A Guide to Your Benefits - Sinai, Northwest, Levindale (Non-Union) 2020 - LifeBridge Health
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
A Guide to Your Benefits Sinai, Northwest, 2020 Levindale (Non-Union)
Enrolling in
Your Benefits
Welcome to your benefits
At LifeBridge Health, we CARE BRAVELY not only for our patients and their families, but
also for our dedicated team members who help our patients and families every day.
Review this guide and
the information on Please use this benefits guide as a resource for the plans offered by LifeBridge Health
BridgeNet for the 2020 calendar year. We want to ensure you understand the benefits and the
packages we offer, so you can get the most out of them.
Please take the time to review the options outlined in this booklet and select coverage
that works best for you and your family. Typically, unless you have a change in your family
status, the selections that you make will stay in place for the entire 2020 calendar year.
If you have any questions, please do not hesitate to reach out to Employee Services by
calling 410-601-8000 or emailing employee_services@lifebridgehealth.org.
Collect any
dependent/spouse
documentation As a LifeBridge Health team member, your health and well-being are important to us. We
required and are excited to CARE BRAVELY for you, so you can care for others, and we’re proud of the
submit to Employee benefits that we have to offer to you and your loved ones.
Services
Best,
Neil M. Meltzer
President & Chief Executive Officer
Make your benefit
elections and enroll
in GHR
Table of Contents
3 Benefit Basics
5 Medical Plan New Hires
You have 30 days to
6 Prescription Drug Coverage
enroll in your benefits.
Review and print 8 Health Savings Account If you do not enroll
your benefits
confirmation 9 Flexible Spending Accounts during this time, you
statement
10 Dental Plan
will not be eligible to
enroll until the next
11 Life Insurance & Disability annual enrollment
13 Additional Benefits period unless you
16 403(b) Retirement Savings Plan experience a qualified
life event.
17 Dependent Verification Process
Pay close attention to 18 Glossary of Terms
your first paycheck
with your new payroll 19 Contact Information
deductions
2
Benefit Basics
Your 2020 Benefits Are Effective January 1 Through December 31
Covering Yourself and Your Family You and the Affordable Care Act
Medical, prescription, dental and Spending Account If you work full-time, as defined by the Affordable Care Act
benefits are effective the first of the month following date (ACA) requires that LifeBridge Health offer you affordable
of hire. All other benefits are effective the first of the month medical coverage. If you are a part-time (.6 FTE or under)
following 30 days of employment. or variable hour associate, the number of hours you work
may flex between full-and part-time employment which
The following dependents are eligible: may impact your medical coverage eligibility each year.
• Your legal spouse Full-time, as defined under the ACA, is working on average
30 hours per week during the applicable review period.
• Children up to age 26 (regardless of their student
status or if they are claimed as a dependent for income
tax purposes), or your disabled children if disabled Making Changes During the Plan Year
before age 26* You may only change your benefit elections during the
*Note: Voluntary benefits may have different age year if you experience a qualified life event such as:
requirements so please review the materials carefully.
• Marriage, divorce or legal separation
• Birth or adoption of a child
Are You Providing Coverage to a
• Death of your spouse or dependent child
New Dependent? • Change in employment status of team member, spouse
If you enroll a new dependent for benefits, you or dependent child
will be required to provide documentation to
confirm their eligibility. All documentation should To make changes, contact Employee Services within 30
be submitted to Employee Services at days of a qualifying life event. You may need to provide
employee_services@lifebridgehealth.org or via fax at proof of the event, such as a marriage license. If you don’t
410-601-8001. If you do not provide the required take action, you’ll have to wait until the next enrollment
documents within 30 days, your dependents will not period to make changes unless you experience another
have coverage. View page 18 for detailed requirements. qualifying life event.
3
Benefit Basics
LifeBridge Health pays the full Benefit Who Pays Tax Treatment
cost of many of your benefits.
Medical LifeBridge Health/You Pretax
For others, LifeBridge Health and
you share the cost or you pay the Dental LifeBridge Health/You Pretax
full cost. Pretax means the cost
Basic Life and Accidental N/A, except on
comes out of your pay before Death & Dismemberment LifeBridge Health Life Insurance greater
taxes are deducted. After-tax (AD&D) Insurance than $50,000
means your cost comes out of Supplemental Life and
your pay after taxes are deducted. Accidental Death &
You After-tax
Dismemberment (AD&D)
The chart shows who pays for Insurance
each benefit and the related
Disability Coverage You (STD)
tax treatment. After-tax
LifeBridge Health (LTD)
Buy-up Long-Term
You After-tax
Disability
Flexible Spending
You Pretax
Accounts
Employee Assistance Plan LifeBridge Health N/A
403(b) Retirement
LifeBridge Health/You Pretax
Savings Plan
4
Medical Plans
LifeBridge Health offers two medical plan options - administered by CareFirst BlueCross BlueShield
(CareFirst). Each plan offers comprehensive health care benefits, including free preventive care
services and coverage for prescription drugs. Here’s how the plans compare.
