMERGENCY SERVICES
Urgent Care
Includes Lab & X-ray & Physician                 $50 Copay then 100%               $50 Copay then 100%                $50 Copay then 100%
Charges
Emergency Room Facility Services &
                                               $150 Copay and then 100%         $150 Copay and then 100%            $150 Copay and then 100%
Physician Charges
MENTAL HEALTH/SUBSTANCE DEPENDENCY
                                                  Covered at 90% after              Covered at 70% after               Covered at 60% after
Inpatient Facility Services
                                                      deductible                        deductible                         deductible
                                                  Covered at 90% after              Covered at 70% after               Covered at 60% after
Inpatient Physician Charges
                                                      deductible                        deductible                         deductible
                                                                                                                       Covered at 60% after
Outpatient Hospital Services                        Covered at 100%                   Covered at 100%
                                                                                                                           deductible
Outpatient Hospital Physician                                                                                          Covered at 60% after
                                                    Covered at 100%                   Covered at 100%
Charges                                                                                                                    deductible
Physician Office Visit                                                                                                 Covered at 60% after
                                                    Covered at 100%                   Covered at 100%
Primary Care providers                                                                                                     deductible
                                                                                                                       Covered at 60% after
Specialist Office Visit                             Covered at 100%                   Covered at 100%
                                                                                                                           deductible
OTHER SERVICES
Chiropractic Care
30 Visits per Calendar Year combined                                                                                   Covered at 60% after
  for all tier levels. Also combined with        $20 Copay then 100%               $50 Copay then 100%
                                                                                                                           deductible
  Physical Therapy and Occupational
  Therapy.
                                                  Covered at 90% after              Covered at 70% after               Covered at 60% after
Durable Medical Equipment
                                                      deductible                        deductible                         deductible
Occupational and Physical Therapy
30 Visits per Calendar Year for Occupa-
  tional Therapy combined for all tier                                         Outpatient Hospital Setting
                                                                                   and Office Setting                  Covered at 60% after
  levels. Also combined with Chiropractic.       $20 Copay then 100%
                                                                                                                           deductible
30 Visits per Calendar Year for Physical                                           $50 Copay then 100%
  Therapy combined for all tier levels.
  Also combined with Chiropractic.
Speech Therapy                                                                 Outpatient Hospital Setting
                                                                                                                       Covered at 60% after
30 Visits per Plan Year combined                 $20 Copay then 100%               and Office Setting
                                                                                                                           deductible
for all tier levels                                                              $50 Copay then 100%
                                               Benefit varies based on the       Benefit varies based on the        Benefit varies based on the
                                                facility in which it is per-   facility in which it is performed.    facility in which it is per-
Infertility Treatment
                                                formed. Lifetime benefit        Lifetime benefit maximum of          formed. Lifetime benefit
                                                   maximum of $7500                          $7500                      maximum of $7500
PHARMACY INFORMATION
Prescription Drugs                             UNC In-house Pharmacies          UNC In-house Pharmacies                 Retail Pharmacies
Member Cost Share                                    30-day Supply               Mail Order 90-day Supply                 30-day Supply
                 Generic                                $0 Copay                           $10 Copay                         $10 Copay
            Preferred Brand                         Covered at 80%                     Covered at 60%                    Covered at 60%

         Non-Preferred Brand                        Covered at 80%                     Covered at 60%                    Covered at 60%

                Specialty                           Covered at 80%                       No Coverage                        No Coverage

                                                                                        2018 Benefits and Enrollment Guide                 5
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
Medical Plan Summary: PPO Buy-Up Plan (Rates on page 20.)

   Healthcare is one of the most important and necessary parts of your benefit package. The following is a summary of our benefit plan.
   For a more detailed explanation of benefits, please refer to your Summary Plan Description and Summary of Benefits and Coverage
   (SBC).
                                          PPO BUY-UP PLAN- BENEFIT PLAN 009
                                         DOMESTIC NETWORK               IN-NETWORK SERVICES                 NON-NETWORK SERVICES
 SUMMARY OF BENEFITS
                                          UNC Providers               UHC Choice Plus Providers            Out-of-Network Providers
DEDUCTIBLES & M AXIMUMS
Lifetime Benefit Maximum                      Unlimited                           Unlimited                           Unlimited
                                             $250 Single                         $500 Single                        $1,000 Single
Annual Deductible
                                             $500 Family                        $1,000 Family                       $2,000 Family
Member Coinsurance                               10%                                20%                                 30%
Out-of-Pocket Maximum –                     $1,000 Single                       $2,000 Single                       $4,000 Single
Includes Coinsurance.                       $2,000 Family                       $4,000 Family                       $8,000 Family
                                        THE DEDUCTIBLE AND OUT-OF-POCKET MAX AMOUNTS FOR THE
                             DOMESTIC NETWORK (UNC PROVIDERS) AND UHC CHOICE PLUS PROVIDERS CROSS-FEED.
                                    THE DOMESTIC DEDUCTIBLE APPLIES TO UNC FACILITY SERVICES ONLY.
PREVENTIVE CARE & OFFICE VISITS
Physician Office Visit
                                         $10 Copay then 100%                $25 Copay then 100%            Covered at 70% after deductible
Primary Care providers
Specialist Office Visit                  $20 Copay then 100%                $40 Copay then 100%            Covered at 70% after deductible
Preventive Office Visit
                                           Covered at 100%                    Covered at 100%                       Not Covered
Primary Care or Specialist
Well Baby Office Visit                     Covered at 100%                     Covered at 100                       Not Covered
Routine Lab & X-rays
                                           Covered at 100%                    Covered at 100%              Covered at 70% after deductible
Primary Care or Specialist
Outpatient Preventive
                                           Covered at 100%                    Covered at 100%              Covered at 70% after deductible
Mammography
Prenatal Care
                                           Covered at 100%                    Covered at 100%                       Not Covered
Does not include Sonograms
                                         Covered at 90% after               Covered at 80% after                Covered at 70% after
Postnatal Care
                                             deductible                         deductible                          deductible
Routine Eye Exam                         $10 Copay then 100%                $25 Copay then 100%                 $25 Copay then 100%
    Lenses and Frames                                         Covered up to $80 at 100%, then 90% for all 3 tiers
INPATIENT & OUTPATIENT SERVICES
Inpatient Facility & Physician           Covered at 90% after               Covered at 80% after                Covered at 70% after
Services                                     deductible                         deductible                          deductible
Outpatient Hospital & Surgery
                                         Covered at 90% after               Covered at 80% after                Covered at 70% after
Services including Physician &
                                             deductible                         deductible                          deductible
Surgeon Charges
DIAGNOSTIC SERVICES
                                           Hospital Services:          Hospital Services: Covered at
Outpatient Lab Charges when              $20 Copay then 100%                80% after deductible
                                                                                                           Covered at 70% after deductible
performed alone                           Physician Services:          Physician Services: Covered at
                                           Covered at 100%                  80% after deductible
Outpatient Hospital X-rays
                                         $20 Copay then 100%           Covered at 80% after deductible     Covered at 70% after deductible
Charges
Independent Clinical Lab                 Covered at 90% after               Covered at 80% after                Covered at 70% after
Facilities                                   deductible                         deductible                          deductible
Outpatient Advanced Imaging
                                         $20 Copay then 100%           Covered at 80% after deductible     Covered at 70% after deductible
(MRI, MRA, CT, CAT Scan)
PET Scans                                $20 Copay then 100%           Covered at 80% after deductible     Covered at 70% after deductible

