Employee Benefits Guide 2018 - Let's deal with it together - Valley Behavioral Health

 
Employee Benefits Guide 2018 - Let's deal with it together - Valley Behavioral Health
Employee
               Benefits Guide
                   2018

                               What’s inside:
                               Contact Information
                               How to Enroll
                               Benefits Information
                               Disclosure

Let’s deal with it together.
Employee Benefits Guide 2018 - Let's deal with it together - Valley Behavioral Health
Employee Benefits Guide 2018 - Let's deal with it together - Valley Behavioral Health
Contact Information

                                                                                                         Enrollment Notice
                          Table of Contents

   Contact Information                                                       3            I understand that, in order to enroll in
   Medical Plan Information                                                  5            benefits, I must login to Ultipro in order to
   Health Savings Account Information                                        7            enroll or decline coverage. I understand
                                                                                          that if I fail to enroll (within 15 days of hire
   Flexible Spending Account Information                                     8
                                                                                          date), I am waiving coverage and will not
   Dental Plan Information                                                   9            have coverage. I understand that my next
   Vision Plan Information                                                  10            opportunity to enroll will not be until the
   Life Plan Information                                                    11            next open enrollment in 2019, unless I have a
   STD Plan Information                                                     12            qualified change in status event.

   LTD Plan Information                                                     12
   401(k)                                                                   13

                                                                   Have an Issue?
                                                  First
                                                     »» Call the insurance company or benefit
                                                        provider using the contact numbers listed
                                                        below.

                                                  Second
                                                     »» If your issues are still not resolved, please
                                                        contact Karyne Anderson in Human
                                                        Resources.

                                                              Contact Information

   Benefit Plan                                                        Telephone                           Internet
   Medical - Group # G1010990
    SelectHealth                                                       800-538-5038                        selecthealth.org

   Dental - Group #5983963
    MetLife                                                            800-275-4638                        metlife.com/mybenefits

   Vision - Group #5983963
     MetLife                                                           800-275-4638                        metlife.com/mybenefits

   Life and Disability
                                                                       800-275-4638                        metlife.com/mybenefits
     MetLife
   Health Savings Account
                                                                       866-382-3510                        healthequity.com
    Health Equity
   Flexible Spending Account
                                                                       855-399-3035                        nbsbenefits.com
     NBS

   Human Resources
     Karyne Anderson                                                    801-263-7214                       karynea@valleycares.com
                                                                                 3
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Employee Benefits Guide 2018 - Let's deal with it together - Valley Behavioral Health
General Information
  Who is Eligible                                                                  Important Notices
    »» Fully benefitted employee that works 40+ hours per week.                    The following benefit summaries are for ease of comparison.
    »» ACA eligible (medical benefits) employee that works 30-40                   This brief highlight brochure provides a summary only of
       hours per week                                                              benefits available to eligible employees and their eligible
    »» Your legal spouse and/or domestic partners.                                 dependents. Valley Behavioral Health reserves the right to
    »» Your children up to age 26 regardless of marital or                         audit the dependency status of individuals enrolled by an
       student status.                                                             employee.     This process may include a complete eligibility
    »» Your unmarried children of any age, if they depend on                       verification of all enrolled dependents and/or verifying
       you for support due to a physical or mental disability                      relationship and status of new dependents registered during
       (documentation required).                                                   open enrollment, by new-hires, and qualifying events. Ensure
                                                                                   that you are covering only eligible dependents when you enroll
                                                                                   in the plan offerings.
  When does coverage begin for new hires?
                                                                                   The information in this booklet supersedes all prior summaries.
  Coverage begins the first of the month following 30 days of                      However, since this booklet is only a summary, it does not
  employment. You must be full time and actively at work for                       describe every detail of the benefit programs outlined. If there
  your coverage to become effective.                                               are any inconsistencies or discrepancies between this booklet
                                                                                   and the governing plan documents and benefit contracts, the
  Choose Wisely                                                                    governing plan documents and benefit contracts will prevail.
                                                                                   The governing plan documents and benefit contracts are
  The choices you make will remain in effect during the 2018                       available for your review in your Human Resource Department.
  plan year unless you have an IRS approved qualifying change
  of status                                                                        Refer to the carrier’s literature for specific details. No rights
                                                                                   shall accrue to you and/or your dependents because of any
                                                                                   statement, error, or omission in this comparison. Reasonable
  Financial hardship is not a qualifying event                                     efforts are made to keep employees informed of any changes
  for benefit changes                                                              in benefit plans. Please note that these benefits are subject to
                                                                                   change.
  A Qualifying Change of Status Occurs for
  the Following:                                                                   When Coverage Ends
    »» You get married, legally separated, or divorced.
    »» You add a dependent child through birth, adoption, or                       Most coverages terminate on the last day of the month your
       change in custody.                                                          employment with Valley Behavioral Health ends. Your life
    »» Your spouse or child dies.                                                  and disability coverages will always end on the last day of
    »» Your work schedule changes, i.e. reduction or increase in                   your employment. Refer to carrier literature, summary plan
       hours which affects eligibility.                                            descriptions, and master plan documents for specific plan
    »» Your spouse begins or terminates employment, which                          provisions, limitations, and exclusions.
       affects benefit coverage.
    »» You or your spouse loses health coverage through his/her
       employer.
    »» You receive a qualified medical child support order
       (QMCSO).                                                                                               »» Your employment with Valley
    »» Your spouse’s open enrollment; may be considered a                                                        Behavioral Health ends
       qualifying status change.                                                                              »» The group policy ends
                                                                                                              »» You are no longer eligible under the
  OR                                                                               Whichever                     plan
                                                                                   is earliest                »» Your death
  You have a 60 day special election period                                                                   »» You retire
  for the following:                                                                                          »» You enter the armed forces of any
                                                                                                                 country on a full-time basis
                                     »» You and/or your spouse
                                     and dependents gain or lose
                                     Medicare or Medicaid coverage.
                                     »» You qualify for a state
                                     sponsored premium assistance
                                     program.