Health Saver Plan (with HSA) Premium Health Plan
LBH CareFirst Out-of- LBH CareFirst Out-of-
Plan Provision
Network In-Network Network Network In-Network Network
Company Contribution to HSA 1
Individual $7001
Family $1,4001 N/A
Calendar Year Deductible
Individual $2,800 $3,000 $3,000 $200 $750 $2,250
Family $5,200 $6,000 $6,000 $400 $1,500 $4,500
Annual Out-of-Pocket Maximum
(Includes deductible, copays
and coinsurances)
Individual $4,000 $5,000 $6,600 $1,000 $4,000 $5,600
Family $8,000 $10,000 $13,200 $3,000 $8,000 $11,200
You Pay You Pay
Primary Physician Office Visit 20%* 40%* 50%* $10 30%* 40%*
Specialist Office Visit 20%* 40%* 50%* $35 30%* 40%*
Preventive Care – one per calendar
year (includes annual physicals, $0 $0 $0 $0
50%* 40%*
immunizations, routine cancer Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100%
screenings and well child visits)
Diagnostic Service (includes
Advanced imaging (PET, MRI, CT), $02 $250 copay $250 copay
20%* 40%* 50%*
other imaging (X-ray, sonogram), Plan pays 100% + 40% + 50%
Lab and other services)
$200 copay $200 copay $200 copay
Emergency Care3 20%* 20%* 20%*
per visit per visit per visit
Urgent Care 20%* 40%* 50%* $10 copay 30% 40%
Outpatient Facility and Ambulatory $250 copay $250 copay
20%* 40%* 50%* $0*
Surgical Facility + 40% + 50%*
$500 copay $500 copay
Inpatient Hospitalization4 20%* 40%* 50%* $0*
+ 30%* + 40%*
* After Deductible
1
If enrolling in the Health Saver Plan; the first half of funding is provided in January and the second half is provided in July as long as you are still
enrolled in the plan.
2
Must be performed by LifeBridge Health Provider, designated LifeBridge health Lab or Facility.
3
Emergency Room copay waived only if admitted; Emergency services available out-of-network.
4
Pre-authorization required.
Important Considerations
• You may use in- or out-of-network providers. You will always pay the least if you use the LifeBridge Provider Network.
Using a provider in the CareFirst network, instead of an out-of-network provider, will also help you save.
• You must meet an annual deductible before the medical plan begins to cover a portion of the cost for most care.
• Deductibles and Out-of-Pocket Maximums cross apply. Anything spent in either the LifeBridge Health Network, CareFirst
In-Network or Out-of-Network levels will accumulate toward all deductibles and out-of-pocket maximums for the year.
• Out-of-pocket maximums apply to both plans. This is the maximum amount you will pay for health care costs in a
calendar year. Your bi-weekly contribution rates will continue.
• You may be required to obtain pre-authorization from the plan prior to receiving certain services. If either you or your
provider does not pre-authorize care when necessary, you may not have coverage for that service.
5
Prescription Drug Coverage
This chart provides information about your prescription drug coverage. You can save on your
prescriptions by using a LifeBridge Health Pharmacy (Sinai Pharmacy, Northwest Outpatient Pharmacy
or Anchor Pharmacy, the on-site location at Carroll Hospital) or Mail Order.
Save With a LifeBridge Health Pharmacy Definitions
No Cost Preventive Medications: There is no copay ($0) Generic – A drug that offers equivalent uses, doses,
for generics used to treat high blood pressure, cholesterol, strength, quality and performance as a brand-name drug,
depression and diabetes if the prescription is filled at a but is not trademarked.
LifeBridge Health Pharmacy. Formulary – A drug with a patent and trademark name that
is considered “preferred” by the drug plan administrator
Long-term Medications: You have two options to receive
because it is appropriate to use for medical purposes and
a 90-day supply if you are taking a long-term medication.
is usually less expensive than other brand-name drugs.
Long-term medications are those taken regularly for
chronic conditions such as high blood pressure, asthma, Non-formulary – This type of drug is “not preferred” and is
diabetes or high cholesterol, and must be filled using one usually more expensive than generic and formulary brand
of these options: drugs.
Specialty – These drugs are typically the most expensive
• Option 1: A LifeBridge Health Pharmacy, including
options, may require special handling, can be difficult to
Sinai Outpatient Pharmacy, Northwest Outpatient
administer and often require additional clinical monitoring.
Pharmacy or Anchor Pharmacy, the on-site location
at Carroll Hospital.