     6           2018 Benefits and Enrollment Guide
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
Medical Plan Summary: PPO Buy-Up Plan (Rates on page 20.)

                                      PPO BUY-UP PLAN- BENEFIT PLAN 009 CONTINUED
                                               DOMESTIC NETWORK                    IN-NETWORK SERVICES                      NON-NETWORK SERVICES
    SUMMARY OF BENEFITS
                                                UNC Providers                    UHC Choice Plus Providers                 Out-of-Network Providers
URGENT CARE & EMERGENCY SERVICES
Urgent Care
Includes Lab & X-ray & Physician               $50 Copay then 100%                     $50 Copay then 100%                     $50 Copay then 100%
  Charges
Emergency Room Facility Services
                                            $150 Copay and then 100%               $150 Copay and then 100%                 $150 Copay and then 100%
& Physician Charges
MENTAL HEALTH/SUBSTANCE DEPENDENCY
                                               Covered at 90% after                    Covered at 80% after                     Covered at 70% after
Inpatient Facility Services
                                                   deductible                              deductible                               deductible
                                               Covered at 90% after                    Covered at 80% after                     Covered at 70% after
Inpatient Physician Charges
                                                   deductible                              deductible                               deductible
                                                                                                                                Covered at 70% after
Outpatient Hospital Services                      Covered at 100%                         Covered at 100%
                                                                                                                                    deductible
Outpatient Hospital Physician                                                                                                   Covered at 70% after
                                                  Covered at 100%                         Covered at 100%
Charges                                                                                                                             deductible
Physician Office Visit                                                                                                          Covered at 70% after
                                                  Covered at 100%                         Covered at 100%
Primary Care providers                                                                                                              deductible
                                                                                                                                Covered at 70% after
Specialist Office Visit                           Covered at 100%                         Covered at 100%
                                                                                                                                    deductible
OTHER SERVICES
Chiropractic Care
30 Visits per Calendar Year combined                                                                                            Covered at 70% after
  for all tier levels. Also combined           $20 Copay then 100%                     $50 Copay then 100%
                                                                                                                                    deductible
  with Physical Therapy and Occupa-
  tional Therapy
                                               Covered at 90% after                    Covered at 80% after                     Covered at 70% after
Durable Medical Equipment
                                                   deductible                              deductible                               deductible
Occupational and Physical Therapy
30 Visits per Calendar Year for Occu-
  pational Therapy combined for all
  tier levels. Also combined with                                                  Outpatient Hospital Setting
                                                                                       and Office Setting                       Covered at 70% after
  Chiropractic Care.                           $20 Copay then 100%
                                                                                                                                    deductible
30 Visits per Calendar Year for Physi-                                                 $40 Copay then 100%
  cal Therapy combined for all tier
  levels. Also combined with Chiropractic
  Care.
Speech Therapy                                                                     Outpatient Hospital Setting
                                                                                       and Office Setting                       Covered at 70% after
30 Visits per Plan Year combined for           $20 Copay then 100%
                                                                                                                                    deductible
  all tier levels                                                                      $40 Copay then 100%
                                              Benefit varies based on the
                                                                                 Benefit varies based on the facility in   Benefit varies based on the facility
                                            facility in which it is performed.
Infertility Treatment                        Lifetime benefit maximum of
                                                                                   which it is performed. Lifetime         in which it is performed. Lifetime
                                                                                     benefit maximum of $7500                 benefit maximum of $7500
                                                          $7500
PHARMACY INFORMATION
Prescription Drugs                          UNC In-house Pharmacies                UNC In-house Pharmacies                       Retail Pharmacies
Member Cost Share                                 30-day Supply                     Mail Order 90-day Supply                       30-day Supply
                Generic                               $0 Copay                               $10 Copay                                $10 Copay

            Preferred Brand                           $10 Copay                              $20 Copay                                $20 Copay

          Non-Preferred Brand                         $20 Copay                              $40 Copay                                $35 Copay

               Specialty                          Covered at 85%                            No Coverage                               No Coverage

                                                                                           2018 Benefits and Enrollment Guide                       7
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
Medical Plan Summary: HSA (Rates on page 20.)

Healthcare is one of the most important and necessary parts of your benefit package. The following is a summary of our benefit plan. For
a more detailed explanation of benefits, please refer to your Summary Plan Description and Summary of Benefits and Coverage (SBC).

