ASSOCIATE BENEFITS GUIDE 2019 - AMITA Health

 
ASSOCIATE BENEFITS GUIDE 2019 - AMITA Health
n

                        2019

    ASSOCIATE BENEFITS GUIDE
ASSOCIATE BENEFITS GUIDE 2019 - AMITA Health
Welcome to the AMITA Health Benefits Program

    AMITA Health is committed to maintaining a positive and productive work environment – one that is dedicated to
    providing the utmost quality care to those we serve in our community.

    To accomplish our mission, it takes the special talent of many competent and highly-skilled people.

    To succeed in a competitive healthcare market, AMITA Health strives to employ only the most capable
    and dedicated associates at all levels, which includes providing a generous associates benefits program.

    Please review the enclosed associate benefits documents and retain them for your personal files.
    Feel free to contact us if you have any further questions.

    Sincerely,

    AMITA Health Benefits Department

    This Benefits material briefly describe the excellent benefits program that is available as part of employment with AMITA Health. This information is not a contract.
    Any of the benefits, policies or procedures may be changed as the organization requires, and nothing contained in this material shall be construed as creating an
    expressed or implied obligation or contract on the part of the AMITA Health.

2                                                                     Benefits Guide 2019
ASSOCIATE BENEFITS GUIDE 2019 - AMITA Health
Table of Contents

   Overview and How to Enroll .................................................................... 4
   Dependent Documentation ..................................................................... 5
   Qualifying Life Events ............................................................................. 6
   Paid Time Off .......................................................................................... 7
   Medical Plan ........................................................................................... 8
   Prescription Drug Coverage .................................................................. 11
   Dental Plan ........................................................................................... 12
   Vision Plan ............................................................................................ 15
   Benefit Plan Premiums - Health, Dental and Vision ............................... 17
   Flexible Spending Accounts .................................................................. 18
   Basic Life and Voluntary Life / AD&D .................................................... 20
   Short Term Disability Plan ..................................................................... 23
   Long Term Disability Plan ...................................................................... 24
   Permanent Life Insurance with Long Term Care .................................... 25
   Accident Insurance ............................................................................... 26
   Critical Illness Insurance ....................................................................... 27
   Employee Assistance Program ............................................................. 29
   Legal Plan ............................................................................................. 30
   Retirement ............................................................................................ 31
   Diabetes Management .......................................................................... 34
   Commuter Benefits ............................................................................... 35
   Additional Benefits ................................................................................ 39
   Vendor Contact Listing .......................................................................... 40
   Mobile Applications ............................................................................... 41
   Important Notices .................................................................................. 42

                                               Benefits Guide 2019                                               3
ASSOCIATE BENEFITS GUIDE 2019 - AMITA Health
Overview
               In today’s changing world, your benefits are an
               increasingly valuable part of your total pay. AMITA
               Health knows how important having the right
               benefits are to you and your family.

               We are pleased to offer you a wide range of bene-                 Various documents will help in certifying your
               fit plan features and choices. The benefit plan year              dependents. To see a complete list of acceptable
               begins January 1 and ends December 31.                            documents please refer to page 5 of this guide.

               Whether you’re single or have a family, you’ll find
               plans here to suit your unique needs. You will be
                                                                                 Provide copies of the documents – not originals as
               able to customize a package of benefits to meet
                                                                                 these will not be returned to you.
               those needs–with an opportunity annually to
               change your selections as your needs change.                      If you are submitting a copy of your most recent
                                                                                 Federal Tax Return, please submit the first page
               This booklet will help you learn more about your
                                                                                 only which shows your dependents (you may hide
               choices, so you can make educated decisions
                                                                                 social security numbers and income by blacking
               when you enroll.
                                                                                 out).

               WHO’S ELIGIBLE                                                    We only accept government Issued documents
                                                                                 such as marriage license, birth certificate, or court
               You are eligible to enroll in benefits if you are a full-         ordered documents.
               time or part-time associate regularly scheduled to
               work a minimum of 20 hours per week.                              These documents are due within 31 days from
                                                                                 your hire date or status change date.
               Temporary associates or those working fewer than
               20 hours per week are not eligible.                               Please submit documents with a cover sheet with
                                                                                 your name, associate ID number and contact tele-
               Your eligible dependents include:                                 phone number to:
OVERVIEW

               • Your spouse
               • Your children up to age 26 (including natural
                 children, stepchildren, or adopted children)
               • Your disabled children of any age, provided they
                 became disabled before age 26 and while
                 covered by the plan

               You may be asked to provide proof of eligibility. If
               you cannot provide the requested documentation,
               your dependent coverage will be terminated.

           ENROLLING IN OUR BENEFIT PLANS
           All associates must enroll through Benefit Express on-line through their secure website: www.amitahealthbenefits.com
           within 31 days from date of hire or qualified life event.

           You will need your 8-digit associate ID number found in iAMITA > rAMITA > My Information > Associate Id
           number and the social security numbers for all dependents you plan to add.

           Associates who fail to enroll within 31 days from date of hire, or qualified life event must wait until next
           enrollment period.

           Hint: The website can only be entered through Internet Explorer not through Google.

 4                                                                Benefits Guide 2019
ASSOCIATE BENEFITS GUIDE 2019 - AMITA Health
Dependent Documentation
DEPENDENT DOCUMENTATION GUIDE
    DEPENDENT TYPE            AGE                        DOCUMENTATION REQUIREMENTS
                                      • Government Issued Marriage Certificate and last year filed Federal Tax
                                         Return OR

                                      • Government Issued Marriage Certificate and Proof of Joint Ownership
Legal Spouse                  NA
                                         Issued in last 6 months OR

                                      • Government Issued Marriage Certificate ONLY (if married in current
                                         calendar year).
                            Age 0 up
Biological Child                     • Government Issued Birth Certificate ONLY.
                             to 26
                                      • Government Issued Birth Certificate AND
Disabled Biological Child   Over 26   • Completed disabled child certification form (must be medically certified
                                         by a physician as disabled).

                            Age 0 up • Government issued Birth Certificate AND
Step-Child

                                                                                                                   DEPENDENT DOCUMENTATION
                             to 26   • Associate’s Government issued Marriage Certificate.
                                      • Government issued Birth Certificate AND

                                      • Associate’s Government issued Marriage Certificate AND
Disabled Step-Child         Over 26
                                      • Completed disabled child certification form (must be medically certified
                                         by a physician as disabled).

                            Age 0 up • Adoption Placement Agreement and Petition for Adoption ONLY OR
Adopted Child
                             to 26   • Adoption Certificate ONLY.
                                      • Adoption Certificate AND
Disabled Adopted Child      Over 26   • Completed disabled child certification form (must be medically certified
                                         by a physician as disabled).

                            Age 0 up • Government Issued Birth Certificate AND
Legal Ward
                             to 26   • Court Ordered Document of Legal Custody.
                                      • Government Issued Birth Certificate AND

                                      • Court Ordered Document of Legal Custody AND
Disabled Legal Ward         Over 26
                                      • Completed disabled child certification form (must be medically certified
                                         by a physician as disabled).
Qualified Medical Child     Age 0 up • Qualified Medical Child Support Order ONLY. Must be ordered for the
Support Order                to 26      associate or spouse.

