2020 BENEFIT GUIDE - AMITA Health

 
2020 BENEFIT GUIDE - AMITA Health
2020
BENEFIT GUIDE
2020 BENEFIT GUIDE - AMITA Health
Covering Dependents
                                                                            Qualifying Life Events.............................................p. 6
                                                                            Proof of Dependent Relationship.........................p. 7
                                                                              Accepted Forms for Proof of
                                                                              Dependent Relationship

                                                                            Health
                                                                            Medical Plan..............................................................p. 8
                                                                            Prescription Drug Plan............................................p. 11
                                                                            Wellness Program....................................................p. 12
                                                                            Diabetes Management, Simplified.......................p. 12
                                                                            Dental Plan.................................................................p. 13
                                                                            Vision Plan.................................................................p. 15
                                                                            Premiums for Medical, Dental, Vision.................p. 16
                                                                            Income Security
                                                                            Basic Life and Supplemental Life/AD&D............p. 17
                                                                            Spouse/Child Life and AD&D….............................p. 18
                                                                            Short-Term Disability...............................................p. 19
                                                                            Long-Term Disability................................................p. 19
                                                                            Voluntary Whole Life...............................................p. 20
                                                                            Voluntary Accident...................................................p. 20
                                                                            Voluntary Critical Illness.........................................p. 20
                                                                            Ascension Health Retirement Plan......................p. 21

                                                                            Additional Benefits
                                                                            Legal Plan…................................................................p. 23
                                                                            Flexible Spending Accounts..................................p. 24
                                                                            Commuter & Transit Benefits................................p. 26
                                                                            Employee Assistance Program.............................p. 27
What’s Inside
                                                                            Resources
Key Takeaways
                                                                            Mobile Information...................................................p. 28
Benefits at a Glance................................................ p. 4
                                                                            Benefit Contacts.......................................................p. 29
 How to Enroll
                                                                            Important Notifications............................................p. 30
 Where to find Benefit Information
                                                                            Frequently Asked Questions (FAQs)...................p. 31
 Changes to Benefits
 Reminders
Eligibility and Effective Dates................................ p. 5
  Eligible Dependents
  Available Coverage Levels
  Paid Time Off Snapshot
  Coverage Termination

This benefits material briefly describes 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
AMITA Health. Associate is responsible for monitoring work emails, understanding benefit information, how to enroll and
premium payroll deductions review.
2020 BENEFIT GUIDE - AMITA Health
KEY TAKEAWAYS                                                                                                                                                                                            KEY TAKEAWAYS

BENEFITS AT A GLANCE                                                                                                    Benefits include - Health, Income Security and additional benefit offerings.
                                                                                                              Medical (Includes Prescription)
This guide provides general information regarding benefit options available to full-time and part-time        *To see if your provider(s) are in plan, go to   Basic Life/AD&D 1x Salary     Long-Term Disability
associates including enrollment instructions for your convenience. You will see a few variances between         http://www.AMITAhealthprovider.org
the ministry benefit offerings. Your enrollment record in Benefit Express will indicate the benefits
                                                                                                              Dental                                            Voluntary Life/AD&D           Hyatt Legal Plan
available to you at your work ministry.
                                                                                                              Vision                                            Spouse Life/AD&D              VOYA Critical Illness
How to Enroll                                         Where to find Benefit Information                       Wellness Program / Diabetes Management            Child Life/AD&D               VOYA Accident Insurance
• Log into Benefits Express via a work computer      • iAMITA Intranet Site:                                Health Care Flexible Spending Account             Short-Term Disability         VOYA Whole Life
   www.AMITAHealthBenefits.com                          My Life > Human Resources > Benefits
                                                                                                              Dependent Care Flexible
    • After your initial login to a work computer,   • Benefit Express under Library:                                                                         Wellness Program              Paid Time Off
                                                                                                              Spending Account
       enrollment can be completed from a personal       www.AMITAHealthBenefits.com
                                                                                                              Employee Assistance Program                       Ascension Health Retirement Plan
       computer or mobile device.
• You MUST enroll within 31 days of start date       Changes to Benefits
  on the Benefits Express website.
                                                                                                             Eligibility and Effective Dates                           Available Coverage Levels
                                                      Outside of New Hire Enrollment or annual Open
                                                      Enrollment, associates have 31 days from their         • Full-Time is 36 – 40 standard hours per week            • Employee Only            • Employee + Children*
Benefit Express                                       qualified life event to make a change in benefit       • Part-Time is 20 – 35.99 standard hours per week         • Employee + Spouse*       • Employee + Family*
                                                      elections via the Benefit Express website.             Medical, dental, vision, flexible spending accounts,      *You must click on the check box next to each
                                                      Examples of Typical Qualified Life Events:             life, and legal benefits are effective 1st of the           dependent's name, within each benefit page
                                                                                                             month following 30 days of employment based on              to link dependents to each plan that you want
                                                      • Birth/Adoption of Child                                                                                          them enrolled in. Select WAIVE if you do not
                                                                                                             benefit eligibility date. Long-Term (LTD) and Short-
                                                      • Change in Job Status (FT, PT, or PRN)                Term Disability (STD) benefit effective dates are           want a benefit.
                                                      • Gain or Loss of other Coverage                       dependent on the ministry in which you work.
                                                      • Marriage/Divorce                                     When you access your enrollment record in                 Paid Time Off (PTO) Snapshot
                                                                                                             Benefit Express, you will see one of the two              Exempt/Salary associates will receive a front-
Logging into Benefit Express:                                                                                effective dates below:                                    loaded PTO bank of 27 days per year, prorated
                                                      REMINDERS
STEP 1:                                                                                                      • LTD/STD effective 1st of month following 90 days,      based on FTE (Full-Time Equivalent). This PTO bank
                                                      • YOU MUST ENROLL FOR BENEFITS WITHIN 31                                                                        is “use it or lose it” meaning hours remaining in
• Your USERNAME and PASSWORD is the same                DAYS OF YOUR DATE OF HIRE, FIRST DAY IN A              or
                                                                                                             • LTD/STD effective 1st of month following 30 days        bank at end of year will be forfeited.
   that you chose after logging into your network        BENEFIT ELIGIBLE POSITION, OR A QUALIFYING
   computer for the first time.                          LIFE EVENT. This includes uploading dependent                                                                 Non-Exempt/Hourly associates accrue PTO based
                                                         verification document(s), and/or documentation to   Coverage Termination                                      on years of service (prorated based on FTE) and
STEP 2:                                                                                                                                                                eligible paid hours up to a maximum of 80 paid
                                                         support your life event.                            • For dependent child reaching age 26, all
• Once you login to Benefits Express, choose                                                                                                                          hours per pay period. First year associates can
                                                      • YOU CAN ONLY MAKE CHANGES TO BENEFITS                  coverage ends 11:59 pm day before 26th birthday        accrue up to 16 days.
  the option to accept the website’s terms
                                                         DURING NEW HIRE ENROLLMENT, OPEN                    • Coverage upon termination of employment:
  and conditions.                                                                                                                                                      Medical Residents, Pharmacy Residents,
                                                         ENROLLMENT, OR WHEN A QUALIFIED LIFE
• Click Next to proceed to your personalized            EVENT OCCURS.                                        • Medical, dental and vision ends last day of the       Physicians, Hospitalists, Hospitals, Mid-Level
   Benefit Express welcome page.                                                                                 month in which termination falls                      Providers and contracted associates–refer to
                                                                                                              • All other coverages end on termination date            your agreement.
• Choose the Enroll Now option to begin, or select    Please note!! In the event you elect benefits in
   the appropriate life event allowing you to make     Benefits Express just to view costs, you MUST         •	A status change to registry or benefit                 Holidays during the course of the year consist of
   benefit changes outside of Open Enrollment.         make sure to select WAIVE if you do NOT want             ineligible will have coverage to last day              eight holiday’s including New Year’s Day, Martin
                                                       the benefit BEFORE exiting system.                       of the month                                           Luther King, Jr. Day, Good Friday, Memorial Day,
                                                                                                                                                                       Independence Day, Labor Day, Thanksgiving,
                                                      Any selections made are finalized during                                                                         Christmas Day.
                                                      overnight processing regardless of
                                                                                                             See respective policies for additional information.
                                                      completing your enrollment or clicking
                                                      on the Submit button.