                                          HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
                                           DOMESTIC NETWORK             IN-NETWORK SERVICES                NON-NETWORK SERVICES
    SUMMARY OF BENEFITS
                                            UNC Providers             UHC Choice Plus Providers           Out-of-Network Providers
DEDUCTIBLES & M AXIMUMS
Lifetime Benefit Maximum                        Unlimited                       Unlimited                           Unlimited
                                              $1,500 Single                   $2,750 Single                     $3,000 Single
Annual Deductible
                                              $3,000 Family                   $5,500 Family                     $6,000 Family
Member Coinsurance                                15%                             25%                                 35%
Out-of-Pocket Maximum – In-
                                              $3,000 Single                   $5,000 Single                      $5,000 Single
cludes Calendar Year Deductible &
                                              $6,000 Family                  $10,000 Family                     $10,000 Family
Member Coinsurance
                                    THE DEDUCTIBLE AND OUT-OF-POCKET MAX AMOUNTS FOR THE
                         DOMESTIC NETWORK (UNC PROVIDERS) AND UHC CHOICE PLUS PROVIDERS CROSS-FEED.
                                 THE DOMESTIC DEDUCTIBLE APPLIES TO UNC FACILITY SERVICES ONLY.
PREVENTIVE CARE & OFFICE VISITS
Physician Office Visit                    Covered at 85% after            Covered at 75% after
                                                                                                       Covered at 65% after deductible
Primary Care & Specialist                     deductible                      deductible
Preventive Office Visit
                                            Covered at 100%                 Covered at 100%            Covered at 65% after deductible
Primary Care or Specialist

Well Baby Office Visit                      Covered at 100%                 Covered at 100%            Covered at 65% after deductible

Routine Lab & X-rays
                                            Covered at 100%                 Covered at 100%            Covered at 65% after deductible
Primary Care or Specialist

Routine Eye Exam                            Covered at 100%                 Covered at 100%                    Covered at 100%

    Lenses and Frames                                         Covered up to $80 at 100%, then 90% for all 3 Tiers
Prenatal Care
                                            Covered at 100%                 Covered at 100%            Covered at 65% after deductible
Does not include Sonograms
                                          Covered at 85% after            Covered at 75% after               Covered at 65% after
Postnatal Care
                                              deductible                      deductible                         deductible
INPATIENT & OUTPATIENT SERVICES
                                          Covered at 85% after            Covered at 75% after               Covered at 65% after
Inpatient Facility Services
                                              deductible                      deductible                         deductible
                                          Covered at 85% after            Covered at 75% after               Covered at 65% after
Inpatient Physician Charges
                                              deductible                      deductible                         deductible
Outpatient Hospital & Surgery             Covered at 85% after            Covered at 75% after         Covered at 65% after deductible
Services                                      deductible                      deductible                Note: Surgery is excluded

Outpatient Hospital Physician &           Covered at 85% after            Covered at 75% after         Covered at 65% after deductible
Surgeon Charges                               deductible                      deductible                Note: Surgery is excluded
DIAGNOSTIC SERVICES
Outpatient Hospital Lab and               Covered at 85% after            Covered at 75% after               Covered at 65% after
X-rays Charges                                deductible                      deductible                         deductible
Independent Clinical Lab                  Covered at 85% after            Covered at 75% after               Covered at 65% after
Facilities                                    deductible                      deductible                         deductible
Outpatient Advanced Imaging               Covered at 85% after            Covered at 75% after               Covered at 65% after
(MRI, MRA, CT, CAT Scan)                      deductible                      deductible                         deductible
                                          Covered at 85% after            Covered at 75% after               Covered at 65% after
PET Scans
                                              deductible                      deductible                         deductible

    8            2018 Benefits and Enrollment Guide
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
Medical Plan Summary: HSA (Rates on page 20.)

                                           HIGH DEDUCTIBLE HEALTH PLAN (HDHP) CONTINUED
                                                                                        IN-NETWORK SERVICES
                                                 DOMESTIC NETWORK                                                            NON-NETWORK SERVICES
     SUMMARY OF BENEFITS                                                                  UHC Choice Plus
                                                  UNC Providers                                                             Out-of-Network Providers
                                                                                             Providers
URGENT CARE & EMERGENCY SERVICES
Urgent Care
                                                  Covered at 85% after                    Covered at 75% after                   Covered at 65% after
Includes Lab & X-ray & Physician
                                                      deductible                              deductible                             deductible
Charges
Emergency Room Facility                           Covered at 85% after                    Covered at 85% after                   Covered at 85% after
Services & Physician Charges                          deductible                              deductible                             deductible
MENTAL HEALTH/SUBSTANCE DEPENDENCY
                                                  Covered at 85% after                    Covered at 75% after                   Covered at 65% after
Inpatient Facility Services
                                                      deductible                              deductible                             deductible
                                                  Covered at 85% after                    Covered at 75% after                   Covered at 65% after
Inpatient Physician Charges
                                                      deductible                              deductible                             deductible
                                                  Covered at 85% after                    Covered at 75% after                   Covered at 65% after
Outpatient Hospital Services
                                                      deductible                              deductible                             deductible
Outpatient Hospital Physician                     Covered at 85% after                    Covered at 75% after                   Covered at 65% after
Charges                                               deductible                              deductible                             deductible
Physician Office Visit                            Covered at 85% after                    Covered at 75% after                   Covered at 65% after
Primary Care providers                                deductible                              deductible                             deductible
                                                  Covered at 85% after                    Covered at 75% after                   Covered at 65% after
Specialist Office Visit
                                                      deductible                              deductible                             deductible
OTHER SERVICES
Chiropractic Care
                                                  Covered at 85% after                    Covered at 75% after                   Covered at 65% after
30 Visits per Calendar Year com-                      deductible                              deductible                             deductible
  bined for all tier levels
                                                  Covered at 85% after                    Covered at 75% after                   Covered at 65% after
Durable Medical Equipment
                                                      deductible                              deductible                             deductible
Occupational and Physical Therapy
30 Visits per Calendar Year for Occupa-
  tional Therapy combined for all tier            Covered at 85% after                    Covered at 75% after                   Covered at 65% after
  levels.                                             deductible                              deductible                             deductible
30 Visits per Calendar Year for Physical
  Therapy combined for all tier levels.
Speech Therapy
                                                  Covered at 85% after                    Covered at 75% after                   Covered at 65% after
30 Visits per Plan Year combined for
                                                      deductible                              deductible                             deductible
all tier levels
                                             Benefit varies based on the facility    Benefit varies based on the facility   Benefit varies based on the facility
Infertility Treatment                        in which it is performed. Lifetime      in which it is performed. Lifetime     in which it is performed. Lifetime
                                                benefit maximum of $7,500.              benefit maximum of $7,500.             benefit maximum of $7,500.
PHARMACY INFORMATION
                                     UNC In-house                   UNC In-house                    UNC In-house
Prescription Drugs                                                                                                                 Retail Pharmacies
                                      Pharmacies                     Pharmacies                      Pharmacies
Member Cost Share                                                                                                                    30-day Supply
                                      30-day Supply                  60-day Supply             Mail Order 90-day Supply
                                    Covered at 90%                 Covered at 90%                   Covered at 90%                   Covered at 80%
                    Generic
                                    after deductible               after deductible                 after deductible                 after deductible
                                    Covered at 90%                 Covered at 90%                   Covered at 90%                   Covered at 80%
          Preferred Brand
                                    after deductible               after deductible                 after deductible                 after deductible
                                    Covered at 80%                 Covered at 80%                   Covered at 80%                   Covered at 70%
    Non-Preferred Brand
                                    after deductible               after deductible                 after deductible                 after deductible
                                    Covered at 80%
                  Specialty                                          No coverage                     No Coverage                       No Coverage
                                    after deductible
                                                                                                                                 Covered at 80% or 70%
                                   Covered at 100%,              Covered at 100%,                 Covered at 100%,
 Preventive Medications                                                                                                        (dependent on medication)
                                   Deductible Waived             Deductible Waived                Deductible Waived
                                                                                                                                    after deductible