• Option 2: Mail Order through a LifeBridge Health NEW: Effective January 1, 2020, if you have the option
Pharmacy or CVS Caremark. For LifeBridge Health, to fill a generic prescription but the pharmacy dispenses
please call 410-601-7100 or visit lifebridgehealth.org/ the brand-name medication for any reason other than
outpatientpharmacy. For CVS Caremark, the prescriber indicates "dispense as written," you will
call 866-294-2110 or visit www.caremark.com. pay the cost difference between the brand-name and
the generic medication plus the brand-name copay.
Health Saver Plan (With HSA) Premium Health Plan
CVS/Other Retail
Plan Provision Retail and Mail Order LBH Pharmacy1 Pharmacies
Annual Deductible
Individual Included in Medical $75 per person
Family (see page 5) $225 per family
Annual Out-of-Pocket Maximum
Individual Included in Medical $1,000 per person
Family (see page 5) $2,000 per family
Retail Prescription Drugs (30-day supply)
• Generic 20%* $10*2 $10*
• Formulary 30%* $30* $40*
• Non-formulary 40%* $50* $70*
• Specialty 50%* (LifeBridge Health Pharmacy only) $50* Not Covered
Mail Order Prescription Drugs (90-day Supply)3
• Generic 20%* $20*2 $20*
• Formulary 30%* $60* $80*
• Non-formulary 40%* $100* $140*
• Specialty 50%* (LifeBridge Health Pharmacy only) $100* Not Covered
*After deductible
1
LifeBridge Health Pharmacies: Sinai, Northwest, and Anchor Pharmacy (at Carroll Hospital Location only).
2
$0 copay for generics to treat high blood pressure, cholesterol, depression and diabetes, if the prescription is filled at LifeBridge Health Pharmacy.
3
Long Term Medications (Maintenance) must be filled at a LifeBridge Health Pharmacy or through CVS Mail Order.
6
Medical & Prescription Drug Rates
Bi-Weekly Rates Health Saver Plan (With HSA) Premium Health Plan
Full-Time Full-Time Full-Time
Full-Time Part-Time Part-Time
(
Health Savings Account
A Health Savings Account (HSA) provides additional options for paying medical expenses with tax-free
savings. LifeBridge contributes to your account to help offset some of your eligible expenses.
Account Type Health Savings Account (HSA)
Eligibility You must be enrolled in the Health Saver Plan with HSA and meet these requirements:
• Not be claimed as a dependent on another person’s tax return.
• Not be covered under another medical plan that is not HSA-eligible
• Not be enrolled in Medicare Part A or B, or be in receipt of VA medical or prescription benefits
within the previous three months.
Your contributions You contribute on a pretax basis and you can change how much you contribute from each paycheck.
The IRS maximum annual contribution is $3,500 for individual coverage and $7,000 for family
coverage. If you are age 55 or older, you may make a “catch-up” contribution of $1,000.
Company’s contributions LifeBridge Health contributes to your account (the first half is paid in January and the second half is
paid in July as long as you are still enrolled in the plan).
• $700 for individual coverage
• $1,400 for family coverage
The combination of your contribution and the company contribution cannot exceed the IRS maximum
for 2020 of $3,550 for individual coverage and $7,100 for family coverage.
Eligible expenses Medical, dental, vision and prescription drug expenses incurred by you and
your covered family members.
If you also wish to enroll in a Health Care FSA, you will only be eligible for
a Limited-Purpose Health Care Flexible Spending Account (FSA).
Using your account Use the debit card linked to your HSA or submit a claim form to cover the expenses, or pay the
expenses out of pocket and save your HSA money for future health care expenses.
Remaining Funds Any money left in your HSA at the end of the year will roll over to the next year —
you’ll never lose your HSA dollars.
If you leave LifeBridge Health or retire, you can take your HSA with you so you can
continue to pay and save for eligible health care expenses.
Fees There is a monthly fee of $2 for the HSA. As long as you are enrolled in the Health Saver Plan, at the
end of the year, LifeBridge Health reimburses the fee for you.
Setting Up Your HSA
To set up your HSA, you must complete the Customer Identification Program (CIP) process within 90 days
of enrolling. BNY Mellon will verify the information you provide, which is similar to the information you must
provide when setting up any bank account. If additional information is needed, BNY Mellon will contact you via
U.S. mail, and you will have up to 90 days to respond.
Once you pass the CIP process, you will receive a debit card from WageWorks in the mail. To view your balance,
submit claims and more, set up a WageWorks account at www.wageworks.com.
Remember to set up your beneficiary directly with WageWorks.
8
Flexible Spending Accounts
A Flexible Spending Account (FSA) helps you pay for eligible health care and dependent care costs
using tax-free dollars. You decide how much money you would like to contribute to each account on a
pretax basis.