                                                      Always review and keep a copy of your benefit
                                                      confirmation statement for your records!                 QUESTIONS? Call 888.629.6424

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2020 BENEFIT GUIDE - AMITA Health
COVERING                                                                                                                                                                                                                 COVERING
 DEPENDENTS                                                                                                                                                                                                               DEPENDENTS

                                                                                                              Proof of Dependent Relationship
All qualifying events                                                                                         If you are adding a dependent to any of the benefit              If your document is not uploaded and approved
must be entered into                                                                                          options, you are required to upload dependent                    within 31 days, you and/or your dependent will be
                                                                                                              verification documents within 31 days of the                     removed from coverage.
My Benefit Express                                                                                            event date. Documents accepted for verification                  Dependent verification document approval
                                                                                                              are listed below. Please note: Provide copies of
within 31 days of the                                                                                         the documents – not originals as these will not be
                                                                                                                                                                               generally takes place within 24–72 hours.
                                                                                                                                                                               If you still have not received an email or
event date and required                                                                                       returned to you. If you are submitting a copy of
                                                                                                              your most recent federal tax return, please upload               do not see a dependent verified and linked
                                                                                                                                                                               to coverage within 72 hours, contact rHR
documentation uploaded                                                                                        the first page only which shows your dependents
                                                                                                              (blackout income information).                                   immediately at 888.629.6424.
                                                                                                              Only government issued documents such as                            If you are having trouble obtaining required
                                                                                                              marriage certificate, birth certificate, or court                   documentation for life event or dependent
                                                                                                              ordered documents are accepted. Please upload                       verification, you must contact rHR BEFORE
                                                                                                              documents into My Benefit Express for review                        the 31 day enrollment window closes.
                                                                                                              and approval within 31 days of your life event.
Qualifying Life Events                                  My Benefit Express no later than March 31st.                                                                              Verification documents must be uploaded
                                                        This includes uploading dependent verification        If approved, your eligible dependents will
A qualifying life event is a change in your situation                                                         remain covered.                                                     and approved in Benefit Express prior to
                                                        documents and/or applicable supporting life event                                                                         the 31 day close of life event window, life
– like getting married, having a baby or a gain
                                                        documentation (i.e. proof of loss or gain of other                                                                        or dependent verification.
or loss of health coverage – that can make you
                                                        coverage). If you do not, you will not be able to
eligible for a special enrollment period, allowing
                                                        make a coverage change until the next annual
you to enroll or cancel some benefit coverages
                                                        open enrollment period.
outside of the annual open enrollment period,
                                                                                                                     Accepted Forms of Dependent Verification (Relationship) Documentation
which is generally in November.
                                                        All qualifying events require proof (e.g., marriage
Qualifying events include:                                                                                    DEPENDENT TYPE        DOCUMENTATION REQUIREMENTS
                                                        certificate, etc.) and must be uploaded into My
                                                        Benefit Express when you enter your life event.       Legal Spouse          • Government Issued Marriage Certificate and last year filed federal tax return OR
• Birth (including adoption)*
                                                        If the document is NOT approved, you will                                   • Government Issued Marriage Certificate and Proof of Joint Ownership Issued in last 6 months OR
• Death of dependent (spouse or child)                                                                                              • Government Issued Marriage Certificate ONLY (if married in current calendar year).
                                                        receive a work email letting you know what
• Entitlement to or loss of Medicare or Medicaid       else is needed, or if there is a problem with         Biological Child      • Government Issued Birth Certificate ONLY.
   (60 day enrollment window)                                                                                 (Age 0 up to 26)
                                                        your enrollment.
                                                                                                              Disabled              • Government Issued Birth Certificate AND completed disabled child certification form (must be
• Gain of other coverage                               Adding a dependent will require a dependent           Biological Child         medically certified by a physician as disabled or by Social Security Disability (SSDI).
• Legal Separation                                      verification supporting document to be uploaded
                                                                                                              Step-Child            • Government issued Birth Certificate AND Associate’s Government issued Marriage Certificate.
                                                        and approved before your dependent information
• Loss of eligibility for participation in Dependent                                                         (Age 0 up to 26)
                                                        will be sent to the carrier(s). Link dependents to
   Care Flexible Spending Account (DFSA)                                                                      Disabled Step-Child   • Government issued Birth Certificate AND Associate’s Government issued Marriage Certificate AND
                                                        applicable cover as you are completing your
                                                                                                                                       completed disabled child certification form (must be medically certified by a physician as disabled or
• Loss of other coverage                                life event.                                                                    by Social Security Disability (SSDI).
• Marriage/Divorce                                      *F
                                                          or a birth or adoption event, you will be          Adopted Child         • Adoption Placement Agreement and Petition for Adoption OR
A status change from full-time to part-time or           able to add the dependent without the social         (Age 0 up to 26)      • Adoption Certificate ONLY.
a benefit ineligible to an eligible position will        security number. Once you receive his/her
                                                                                                              Disabled              • Adoption Certificate AND completed disabled child certification form (must be medically certified by a
automatically trigger an enrollment event. You will      social security number, you must enter it into My    Adopted Child            physician as disabled or by Social Security Disability (SSDI).
need to access My Benefit Express to enroll in           Benefit Express as soon as possible. However,
                                                                                                              Legal Ward            • Government Issued Birth Certificate AND Court Ordered Document of Legal Custody.
coverage(s) within 31 days of the change date.           the newborn will not be marked as verified
                                                         until you have provided a government issued          Disabled Legal Ward   • Government Issued Birth Certificate AND
                                                         birth certificate. The birth certificate MUST be                           • Court Ordered Document of Legal Custody AND
 All qualifying events must be entered into My
                                                         provided within 31 days of the date of birth. If                           • Completed disabled child certification form (must be medically certified by a physician as disabled or
 Benefit Express within 31 days of the event date                                                                                      by SSDI.
 and required documentation uploaded.                    you do not provide the birth certificate within
                                                         31 days, your newborn will be removed from           Qualified Medical     • Qualified Medical Child Support Order ONLY. Must be ordered for the associate or spouse.
                                                         coverage. If there is a problem with your life       Support Order
For example, if your child is born on March 1st,
                                                         event or supporting dependent verification, an       PLEASE NOTE: Verified dependent's are covered ONLY, if you have clicked the check box in each plan next to their name.
you must enter the date of birth as the event
date AND link the child to coverage(s) in                email will be sent from Benefit Express to your
                                                         work email. It is your responsibility to monitor
6                                                        work emails!                                                                                                                                                                           7
2020 BENEFIT GUIDE - AMITA Health
HEALTH                                                                                                                                                                                                                                                                         HEALTH