                                              Benefits Guide 2019                                                  5
ASSOCIATE BENEFITS GUIDE 2019 - AMITA Health
Qualifying Life Events
                         The annual open enrollment period is the only time you can change benefit plans or add/drop dependents during
                         a plan year, unless you experience a qualifying family status change. A qualifying event to change benefits during
                         the plan year is defined as a change in your status due to:

                         • New employment

                         • Marriage

                         • Birth or adoption of a child(ren)

                         • Death of an immediate family member

                         • Divorce

                         • Loss or gain of insurance coverage by your spouse’s employer-sponsored coverage

                         • Unpaid leave of absence by you or your spouse

                         • Ineligibility of a dependent

                         • Termination of employment

                         To change your benefit elections, you must notify AMITA Health Benefits Department within 31 days of the quali-
                         fying event triggering the need for the change. For example, if you were married September 3, you would need to
                         notify the AMITA Health Benefits Department (within 31 days of the marriage).
QUALIFYING LIFE EVENTS

                         YOUR BENEFIT CHOICES
                         AMITA Health provides a wide variety of benefits. Some are provided automatically at no cost to you. Other
                         benefits are available if you elect them. Review the guide in detail to see which benefits you need to create a
                         successful program designed to meet your needs and, if applicable, the needs of your family.

 6                                                                       Benefits Guide 2019
Paid Time Off
Paid Time Off (PTO)
PTO is available to all Full-Time and Part-Time associates who are regularly scheduled to work 40 hours or
more per pay period. Associates are eligible to use PTO for any supervisor-approved reason, including
vacations, personal business or illness.

Paid Time Off (PTO) Accrual
Non-exempt (hourly) associates PTO is accrued based on hours worked in a pay period (not to exceed 80 hours
for this purpose). The amount associates may earn will depend on their job classification, length of service,
and hours worked in a pay period (with exception of premium hours, e.g., call pay, stand-by pay, etc.). Current
Associates may accumulate up to a maximum of 320 hours. PTO accruals will cease until the accumulated PTO
falls below the maximum.

PTO Accrual Schedule for Non-exempt (hourly) (cap at 320 hours)
Completed Years of Service
Years (Months per Year)      Hours Per Year*             Days Per Year*              Accrual Per Hour Paid
0-1    (0-11.9)              128                         16                          0.061538
2-3    (12-35.9)             136                         17                          0.065385
4-5    (36-59.9)             152                         19                          0.073077
6-8    (60-95.9)             168                         21                          0.080769
9-11 (96-131.9)              192                         24                          0.092308
12-15 (132-179.9)            200                         25                          0.096154
16+   (180+)                 216                         27                          0.103846

                                                                                                                  PAID TIME OFF
Example to Pro-rate: If you work 72 hours a pay period and your year of service is 1 year
0.0161538 (hourly accrual rate) x 72 pp hours = 4.43 x 26 (pay periods/year) = 115.20 (annual hours)

Paid Time Off (PTO) Front Loaded Plan
Annual Front-Loaded PTO will be awarded to exempt (salaried) associates and available for use at the
beginning of each year. During pay period one of each year, 27 days of non-accrued PTO will be advanced
into the associate’s bank (prorated based on FTE). Unused PTO hours are forfeited following the last pay
period of the year.

Legal/Observed Holidays
Legal Holidays are available to all Full-Time and Part-Time associates. New Year’s Day, Martin Luther King Day,
Good Friday, Memorial Day, July 4th, Labor Day, Thanksgiving Day and Christmas Day. These holidays are in
addition to PTO. All associates required to work on a recognized holiday will have those holiday hours added to
his/her PTO bank. Those holiday hours will then be available to use as any other PTO hours.

                                                    Benefits Guide 2019                                           7
Medical Plan

               Eligibility
               All full-time or part-time benefit eligible associates may elect coverage. Eligible dependents include your legal spouse,
               and children up to the date in which they turn age 26. Any unmarried child of any age with a mental or physical
               handicap or disability who is incapable of self-support is eligible provided they became disabled before age 26 and
               while covered by the plan.

               Coverage Levels
               You can choose from four levels of coverage:
               • Associate Only
               • Associate + Spouse
               • Associate + Child(ren)
               • Family

               Coverage Begins
               If you enroll in this plan, coverage is effective the 1st of the month following 30 days of employment.

               Coverage Ends
               Coverage ends on the last day of employment or when you cease to be an eligible associate. Dependents
               terminate on the day of their 26th birthday. Please see the Medical Plan book for additional instances when
               coverage ends.

               AMITA Health Medical Plan
               AMITA Health will offer associates a Preferred Provider Organization (PPO) plan administered by Automated Benefit
               Services (ABS) and it consists of the BlueCross BlueShield’s national provider network. PPO plans allow associates to
               seek services from the provider of their choice.

               The AMITA Health Medical Plan is a ‘tiered’ network with three tiers: (1) * SmartHealth Network consisting of AMITA
MEDICAL PLAN

               Health (Adventist Midwest Health, Alexian Brothers and Presence Health), Ascension and Adventist Health System
               facilities and contracted providers; (2) BlueCross BlueShield National Provider Network; and (3) Out of Network –
               facilities and providers not contracted with BlueCross BlueShield National Provider Network. You and your family
               members will experience a significantly higher level of benefits when receiving your care from an AMITA provider. If
               you choose to seek care outside of AMITA Health, you will have access to BlueCross BlueShield’s national provider
               network.

8                                                               Benefits Guide 2019
Certain services may require satisfying a deductible. Once the deductible is satisfied by the member, the plan will begin
paying a portion of your remaining charges known as co-insurance. AMITA Health PPO plan provides associates financial
security by placing an out-of-pocket limit on an associate’s health care expenses.

Associates are free to seek services from the provider of their choice, however, associates’ out-of-pocket expenses will be
significantly lower when services are received from an AMITA Health provider.

Health Benefits Subsidy is offered to Full-Time associates at the time of the annual open enrollment or initial enrollment
for benefits (New hire or from PRN to Full-time benefits eligible status). The Health Benefits Subsidy is designed to assist
associates who may not have affordable access to healthcare. The subsidy provides a discount of:

• 25%, 50%, 75% or 100% on associate bi-weekly deductions for coverage on the SmartHealth PPO plan.
• 50% or 100% on deductibles, coinsurance and maximum out-of-pocket costs for covered expenses under the
  SmarthHealth PPO medical plan for care that you and covered dependents receive in the PPO Plan Tier 1 Network.
  (The discount does not apply to co -payments)
• The subsidy also includes reduced pharmacy copays for associates who qualify for all levels of the subsidy.

Associates have 31 days to apply from the initial enrollment period or by the deadline provided during the annual open
enrollment period.

For more information about the Health Benefits Subsidy and how to apply, please visit iAMITA > Departments > Human
Resources > Benefits > Health Plan Subsidy or www.amitahealthbenefits.com.

Please review both the schedule of benefits below as well as your bi-weekly premiums on www.amitahealthbenefits.com.

                                                                                                                               MEDICAL PLAN
  Deductible: The amount you owe before insurance or plan begins to pay.

  Co-insurance: Once the deductible is met, this is the share of the costs of a covered service for which the member
  is responsible. It is a percent (%) of the allowed amount of the service.

  Co-payment: This is a fixed amount you pay for a covered service. This amount can vary depending on the service
  received. The co-pay may or may not count toward the deductible.