                                                                                              2018 Benefits and Enrollment Guide                       9
2018-2019 Benefits and Enrollment Guide - UNC Medical Center
UNCHCS Pharmacy Services

 UNC Health Care System GME Health Plan
 Pharmacy Benefits—Domestic Incentive Program
                                          Get the most out of your pharmacy benefit
Save Money
Did you know you could save money on your prescriptions by using one of the UNCHCS Domestic
Pharmacies? All you have to do is transfer your prescriptions to one of the UNCHCS Domestic Pharmacies to
begin saving TODAY!
Save Time
Enroll into home delivery and enjoy prescriptions delivered directly to your home for up to a 90 day supply!
Currently, your pharmacy benefit includes two home delivery options: UNC Shared Services Center Pharmacy
(for all members) & Rex Pharmacy of Raleigh (for Rex Members).
Do You Need Specialty Pharmacy Services?
All Specialty Prescriptions are provided through the UNCHCS Domestic Pharmacy Network.
Please note Specialty prescriptions are limited to a 30 day supply.

            UNCHCS
                                                                              Address                                     City                      Phone
   Domestic Pharmacy Network
Ambulatory Care Center Pharmacy                              102 Mason Farm Road                                 Chapel Hill                  (984) 974-5770
Central Outpatient Pharmacy                                  101 Manning Drive                                   Chapel Hill                  (984) 974-2374
Community Pharmacy                                           321 Mulberry Street                                 Lenoir                       (828) 757-5162
Eden Drug                                                    103 West Stadium Drive                              Eden                         (336) 627-4854
Employee Pharmacy for UNC Medical                            101 Manning Drive                                   Chapel Hill                  (984) 974-5415
                                                                                                                                              (336) 878-
High Point Regional Retail Pharmacy                          601 North Elm Street                                High Point
                                                                                                                                              6599
Johnston Health Outpatient Pharmacy                          509 North Bright Leaf Blvd                          Smithfield                   (919) 938-7386
Kinston Clinic Pharmacy                                      701 Doctors Drive, Suite P                          Kinston                      (252) 523-3187
Layne’s Family Pharmacy                                      509 South Van Buren Rd                              Eden                         (336) 627-4600
Mitchell’s Discount Drugs, Inc.                              544 Morgan Road                                     Eden                         (336) 623-7747
Nash Hospital Employee Pharmacy                              2460 Curtis Ellis Drive                             Rocky Mount                  (252) 962-3880
Pardee Outpatient Pharmacy                                   800 North Justice Street                            Hendersonville               (828) 696-1078
Rex Pharmacy of Raleigh                                      4420 Lake Boone Trail                               Raleigh                      (919) 784-3242
Realo Discount Drugs                                         300 N Queen Street                                  Kinston                      (252) 527-6929
Realo Discount Drugs                                         1302 W Vernon Ave                                   Kinston                      (252) 523-6069
Shared Services Pharmacy                                     4400 Emperor Boulevard                              Durham                       (919) 957-6900
Siler City Pharmacy                                          202 East Raleigh Street                             Siler City                   (919) 663-5541
UNC Hillsborough Outpatient Pharmacy                         430 Waterstone Drive                                Hillsborough                 (984) 215-2060
Wayne UNC Health Care Pharmacy                               2700 Wayne Memorial Drive                           Goldsboro                    (919) 731-6057
                                                                                                                                                                         This
          booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents.
          In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
  10         2018 Benefits and Enrollment Guide
UNCHCS Pharmacy Services

   UNC Health Care System GME Health Plan
   Pharmacy Benefits—Domestic Incentive Program

                                                         Pharmacy Information – PPO Core Plan
                                                                                                                    UNC Domestic
                                                  UNC Domestic                     UNC Domestic                                                          Retail
      Prescription Drugs                                                                                             Pharmacies
                                                   Pharmacies                       Pharmacies                                                        Pharmacies
      Member Cost Share                                                                                               Mail Order                     30-day Supply
                                                  30-day Supply                    60-day Supply
                                                                                                                    90-day Supply
                              Generic                 $0 Copay                        $7.50 Copay                      $10 Copay                        $10 Copay
                 Preferred Brand                 Covered at 80%                        $30 Copay                   Covered at 60%                   Covered at 60%
          Non-Preferred Brand                    Covered at 80%                      $52.50 Copay                  Covered at 60%                   Covered at 60%
                            Specialty            Covered at 80%                       No coverage                     No Coverage                     No Coverage

                                                       Pharmacy Information – PPO Buy-Up Plan

                                                                                                                    UNC Domestic
                                                  UNC Domestic                      UNC Domestic                                                         Retail
       Prescription Drugs                                                                                            Pharmacies
                                                   Pharmacies                        Pharmacies                                                       Pharmacies
       Member Cost Share                                                                                              Mail Order                     30-day Supply
                                                  30-day Supply                     60-day Supply
                                                                                                                    90-day Supply