AMITA Health Medical Plan                                                                                                                                 2020 Schedule of Benefits: PPO 500 90/10 Plan
AMITA Health offers associates a Preferred                                                                                                                • Claims questions, benefit questions, eligibility: Contact ABS Customer Service at 844.659.2519
                                                                                                                                                          • To view claims or order an ID card visit: www.abs-tpa.com
Provider Organization (PPO) plan administered by
                                                                                                                                                          • To find a doctor or view the provider directory at www.mysmarthealth.org
Automated Benefit Services (ABS) and consists
                                                                                                                                                          All eligible medical expenses apply towards all deductibles and out-of-pocket maximums.
of the BlueCross BlueShield’s National Provider
                                                                                                                                                          Benefits                                     Tier 1 AMITA Network              Tier 2 National Network (BCBS)   Tier 3 Out-of-Network*
Network (BCBS of Michigan, aka BCBSM). PPO
plans allow associates to seek services from the                                                                                                          Deductible • Individual • Family             $500 / $1000                      $1,500 / $3,000                  $4,000 / $8,000

provider of their choice. The AMITA Health Medical                                                                                                        Coinsurance
Plan is a ‘tiered’ network with three tiers:                                                                                                              • Plan Pays                                  90% after AMITA                   70% after National               50% after
                                                                                                                                                                                                       Network Deductible                Network Deductible               OON Deductible

1. SmartHealth Network (Tier 1) consisting of                                                                                                            • You Pay                                    10% after AMITA                   30% after National               50% after
                                                                                                                                                                                                       Network Deductible                Network Deductible               OON Deductible
    AMITA Health, Adventist Midwest Health,                                     You and your family members will experience                               • Total out-of-pocket Maximum (Deductible plus coinsurance and copays)
   Alexian Brothers Health System and                                           a significantly higher level of benefits when                             • All eligible medical / Rx expenses apply toward all out-of-pocket maximums
   Presence Health System facilities and                                        receiving your care from a SmartHealth                                    • Individual • Family                        $4,000 / $8,000                   $6,000 / $12,000                 $10,000 / $20,000
   contracted providers; Providers can be                                       Network provider.                                                         Lifetime Maximum                             Unlimited
   found by going to the AMITA Health
                                                                                                                                                          Services                                     AMITA Network                     National Network                 Out-of-Network* (OON)
   provider website at www.mysmarthealth.org.                                   Certain services may require satisfying a                                 Preventive Service                           $0                                $0                               50% coinsurance after OON
                                                                                deductible. Once the deductible is satisfied by the                       Annual Routine Physical, Annual Sports                                                                          Deductible
2. BlueCross BlueShield National Provider                                      member, the plan will begin paying a portion of                           Physical, Well Baby/Child Care, Routine
    Network (Tier 2); and                                                       your remaining charges known as co-insurance.                             Immunizations, Annual Gynecological
                                                                                                                                                          Exam/Annual Mammogram,
                                                                                AMITA Health PPO plan provides associates                                 Screening Colonoscopy
3. Out of Network (Tier 3) – facilities/providers not                          financial security by placing an out-of-pocket limit                      Outpatient/Diagnostic Services               10% after AMITA                   30% after National               50% after
    contracted with BlueCross BlueShield National                               on health care expenses.                                                  Physical/Occupational/Speech Therapy         Network Deductible                Network Deductible               OON Deductible
    Provider Network.                                                                                                                                     (Annual Maximum – 60 Visits), Lab,
                                                                                Associates are free to seek services from the                             Pathology, Radiation and Chemotherapy,
                                                                                provider of their choice, however, associates’                            Radiology, Outpatient Surgery
You and your family members will experience a
                                                                                out-of-pocket expenses will be significantly                              High Tech Radiology                          Pre-Certification Required        Pre-Certification Required       Pre-Certification Required
significantly higher level of benefit coverage when                                                                                                       • MRI, PET Scan, MRA                         10% after AMITA                   30% after National               50% after OON Deductible
                                                                                lower if services are received from a
receiving your care from a SmartHealth Network                                                                                                                                                         Network Deductible                Network Deductible
                                                                                SmartHealth Network Provider.
provider. If you choose to seek care outside of                                                                                                           • Dialysis                                   10% after AMITA                   30% after National               50% after
AMITA Health, you will have access to BlueCross                                 Detailed Plan documents are available in                                                                               Network Deductible                Network Deductible               OON Deductible
BlueShield’s National Provider Network.                                         Benefit Express > Library.                                                Office Visits Primary Care                   $20 Copay                         $40 Copay                        50% after
                                                                                                                                                          (Family Practice/General Internal                                                                               OON Deductible
                                                                                                                                                          Medicine/Pediatrics)
                                                                                                                                                          • Specialist (Including OB/GYN)              $40 Copay                         $60 Copay                        50% after
                                                                                                                                                                                                                                                                          OON Deductible

              SmartHealth                                  BlueCross BlueShield                                                                           • Pre/Postnatal Care                         $20 Copay                         $40 Copay                        50% after
                                                                                                                    Out-of-Network                                                                                                                                        OON Deductible
               Network                                       National Network                                                                             • Chiropractic Office Visit (Annual         $20 Copay                         $40 Copay                        50% after
                                                                                                                                                             maximum – 60 visits) Ancillary services                                                                      OON Deductible
                                                                                                                                                             are subject to deductible/coinsurance
                    Tier 1                                              Tier 2                                              Tier 3                        Mental Health                                $20 Copay                         $40 Copay                        50% after
                                                                                                                                                          • Individual Therapy/Group Therapy                                                                              OON Deductible
         AMITA, Ascension,                                 Providers in the BCBS                                 Providers not in the
                                                                                                                                                          • Inpatient Admission/Partial Day           10% after AMITA                   30% after National               50% after
          and Adventist                                      National Network                                      BCBS Network                              Treatment, Intensive Outpatient Therapy   Network Deductible                Network Deductible               OON Deductible
          Health System                                                                                                                                   Substance Abuse                              $20 Copay                         $40 Copay                        50% after
                                                                                                                                                          • Individual Therapy/Group Therapy                                                                              OON Deductible
                                                                                                                                                          • Intensive Outpatient Therapy, Acute       10% after AMITA                   30% after AMITA                  50% after
                        Least Expensive                                                                   Most Expensive                                     Inpatient Care                            Network Deductible                Network Deductible               OON Deductible
                                                                                                                                                          • Residential Treatment Center               Pre-Certification Required        Pre-Certification Required       Pre-Certification Required
                                                                                                                                                                                                       10% after AMITA                   30% after National               50% after
                                                                                                                                                                                                       Network Deductible                Network Deductible               OON Deductible
Note: If you or your spouse are Medicare-eligible and continuing medical coverage through COBRA, your medical coverage through AMITA Health
becomes secondary and Medicare is primary even if you are not enrolled in Medicare Part B. If you leave employment or lose benefit eligibility, contact   • Partial Hospital Program                   10% after AMITA                   30% after National               50% after
your local Social Security office to enroll in Medicare Part B as soon as possible                                                                                                                     Network Deductible                Network Deductible               OON Deductible
                                                                                                                                                          Emergency Care • ER Visit – Copay            $200 Copay                        $200 Copay                       $200 Copay
                                                                                                                                                          waived if admitted

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2020 BENEFIT GUIDE - AMITA Health
HEALTH                                                                                                                                                                                                                                                                                                                        HEALTH