  Network Providers: These are facilities, providers, and suppliers who have a contract to deliver services under the
  network, which is managed by the insurer.

  Out-of-Pocket Maximum: This is the most the enrolled associate will pay during the year before the plan begins to
  pay 100% of the allowed amount.

  Precertification: A decision by the plan that a service, treatment, prescription drug or durable medical equipment
  is medically necessary.

                                                     Benefits Guide 2019                                                       9
2019 Schedule of Benefit
                                                 Benefits                                        Tier 1 AMITA Network                Tier 2 National                       Tier 3
                                                                                                                                     Network (BCBS)                   Out-of-Network*
               Claims questions, benefit questions, eligibility                                                          Contact ABS Customer Service at (844) 659-2519
               Find a doctor                                                                                          View provider directory at www.mysmarthealth.org
                                                                                                      All eligible expenses apply towards all deductibles and out-of-pocket maximums.
               Deductible
               • Individual                                                                               $300                             $1,000                           $2,000
               • Family                                                                                   $600                             $2,000                           $4,000
               Coinsurance
               • Plan Pays                                                                             90% after                      70% after National          50% after OON Deductible
                                                                                                AMITA Network Deductible             Network Deductible
               • You Pay                                                                          10% coinsurance after           30% after National Network      50% after OON Deductible
                                                                                                AMITA Network Deductible                 Deductible
               Total Out-Of-Pocket Maximum (Deductible plus coinsurance and copays)                                                  Medical Out of Pocket
               • Individual                                                                              $4,000                            $5,850                              $0
               • Family                                                                                  $8,000                            $11,700                             $0
                                                                                                                                        Rx Out of Pocket
               • Individual                                                                              $1,500                            $1,500                             N/A
               • Family                                                                                  $3,000                            $3,000                             N/A
               Lifetime Maximum                                                                                                             Unlimited
                                                 Services                                           AMITA Network                    National Network                 Out-of-Network*
               Preventive Service
                                                                                                                                                                    50% coinsurance after
               Annual Routine Physical, Well Baby/Child Care, Routine Immunizations, Annual                 $0                                $0
                                                                                                                                                                      OON Deductible
               Gynecological Exam/Annual Mammogram, Screening Colonoscopy
               Outpatient/Diagnostic Services
                                                                                                                                    30% coinsurance after
               • Diagnostic Infertility Testing, Physical/Occupational/Speech Therapy (Annual     10% coinsurance after                                             50% coinsurance after
                                                                                                                                      National Network
               Maximum - 60 Visits), Lab, Pathology, Radiation and Chemotherapy,                AMITA Network Deductible                                              OON Deductible
                                                                                                                                         Deductible
               Radiology, Outpatient Surgery
               High Tech Radiology MRI, PET Scan, MRA                                           Pre-Certification Required      Pre-Certification Required 30%     Pre-Certification Required
                                                                                                 10% coinsurance after            coinsurance after National      50% coinsurance after OON
                                                                                                AMITA Network Deductible             Network Deductible                   Deductible
               • Dialysis                                                                         10% coinsurance after             30% coinsurance after         50% coinsurance after OON
                                                                                                AMITA Network Deductible         National Network Deductible             Deductible
               Office Visits
                                                                                                                                                                 50% aft 50% coinsurance after
               Primary Care (Family Practice/General Internal                                          $15 Copay                         $30 Copay
                                                                                                                                                                 OON Deductible er Deductible
               Medicine/Pediatrics)
MEDICAL PLAN

               • Specialist (Including OB/GYN)                                                                                                                    50% coinsurance after OON
                                                                                                       $35 Copay                         $50 Copay
                                                                                                                                                                         Deductible
               • Pre/Postnatal Care                                                                                                                               50% coinsurance after OON
                                                                                                       $15 Copay                         $30 Copay
                                                                                                                                                                         Deductible
               • Chiropractic Office Visit (Annual maximum - 60 visits)                                                                                           50% coinsurance after OON
                                                                                                       $15 Copay                         $30 Copay
               Ancillary services are subject to deductible/coinsurance                                                                                                  Deductible
               Mental Health                                                                                                                                      50% coinsurance after OON
                                                                                                       $15 Copay                         $30 Copay
               • Individual Therapy/Group Therapy                                                                                                                        Deductible
               • Inpatient Admission/Partial Day Treatment, Intensive                             10% coinsurance after          30% coinsurance after AMITA      50% coinsurance after OON
               Outpatient Therapy                                                               AMITA Network Deductible            Network Deductible                   Deductible
               Substance Abuse                                                                                                                                    50% coinsurance after OON
                                                                                                       $15 Copay                         $30 Copay
               • Individual Therapy/Group Therapy                                                                                                                        Deductible
               • Intensive Outpatient Therapy, Acute Inpatient Care                               10% coinsurance after          30% coinsurance after AMITA      50% coinsurance after OON
                                                                                                AMITA Network Deductible            Network Deductible                   Deductible
               Emergency Care
                                                                                                       $150 Copay                        $150 Copay                       $150 Copay
               • ER Visit
               • Urgent Care                                                                                                                                      50% coinsurance after OON
                                                                                                       $35 Copay                         $50 Copay
                                                                                                                                                                         Deductible
               • Ambulance                                                                        10% coinsurance after          10% coinsurance after AMITA     10% coinsurance after AMITA
                                                                                                AMITA Network Deductible            Network Deductible              Network Deductible
               • Medical Transfer/Transport (non-emergent)                                           Pre-Certification                 Pre-Certification                  Pre-Certified
                                                                                                        Required                          Required                         Required
               Inpatient Services
               • Per Admission
                 • Room and Board                                                               Pre-Certification Required      Pre-Certification Required 30%     Pre-Certification Required
                 • Ancillary Services                                                            10% coinsurance after            coinsurance after National      50% coinsurance after OON
                 • Surgery                                                                      AMITA Network Deductible             Network Deductible                   Deductible
                 • Anesthesia
                 • Physician Charges
               • Emergency Room Admission                                                         10% coinsurance after             30% coinsurance after
                                                                                                                                                                  50% after OON Deductible
                                                                                                AMITA Network Deductible         National Network Deductible
               • Extended Care Facility (Annual maximum - 120 days)                               10% coinsurance after             30% coinsurance after
                                                                                                                                                                  50% after OON Deductible
                                                                                                AMITA Network Deductible         National Network Deductible