                              Generic                 $0 Copay                        $7.50 Copay                       $10 Copay                       $10 Copay
                  Preferred Brand                    $10 Copay                         $30 Copay                        $20 Copay                       $20 Copay
          Non-Preferred Brand                        $20 Copay                       $52.50 Copay                       $40 Copay                       $40 Copay
                            Specialty             Covered at 85%                      No coverage                     No Coverage                     No Coverage

                                              Pharmacy Information – High Deductible Health Plan
                                                                                                                    UNC Domestic
     Prescription Drugs                          UNC Domestic                       UNC Domestic                                                         Retail
                                                                                                                     Pharmacies
                                                  Pharmacies                         Pharmacies                                                       Pharmacies
     Member Cost Share                                                                                                Mail Order
                                                 30-day Supply                      60-day Supply                                                    30-day Supply
                                                                                                                    90-day Supply
                                             Covered at 90% after                  Covered at 90%                   Covered at 90%                  Covered at 80%
                             Generic
                                                 deductible                        after deductible                 after deductible                after deductible
                                             Covered at 90% after                  Covered at 90%                   Covered at 90%                  Covered at 80%
                Preferred Brand
                                                 deductible                        after deductible                 after deductible                after deductible
                                             Covered at 80% after                  Covered at 80%                   Covered at 80%                  Covered at 70%
         Non-Preferred Brand
                                                 deductible                        after deductible                 after deductible                after deductible
                           Specialty         Covered at 80% after                     No coverage                     No Coverage                     No Coverage
                                                                                                                                                 Covered at 80% or
                                                                                                                  Covered at 100%,
                                               Covered at 100%,                  Covered at 100%,                                                70% (dependent on
     Preventive Medications                                                                                          Deductible
                                               Deductible Waived                 Deductible Waived                                                medication) after
                                                                                                                      Waived
                                                                                                                                                    deductible
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In
the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

                                                                                                        2018 Benefits and Enrollment Guide                            11
Personal Health Advocate

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

   12           2018 Benefits and Enrollment Guide
Personal Health Advocate

What is UNC Hospitals Health Care Network Health Plan?                              What is the cost?
This is the health plan offered to UNCHC Co-workers and their                       This benefit is part of your health insurance plan and there is
dependents across the system except for those Co-workers who are                    no additional cost to you.
NC state Co-workers and their dependents who are offered the
State Health Plan. Most Co-workers will recognize the UNC Health                    To use this benefit, am I limited to UNCHC physicians
Care Network Health Plan as the health plan of their direct employer                and facilities for care?
(e.g., “UNC Hospitals Office of GME).                                               No, you may see any health care providers you choose and
                                                                                    your Personal Health Advocate will work directly with your
Who will be invited to join the program?                                            providers whether or not they are part of UNCHC. If you do
                                                                                    not have a primary care physician, or would like to switch to
Enrollment in 2018 is by invitation only to members with specific                   a new one, we will help you with that.
conditions or need for extra support such as members taking many
medications or members with multiple disease states, cancer,                        What’s the benefit to UNCHC? Why are they offering
autoimmune disease, recent hospital discharges or multiple ER                       this program?
visits.                                                                             The good health of our Co-workers and their dependents is
                                                                                    very important to us. Our ultimate goal is to provide better
Are all Co-workers covered by the UNCHC Network Health Plan                         care for members that have more complex care needs so
eligible to enroll?                                                                 that our Co-workers and their dependents can be healthier
                                                                                    and happier.
Only Co-workers who have primary health care coverage through
the UNCHC Network Health Plan administered by UMR are eligible                      Do I have to join if asked?
and during 2018, Co-workers and dependents must be invited to                       No, the program is optional. However, there is a financial
enroll.                                                                             benefit and other valuable care coordination benefits
                                                                                    associated with participation.
If I get sick, can I request access to the program?                                 How is this different from other programs offered by
No, but if you are suffering from an illness that causes you to access              health insurance plans?
multiple physicians, be admitted to the hospital or take more than                  Unlike other programs, we will support your current
ten prescription medications or certain medications, you may be                     treatment plan by coordinating directly with your physicians,
eligible for the program.                                                           the hospital or other health care providers that you may
                                                                                    benefit from seeing through comprehensive care
I don’t want my employer to know my health information. Who                         management tailored to meet your needs. If you don’t
sees my health information?                                                         currently have a treatment plan or access to appropriate
                                                                                    providers, we can help you with these.
Under federal HIPAA requirements, your private health information
is private. Personal Health Advocate is part of UNCHC’s clinical                    How is this different from the UNCHC health benefit,
operations, separate from UNCHC Human Resources or Employee                         Nurseline?
Health. All personal health information used as part of this program                The UNC HealthLink Nurseline is another benefit of the UNC
is protected with the same precautions as our patients’ health
information.                                                                        Health Care Network Health Plan for all plan members and
                                                                                    their enrolled dependents. You can call the toll free number
                                                                                    24/7 and an experienced registered nurse will review
I received a call or letter encouraging me to join. Why was I
                                                                                    symptoms and determine if and when you should go to your
contacted?
                                                                                    primary care provider, urgent care or emergency room. They
We are here to support you to achieve optimum health, based on                      will suggest home care advice for urgent issues, discuss
your individual needs. A review of your claims history and health
                                                                                    medications and can recommend a primary care physician
information suggests you could benefit from additional resources to
help you manage your medical condition.                                             within UNCHC. Members of the Personal Health Advocate
                                                                                    program can use the UNC HealthLink Nurseline for urgent
Can dependents enroll in the program?
                                                                                    issues. The nurse assisting you will communicate with your
Yes, if invited.                                                                    Personal Health Advocate to ensure we provide you with
                                                                                    continuity of care.

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

                                                                                           2018 Benefits and Enrollment Guide                    13
UMR Resources

By registering online at www.umr.com, you have access to helpful information, including the ability to:

   View your claims and download copies of your Explanation of Benefits (EOB’s)

   View your health plan benefit information such as copays and deductible amounts

   Find out how much you have paid towards your deductible and out-of-pocket maximum

   Order duplicate or replacement ID cards

   Search for network providers and medical facilities in your area

   Find a glossary of common health care terms

You are encouraged to use this resource. The key to controlling health care costs is your informed engagement in
spending and treatment decisions. The information you need is at your fingertips.