2020 Schedule of Benefits: PPO 500 90/10 Plan (continued)                                                                                                                                              Prescription Drug Coverage
 • Urgent Care                                                $40 Copay                                      $60 Copay                                       50% after                                 Associates enrolled in the Medical Plan
                                                                                                                                                             OON Deductible
                                                                                                                                                                                                       automatically receive the Prescription Drug
 • Ambulance                                                  10% after AMITA                                10% after AMITA                                 10% after AMITA                           Coverage benefit which is managed through Cigna.
                                                              Network Deductible                             Network Deductible                              Network Deductible
                                                                                                                                                                                                       Members (including dependents) will receive
 • Medical Transfer/Transport                                Pre-Certification Required                     Pre-Certification Required                      Pre-Certification Required
    (non-emergent)
                                                                                                                                                                                                       their own Pharmacy ID card. For a complete listing
                                                                                                                                                                                                       of medications covered, go to www.myCigna.com.
 Inpatient Services • Per Admission                           Pre-Certification Required                     Pre-Certification Required                     Pre-Certification Required
 • Room and Board • Ancillary Services                        10% after AMITA                                30% after National                             50% after OON Deductible
 • Surgery • Anesthesia                                       Network Deductible                             Network Deductible                                                                        Use of AMITA Health In-House pharmacies, may
 • Physician Charges
                                                                                                                                                                                                       reduce your medication expense.
 • Emergency Room Admission                                   10% after AMITA                                30% after National                             50% after
                                                              Network Deductible                             Network Deductible                             OON Deductible
                                                                                                                                                                                                       Certain medications require Prior Authorization
 • Extended Care Facility                                    10% after AMITA                                30% after National                             50% after
    (Annual maximum – 120 days)                               Network Deductible                             Network Deductible                             OON Deductible
                                                                                                                                                                                                       from Cigna before they are covered by the plan. If
                                                                                                                                                                                                       you are not sure a medication requires approval,
 Other Services                                               Pre-Certification Required                     Pre-Certification Required                     Pre-Certification Required
 • Durable Medical Equipment (DME)                            10% after AMITA                                30% after National                             50% after OON Deductible                   please check on-line or call the toll-free number
                                                              Network Deductible                             Network Deductible                                                                        on the back of your Cigna ID card. In these cases,
 • Prosthetics & Orthotics (P&O)                              10% after AMITA                                30% after National                             50% after                                  if your doctor feels that an alternative medication
                                                              Network Deductible                             Network Deductible                             OON Deductible                             isn’t right for you, he or she can ask Cigna to
 • Foot Orthotics – 2 pairs every 3 years                     50% after AMITA                                50% after National                             50% after                                  consider approving coverage of your medication.
                                                              Network Deductible                             Network Deductible                             OON Deductible
                                                                                                                                                                                                       In addition, certain high-cost medications are
 • Hearing Aid ($2,000 max, every 3 years)                   10% after AMITA                                30% after National                             50% after                                  part of the Step Therapy program. Step Therapy
                                                              Network Deductible                             Network Deductible                             OON Deductible
                                                                                                                                                                                                       encourages the use of lower-cost medications
 •Home Health Care (Annual max –                             10% after AMITA                                30% after National                             50% after
  100 visits)                                                 Network Deductible                             Network Deductible                             OON Deductible                             (typically generics and preferred brands) that can
 • Hospice                                                    10% after AMITA                                30% after National                             50% after
                                                                                                                                                                                                       be used to treat the same condition as the higher-
                                                              Network Deductible                             Network Deductible                             OON Deductible                             cost medication.
 • Allergy Testing & Treatment                                10% after AMITA                                30% after National                             50% after
                                                              Network Deductible                             Network Deductible                             OON Deductible                             Please note: 90-day supplies must be filled by
 • Bariatric Surgery                                          Pre-Certification Required                     Pre-Certification Required                     Pre-Certification Required                 the AMITA Health pharmacies. Prescription drugs
                                                              10% after AMITA                                30% after National                             50% after OON Deductible                   classified as specialty medications may only be
                                                              Network Deductible                             Network Deductible
                                                                                                                                                                                                       filled through an AMITA Health pharmacy.
 • Organ/Bone Marrow/Other Transplants                       Pre-Certification Required                     Pre-Certification Required                     Pre-Certification Required
                                                              10% after AMITA                                30% after National                             50% after OON Deductible
                                                              Network Deductible                             Network Deductible
 • Wellness/Disease Management                               $0                                             $0                                             50% after
 • Diabetic Education                                                                                                                                       OON Deductible
 • Smoking Cessation
    Counseling Intervention
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 ABS Customer Service at the number shown on the back of your ID card. Network Description: Tier 1 rep-
resents the AMITA network, which is comprised of participating AMITA providers and facilities, as well as the broader Ascension AMITA network. Tier 2 represents BCBS participating providers.
Members should make every effort to utilize a BCBS provider whenever an AMITA provider is not available in their area. Tier 3 represents Out-of-Network (OON) and any claim incurred could
result in balance billing and/or additional charges to the member. Pre-certification Required - Failure to secure “Pre-certification” for services noted in the Summary Plan Description will
result in no coverage/benefit paid under the Plan. For inpatient admissions, failure to obtain a pre-cert within (2) business days of admission will result in a $500 reduction in the facility pay-                                        In-House Pharmacies                 Retail Pharmacies                   Out-of-Network*
ment. 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 of an array of women’s pre-             Generic           • 30 day          $5                                  $10                                 No Coverage
ventive services that must be included in health plans without cost sharing to covered participants (for AMITA and Alexian Brothers ministries). Exclusions - See the Summary Plan Description                            • 90 day supply   $10                                 No coverage
for complete information regarding exclusions.
                                                                                                                                                                                                        Preferred Brand • 30 day            15% ($25 Min / $50 Max)             25% ($40 Min / $80 Max)             No Coverage
                                                                                                                                                                                                                        • 90 day supply     15% ($50 Min / $100 Max)            No coverage)
Benefit Elevation                                                                                                                                                                                       Non-Preferred Brand
AMITA's Benefit Elevation Program expands our                                                                                                                                                                            • 30 day           20% ($50 Min / $100 Max)            25% ($80 Min / $160 Max)            No Coverage
                                                                                                     **Please note that it takes a minimum of                                                                           • 90 day supply    20% ($100 Min / $200 Max)           No coverage
network for needed specialties by allowing you                                                         10 business days to process all benefit                                                          Specialty Rx – 30 Day Supply
to use a National Network (Tier 2) provider and                                                        elevation requests.**                                                                            • Available at AMITA               15% ($50 Min / $100 Max)            No Coverage                         No Coverage
receive the Tier 1 benefit coverage when a Tier 1                                                                                                                                                          In-House Pharmacy
provider is not available within 20 miles radius of                                                      For more information, go to                                                                    Specialty medication administered by a healthcare provider or via infusion will be billed through medical and medical deductible/coinsurance
participant’s zip code on record.                                                                        http://www.amitahealthproviders.org/provider/                                                  will apply. Self-administered specialty medications will be billed through Cigna.
                                                                                                         infocenter/member                                                                             In-House pharmacy list is available at www.AMITAHealthproviders.org under Member Info Center/Pharmacy Self Service/AMITA In-House
                                                                                                                                                                                                       Pharmacy Directory.