Provision Health Care (FSA) Limited Purpose (FSA) Dependent Care (FSA)**
Specifically for associates enrolled in
Saves on eligible expenses not Save on eligible expenses for
the Health Saver Plan. Saves on eligible
Benefits covered by insurance; reduces qualified dependent care; reduces
expenses not covered by insurance;
your taxable income your taxable income.
reduces your taxable income
Maximum contribution is $5,000
Your
Maximum contribution is $2,700 Maximum contribution is $2,700 per year $2,500 if married and filing
contributions*
separate tax returns
Dependent care expenses (such as
Most medical, dental and vision day care, after school programs or
Eligible Eligible expenses are limited to
care expenses that are not elder care programs) for children up
expenses qualifying dental and vision expenses.
covered by your health plan. to age 13 so you and your spouse
can work or attend school full-time.
When you incur expenses, you
can access account funds in When you incur expenses, you can
your account to pay for eligible access account funds in your account When you incur eligible expenses,
expenses. to pay for eligible expenses. you can access account funds
Using your
Use the debit card linked to your HSA that have been contributed and
account Use the debit card linked to
to cover the expenses, or pay the submit a “pay me back” claim with
your FSA to cover the expenses,
expenses out of pocket and submit a WageWorks.
or pay the expenses out of
pocket and submit a claim to be claim to be reimbursed by your FSA.
reimbursed by your FSA.
Use It or Reimbursable expenses must be incurred between January 1 and December 31. Claims for reimbursement
Lose It must be submitted by March 31, of the following year. Please plan your contributions carefully. With the exception
of up to $500 in the Health Care FSA rolling over from year-to-year, any money remaining in your account as of
March 31, 2020 will be forfeited per Internal Revenue Service regulations. FSA elections do not automatically
continue from year to year; you must actively enroll each year.
*You are not able to make changes to your annual contribution unless you experience a qualified life event.
** Due to IRS testing requirements associates designated as highly compensated employees may have their Dependent Care election limited to lower
annual amount.
9
Dental Plan
Regular dental care is an important part of caring for your overall health. Your dental plan is the Cigna Preferred Dental Plan,
with the DPPO network.
Provision In-Network Out-of-Network*
Annual deductible (Individual/Family) $50/$150 $50/$150
Annual maximum (per Individual) $1,500 $1,500
You Pay You Pay
Diagnostic and preventive (includes cleanings,
$0, no deductible $0, no deductible
fluoride treatments, sealants and X-rays)
Basic services (includes fillings, periodontics,
20% after deductible 40% after deductible
scaling and root planning, oral surgery)
Major Services (includes crowns, bridges, full
50% after deductible 50% after deductible
and partial dentures)
Major services (surgical) 50% after deductible 60% after deductible
Orthodontia (Child only up to age 19) 50%, after deductible, up to $1,200 Lifetime Maximum
Note: Additional cleanings are covered during pregnancy.
Dental Bi-weekly Rates Full Time Part Time
Individual $8.53 $10.10
Employee/Child(ren) $10.02 $15.03
Employee/Spouse $13.35 $20.04
Family $18.85 $28.23
* Out-of-Network may be subject to balance billing.
10Life Insurance & Disability
What would your family do if your income was lost due to death or disability? Life and disability
insurance are important for you and your family’s financial security.
Company-Provided Insurance Associate Paid Insurance
LifeBridge Health automatically provides the following
insurance benefits at no cost to you.1 You do not need Account Type Benefit
to enroll. Supplemental • Up to 5x your base annual salary, up to
Life and AD&D $2,000,000
Insurance • Guaranteed issue of 3x your salary, up
Account Type Benefit for you to $500,000 for new hires or newly
eligible employees
Basic Life • 1x your base annual earnings, up to
Insurance a maximum benefit of $200,000
Supplemental • Increments of $15,000, $25,000 or
Life and AD&D $50,000 (not to exceed the amount of
Basic Accidental • 1x your base annual earnings, up to
Insurance for the Associates basic and supplemental
Death and a maximum benefit of $200,000
your spouse coverage)
Dismemberment • Benefit is reduced beginning at
• Guaranteed issue up to $50,000 for
(AD&D) Insurance age 70
new hires or newly eligible employees
Long-Term • 50% of your base weekly earnings,
Supplemental • $10,000 per child up to the age of 26,
Disability up to $10,000 per month
Life and AD&D unless disabled before age 26
• 90 calendar day elimination period
Insurance for • Must be added within 30 days of birth
• Benefit begins on the 91st day of
your child(ren) or adoption, as a new hire or at open
disability and normally continues
enrollment
until the date that you are no longer
disabled, the date you reach Social
Short-Term • 60% of your weekly earnings, up to
Security age or the date of
Disability $1,500 per week
your death
for you* • 21 calendar day elimination period
1
The IRS requires you to be taxed on the value of employee-provided • Benefits begin on the 22nd day of
basic life insurance coverage that is greater than $50,000. This amount disability due to a non-work related
appears as imputed income (GTL) on your paycheck. injury and illness, and are payable up to
the 90th day, if approved
Buy-up • Covers up to 60% of your base weekly
Long-Term earnings up to $15,000 per month
Reminder regarding Life Insurance: Keep your Disability • Pre-existing conditions apply, please
beneficiary information up-to-date in GHR. for you reference Policy for detailed information
*EOI may apply
11Buy-up Long-Term Disability Supplemental Life and AD&D Insurance
You may purchase additional long-term disability (LTD) You may choose to purchase additional life and AD&D
coverage that provides up to 60% of your annual salary, up coverage for yourself and your dependents at affordable
to a $15,000 maximum monthly benefit. If you are interested group rates. Rates are based on age and the coverage
in purchasing this coverage, you may do so without level chosen.