 10                                                                                     Benefits Guide 2019
Other Services                                                                                                                 Pre-Certification Required                     Pre-Certification Required 30%
                                                                                                                                                                                                                                        Pre-Certification Required
• Durable Medical Equipment (DME)                                                                                               10% coinsurance after                           coinsurance after National
                                                                                                                                                                                                                                          50% after Deductible
                                                                                                                               AMITA Network Deductible                            Network Deductible
• Prosthetics & Orthotics (P&O)                                                                                                  10% coinsurance after                         30% coinsurance after Nation-                          50% coinsurance after OON
                                                                                                                               AMITA Network Deductible                           al Network Deductible                                      Deductible
• Foot Orthotics - 2 pairs every 3 years                                                                                        50% coinsurance after                                                                                 50% coinsurance after OON
                                                                                                                                                                               50% after Network Deductible
                                                                                                                               AMITA Network Deductible                                                                                      Deductible
• Hearing Aid (3-year maximum - $2,000)                                                                                          10% coinsurance after                         30% coinsurance after Nation-                          50% coinsurance after OON
                                                                                                                               AMITA Network Deductible                           al Network Deductible                                      Deductible
• Home Health Care (Annual maximum - 100 visits)                                                                                 10% coinsurance after                         30% coinsurance after Nation-                          50% coinsurance after OON
                                                                                                                               AMITA Network Deductible                           al Network Deductible                                      Deductible
• Hospice                                                                                                                        10% coinsurance after                         30% coinsurance after Nation-                          50% coinsurance after OON
                                                                                                                               AMITA Network Deductible                           al Network Deductible                                      Deductible
• Allergy Testing & Treatment                                                                                                    10% coinsurance after                         30% coinsurance after Nation-                          50% coinsurance after OON
                                                                                                                                AMITA Network Deductible                          al Network Deductible                                      Deductible
• Bariatric Surgery                                                                                                            Pre-Certification Required                     Pre-Certification Required 30%
                                                                                                                                                                                                                                       Pre-Certification Required
                                                                                                                                10% coinsurance after                           coinsurance after National
                                                                                                                                                                                                                                       50% after OON Deductible
                                                                                                                               AMITA Network Deductible                            Network Deductible
• Organ/Bone Marrow/Other Transplants                                                                                          Pre-Certification Required                     Pre-Certification Required 30%
                                                                                                                                                                                                                                       Pre-Certification Required
                                                                                                                                10% coinsurance after                           coinsurance after National
                                                                                                                                                                                                                                       50% after OON Deductible
                                                                                                                               AMITA Network Deductible                            Network Deductible
• Wellness/Disease Management
  • Diabetic Education                                                                                                                                                                                                                50% coinsurance after OON
                                                                                                                                                  $0                                                 $0
                                                                                                                                                                                                                                             Deductible
 • Smoking Cessation Intervention (Counseling)

This is a brief summary of benefits, which are subject to change. In the case of a conflict between this summary and the official Summary Plan Description, the language in the Summary Plan Description will prevail. For further details about plan benefits, please contact Cus-
tomer Service at the number shown on the back of your ID card. Network Description: Tier 1 represents the AMITA network, which is comprised of participating AMITA providers and facilities, as well as the broader Ascension AMITA network. Your out-of-pocket costs will always
be lower when utilizing a AMITA provider. Tier 2 represents BCBS participating providers. Members should make every effort to utilize a BCBS provider whenever a AMITA provider is not available in their area. Contraceptive Coverage: The U.S. Department of Health and Human
Services, the Department of Labor and the Internal Revenue Service have jointly released final regulations regarding women’s preventive services under the Affordable Care Act (“ACA”). The ACA requires group health plans to provide coverage for “contraceptive services” as part

                                                                                                                                                                                                                                                                                       PRESCRIPTION DRUG COVERAGE
of an array of women’s preventive services that must be included in health plans without cost sharing to covered participants. AMALX-MED-300 AMADV-MED-300

Prescription Drug Coverage
Associates enrolled in the Medical Plan automatically receive the Prescription Drug Coverage benefit which is managed
through Cigna. Members will receive their own Pharmacy ID card in addition to their Medical ID cards. For a complete
listing of medications covered you may go to www.myCigna.com.

Use of AMITA in-house pharmacies may reduce your medication expense and you can only receive a 90 Day Supply
through our in-house pharmacies. Certain medications require approval from Cigna before they’re covered by the
plan. If you are not sure a medication requires approval, please check on-line or call the toll-free number on the back
of your Cigna ID card. In these cases, if your doctor feels that an alternative medication isn’t right for you, he or she
can ask Cigna to consider approving coverage of your medication.

                                                                                                                                                     Prescription Drug Coverage
                                                                                                   In-House Pharmacies                                          Retail Pharmacies                                           Out-of-Network*
                                               Individual MOOP (Rx)                                                 $1,500                                                   $1,500                                                        N/A
                                                     Family MOOP (Rx)                                               $3,000                                                   $3,000                                                        N/A
                                                                            Generic                                      $5                                                      $10                                                       N/A
                                                         Preferred Brand                                    85%                                                      75%                                                                   N/A
                                                                                                     ($25 Min / $50 Max)                                      ($40 Min / $80 Max)
           PHARMACY

                                               Non-Preferred Brand                                         80%                                                       75%                                                                   N/A
                                                                                                    ($50 Min / $100 Max)                                     ($80 Min / $160 Max)
                                       Generic - 90 Day Supply                                                          $10                                                      N/A                                                       N/A

                       Preferred Brand - 90 Day Supply                                                      85%                                                                  N/A                                                       N/A
                                                                                                    ($50 Min / $100 Max)
                          Non-Preferred - 90 Day Supply                                            80% ($100 Min / $200                                                          N/A                                                       N/A
                                                                                                          Max)
                              Specialty Rx - 30 Day Supply                                           85% ($50 Min / $100                                             75%                                                                   N/A
                                                                                                            Max)                                             ($80 Min / $160 Max)
                      *Please note: 90-day supplies must be filled by the AMITA Health In-House Pharmacies. Prescription drugs classified as Specialty medications may only be filled up to a 30-day supply through an AMITA Health In-House pharmacy or Cigna
                      Home Delivery. One 30-day supply grace fill is allowed at retail.

                                                                                                                    Benefits Guide 2019                                                                                                                                                11
Dental PPO
              Eligibility
              All full-time or part-time benefit eligible associates may elect coverage. Eligible dependents include your legal
              spouse, and children up to the date in which they turn age 26. Any unmarried child of any age with a mental or
              physical handicap or disability who is incapable of self-support is eligible provided they became disabled before
              age 26 and while covered by the plan.

              Coverage Levels
              You can choose from four levels of coverage:

              • Associate Only

              • Associate + Spouse

              • Associate + Child(ren)

              • Family

              When Coverage Begins
              If you enroll in this plan, coverage is effective the 1st of the month following 30 days of employment.

              When Coverage Ends
              Coverage ends on the last day of employment or when you cease to be an eligible associate. Dependents
              terminate on the day of their 26th birthday. Please see the Dental Plan book for additional instances when
              coverage ends.

              AMITA Health Dental Plan
              AMITA Health provides you with a choice of 2 dental PPO plans through Delta Dental the “High” and “Low” Plan.
DENTAL PLAN

              With the Delta Dental Preferred Provider Organization (PPO) plans, you have the freedom to visit any licensed net-
              work or non-network Dentist for covered services. You do not have to designate a primary care dentist. Plus, you
              can visit any dental specialist for covered benefits up to an annual limit without waiting for prior approval from the
              plan. You will generally save on the cost of covered dental care when you use a dentist who participates in the PPO
              network.