10                                                                                                                                                                                                                                                                                                                                                     11
2020 BENEFIT GUIDE - AMITA Health
HEALTH                                                                                                                                                                                                                                                                  HEALTH

Wellness Program                                       What do I need to do in order to be eligible for       AMITA Health Dental Plan
                                                       incentives?                                            AMITA Health provides you with a choice of

Healthy                    Journey                     To be eligible for the grand prize drawing and 2021
                                                       medical insurance incentive, you must complete
                                                                                                              two dental PPO plans through Delta Dental—a
                                                                                                              “High” and “Low” Plan. Both are Delta Dental
Together with CREATION Health                          the following steps by September 30, 2020:             Preferred Provider Organization (PPO) plans, giving
                                                                                                              you the freedom to visit any licensed network or
Our goal at AMITA Health is to improve the quality     1. Complete the on-site biometric screening           non-network dentist for covered services. You do
of life of the patients and communities we serve,         (see schedule in Wellness portal),                  not have to designate a primary care dentist. Plus,
but too often we are so focused on taking care of      2. Complete the online Health Risk Assessment,        you can visit any dental specialist for covered
others that we forget about our own health and             and                                                benefits up to an annual limit without waiting for
wellness. That’s why the Wellness department is                                                               prior approval from the plan.
                                                       3. Earn a minimum of 100 points on the
dedicated to inspiring, motivating and encouraging         Wellness portal.
healthy behaviors in you!                                                                                     You will generally save on the cost of covered
                                                       Additional information on Wellness                     dental care when you use a dentist who
The Wellness team invites you to join Healthy
                                                       Program is available on iAmita under                   participates in the Delta Dental PPO network.
Journey in 2020. This exciting, innovative program
is designed to engage you all year long. Focused       Departments>Wellness.
on choice and convenience, Healthy Journey offers
a variety of programs with the chance to win prizes!                                                          For More Information:
                                                                                                              • Search Delta Dental’s online dentist directory at
Who can participate in the Healthy                                                                               http://www.deltadentalil.com                                                                Preventative Dental Care Is Important!
Journey program?                                       Diabetes Management, Simplified                                                                                                                       You may receive two in-network cleanings
                                                                                                              • AMITA Health is part of the Delta Dental PPO                                                free-of-charge each plan year.
You are eligible to participate in Healthy Journey     AMITA Health now offers Livongo® for Diabetes            Plus Premier Network – meaning you can go to
if you are eighteen (18) years of age and an AMITA     to you. It’s covered 100% by your health plan. This      any dentist in the PPO or Premier Network                                                    Seeing a dentist regularly helps to keep your
Health associate or an Independent Contractor,         open enrollment period, register for Livongo®                                                                                                         teeth healthy and allows your dentist to watch for
Student, Intern, Volunteer, or otherwise employed      and receive a welcome kit in only 3-5 days. The        • The Delta Dental PPO toll free number                                                       developments that may point to health issues.
at an AMITA Health facility. You do not have to        program is available at no cost to you and your           is 800.323.1743                                                                             Remember to visit your dentist for your exam and
be benefit eligible to participate! However, if you    dependents who have diabetes and are covered                                                                                                          teeth cleaning.
are not paying for your own medical coverage,          through the AMITA Health medical plan.
you will not be eligible for the premium reduction.
Coverage for spouse and children is not eligible for   Eligible Members: The program is available
premium reduction.                                     at no cost to you and your dependents who have         High Plan Dental Highlights
                                                       diabetes and are covered through the AMITA              Annual Deductible (applies to Basic and Major Services Only)                                                      $50/person; $150/family
What is the 2021 incentive?                            Health medical plan.                                    Annual Maximum                                                                                                    $1,500/person

All participants can earn an entry into the            Here are some of the benefits of this program:          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.
Grand Prize Drawing for a chance to win one
of ten $1,000 prizes.                                  • More Than a Standard Meter: The Livongo®             Lifetime Orthodontic Maximum                                                                                      $1,500/person
                                                          meter is connected and provides real-time tips                                                                                                                         Delta Dental PPO        Delta Dental Premier®      Non- Network
                                                                                                                                                                                                                                 Network Dentist         Network Dentist            Dentist
Associates who pay for medical coverage can               and automatically uploads your blood glucose
potentially earn a premium discount for plan              readings, making log books a thing of the past.      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
                                                                                                                                                                                                                                 100%*                   100%**                     100%***

year 2021.                                                                                                     year; full mouth-every three years) • Fluoride treatments (once per benefit year to age 19) •
                                                       • Unlimited Strips at No Cost to You: Get as many      Space maintainers (once per lifetime to age 14) • Sealants (to age 16) • Periodontal maintenance •
                                                                                                               Emergency exams and palliative treatment
The premium reduction applies to medical                  strips and lancets as you need with no hidden
                                                                                                               BASIC SERVICES • Amalgam and composite resin (anterior) fillings • Posterior composites (tooth                    80%*                    80%**                      80%***
coverage only and cannot be applied to dental or          costs. When you are about to run out, Livongo        colored fillings on back teeth) • Non-surgical Periodontics • Surgical Periodontics • Endodontics •
vision premiums or combined with the Social               ships more supplies, right to your door.             Oral surgery – simple extractions • Oral surgery – surgical extractions including general anesthesia
                                                                                                               • IV sedation • Denture repairs
Just Subsidy.
                                                       • Coaching Anytime and Anywhere: The Livongo®          MAJOR RESTORATIVE SERVICES • Implants • Cast restorations – crowns, onlays, post and core •                       50%*                    50%**                      50%***
                                                                                                               Prosthodontics – bridges, partial dentures/complete
Each period, participants also have a chance to           coaches are Certified Diabetes Educators who
                                                                                                               ORTHODONTICS – dependents to age 26 and Adults Treatment necessary for proper alignment                           50%*                    50%**                      50%***
earn wellness merchandise items or enter the              are available anytime via phone, text, and our       of teeth
drawing for a chance to win one of the fifteen            mobile app to give you guidance on your nutrition    No TMJ Coverage                                                                                                   0%                      0%                         0%
$300 prizes.                                              and lifestyle questions.                            *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 den-
                                                       To Learn More or Join: join.livongo.com/AMITA/hi       tists 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.

12                                                                                                                                                                                                                                                                                                 13
2020 BENEFIT GUIDE - AMITA Health
HEALTH                                                                                                                                                                                                                                                                                                                                                    HEALTH

                                                                                                                                                                                           Vision Care through Vision
                                                                                                                                                                                           Service Plan (VSP)
                                                                                                                                                                                           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.

                                                                                                                                                                                           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 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 from
                                                                                                                                                                                              www.vsp.com.
                                                                                                                                                                                           •T
                                                                                                                                                                                             hat is it! There are no claim forms to complete
                                                                                                                                                                                            when you see a VSP provider.
                                                                                                                                                                                            Eyeconic Eyewear Store 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.