Evidence of Insurability (EOI) when you are first benefits
eligible. Supplemental Life and AD&D Insurance for you
If you are interested in purchasing this coverage it is You may purchase coverage for yourself through after-tax
important that you understand if EOI will be required: payroll deductions as follows:
• New Hires or Newly Eligible - Guarantee issue, no EOI • Up to 5x your base annual salary, to a maximum
required of $2,000,000.
• Newly electing coverage and not a new hire or newly • Guarantee issue is 3x salary, up to $500,000 for new
eligible employee - Subject to EOI hires or newly eligible employees.
Employee earning $80,000 per year: EOI will be required during Annual Enrollment if:
• Monthly covered payroll: $6,667 • You are newly enrolling in supplemental life
(annual salary divided by 12) • You are increasing your coverage by more than 1x your
• Buy Up Rate: $0.382 per $100 of monthly covered payroll annual salary
• 0.382 x $6,667/$100 = $25.47 per month or $11.76 • You are electing coverage above 3x your annual salary
per 26 pays or $500,000
Employee earning $100,000 per year: Supplemental Life and AD&D Insurance for
your dependents
• Monthly covered payroll: $8,333
(annual salary divided by 12) You may purchase coverage through payroll deductions
• Buy Up Rate: $0.382 per $100 of monthly covered payroll as follows:
• 0.382 x $8,333/$100 = $31.83 per month x 12/ 26 or
Spouse
$14.69 per 26 pays
• Increments of $15,000, $25,000, or $50,000 (cannot
total more than basic plus supplemental life and AD&D
insurance coverage on the Associate)
Important Considerations • Guarantee issue up to $50,000 for new hires or newly
eligible
For Your Disability Plans
• If approved by the carrier, your disability • If you are enrolling for the first time or increasing the
payments begin after an elimination period. The coverage during Annual Enrollment, EOI will be required.
elimination period is the length of time you must Please contact Employee Services with questions.
be continuously disabled and unable to perform Child(ren)
your primary position (due to a non-work related
injury or illness) and under the appropriate care • $10,000 per child
of a physician before the disability benefits • Must be added within 30 days of birth or adoption, as a
become payable. new hire or at open enrollment
• Benefits may be reduced by other income, such • Coverage up to age 26, or disabled children
as Social Security.
• For Long-Term Disability, if in your first 12
months of coverage, any disability arises from Dependent Coverage Bi-weekly Rate
a condition for which you received treatment or Spouse $15,000 $1.42
took medications to treat in the three months
Spouse $25,000 $2.36
prior to your effective date will be excluded.
Spouse $50,000 $4.73
• To place a disability claim please contact
Cigna directly. Child* $10,000 $1.06
*Note: Rate is the same regardless of how many children are covered.
12Additional Benefits
Employee Assistance Program – CareBridge
If you find yourself in need of professional support to
deal with personal, work, financial or family issues, the
Employee Assistance Program (EAP) can help. You and
your immediate family (spouse, dependent children) can
use the EAP for help with:
• Marriage and family problems
• Job-related issues
• Stress, anxiety and depression
• Parent and child relationships
• Legal and financial counseling
• Identity theft counseling
• Financial planning
• Various other issues
The program is available 24/7, is completely confidential
and offered at no cost. If you need help or guidance,
call a CareBridge counselor at 800-437-0911 or visit
www.myliferesource.com, access code: KKNH3.
Hyatt Legal Group Voluntary Critical Illness Coverage
Attorney fees can be expensive. With this plan, attorney Group Voluntary Critical Illness coverage through MetLife
fees for the legal services listed below are fully paid for pays benefits for non-medical, critical illness-related
when you use a network attorney. There is no limit on the expenses that your medical plan might not cover. Benefits
number of times you may use the plan. are in the form of a lump sum payment, which is paid after
a diagnosis is made.