                     Search Delta Dental’s online dentist directory at www.deltadentalil.com

                     AMITA Health is part of the Delta Dental PPO Plus Premier Network– meaning you can go to any dentist
                     in the PPO or Premier Network

                     The PPO toll free number is 800-323-1743

  12                                                          Benefits Guide 2019
AMITA Health - Adventist Midwest Health #11510

                                                                                                       AMITA Health - Alexian Brothers Health System #11506

                                                                                                       AMITA Health – Presence Health #11506
DENTAL PLAN HIGHLIGHTS
HIGH PLAN

 Annual Deductible (applies to Basic and Major Services Only)                                $50/person; $150/family
 Annual Maximum                                                                              $1,500/person
 Enhanced Benefits Program                                                                   Your plan provides additional cleanings and/or
                                                                                             applications of topical fluoride to people with
                                                                                             specific health conditions that put them at risk
                                                                                             for oral health disease.
 Lifetime Orthodontic Maximum                                                                $1,500/person
                                                                                             Delta Dental           Delta Dental               Non-
                                                                                             PPO Network            Premier®                   Network
                                                                                             Dentist                Network Dentist            Dentist
 PREVENTIVE/DIAGNOSTIC SERVICES
 Not subject to annual maximum
 • Routine exams (twice per benefit year)
 • Dental prophylaxis (twice per benefit year)
 • X-rays (bitewings-twice per benefit year; full mouth-every three years)
                                                                                                   100%*                   100%**                 100%***
 • Fluoride treatments (once per benefit year to age 19)
 • Space maintainers (once per lifetime to age 14)
 • Sealants (to age 16)
 • Periodontal maintenance
 • Emergency exams and palliative treatment
 BASIC SERVICES
 • Amalgam and composite resin (anterior) fillings
 • Posterior composites (tooth colored fillings on back teeth)
 • Non-surgical Periodontics
 • Surgical Periodontics
                                                                                                   80%*                     80%**                  80%***
 • Endodontics

                                                                                                                                                                    DENTAL PLAN
 • Oral surgery – simple extractions
 • Oral surgery – surgical extractions including general anesthesia
 • IV sedation
 • Denture repairs
 MAJOR RESTORATIVE SERVICES
 • Implants
                                                                                                   50%*                     50%**                  50%***
 • Cast restorations – crowns, onlays, post and core
 • Prosthodontics – bridges, partial dentures and complete
 ORTHODONTICS-dependents to age 26 and Adults
                                                                                                   50%*                     50%**                  50%***
 Treatment necessary for proper alignment of teeth
 No TMJ Coverage                                                                                     0%                       0%                      0%

*Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network
dentists cannot charge you for costs exceeding the PPO fee. **Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual
fee) or Delta Dental’s maximum plan allowance. Premier dentists may not charge you for costs exceeding the maximum plan allowance. ***Non-network dentists
(non-Delta Dental PPO/non-Delta Dental Premier) do not agree to accept Delta Dental’s allowed fees as payment in full; payment is based on the lesser of the
submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. These dentists can charge you for costs exceeding the maximum plan allowance.

                                                                      Benefits Guide 2019                                                                          13
AMITA Health - Adventist Midwest Health #11510

                                                                                                               AMITA Health - Alexian Brothers Health System #11506

                                                                                                               AMITA Health – Presence Health #11506

              DENTAL PLAN HIGHLIGHTS
              LOW PLAN

               Annual Deductible (applies to Basic and Major Services Only)                               $75/person; $225/family
               Annual Maximum                                                                             $1,000/person
               Enhanced Benefits Program                                                                  Your plan provides additional cleanings and/or
                                                                                                          applications of topical fluoride to people with spe-
                                                                                                          cific health conditions that put them at risk for oral
                                                                                                          health disease.
               Lifetime Orthodontic Maximum                                                               $1,000/person
                                                                                                          Delta Dental            Delta Dental              Non-Network
                                                                                                          PPO Network             Premier®                  Dentist
                                                                                                          Dentist                 Network Dentist
               PREVENTIVE/DIAGNOSTIC SERVICES
               Not subject to annual maximum
               • Routine exams (twice per benefit year)
               • Dental prophylaxis (twice per benefit year)
               • X-rays (bitewings-twice per benefit year; full mouth-every three years)
                                                                                                                100%*                    100%**                 100%***
               • Fluoride treatments (once per benefit year to age 19)
               • Space maintainers (once per lifetime to age 14)
               • Sealants (to age 16)
               • Periodontal maintenance
               • Emergency exams and palliative treatment
               BASIC SERVICES
               • Amalgam and composite resin (anterior) fillings
               • Posterior composites (tooth colored fillings on back teeth)
               • Non-surgical Periodontics
               • Surgical Periodontics
                                                                                                                 60%*                    60%**                   60%***
               • Endodontics
DENTAL PLAN

               • Oral surgery – simple extractions
               • Oral surgery – surgical extractions including general anesthesia
               • IV sedation
               • Denture repairs
               MAJOR RESTORATIVE SERVICES
               • Implants
                                                                                                                 50%*                    50%**                   50%***
               • Cast restorations – crowns, onlays, post and core
               • Prosthodontics – bridges, partial dentures and complete
               ORTHODONTICS-dependents to age 26 and Adults
                                                                                                                 50%*                    50%**                   50%***
               Treatment necessary for proper alignment of teeth
               No TMJ Coverage                                                                                     0%                       0%                      0%

              *Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network
              dentists cannot charge you for costs exceeding the PPO fee. **Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual
              fee) or Delta Dental’s maximum plan allowance. Premier dentists may not charge you for costs exceeding the maximum plan allowance. ***Non-network dentists
              (non-Delta Dental PPO/non-Delta Dental Premier) do not agree to accept Delta Dental’s allowed fees as payment in full; payment is based on the lesser of the
              submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. These dentists can charge you for costs exceeding the maximum plan allowance.

  14                                                                           Benefits Guide 2019
Vision Plan
Eligibility
All full-time or part-time benefit eligible associates may elect coverage. Eligible dependents include your legal spouse,
and children up to the date in which they turn age 26. Any unmarried child of any age with a mental or physical
handicap or disability who is incapable of self-support is eligible provided they became disabled before age 26 and
while covered by the plan.

Coverage Levels
You can choose from four levels of coverage:

• Associate Only

• Associate + Spouse

• Associate + Child(ren)

• Family

When Coverage Begins
If you enroll in this plan, coverage is effective the 1st of the month following 30 days of employment.

When Coverage Ends
Coverage ends on the last day of employment or when you cease to be an eligible associate. Dependents
terminate on the day of their 26th birthday. Please see the Vision Plan book for additional instances when
coverage ends.

AMITA Health Vision Plan
AMITA Health vision benefits are administered by Vision Service Plan (VSP). You can go to any eye care professional
you choose but if you use a VSP network provider you’ll pay less.

                                                                                                                            VISION PLAN
To use your VSP benefit:

• Create an account at www.vsp.com to review your benefits.

• To find a doctor who is right for you, visit www.vsp.com or call 1-800-877-7195

• At your appointment, tell your provider you have VSP. There is no ID card necessary. If you’d like a card
  as a reference, you can print one on www.vsp.com.

• That is it! There are no claim forms to complete when you see a VSP provider.

    Convenient online shopping! Eyeconic is an online eyewear store for VSP members.
    You can visit Eyeconic to purchase eyewear or contact lenses with your VSP insurance – in-network.

    Visit www.eyeconic.com and connect your VSP account to the Eyeconic store.