                                                                                                                                                                                            Benefit                       Description                                                                                         Copay                          Frequency
                                                                                                                                                                                                                                                                                                                                      Your Coverage with a VSP Provider

                                                                                                                                                                                            WellVision 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

Dental Plan Highlights - Low Plan                                                                                                                                                                                         • $90 Costco® frame allowance
                                                                                                                                                                                            Lenses                        • Single vision, lined bifocal, and lined trifocal lenses                                           Included in                    Every 12 months
 Annual Deductible (applies to Basic and Major Services Only)                                                      $75/person; $225/family                                                                                • Polycarbonate lenses for dependent children                                                       Prescription Glasses
 Annual Maximum                                                                                                    $1,000/person                                                            Lens Enhancements             • Scratch Resistant Coating                                                                         $0                             Every 12 months
                                                                                                                                                                                                                          • Standard progressive lenses                                                                       $55
 Enhanced Benefits Program – Your plan provides additional cleanings and/or applications of topical fluoride to people with specific health conditions that put                                                           • Premium progressive lenses • Custom progressive lenses                                            $95-105
 them at risk for oral health disease.                                                                                                                                                                                    • Average savings of 20-25% on other lens enhancements                                              $150-$175
 Lifetime Orthodontic Maximum                                                                                      $1,000/person                                                            Contacts                      • $160 allowance for contacts; copay does not apply                                                 Up to $50                      Every 12 months
                                                                                                                   Delta Dental PPO        Delta Dental Premier®      Non- Network          (instead of glasses)          • Contact lens exam (fitting and evaluation)
                                                                                                                   Network Dentist         Network Dentist            Dentist               Diabetic Eyecare Plus         • Services related to diabetic eye disease, glaucoma and age-related macular                       $20                            As needed
 PREVENTIVE/DIAGNOSTIC SERVICES Not subject to annual maximum • Routine exams (twice                               100%*                   100%**                     100%***               Program                          degeneration (AMD). Retinal screening for eligible members with diabetes.
 per benefit year) • Dental prophylaxis (twice per benefit year) • X-rays (bitewings-twice per benefit                                                                                                                       Limitations and coordination with medical coverage may apply. Ask your VSP
 year; full mouth-every three years) • Fluoride treatments (once per benefit year to age 19) •                                                                                                                               doctor for details.
 Space maintainers (once per lifetime to age 14) • Sealants (to age 16) • Periodontal maintenance •                                                                                                                                                                               Extra Savings
 Emergency exams and palliative treatment
                                                                                                                                                                                            Glasses and Sunglasses
 BASIC SERVICES • Amalgam and composite resin (anterior) fillings • Posterior composites (tooth                    60%*                    60%**                      60%***                • Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details.
 colored fillings on back teeth) • Non-surgical Periodontics • Surgical Periodontics • Endodontics •                                                                                        • 20% savings on additional glasses/sunglasses, including lens enhancements, from VSP provider within 12 months of WellVision Exam.
 Oral surgery – simple extractions • Oral surgery – surgical extractions including general anesthesia
 • IV sedation • Denture repairs                                                                                                                                                            Retinal Screening
 MAJOR RESTORATIVE SERVICES •Implants • Cast restorations – crowns, onlays, post and core •                        50%*                    50%**                      50%***                • No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam • Laser Vision Correction
 Prosthodontics – bridges, partial dentures and complete                                                                                                                                    • Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

 ORTHODONTICS – dependents to age 26 and Adults Treatment necessary for proper alignment                           50%*                    50%**                      50%***                                                                                   Your Coverage with Out-of-Network Providers
 of teeth                                                                                                                                                                                   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
 No TMJ Coverage                                                                                                   0%                      0%                         0%                    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 • Contacts…up to $105
*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    Lined Trifocal Lenses…up to $65 • Single Vision Lenses…up to $30
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 den-
tists 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     Coverage with participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information subject to change. In the event of conflict between
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   this information and your organization’s contract with VSP, the terms of contract prevails. Based on applicable laws, benefits may vary by location. In state of Washington, VSP Vision Care,
exceeding the maximum plan allowance.                                                                                                                                                      Inc., is the legal name of the corporation through which VSP does business.

14                                                                                                                                                                                                                                                                                                                                                                                     15
2020 BENEFIT GUIDE - AMITA Health
INCOME
 HEALTH                                                                                                                                                                                        SECURITY

2020 Medical, Dental and Vision Premiums                                                           Life and Disability Benefits
                                              Per Pay Period (Bi-Weekly)                           Basic Life                                                Supplemental AD&D* 100% Associate Paid
 Full-Time           Salary Banding       Associate          Associate +   Associate +   Family    Associates are automatically enrolled in Basic Life       All benefit eligible associates can purchase
 Standard Premium                                            Spouse        Children                and AD&D. AMITA Health provides this benefit              supplemental life coverage for one to ten times
                     $0 – $14.42          $62.66             $125.99       $118.07       $181.40   at no cost to benefit eligible associates. All full-      your covered base annual earnings up to a
                     $14.43 – $28.85      $69.64             $144.15       $134.84       $209.34   time and part-time benefit eligible associates are        maximum of $2,500,000. Premiums are deducted
                                                                                                   provided employer paid Basic Life/AD&D coverage           on an after tax basis from your paycheck. Coverage
                     $28.86 – $48.08      $74.30             $156.26       $146.01       $227.97
                                                                                                   at 1x annual earnings to a maximum of $1,000,000.         will be reduced as you age – 50% at age 70.
                     $48.09+              $78.96             $168.36       $157.19       $246.60
                                                                                                   The Prudential Insurance Company of America
 Full-Time           $0 – $14.42          $39.58             $102.91       $94.99        $158.32   provides this insurance.                                  When Coverage Ends
 Wellness Premium    $14.43 – $28.85      $46.57             $121.07       $111.76       $186.26                                                             Life and disability coverages end date of
                                                                                                   Basic Life – Key Provisions                               termination of your employment, or if you transfer
                     $28.86 – $48.08      $51.22             $133.18       $122.93       $204.89
                                                                                                   • If you are terminally ill, you can get a partial       to a benefit ineligible position. You may port
                     $48.09+              $55.88             $145.29       $134.11       $223.52
                                                                                                      payment of your group life insurance benefit. You      (continue) your group coverage in an amount
 Part-Time                                $119.73            $220.23       $198.97       $323.65      can use this payment as you see fit. The payment       equal to or lower than your current benefit amount
 Standard Premium                                                                                     to your beneficiary will be reduced by the amount      (exclusions and limits apply, see SPD for details).
                                                                                                      you receive with the Accelerated Benefit Option.
 Part-Time                                $96.65             $197.16       $175.90       $300.57
 Wellness Premium
                                                                                                   • Payment of premium can be waived if you are
                                                                                                      totally disabled for 6 months, you are less than         PLEASE NOTE!
 Dental HIGH                              $5.47              $10.95        $13.29        $20.61       60 years old when disability begins, and you             Changes to salary will impact Life, AD&D,
 Full-Time Premium                                                                                    continue to be totally disabled. The waiver              and disability elected levels of coverage.
                                                                                                      terminates at normal social security retirement
 Dental HIGH                              $15.66             $31.32        $38.02        $58.98       age. This provision may vary by state.
 Part-Time Premium
                                                                                                   • Coverage will be reduced as you age –
 Dental LOW                               $4.46              $8.92         $10.85        $16.83      50% at age 70.
 Full-Time Premium
                                                                                                   Supplemental Life* 100% Associate Paid
 Dental LOW                               $12.76             $25.52        $31.06        $48.17
 Part-Time Premium
                                                                                                   • You can elect a coverage from one to seven
                                                                                                      times your covered base annual earnings, not              Refer to any benefit
 Vision                                   $4.21              $6.73         $6.88         $11.10       to exceed $2,500,000. Rates for this insurance            Summary Plan
                                                                                                      are determined by your use of tobacco and age.            Document (SPD)
 Legal Plan                               $3.81              NA            NA            $5.54        Premiums are deducted on an after tax basis from          located on the
                                                                                                      your paycheck.                                            intranet, or in the
                                                                                                   • Coverage will be reduced as you age –                     Benefit Express
  There are 26 pay periods in the                                                                     50% at age 70.                                            Library for detailed
  calendar year. It is an associate’s                                                                                                                           Plan information.
  responsibility to confirm payroll                                                                Basic Accidental Death & Dismemberment
  accuracy, including benefit                                                                      (AD&D)* – Key Provisions
  deductions. Any missed deductions
                                                                                                   • Basic AD&D pays you and your beneficiary a
  will automatically be collected.
                                                                                                      benefit for loss of life or other injuries resulting
                                                                                                      from a covered accident. 100% is paid for loss of
Premiums for Life, Supplemental Life,                                                                 life. A lesser percentage is paid for other injuries
Supplemental Accidental Death &                                                                       such as loss of sight or speech, paralysis, and
Disability (AD&D), disability benefits,                                                               dismemberment of hands or feet.
and voluntary benefits will be                                                                     • Basic AD&D benefits are paid regardless of other
available during the enrollment                                                                       coverages in place.
process in Benefit Express website.
                                                                                                   • You are automatically enrolled for an amount
                                                                                                      equal to your Basic Life coverage amount.
                                                                                                   • Coverage will be reduced as you age –
                                                                                                      50% at age 70.                                             *SEE NEXT PAGE
16                                                                                                                                                                                                             17
2020 BENEFIT GUIDE - AMITA Health
INCOME                                                                                                                                                                                                                                                        INCOME
 SECURITY                                                                                                                                                                                                                                                      SECURITY