Covered services include, but are not limited to:
• Wills, trusts, powers of attorney, guardianship Critical Illness Insurance
• Mortgages, home equity loans, deeds, property Eligible Individual Initial Benefit
tax assessments Employee $10,000 or $20,000
• Small claims assistance Spouse 100% of the employees Initial Benefit
• Elder law Dependent Children 50% of the employee's Initial Benefit
• Identity theft
• Immigration assistance Your initial benefit provides a lump-sum payment upon the
• Debt collection defense/consumer protection first diagnosis of a covered condition. Your plan also pays
• Bankruptcy issues a recurrence benefit for the certain covered conditions.
The maximum amount that you can receive through your
• Adoption
Critical Illness Insurance is three times the amount of your
• Traffic ticket defense, restoration of driving privileges initial benefit.
Bi-weekly Rate MetLife will provide an annual benefit of $50 per calendar
Hyatt Legal $8.54 year for taking one of the eligible screening/prevention
measures. MetLife will pay only one health screening
benefit per covered person per calendar year. More details
can be found on BridgeNet.
13Group Voluntary Accident Coverage
Group Voluntary Accident coverage through MetLife can pay benefits for off-the-job accidents, plus some benefits that
correspond with medical care. The coverage can be used on its own or to fill a gap left by other coverage. It pays a benefit
up to a specified amount for dislocation/fracture, initial hospitalization confinement, hospitalization confinement, intensive
care, ambulance service, medical expenses, outpatient physician’s treatment and more.
The below chart shows a range of potential payment amounts for a given category of covered conditions. Actual payments
are determined by the benefit type.
Covered Benefits Low Plan High Plan
MetLife Accident Insurance Pays You MetLife Accident Insurance Pays You
Injuries –
Ranging from $25 – $5,000 per injury Ranging from $50 – $10,000 per injury
12 covered injury types
Medical Services & Treatment – Ranging from $15 – $1,000 per medical Ranging from $25 – $2,000 per medical
15 covered types service/treatment type service/treatment type
Hospital Coverage (Accident) $500 (non-ICU) or $1,000 (ICU) per accident $1,000 (non-ICU) or $2,000 (ICU) per accident
Admissions $100 per day (non-ICU), up to 31 days $200 per day (non-ICU), up to 31 days
Confinement $200 per day (ICU), up to 31 days $400 per day (ICU), up to 31 days
$100 per day, up to 15 days per accident and $200 per day, up to 15 days per accident and
Inpatient Rehab
30 days per calendar year 30 days per calendar year
$25,000 $50,000
Accidental Death
$75,000 is passenger in common carrier $150,000 is passenger in common carrier
Dismemberment, Loss & Paralysis $250 - $10,000 per injury $500 – $50,000 per injury
$100 per night, up to 31 nights; $200 per night, up to 31 nights;
Lodging up to $3,100 in total lodging benefits available up to $6,200 in total lodging benefits available
per calendar year per calendar year
$50 payable 1x per covered insured per $50 payable 1x per covered insured per
Health Screening (Wellness) calendar year, if covered insured takes a calendar year, if covered insured takes a
covered test covered test
Bi-Weekly Group Voluntary
Low Plan High Plan
Accident Rates
Employee Only $3.30 $5.46
Employee Plus Spouse $6.94 $11.63
Employee Plus Child $6.92 $11.40
Family $8.34 $14.34
14Pet Insurance Home and Auto Discount Program
Pet Insurance through PetFirst helps offset the You can receive special group discounts on auto, home,
cost of caring for your dog or cat, and covers and renter’s insurance through Liberty Mutual. The policies
everything from preventive care to accidents are tailored to suit your needs. Please contact Liberty
and illness, as well as the costs of X-rays, office Mutual to inquire and/or enroll.
visits, medications, surgeries and hospital stays.
Please note: Liberty Mutual will bill you directly. No payroll
deduction is offered.
Identity Theft Protection
This service through InfoArmor is designed to protect your
PrivacyArmor PrivacyArmor
identity and assets through identity, credit and social media Feature
Essential Plus
monitoring. InfoArmor also extends dependent coverage
to any dependent who lives in the same household as the Credit Monitoring 9 9
employee or who is financially dependent on them, with no
age limit.