                                                     Benefits Guide 2019                                                    15
Benefit                                   Description                                                             Copay                             Frequency
                                                                           Your Coverage with a VSP Provider
               Well Vision Exam                          • Focuses on your eyes and overall wellness                             $10                               Every 12 months
               Prescription Glasses                                                                                              $15                               See frame and
                                                                                                                                                                   lenses
               Frame                                     • $160 allowance for a wide selection of frames                         Included in                       Every 12 months
                                                         • $180 allowance for featured frame brands                              Prescription Glasses
                                                         • 20% savings on the amount over your allowance
                                                         • $90 Costco® frame allowance
               Lenses                                    • Single vision, lined bifocal, and lined trifocal                      Included in                       Every 12 months
                                                         lenses                                                                  Prescription Glasses
                                                         • Polycarbonate lenses for dependent children
               Lens Enhancements                         • Scratch Resistant Coating                                             $0                                Every 12 months
                                                         • Standard progressive lenses                                           $55
                                                         • Premium progressive lenses                                            $95-105
                                                         • Custom progressive lenses                                             $150-$175
                                                         • Average savings of 20-25% on other lens
                                                          enhancements
               Contacts                                  •$160 allowance for contacts; copay does not apply Up to $50                                              Every 12 months
               (instead of glasses)                      • Contact lens exam (fitting and evaluation)

               Diabetic Eyecare Plus                     • Services related to diabetic eye disease,                             $20                               As needed
               Program                                    glaucoma and age-related macular degeneration
                                                         (AMD). Retinal screening for eligible members
                                                         with diabetes. Limitations and coordination with
                                                         medical coverage may apply. Ask your VSP
                                                         doctor for details.
               Extra Savings                             Glasses and Sunglasses
                                                         • Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details.
                                                         • 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP
VISION PLAN

                                                         provider within 12 months of your last WellVision Exam.
                                                         Retinal Screening
                                                         • No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam
                                                         Laser Vision Correction
                                                         • Average 15% off the regular price or 5% off the promotional price; discounts only available from
                                                         contracted facilities
                                                                   Your Coverage with Out-of-Network Providers
               Get the most out of your benefits and greater savings with a VSP network doctor. Your coverage with out-of-network providers will
               be less or you’ll receive a lower level of benefits. Visit vsp.com for plan details.

               Exam ................................... up to $45 Lined Bifocal Lenses ........................ up to $50 Progressive Lenses ........................... up to $50
               Frame ..................................up to $70 Lined Trifocal Lenses ........................ up to $65 Contacts ................................................ up to $105
               Single Vision Lenses ......... up to $30

              Coverage with a participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information is subject to change. In the
              event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may
              vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.

 16                                                                                 Benefits Guide 2019
AMITA 2019 Bi-Weekly Benefit Rates
                                                        MEDICAL RATES - Bi Weekly – Non-Wellness
                      Salary Banding     Associate            Associate +    Associate +   Family
                                                              Spouse         Children
                      $0-$14.42          $64.31               $130.28        $122.03       $188.00
Full-TIme             $14.43-$28.85      $71.58               $149.19        $139.49       $217.10
Non-wellness
                      $28.86-$48.08      $76.43               $161.81        $151.13       $236.51
Rates
                      $48.09+            $81.28               $174.42        $162.78       $255.91

Part-TIme             Associate          $123.75              $228.45        $206.30       $336.17
Non-wellness
Rates

                                                                                                     AMITA 2019 BI-WEEKLY BENEFIT RATES
                                                                DENTAL RATES - Bi Weekly
                                          Associate            Associate +   Associate +   Family
                                                               Spouse        Children
 Full-Time Rates - Low Plan               $4.46                $8.92         $10.85        $16.83
 Part-Time Rates - Low Plan               $12.76               $25.52        $31.06        $48.17
  Full -Time Rates - High Plan            $5.47                $10.95        $13.29        $20.61
 Part- Time Rates - High Plan             $15.66               $31.32        $38.02        $58.98

                                                              VISION RATES - Bi Weekly
                                       Associate               Associate +   Associate +   Family
                                                               Spouse        Children
                                       $4.08                   $6.54         $6.68         $10.77

                                                      Benefits Guide 2019                            17
Flexible Spending Accounts
                             Eligibility                                                    Dependent Daycare Flexible Spending Account:

                             All full-time or part-time benefit eligible associates may     Estimate your eligible expenses for dependent day care
                             elect coverage. Eligible dependents include your legal         while you work, or other dependent care expenses. The
                             spouse, and children up to the date in which they turn         maximum you may elect is based on your tax filing status:
                             age 26. Any unmarried child of any age with a mental
                                                                                            $5,000 (if you are single or married and filing a joint
                             or physical handicap or disability who is incapable of
                                                                                            return) or $2,500 (if you are married and filing a separate
                             self-support is eligible provided they became disabled
                                                                                            return).
                             before age 26 and while covered by the plan.
                                                                                            • Pay for eligible dependent care expenses out of your
                             Coverage Begins                                                  own pocket and submit a claim for reimbursement,
                                                                                              with a copy of any necessary documents (receipts,
                             You must enroll in a Flexible Spending Account (FSA)             etc.) to ConnectYourCare at the address listed on the
                             during your enrollment window to have an FSA, which              claim form.
                             is effective the 1st of the month following 30 days of
                             employment, or during each open enrollment for the             • ConnectYourCare will direct deposit your
                             first day of the new benefit year.                               reimbursement into your designated account within
                                                                                              24-48 hours after processing your claim (Monday -
                             As part of the wide range of choices the AMITA benefits
FLEXIBLE SPENDING ACCOUNTS

                                                                                              Friday) provided you have a balance. Otherwise,
                             program offers, you may also elect to set up a Flexible          your claim will be processed once a contribution
                             Spending Account to help save income taxes on                    is received.
                             predict- able eligible health and/or dependent care
                             expenses.                                                      Make your elections:

                             You may choose to set up either or both:                       • During Open Enrollment or any enrollment period
                                                                                              after you become eligible; or
                             • A Health Care Flexible Spending Account
                                                                                            • In the event of a qualifying life status change.
                             • A Dependent Daycare Flexible Spending Account

                             HOW A FLEXIBLE SPENDING                                        HEALTH CARE FLEXIBLE SPENDING
                             ACCOUNT WORKS                                                  ACCOUNT QUALIFYING EXPENSES
                             Health Care Flexible Spending Account:                         Any health care expenses qualifying under the Internal
                                                                                            Revenue Code for income tax purposes also qualify for
                             Estimate how much you expect to spend on eligible
                                                                                            reimbursement through the Health Care Flexible Spend-
                             health care expenses for the plan year (January 1, 2019
                                                                                            ing Account. If you use the account for these expenses,
                             through December 31, 2019). Consider medical, dental,
                                                                                            you cannot take an income tax deduction as well.
                             vision, and hearing expenses not covered by the benefit
                             plans, such as copays and deductibles, as well as other
                             eligible expenses. The maximum contribution you may
                             elect is $2,650 per plan year. The minimum is $120 per
                             plan year.

                             • Pay for eligible health care expenses out of your own
                               pocket and submit a claim for reimbursement, with
                               a copy of any necessary documents (receipts,
                               explanation of benefits, etc.) to the ConnectYourCare
                               at the address listed on the claim form.

                             • Pay using a VISA payment card. Automatically records
                               purchase online and no need to pay upfront and wait
                               for reimbursement.