*Evidence of Insurability (EOI) is a questionnaire                                Insurance companies will request EOI to approve                               Short-Term Disability* (STD) Benefit
  that insurance companies use to ask about the                                    limits of insurance beyond the Guaranteed Issue                                                                                         Remember to review Plan information
  health of an associate and/or dependent spouse.                                  amount and, if you waived coverage upon initial                               STD is a benefit with coverage amounts and                and coverage options in Benefit Express.
  Depending on responses, this may lead into further                               offer. If coverage is approved, the effective date                            eligibility varying depending on the Ministry where
  questions about your/your dependent’s health.                                    will be the date the carrier approves coverage.                               you work. When you access Benefit Express, you
                                                                                                                                                                 will be able to see Plan details, eligibility, coverage   Benefit Express uses the same network user ID
                                                                                                                                                                 effective date, costs and coverage amounts                and password that you use to access a computer
Dependent Life*                                                                                                                                                  specific to your Ministry.                                at work. The enrollment site is available for Plan
Spouse - Dependent Life* (100% associate paid)                                                                                                                                                                             information review from any location with internet
                                                                                                                                                                 • This plan provides a benefit for disability,           access 24 hours / 7 days a week. You can also
          Spouse*                                       Term Life                                                           AD&D                                   illness or injury that is not work-related,             access Benefit Express through rAMITA.
 Eligibility                May purchase only if associate elects Supplemental Life.           May purchase only if associate elects Supplemental AD&D.
                                                                                                                                                                   including pregnancy.
                                                                                                                                                                 • Your plan also includes Rehabilitation benefits        *Evidence of Insurability (EOI) is a questionnaire
 Coverage and Limits        • Coverage amount cannot be greater than 50% of the               Spouse AD&D must not exceed 65% of the associate’s
                               associate Supplemental Life coverage amount.                    Supplemental AD&D.                                                   that provide services and support targeted at            that insurance companies use to ask about the
                            • May elect in increments up to $250K.                                                                                                  helping you return to active work.                       health of an associate. Depending on response,
                                                                                                                                                                                                                             this may lead into further questions about your
 Evidence of Insurability
 (EOI)
                            At time of hire may elect up to 25K without EOI. If increased or
                            elected any other time, EOI will be required.
                                                                                               There are no health requirements.                                 • Pre-existing Condition clause: STD and LTD               health.
                                                                                                                                                                    benefits will not be paid for a disability that
 Age Reduction              50% at age 70                                                      50% at age 70                                                                                                                Insurance companies will request EOI to approve
                                                                                                                                                                    begins within 3 months of your coverage
                                                                                                                                                                                                                            limits of insurance beyond the Guaranteed Issue
 Portability                Coverage will end at the termination of your employment or         Coverage will end at the termination of your employment or if        effective date and due to a pre-existing condition.     amount and, if you waived coverage upon initial
                            if an associate transfers to a benefit ineligible position. You    an associate transfers to a benefit ineligible position. May be
                            may port (continue) your group coverage in an amount equal         ported only if associate coverage is ported.                         A pre-existing condition is an injury or sickness       offer. If coverage is approved, the effective date
                            to or lower than your current coverage level only if associate                                                                          (including pregnancy) for which you received            will be the date the carrier approves coverage.
                            coverage is ported (exclusions and limits apply, see SPD
                            for details).                                                                                                                           medical treatment, consultation, diagnostic
                                                                                                                                                                    measures, prescribed drugs or medicines, or for
Child Dependent Life (100% associate paid)                                                                                                                          which you followed treatment recommendations
                                                                                                                                                                    during the 12 months prior to your effective date
               Child                                    Term Life                                                           AD&D                                    of coverage.
 Eligibility                May purchase only if associate elects Supplemental Life.           May purchase only if associate elects Supplemental AD&D.
                            Coverage may begin from live birth up to age 26.                   Coverage may begin from live birth up to age 26.
 Coverage and Limits        •Coverage amount elected cannot be greater than 50% of the        Child AD&D must not exceed 25% of the associate’s
                                                                                                                                                                 Long-Term Disability* (LTD) Benefit
                             associate Supplemental Life coverage amount.                      Supplemental AD&D.                                                LTD is a benefit with coverage amounts and
                            • May elect either $5,000 per $10,000 per child.
                                                                                                                                                                 eligibility varying depending on the Ministry where
 Evidence of Insurability
 (EOI)
                            There are no health requirements.                                  There are no health requirements.
                                                                                                                                                                 you work. When you access Benefit Express, you
                                                                                                                                                                 will be able to see Plan details, eligibility, coverage
 Portability                Coverage will end at the termination of your employment or         Coverage will end at the termination of your employment or if
                            if an associate transfers to a benefit ineligible position. You    an associate transfers to a benefit ineligible position. May be   effective dates, costs and coverage amounts
                            may port (continue) your group coverage in an amount equal         ported only if associate coverage is ported.                      specific to your Ministry.
                            to or lower than your current coverage level only if associate
                            coverage is ported (exclusions and limits apply, see SPD for                                                                         • Provides coverage for on–and-off-the-job
                            details).
                                                                                                                                                                    accidents, and benefits may be reduced if
                                                                                                                                                                    receiving other income.
                                                                                                                                                                 • Pre-existing Condition clause: STD and LTD
                                                                                                                                                                    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
                                                                                                                                                                   (including pregnancy) 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

18                                                                                                                                                               D                                                                                                               19
INCOME                                                                                                                                                                                                                                                                           INCOME
 SECURITY                                                                                                                                                                                                                                                                         SECURITY

Voluntary Permanent Whole Life –                        Accident Insurance pays you benefits for specific         Ascension Healthcare Retirement Savings Program—
                                                        injuries and events resulting from a covered
Voya Voluntary Benefit                                  accident that occurs while you are not at work, on
                                                                                                                  Alexian Brothers/Presence Health
Voluntary Permanent Whole Life Insurance through        or after your coverage effective date.
                                                                                                                                                                      Features                                                                             How It Works
VOYA Financial is an associate paid benefit
available to benefit eligible full-time and part-time   The benefit amount depends on the type of injury           2020 retirement plan components
associates. To supplement your Basic Life AD&D          and care received. You have the option to elect            • Your pretax contribution                                                                            This is the amount you elect to contribute to the plan.