Tri-Bureau Credit
Monitoring 8 9
PrivacyArmor is available in two comprehensive plans to fit Annual Credit Report 9 9
your needs with PrivacyArmor Essential and PrivacyArmor
Monthly Credit Score
Plus. Both products include:
Tracking 9 9
• Identity and credit monitoring
Social Media
• Annual credit report and monthly credit score tracking Reputation Monitoring 9 9
• Threshold monitoring
Digital Wallet Storage
• Social media reputation monitoring & Monitoring 9 9
• Digital wallet storage and monitoring
Full-Service Identity
• Full-service identity restoration Restoration 9 9
• $1,000,000 identity theft insurance policy
Privacy Advocate
• A digital exposure report Assistance 9 9
Note: If you are newly enrolling, you need to set up an $1,000,000 Identity
account with InfoArmor. You will receive a home mailer and Theft Insurance Policy 9 9
an email to your work email address. Expanded Data
Learn more at MyPrivacyArmor.com
Questions? Contact InfoArmor
Sources for
Transactions on 8 9
Financial Accounts
Additional Proactive
PrivacyArmor Essential
$3.66 per Individual
PrivacyArmor Plus
$4.59 per Individual
Alerts on Financial
Account Transactions
8 9
per Paycheck per Paycheck
Threshold Monitoring
$6.43 per Family $8.28 per Family on all Financial 9 9
per Paycheck per Paycheck Accounts
15403(b) Retirement Savings Plan
LifeBridge Health offers 403(b) Retirement
Savings Plan giving you an easy way to save for Vesting
your future through payroll deductions. Vesting refers to your right of ownership to the
money in your account. You are immediately
Eligibility vested in all of your contributions and earnings
on your contributions. You are 100% vested in
You are eligible to participate in the plan as of the first of employer match contributions after three years of
the month following completion of one month of service service. For vesting purposes, a year of service is
with the company. defined as a Plan Year in which you are credited
with 1,000 hours.
Your Contributions
Contributions from your pay are made on a pretax basis
up to the IRS annual limit of $19,500 for 2020. If you are
50 years of age or older, (or if you will reach age 50 by For More Information
the end of the year), you may make an additional catch-up For additional details about the 403(b) Retirement
contribution of $6,500, in addition to the IRS annual limit. Savings Plan or to enroll or change your contribution
rates or investment elections, please refer to
LifeBridge Health Contributions Transamerica Retirement Solutions at 800-755-5801,
or www.lbh.trsretire.com.
For details on your 403(b) match from LifeBridge Health,
visit BridgeNet at lbhweb/benefits. Remember: you can make changes to your 403(b) plan at
anytime during the plan year.
16Dependent Verification Process
You are required to complete the Dependent Verification Process for any dependent or spouse that
will be newly covered with LifeBridge Health Benefits. If you are not sure if you have the required
dependent verification on file, please contact Employee Services. Your dependent(s) will not have
coverage until you complete this process.
As part of our commitment to control health care costs, LifeBridge Health (LBH) is taking steps to ensure that only eligible
dependents are covered under our medical, dental and/or vision plans. To accomplish this, LBH has implemented a
dependent verification program. This process is intended to ensure that each dependent enrolled in the LBH medical,
dental and/or vision plans is accurately listed and eligible for coverage.
There are three (3) steps to the verification program clearly detailed below. Please complete all 3 steps for the dependents
you enrolled in benefits, if applicable.
1. Make sure that you provide legible copies of all required documentation.
2. Write your name and employee ID number on each piece of documentation.
3. Write “Not For Official Use” on each document and cross out the first five digits of any social security number.
Required Documentation:
Spouse: Disabled Dependent:
• A copy of your marriage certificate AND • A copy of the child’s birth certificate, naming you or
• One form of documentation establishing current marital your legally married spouse as the child’s parent, or
status such as a joint household bill, joint bank/credit appropriate court order / adoption decree naming
account, joint mortgage or lease, or front page of your you or your legally married spouse as the child’s legal
jointly filed federal tax return. guardian AND
• A copy of a physician certification confirming the
Child:
child’s disability status.
• A copy of the child’s birth certificate, naming you or your
legally married spouse as the child’s parent, or appropriate
court order / adoption decree naming you or your legally
married spouse as the child’s legal guardian.
All required documentation must be received by Employee Services as soon as possible. You can submit documentation via
fax at 410-601-8001 or email at employee_services@lifebridgehealth.org
Your dependent(s) will not have coverage until we receive the documentation. If documentation is not received within 30
days of your start date, your dependent will not be eligible for coverage until the next open enrollment period unless they
experience a qualifying life event.