         18                                                                    Benefits Guide 2019
Flexible Spending Accounts
Eligible expenses include, but are not limited to:                  General Plan Rules

  •   Deductibles, coinsurance, and copays – for medical, The Internal Revenue Service imposes the following rules
      dental, pharmacy, and vision care;                  and regulations on pre-tax Flexible Spending Accounts:

  •   Amounts you pay in excess of plan limitations for     • You lose any money left in your account at the end of the
      allowed charges;                                        plan year, so decide carefully how much to contribute
                                                              when you enroll each year. However, there is a 90-day
  •   Amounts in excess of annual or lifetime benefit         grace period after the end of the plan year to submit
      maximums;                                               eligible health care and dependent daycare expenses
                                                              incurred during the plan year.
  •   Expenses not covered or not fully covered by your
      plan; and                                             • You may be eligible for a Federal Child and Dependent
                                                              Daycare Tax Credit and/or to deduct certain health care
  •   Certain over-the-counter medications if prescribed      expenses on your tax return. Be sure to talk to a tax
      by a physician.                                         advisor to see whether the tax credits and deductions
                                                              or the Flexible Spending Accounts are the best choice
                                                              for you.
DEPENDENT DAYCARE FLEXIBLE SPENDING                         • For the Health Care Flexible Spending Account, you can

                                                                                                                          FLEXIBLE SPENDING ACCOUNTS
ACCOUNT QUALIFYING EXPENSES                                     be reimbursed up to the full amount you elect to
                                                                contribute for the plan year even if funds are not yet
Any expenses qualifying for a Federal Child and Dependent
                                                                deposited into your account. However, you can only be
Daycare Tax Credit for income tax purposes also qualify for
                                                                reimbursed up to the amount deposited into your
reimbursement through the Dependent Daycare Flexible
                                                                Dependent Daycare Flexible Spending Account at the
Spending Account.
                                                                time of your claim.
If you use the account to reimburse yourself for eligible
expenses, you cannot take the Federal Tax Credit for the • You cannot use money in your Health Care Flexible
same expenses. Eligible expenses include those services         Spending Account to be reimbursed for dependent day
provided inside or outside your home while you work by          care expenses, and you cannot use money in your
                                                                Dependent Daycare Flexible Spending Account to be
anyone other than your spouse or your dependents to care
for eligible dependent children (under age 13) or depen-        reimbursed for health care expenses. You also cannot
dents who are physically or mentally unable to care for         transfer money from one account to the other.
themselves for whom you contribute more than half of their
support.                                                     • Flexible spending accounts (medical) allow $500 per
                                                             • Flexible Spending Accounts (medical) allow $500 per
                                                                year to be rolled over.

                                                     Benefits Guide 2019                                                  19
Basic and Voluntary Life / AD&D
                        BASIC LIFE

                        Eligibility
                        All full-time and part-time benefit eligible associates are provided employer paid Basic Life/AD&D coverage at
                        1x annual earnings to a maximum of $1,000,000. Associates are automatically enrolled in Basic Life and AD&D.
                        AMITA Health provides this benefit at no cost to the Associate. The Prudential Insurance Company of America
                        provides this insurance.

                        When Coverage Begins
                        Coverage is effective the 1st of the month following 30 days of employment.

                        When Coverage Ends
                        Coverage will end at the termination of your employment. You may convert your insurance to an individual life
                        insurance policy issued by the Prudential Insurance Company of America. Please see the Life Plan book for
                        additional instances when coverage ends.

                        Basic Life – Key Provisions
                        • If you are terminally ill, you can get a partial payment of your group life insurance benefit. You can use this
                          payment as you see fit. The payment to your beneficiary will be reduced by the amount you receive with the
                          Accelerated Benefit Option.
LIFE - BASIC AND AD&D

                        • Payment of premium can be waived if you are totally disabled for 6 months, you are less than 60 years old when
                          disability begins, and you continue to be totally disabled. The waiver terminates at normal social
                          security retirement age. This provision may vary by state.

                        • Coverage will be reduced as you age – 50% at age 70.

                        Please refer to the Life plan summary plan description for more information.

                        Basic Accidental Death & Dismemberment – Key Provisions
                        • Basic AD&D pays you and your beneficiary a benefit for loss of life or other injuries resulting from a covered
                          accident. 100% is paid for loss of life. A lesser percentage is paid for other injuries such as loss of sight or
                          speech, paralysis, and dismemberment of hands or feet.

                        • Basic AD&D benefits are paid regardless of other coverages you may have.

                        • You are automatically enrolled for an amount equal to your Basic Life coverage amount.

    20                                                                   Benefits Guide 2019
VOLUNTARY LIFE

Eligibility
All full-time and part-time benefit eligible associates may purchase voluntary employee optional life coverage for
1.0 to 7.0 times your covered annual earnings up to a maximum of $2,500,000. You must elect voluntary life insurance
at enrollment. Rates for this insurance are determined by your use of tobacco, which is self-reported. Premiums are
deducted on an after tax basis from your paycheck.

When Coverage Begins
Coverage is effective the 1st of the month following 30 days of employment.

When Coverage Ends
Coverage will end at the termination of your employment. You may port (continue) your group coverage in an
amount equal to or lower than your current benefit amount. Coverage amounts will be subject to maximum of five
times your annual earnings or $1 million, whichever is less. Please see the Life Plan book for additional
instances when coverage ends.

Voluntary Employee Optional Life – (100% Associate Paid)
• Enrollment at time of hire. You can elect a coverage up to the Guaranteed Issue amount of up to the lesser
  of 2.0 times your covered annual earnings or $750,000, without providing evidence of insurability to The Prudential
  Insurance Company of America. If you enroll in voluntary life any other time outside your hire date or increase your
  amount of coverage at open enrollment, you will be required provide evidence of insurability.

                                                                                                                            LIFE - BASIC AND AD&D
• If you are terminally ill, you can get a partial payment of your group life insurance benefit. You can use this payment
  as you see fit. In the event of your death, your beneficiary will receive a benefit payout which has been reduced by
  the amount you receive.

• Payment of premium can be waived if you are totally disabled for 6 months, you are less than 60 years old when
  disability begins, and you continue to be totally disabled. The waiver terminates at social security retirement age.
  This provision may vary by state.

• Coverage will be reduced as you age – 50% at age 70.

.

                                                     Benefits Guide 2019                                                    21
Spouse - Dependent Life (100% Associate Paid)
                        Spouse                      Term Life                                            AD&D

                        Eligibility                 May purchase only if Associate elects Voluntary      May purchase only if Associate elects Voluntary
                                                    Life.                                                AD&D.

                        Coverage and Limits         1. Coverage amount cannot be greater than 50%        Purchase a coverage amount equal to 65% of
                                                    of the Associate Voluntary coverage amount.          the Associate Voluntary AD&D coverage with a
                                                                                                         maximum of $1 Million.
                                                    2. May elect $10K to $250K in $25K increments.
                        Evidence of Insurability    At time of hire may elect up to 25K without EOI. There are no health requirements.
                                                    If increased or elected any other time, EOI will be
                                                    required.
                        Age Reduction               50% at age 70                                        50% at age 70
                        Portability                 Coverage will end at the termination of your         May be ported only if Associate coverage is
                                                    employment. You may port (continue) your             ported.
                                                    group coverage in an amount equal to or lower
                                                    than your current benefit amount only if Asso-
                                                    ciate average is ported. Coverage amounts will
                                                    be subject to maximum of five times your annual
                                                    earnings or $1 million, whichever is less.