             Compare provider costs and become a more educated consumer at umr.com!
Health Education Library – offers health education content including Care Guides, DrugNotes, Drug Interaction
checker and Symptom Navigator.

myHealthcare Cost Estimator – provides fee schedule estimates of care costs and integrates health plan coverage
to estimate patient responsibility. Includes UHC Choice Plus network data grading physician quality and efficiency. The
tool allows you to comparison shop based on cost and quality before services are received.

Health Center – here you can search your health symptoms and find first aid information, utilize health education tools
including healthy body apps and calculators, watch step-by-step recipe videos, read health articles and much more!

Plan Cost Estimator – this tool helps you compare estimated healthcare expenses between our health plans so you
can decide which health plan is most appropriate for you and your family.

                                                                                                     UMR Mobile
                                                                                    You can access your health plan benefit and
                                                                                    claim information on the go from a mobile
                                                                                    device. Just go to www.umr.com on a mobile
                                                                                    device and log in using the same username and
                                                                                    password that you use on the full site. It’s quick
                                                                                    and easy! There's no app to download, nothing
                                                                                    to install and no waiting. Go mobile today!

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

    14          2018 Benefits and Enrollment Guide
Emergency Care/Urgent Care

Emergency Room (ER) vs. Urgent Care (Express Care)
It’s second nature for many of us to visit the emergency room (ER) if we’re suddenly sick or injured – a sound idea, in
many cases. But what if you have an urgent, but non-life-threatening medical issue like a sinus infection or ankle
sprain?
A hefty ER wait time, and an even heftier hospital bill might not be your best option. Quicker, more affordable and more
convenient treatment is closer than you think: your local urgent care center. Many of these facilities are open seven
days a week, nights, weekends and even holidays with no appointments necessary.
Patients should be aware that their out of pocket cost is based on the facility they visit. It is usually much cheaper to go
to urgent care centers than ERs. The average urgent care visit costs patients $71-125 for basic care, with additional
costs added for shots, x-rays, and labs. The average emergency room visit costs $1,318.
Being informed about the differences and similarities between these kinds of facilities is important. Whether you choose
to receive care from an urgent care center or an emergency room, it is important to follow-up with additional treatments
as necessary.

        Comparisons for treatment for some of the most common
                                                                                                            EXAMPLES OF TIMES YOU
        ailments at an emergency room vs. an urgent care center
                                                                                                            SHOULD GO TO THE ER
                                       Emergency            Urgent Care          Potential                      Poisoning
 Ailments
                                         Room                 Center             Savings
                                                                                                                Sudden, severe abdominal pain
 Acute Bronchitis                           $814                 $122               85%
                                                                                                                Coughing up or vomiting blood
 Sore Throat                                $620                  $93               85%
 Low Back Pain                              $751                 $113               85%
                                                                                                                Cut or wound that will not stop
                                                                                                                 bleeding
 Attention to Dressing/
                                            $343                  $76               78%                         Major trauma or accident
 Removal of Sutures
                                                                                                                Heart attack or chest pain
                                                                                                                Loss of consciousness

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

                                                                                           2018 Benefits and Enrollment Guide                    15
Preventive Care

UMR is dedicated to helping people live healthier lives. You are encouraged to obtain preventive care services and
health screenings, as appropriate for your age, to help maintain or improve your health and achieve your health and
wellness goals. Regular preventive care visits and health screenings may help to identify potential health risks for early
diagnosis and treatment. Consult your doctor for your specific preventive care recommendations, as he or she is your
most important source of information about your health. Below and on the next page you will find a summary of
preventive care services covered under your health plan with UMR.

  All Members                                                                   Men’s Health Services
  Preventive medicine for adults, all stand-                                    Screening for:
  ard immunizations recommended by the Advisory                                     Abdominal aortic aneurysm for men who are 65-75
  Committee on Immunization Practices of the Centers                                 years old who have ever smoked
  for Disease Control and Prevention (CDC)
                                                                                    Cardiovascular disease aspirin use counseling for
                                                                                     ages 45+

  All Members at an Appropriate Age                                                 High blood pressure
  and/or Risk Status                                                                Diabetes for certain populations
  Screening for:                                                                    Tobacco use

      Obesity                                                                      Diet and nutrition

      Cholesterol level and lipids                                                 Alcohol abuse

      Colorectal cancer for ages 50-plus                                           Depression

      Certain sexually transmitted diseases, including                             Well-man exam
       HIV                                                                          Hepatitis C screening
      Lung cancer with low-dose computer tomography

         Note: Not all preventive care services are eligible for Vitality Points. Please visit www.powerofvitality.com for
                                                        more information.

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

   16           2018 Benefits and Enrollment Guide
Preventive Care

  Women’s Health Services                                                         Children’s Health Services
                                                                                  Services at each of these preventive visits
                                                                                  will vary based on age, but will include
     Screening mammography (film and digital) for all                            some of the following:
      adult women
                                                                                      Measurement of child’s head size
     Cervical cancer screening, including Pap smears
                                                                                      Measurement of length/height and weight
     Breast cancer genetic test evaluation and counseling
      (BRCA)                                                                          Screening blood tests, if appropriate

     Counseling for certain sexually transmitted diseases                            Providing age appropriate immunizations

     Osteoporosis for certain populations                                            Vision screening

     Pregnant women screenings for:                                                  Hearing screening

            Iron-deficiency anemia                                                   Counseling on oral health

            Bacteria in urine                                                        Psychological and behavioral development
                                                                                       assessment
            Hepatitis B virus
                                                                                      Counseling on the harmful effects of smoking and
            Rh incompatibility                                                        illicit use of drugs (for older children and
                                                                                       adolescents)
            Rubella
                                                                                      Counseling for children and their parents on
   Yearly well-women visits
                                                                                       nutrition and exercise
   Sexually transmitted infections counseling
                                                                                      Screening certain children at high risk for
   Contraception methods and counseling                                               cholesterol, sexually transmitted diseases, lead
                                                                                       poisoning, tuberculosis and more
   Domestic violence screening
                                                                                      Fluoride application in primary care
   Gestational diabetes screening
   HIV screening and counseling
   HPV testing (beginning at age 30)
   Breastfeeding support and supplies, including renting
    or purchase of specified breast-feeding equipment
    from an approved vendor and counseling

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

                                                                                           2018 Benefits and Enrollment Guide                    17
Health Savings Account (HSA)
UNC Hospitals GME is pleased to be able to offer a HSA as part of the HDHP Medical Plan. The Health Savings
Accounts are administered by Optum Bank. Below are highlights of a Health Savings Account.