If you have any questions regarding this process please contact Employee Services at 410-601-8000 or
employee_services@lifebridgehealth.org
17Glossary of Terms After-tax – The contributions you make for benefits such as Life and AD&D insurance and Disability insurance are subject to Social Security tax, federal income tax and, in most cases, state and local income taxes. Calendar Year Maximum – The benefit amount paid each year for each family member enrolled in the dental plan. Coinsurance – The sharing of cost between you and the plan. For example, 80 percent coinsurance means the plan covers 80 percent of the cost of service after a deductible is met, and you will be responsible for the remaining 20 percent of the cost. Copay – A fixed amount (for example $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. Deductible – The amount you have to pay for covered health care services before your health plan begins to pay. Elimination Period – The time period between the beginning of an injury or illness and receiving benefit payments from the insurer. Flexible Spending Accounts (FSA) – FSAs allow you to pay for eligible health care and dependent care expenses using tax- free dollars. The Health Care Account can be used to pay for services not covered by your medical, dental or vision plan such as copayments, coinsurance deductibles, prescription expenses, lab exams and tests, contact lenses, and eyeglasses. The Dependent Care Account is used to pay for day care expenses associated with caring for elder or child dependents that are necessary for you or your spouse to work or attend school full-time. The money in the account is subject to the “use it or lose it” rule which means you must spend the money in the account before the end of the plan year. Health Savings Account (HSA) – An HSA is a personal health care account for those enrolled in an HDHP. You may use your HSA to pay for qualified medical expenses such as doctor’s office visits, hospital care, prescription drugs, dental care, and vision care. You can use the money in your HSA to pay for qualified medical expenses now, or in the future. Your HSA can be used for your expenses and those of your spouse and dependents, even if they are not covered by the HDHP. High Deductible Health Plan (HDHP) – A qualified High Deductible Health Plan (HDHP) is defined by the Internal Revenue Service (IRS) as a plan with a minimum annual deductible and a maximum out-of-pocket limit. These minimums and maximums are determined annually and are subject to change. In-network – A designated list of health care providers (doctors, dentists, etc.) with whom the health insurance provider has negotiated special rates. Using in-network providers lowers the cost of services for you and the Company. LifeBridge Health (LBH) Network – LifeBridge Health Provider Network Out-of-network – Health care providers that are not in the Plan’s network and who have not negotiated discounted rates. The cost of services provided by out-of-network providers is much higher for you and the Company. Additional deductibles and higher coinsurance will apply. Out-of-pocket maximum – The most you will pay of your own money before services are 100 percent covered by the medical plan. Your annual deductible is included in your out-of-pocket maximum. Pretax – The contributions you make for medical, dental, vision, HSA, FSA health care spending and FSA dependent care spending are not subject to Social Security tax, federal income tax or, in most cases, state and local income taxes. Reasonable & Customary Charges (R&C) – Prevailing market rates for services provided by health care professionals within a certain area for certain procedures. Reasonable and Customary rates apply to out-of-network charges. 18
Contact Information
Plan Provider Phone Number Website
Medical CareFirst 866-595-6245 www.carefirst.com
Prescription Drugs CVS 866-294-2110 http://caremark.com/wps/portal
Dental Cigna 800-244-6224 www.cigna.com
Flexible Spending Accounts WageWorks 877-924-3967 www.wageworks.com
FMLA/LOA Requests FMLA Source 877-462-3652 www.fmlasource.com
Levindale
410-828-4500 www.ccumd.org
Central Credit Union of Maryland
Northwest
Credit Union 410-663-2500 www.destinationscu.org
Destinations Credit Union
Sinai
800-903-3328 www.firstfinancial.org
First Financial Credit Union
Health Savings Account (HSA) WageWorks 877-924-3967 www.wageworks.com
Life Insurance and AD&D MetLife 800-438-6388 www.mybenefits.metlife.com
Disability Cigna 800-781-2006 www.cigna.com
800-437-0911
Employee Assistance Program Carebridge Company Access Code: www.myliferesource.com
KKNH3
Critical Illness/Accident
MetLife 800-438-6388 www.mybenefits.metlife.com
Insurance
800-438-6388
Legal Assistance Hyatt Legal Company Access Code: www.mybenefits.metlife.com
571687
Identity Theft Protection InfoArmor 800-789-2720 www.InfoArmor.com
Home and Auto Insurance Liberty Mutual 800-295-3549 www.libertymutual.com
Pet Insurance PetFirst 866-937-7387 www.petfirst.com/lifebridge
403(b) Retirement Transamerica Retirement
800-755-5801 www.lbh.trsretire.com
Savings Plan Solutions
Additional Resources Service Phone Number Website
Employee Services For HR/Benefit/Payroll inquires 410-601-8000 employee_services@lifebridgehealth.org
Provides you access to plan
contact information, group
Mobile Wallet Card numbers and benefit guides — mymobilewalletcard.com/lifebridge
anywhere from your computer
or mobile phone
Additional support in
Enrollment Counselors understanding your benefits and/ 855-736-1446 —
or to make enrollment elections
19About this Guide: This benefit summary provides selected highlights of the LifeBridge Health employee benefits program. It is not a legal document and shall not be construed as a guarantee of benefits nor of continued employment at the company. All benefit plans are governed by master policies, contracts and plan documents. Any discrepancies between any information provided through this summary and the actual terms of such policies, contracts and plan documents shall be governed by the terms of such policies, contracts and plan documents. LifeBridge Health reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The authority to make such changes rests with the Plan Administrator.
You can also read