                        Child Dependent Life (100% Associate Paid)
                        Child(ren)                 Term Life                                              AD&D
LIFE - BASIC AND AD&D

                        Eligibility                May purchase only if Associate elects Voluntary        May purchase only if Associate elects Voluntary
                                                   Life. Coverage may begin from live birth and con-      AD&D. Coverage may begin from live birth and
                                                   tinues to age 26.                                      continues to age 26.
                        Coverage and Limits        1. Coverage amount cannot be greater than 50%          Purchase a coverage amount equal to 25% of
                                                   of the Associate Voluntary coverage amount.            the Associate Voluntary AD&D coverage with a
                                                                                                          maximum of $75K.
                                                   2. May elect either $5K or $10K for each child.
                        Evidence of Insurability   There are no health requirements.                      There are no health requirements.

                        Portability                Coverage will end at the termination of your           May be ported only if Associate coverage is
                                                   employment. You may port (continue) your group         ported.
                                                   coverage in an amount equal to or lower than the
                                                   current coverage level only if Associate average is
                                                   ported.

                        Voluntary Optional Accidental Death & Dismemberment (100% Associate Paid)
                        Eligibility
                        All full-time and part-time benefit eligible Associates may purchase coverage for 1.0 to 10.0 times annual earnings to a
                        maximum of $2,500,000. Premiums are deducted on an after tax basis from your paycheck.

                        When Coverage Begins and Ends
                        Coverage is effective the 1st of the month following 30 days of employment. Coverage ends on the last day
                        of employment.

                        Voluntary Accidental Death & Dismemberment – Key Provisions
                        • There are no health requirements for this coverage

                        • Coverage will be reduced as you age – 50% at age 70.

   22                                                                     Benefits Guide 2019
Short-Term Disability
Eligibility
Short-Term Disability (STD) is available to Full-Time and Part-Time benefit eligible associates who are
regularly scheduled 40 hours per pay period.

When Coverage Begins
Coverage is effective the 1st of the month following 30 days of employment.

When Coverage Ends
Coverage ends on the last day of employment or when you cease to be an eligible associate. Please see the
Short Term Disability Plan book for additional instances when coverage ends.

 Benefits of the STD Plan
• Full-time associates: There is no cost to you. You are automatically enrolled in this employer paid benefit.

• Part-time associates: Have the option to purchase this coverage and pay 100% of the premium after tax.

• You can have coverage without providing proof of good health.

• This plan provides a benefit for disability, illness or injury that is not work-related, including pregnancy.

• Your plan also includes Rehabilitation benefits that provide services and support targeted at helping you return
  to active work.

                                                                                                                        SHORT-TERM DISABILITY
  Pre-existing Condition
 STD benefits will not be paid for a disability that begins within 3 months of your coverage effective date and due
  to a pre-existing condition. A pre-existing condition is an injury or sickness for which you received medical
  treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for which you followed
  treatment recommendations during the 12 months prior to your effective date of coverage.

 Coverage      Waiting Period                 Elimination Period          Benefit                            Duration

 Full-time     1st of the month following     14 Calendar days of an      70% of pre-disability weekly       24 weeks
               30 days of employment          injury or illness           earnings, not exceeding
                                                                          maximum of to $2,500

 Part-time     1st of the month following     14 Calendar days of an      60% of pre-disability weekly       24 weeks
               30 days of employment          injury or illness           earnings, not exceeding
                                                                          maximum of to $2,500

                                                      Benefits Guide 2019                                               23
Long-Term Disability
                       Eligibility
                       Long-Term Disability (LTD) is provided at no charge to all Full-time associates only who are regularly scheduled to work
                       72 hours or more per pay period.

                       When Coverage Begins
                       Coverage is effective the 1st of the month following 30 days of employment.

                       When Coverage Ends
                       Coverage ends on the last day of employment or when you cease to be an eligible associate. Please see the
                       Long Term Disability Plan book for additional instances when coverage ends.

                       Benefits of the LTD Plan
                       • Your monthly LTD will be 50% of their monthly pre-disability earnings, up to a maximum of $15,000.

                       • Provides coverage for on–and-off-the-job accidents.

                       • Benefits are payable directly to you to be spent any way you choose.

                       • Pays in addition to any other coverage you may have.

                       • Benefits may be reduced if receiving other income benefits

                       • Benefits will not be paid for a disability that begins within 12 months of your coverage effective date and is due to
                         a pre-existing condition unless you were treatment free for 3 consecutive months after the coverage effective date.
LONG-TERM DISABILITY

                       • Fast and accurate claims service.

                        Coverage        Waiting Period               Elimination Period    Benefit                    Duration

                        CORE LTD        1st of the month following   180 calendar days     50% up to $15K monthly Later of age 65 or
                        Employer        30 days of employment                                                     Social Security Normal
                        paid                                                                                      Retirement Age

                        BUY-UP LTD      1st of the month following   180 calendar days     70% up to $15K monthly Later of age 65 or
                        Associate       30 days of employment                                                     Social Security Normal
                        paid                                                                                      Retirement Age

 24                                                                    Benefits Guide 2019
Voluntary Permanent Whole Life

Eligibility
Voluntary Permanent Whole Life Insurance is an associate paid benefit available to all associates
that work over 20 hours per week.

To supplement your Basic Life AD&D insurance provided by AMITA Health, you may purchase
additional life insurance coverage for yourself, your spouse and dependent children through
Voya.

Voluntary Permanent Life insurance provides a financial benefit that your family can depend on and getting it at work
is easier, more convenient and more affordable than doing it on your own. If you have financial dependents- a spouse,
children or aging parents, having life insurance is a responsible and smart decision. Premiums never increase due to an
increase in age and the coverage is fully portable.

Accelerated Life Benefit Included: A lump sum benefit is paid to you if you are diagnosed with a terminal condition,
as defined by the plan

                                                                                                                                     VOLUNTARY PERMANENT WHOLE LIFE
                                         Medical Evidence of Insurability (EOI) is required
                                  if you enroll at a later date, including future Open Enrollments.

Associate Coverage

• Coverage is available for you in $10,000 increments up to $100,000.

• No medical questions asked, if you enroll when initially offered the coverage unless you elect over the guarantee
  issue amount.

Spouse Coverage

• Coverage is available for you in $5,000 increments to up $25,000.

• Associates and spouses must elect coverage prior to reaching age 70.

Child(ren) Coverage

• Term Life Insurance

• No medical questions asked, if you enroll in up to the guarantee issue amount when initially offered
  the coverage. $5,000-$10,000, 15 days - 24 years.

 Associate                                      15-50                                          Up to $100,000 ($10,000 increments)
                                                51-65                                          Up to $50,000 ($10,000 increments)
                                                66-70                                          Up to $30,000 ($10,000 increments)
 Spouse                                         15-65                                          Up to $25,000 ($5,000 increments)*
                                                66-70                                          $5,000 or $10,000*
 Dependent Child                                15 days-24 years                               $5,000 or $10,000*
*Spouses and Children are limited to 50% of the Associate face amount for amounts in excess of $5,000

For more information regarding Voluntary Permanent Whole Life Insurance, please call Voya at 1-800-537-5024
or visit www.voya.com

                                                            Benefits Guide 2019                                                      25
You can also read
Next slide ... Cancel