    For calendar year 2018, you may deposit up to $3,450 if you have single
     health coverage, and up to $6,900 if you cover dependents.
     Contributions made to your HSA by UNC GME ($500 for single
     coverage and $1,000 if dependents are covered) must be included in
     those limits. If you are age 55 or older you may also make “catch up”
     contributions of up to an additional $1,000 per calendar year.

    If you are paid by UNC Hospitals GME you may deposit funds to your
     HSA on a pre-tax basis through payroll deductions. UNC Hospitals GME
     participates with you in funding your HSA by making a contribution of
     $500 for single coverage and $1,000 if you cover dependents. UNC
     Hospitals GME funds 50% of our contribution in July, and the other 50%
     in January. Contributions are prorated based on your effective date.

    You may change, discontinue and resume HSA payroll deduction deposits at any time.

    You are not required to spend the funds in your account each year as you are when you have an FSA. Unspent
     funds at the end of the year remain in your account to be spent as needed in the future.

    Your funds will earn interest while in your HSA. After a minimum balance is reached, you may invest your funds in a
     variety of mutual funds. Interest and investment earnings accrue in your account tax-free.

    If you open an HSA you may not participate in our regular Medical Flexible Spending Account. You may participate
     in a Limited Purpose FSA covering dental costs.

    You may spend funds in your account tax-free for all eligible medical and dental expenses for you and your family
     members, regardless of whether family members are covered by our health plan. If you spend the funds for expens-
     es that are not eligible, you will pay income tax on these expenditures plus a 20% penalty tax if you have not yet
     reached Social Security retirement age. After you reach retirement age, expenditures that are not eligible will be
     taxed as ordinary income, the same as withdrawals from qualified retirement plans.

    You may also pay certain insurance premiums tax-free from your HSA:

                          COBRA premiums

                          Qualified long term care insurance premiums

                          Medicare premiums

    You will not be required to provide documentation or receipts to Optum Bank. However, it is important to keep
     receipts in case the IRS audits your expenditures.

You can reach Optum Bank at 1-866-234-8913 or online at www.optumbank.com.

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

    18          2018 Benefits and Enrollment Guide
Flexible Spending Accounts

Residents who are paid by UNC Hospitals GME payroll                             Important Rules
have the option of enrolling in Flexible Spending Accounts
for health care and/or dependent care expenses. If you are                      There are important rules which you must understand
not paid by the hospital, you will not be eligible to partici-                  before electing to participate. For example, once you
pate in the FSA plan.                                                           have elected to have a specified amount deducted from
                                                                                each paycheck, you cannot change your election until the
The IRS permits you to pay certain health and dependent                         end of the plan year unless you experience a qualified
related expenses with earnings that are not taxed.                              change in status. You must re-enroll annually for this
If you or your family have predictable medical, dental or                       coverage. There is also a risk of forfeiture of funds not
eye care costs that are not fully reimbursed by insurance,                      used by the end of the grace period. If you currently pay
you could benefit from our Medical Care Reimbursement                           daycare in order to work, you may receive a tax credit on
Account. Eligible expenses include your deductibles,                            your tax return. In lower tax brackets the tax credit may
copays and coinsurance under our health insurance plans,                        be more valuable than the benefits of the Dependent Care
dental expenses, orthodontics, eye exams, glasses and                           Account. You should consult your tax advisor.
contact lenses, Lasik eye surgery, hearing aids, etc.                           IMPORTANT: IRS allows an extended period of two
Under    Health   Care   Reform     over-the-counter                            and one-half months for employees to incur (date of ser-
medications are not considered eligible expenses for                            vice) expenses against their Medical and Dependent Care
the Medical Care Account without a prescription from                            Reimbursement Accounts. UNC Hospitals GME
your physician.                                                                 Healthcare will give you until September 15, 2019 to incur
                                                                                eligible expenses against your 2018-2019 plan year
The Dependent Care Account allows you to pay for                                elections. This extra two and one-half month extended
daycare expenses for children under age 13, or for a                            grace period is designed to give you more time to incur
disabled dependent of any age living in your home, if such                      expenses to reduce your chance of losing money under
daycare is necessary to enable you to work. From your                           the Reimbursement Accounts.
Dependent Care Account, you may deduct expenses for
day care centers or in-home child care, preschool tuition,                      What is a Limited Purpose Health
before or after school care, daytime summer camp, or
adult day care.                                                                 FSA?
                                                                                When you enroll in an HSA medical plan and open a
                                                                                Health Savings Account, you can also contribute to a
How Does It Work?                                                               Limited Purpose Flexible Spending Account to pay for
You choose the dollar amount you want to contribute to                          eligible dental and vision expenses. You cannot use your
each account based on your estimated expenses for the                           Limited Purpose FSA to pay medical expenses. You may
upcoming year. For the Medical Care Account the entire                          contribute up to $2,650 per year in a Limited Purpose
contribution you have elected will be available                                 FSA, however, we encourage you to max out your HSA
immediately. For the Dependent Care Account only the                            contribution before contributing to the limited purpose
amounts that have been deposited from your pay will be                          FSA.
available. Your contributions will be deducted in equal
amounts from each paycheck pre-tax throughout the plan                          Our Flexible Spending Accounts are administered by P&A
year. The important thing is that the deposits to your                          Group. You may call a specialist at 1-800-688-2611.
account are not taxed and are used by you tax-free. The                         You may track your balance and transactions by logging
result is a direct saving to you equal to the taxes you would                   in at www.padmin.com.
otherwise pay on this income.