insurance provided by AMITA, you may purchase           Accident Insurance to meet your needs. Accident
                                                                                                                   • Employer Matching Contribution                                                                      See Employer Matching Contribution below.
                                                                                                                   • Employer Automatic Contribution (EAC)                                                               See EAC information on page 2.
additional life insurance coverage for yourself, your   Insurance is a limited benefit policy. It is not health
                                                                                                                   Your pretax contribution                                                                              • You can make pretax salary deferrals (a percentage of pay or a flat
spouse and dependent children through Voya.             insurance and does not satisfy the requirement of          •A
                                                                                                                     scension Healthcare 403(b) Retirement Savings Plan                                                    dollar amount) up to 80% of salary or IRS dollar limit ($19,500 in 2020). A
                                                        minimum essential coverage under the Affordable             (not-for-profit ministries)                                                                             catch-up provision allows associates age 50 and older to contribute an
                                                                                                                                                                                                                            additional $6,500.
Voluntary Permanent Life insurance provides a           Care Act.                                                                                                                                                        • Standard investment lineup for all plans
financial benefit that your family can depend on
                                                                                                                                                                                                                         • Loans – 403(b). No more than two loans per plan.
and getting it at work is easier, more convenient
and more affordable than doing it on your own.
                                                        Critical Illness Insurance –                                                                                                                                     • Hardship withdrawals – 403(b) only
                                                                                                                                                                                                                         • In-service withdrawal at age 59½
                                                        Voya Voluntary Benefit                                                                                                                                           • Variety of distribution options at termination or retirement
If you have financial dependents - a spouse,            Do you know someone who has had a serious                  Employer Matching Contribution                                                                        • Eligibility: 40 standard scheduled hours per pay period
children or aging parents, having life insurance        illness like a heart attack or stroke? You probably                                                                                                              • 50% of the first 6% of earnings you contribute each pay period to the
is a responsible and smart decision. Premiums           do but don’t expect to ever experience one                                                                                                                          Ascension Healthcare 403(b) Retirement Savings Plan
                                                                                                                                                                                                                         • If you are an eligible associate with at least one paid hour of service prior
never increase due to an increase in age and the        yourself. The problem is, no one thinks it could                                                                                                                    to January 1, 2020, you are 100% vested.
coverage is fully portable. Accelerated Life Benefit    happen to them and when it does, they may not be                                                                                                                 • If you were hired on January 1, 2020 or later, you are vested after three
Included: A lump sum benefit is paid to you if you      prepared for the financial ramifications.                                                                                                                           years of service. A year of vesting service is granted for each calendar year
                                                                                                                                                                                                                            in which you have at least 1,000 hours of service.
are diagnosed with a terminal condition, as defined                                                                                                                                                                      • You can take full advantage of the match by saving at least 6% of your
by the plan.                                            On top of the medical bills, there are still everyday                                                                                                               earnings per pay period.
                                                        expenses to pay for, which can be challenging             Employer Automatic Contribution and the Matching Contribution are subject to plan vesting requirements. Descriptions of plan features and benefits are subject to
                                                                                                                  the plan document, which will govern in the event of any inconsistencies between this newsletter and the formal plan documents.
                                                        during recuperation. Plus, you may need help with
     For more information, call Voya at                 day-to-day tasks like house maintenance, child care
     800.537.5024 or visit www.voya.com.                and transportation. That’s where Critical Illness
                                                                                                                                                                  Plan Features                                                                            How It Works

     You can view plan information                      Insurance can help.                                        Employer Automatic Contribution (EAC)                                                                 Eligibility

     in Benefit Express under the                                                                                  • For those eligible, your employer will put an annual contribution into
                                                                                                                      your retirement account.
                                                                                                                                                                                                                         • You are initially eligible to receive an EAC the first calendar year in which
                                                                                                                                                                                                                            you have at least 1,000 hours of service.
     Library category.                                  For more information, call Voya at 800.537.5024            • How much you receive is based on years of benefit service or $600                                  • Thereafter, the EAC is earned in any calendar year in which you are a
                                                        or visit www.voya.com.                                        (for full time 2,080 hours) — whichever is greater.                                                   participant and have at least 500 hours of service.
                                                                                                                   Years of Contribution                                            Benefit Service Percentage           • You must be employed on December 31 to receive an EAC for the year,
                                                                                                                                                                                                                            unless you leave employment after age 55 and are vested.
No medical questions asked, if you enroll when                                                                     Less than 5 years...........................................................2.0% of earnings
                                                                                                                   5–9 years..........................................................................2.5% of earnings   Vesting
initially offered the coverage unless you elect over                                                                                                                                                                     • A year of vesting service is granted for each calendar year in which you
                                                                                                                   10–14 years.......................................................................3.0% of earnings
the guarantee issue amount.                                                                                                                                                                                                 have at least 1,000 hours of service.
                                                                                                                   15 years or more..............................................................3.5% of earnings
                                                                                                                                                                                                                         • Vesting in your account requires at least five years of vesting service.
• Spouses and Children are limited to 50% of the                                                                  OR if greater, $600 (prorated for less than 2,080 hours)
                                                                                                                                                                                                                         • Active participants who reach age 65 are vested with one year of
   associate face amount for amounts in excess                                                                                                                                                                              vesting service.
  of $5,000                                                                                                                                                                                                              Timing of Contribution
                                                                                                                                                                                                                         • Generally, the EAC is deposited in the spring after the end of each
• Age reduction rules apply. Contact Voya                                                                                                                                                                                  calendar year.
   for details.                                                                                                                                                                                                          • For example, the 2020 EAC will be deposited in late March/early April 2021.
                                                                                                                   Fees
Accident Insurance –                                                                                               The following fees are charged in the Retirement Program:

Voya Voluntary Benefit                                                                                             • Investment management fees — Pay for fund management, investment research, and other investment-related expenses. Fees differ by investment option.
                                                                                                                   • Administrative fees — P
                                                                                                                                             ay for core services provided to all participants. The annual administrative fee is $36 per account, charged monthly at
                                                                                                                                            $3 per account.
Have you ever dislocated a joint or gotten a deep
                                                                                                                   More information on investments and fees can be found at transamerica.com/portal/ascension.
cut? How about something more severe, like a
                                                                                                                   Need help? Contact Transamerica.                                                                      • Meet with your onsite Retirement Planning Consultant.
concussion or broken bone? Most of us have
                                                                                                                                                                                                                         •C
                                                                                                                                                                                                                           all Transamerica at 877.346.7284, and say “Yes” when prompted to
experienced an accident that needed medical                                                                                                                                                                               access your Retirement Savings Program account.
attention as least once in our lives. Accident                                                                                                                                                                           • Visit transamerica.com/portal/ascension.
Insurance can help relieve some of the financial                                                                  Retirement Planning Consultants are registered representatives of Transamerica Investors Securities Corporation (TISC), member FINRA, 440 Mamaroneck Avenue,
stress that goes along with an accidental injury.                                                                 Harrison, NY 10528. Investment advisory services are offered through Transamerica Retirement Advisors, LLC (TRA), registered investment advisor. All Transamerica
                                                                                                                  companies identified are affiliated, but are not affiliated with your employer.

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