How Much Can I Contribute to the FSA Plan?
Medical Flexible Spending or Limited Purpose FSA:
   $2,650 Maximum
Dependent Care Flexible Spending:
   $5,000 married couple filing jointly OR
   $2,500 per person if filing separate returns
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

                                                                                           2018 Benefits and Enrollment Guide                    19
Medical Insurance Payroll Deductions & New UNC Urgent Care 24/7

 Employee Medical Contributions Effective 7/1/2018

                                     Core Plan          Core Plan          Buy-Up Plan         Buy-Up Plan          HDHP Plan           HDHP Plan

                                      Monthly           Bi-weekly             Monthly            Bi-weekly            Monthly           Bi-weekly

 Employee                              $21.06              $10.53              $50.04              $25.02              $15.00              $7.50

 Employee + Spouse                    $236.84             $118.42             $312.82             $156.41             $202.64             $101.32

 Employee + Child(ren)                $209.52             $104.76             $260.26             $130.13             $173.24              $86.62

 Employee + Family                    $528.30             $264.15             $598.06             $299.03             $356.00             $178.00

  New This Year
   UNC Urgent Care 24/7: Access to virtual care for patients and co-workers
   Employees across UNC Health Care have a new virtual care option available called UNC Urgent
   Care 24/7 to provide access to board-certified doctors via a smartphone, tablet, computer or
   telephone.
   UNC Urgent Care 24/7 offers around-the-clock video or phone access to health care
   professionals for non-emergency medical issues such as:

  • Acne                         • Insect Bites
  • Allergies                    • Nausea
  • Constipation                 • Pink Eye
  •                              •
  • Diarrhea                     • Respiratory Problems
  •                              •
  •                              •
  •                              •
  •                              •

  Get started today!
  • Create your account – visit https://UNCUrgentCare247.com to create your free account.
  • Click “Connect Now” and select your group benefit.
  • Cost per visit:
            • UNC GME employees who have the PPO Core or Buy-Up plan pay $0.
            • Employees on the HDHP and others pay only $49.00.
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

   20            2018 Benefits and Enrollment Guide
Dental Insurance

For 2018, UNC Hospitals GME offers residents and subspecialty residents the opportunity to participate in a voluntary
dental plan with MetLife. Premiums are paid by the participant via payroll deduction on a pre-tax basis.

 The Voluntary Dental Plan is currently insured by MetLife. Two plan options are being offered with the Annual
  Maximum Benefit of $1,000 for the Low Option and $1,250 for the High Option.
 A summary of both the Low and High Options are included in this guide. You will want to refer to the Plan Highlights
  for important information including the financial advantage of using the Preferred Dental Provider network.
 To see a list of participating providers go to: www.metlife.com/mybenefits or contact MetLife’s Customer Service
  Line (800) 275-4638, enter company/group name Office of Graduate Medical Education (OMGE) or P&A.
  The Dental Network is MetLife Preferred Dentist Program (PDP) and our group number is 141644.

                      Changes for ALL employees must be completed online at
                                     www. eBenefitsNow.com

                                    • If you and your dependents enroll in either of the plan offerings during the initial
                                    enrollment period, you will not be subject to a waiting period for any services.
        New Employees

                                    • If you decide at a later date to enroll, there will be a 12 month waiting period on
                                    Major / Type C services.

                                    • Current dental insurance participants will remain active
                                    for the July 1, 2018 plan year with MetLife.

        Returning
                                    • You may change your plan option from Low to High without penalty.
        Employees

                                    • Employees and dependents not currently covered will have a 12 month waiting
                                    period for Major / Type C Services

This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

                                                                                           2018 Benefits and Enrollment Guide                    21
Dental Insurance Rates

 For 2018, UNC Hospitals GME offers residents and subspecialty residents the opportunity to participate in the MetLife
 Low Dental Plan or the High Dental Plan. A summary of benefits are shown below:

                                                              Summary of Dental Plan Benefits
                                          Plan Opt 1: Low Plan                                     Plan Option 2: High Plan
                                      In Network                Out of Network                    In Network                 Out of Network

  Preventive                          100% of                        100% of                      100% of                         100% of
  Services                         negotiated fee*                  R&C fee**                  negotiated fee*                   R&C fee**

  Basic Services                         50% of                       50% of                         80% of                        80% of
  (Type B)

  Major Services                      25% of                         25% of                       50% of                          50% of
  (Type C)                         negotiated fee*                  R&C fee**                  negotiated fee*                   R&C fee**

  Deductible                                                             Calendar Year Deductible
  (Applies to Type B & C)

  Individual                                              $75                                                         $50
  Family                                                  $225                                                       $150

  Reimbursement                                                % of Reasonable                                              % of Reasonable
                                   Negotiated Fee                                              Negotiated Fee
  Level                                                         & Customary                                                  & Customary

  Maximum Annual
                                                        $1,000                                                      $1,250
  Benefit

                                        One Year waiting period for all                            One Year waiting period for all
  Late Enrollment
                                          Type C / Major Services                                    Type C / Major Services

                                                                                                    *Negotiated Fee refers to the fees that
                               Bi-Weekly & Monthly Payroll Deductions
                                                                                                    participating dentists have agreed to accept as
                                                                                                    payment in full, subject to any copayments,
                            Low Option Plan                       High Option Plan
                                                                                                    deductibles,    cost    sharing   and    benefit
                                                                                                    maximums. Negotiated Fee fees are subject to
   Coverage             Bi-Weekly           Monthly           Bi-Weekly           Monthly           change.

   Emp Only               $12.05            $24.10              $21.51             $43.02           **R&C Fees refers to the Reasonable and
                                                                                                    Customary (R&C) charge, which is based on
   Emp & Sp               $24.38            $48.76              $43.52             $87.04           the lowest of (1) the dentist’s actual charge, (2)
                                                                                                    the dentist’s usual charge for the same or
                                                                                                    similar services or (3) the charge of most
   Emp & Child            $28.20            $56.40              $50.33            $100.66           dentists in the same geographic area for the
                                                                                                    same or similar services, as determined by
   Family                 $34.01            $68.02              $60.61            $121.22           MetLife.
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.

   22            2018 Benefits and Enrollment Guide
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