                                     Don’t forget to add
                                     newborn babies to your
                                     plan within 30 days of
                                     their birth!

                                                                               4
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Employee Benefits Guide 2018 - Let's deal with it together - Valley Behavioral Health
Medical

                                                   SelectHealth HDHP
                                              High Deductible Health Plan (HSA)
                                                     In-Network                                           Out-of-Network
   Network                                           SelectMed Plus
   Annual Deductible                                 $3,000 per Individual                                $6,000 per Individual
                                                     $6,000 per Family                                    $12,000 per Family

   Out-of-Pocket Max                                 $5,000 per Individual                                $10,000 per Individual
      No Lifetime Max                                $10,000 per Family                                   $20,000 per Family

   Preventive Services                               Covered 100%                                         Not Covered

                                                     Primary Care: $15 AD^
   Office Visits Copay                                                                                    You Pay: 40% AD
                                                     Specialist: $25 AD

   Urgent and Emergency                              Urgent Care: $35 AD                                  Urgent Care: 40% AD
   Care                                              Emergency Room: $75 AD                               Emergency Room: $75 AD

   Mental Health Services
   Inpatient                                         You Pay: 20% AD
                                                     You Pay: 20% AD                                      You Pay: 40% AD
   Outpatient
   Office Visits                                     You Pay: $15 AD

                                                              Preventive medications available prior to deductible*
                                                                              Tier 1: $7 Copay AD
   Prescription Drugs
                                                                                 Tier 2: $21 AD
      30 Day Supply
                                                                                 Tier 3: $42 AD
                                                                                Tier 4: $100 AD
                                                                                           Tier 1 $7 Copay AD
   Prescription Drugs                                                                        Tier 2: $42 AD
      90 Day Supply
                                                                                             Tier 3: $126 AD

    For Inpatient and Outpatient services you pay the full negotiated rate until the annual deductible is met,
                                           then you pay coinsurance.

   Coinsurance AD                                    You Pay: 20% AD                                      You Pay: 40% AD

  Please refer to the Summary Plan Document for full plan description
  ^AD = After Deductible
  *See Carrier Preventive Drug List for specifics

                                                            Employee Rates per Month
                                                                With ValleyFit                             Without ValleyFit
                                                                Participation                               Participation
                      Employee                                      $72.04                                       $93.64
                      Two-Party                                     $142.84                                     $185.74
                      Family                                        $221.98                                     $288.58

                                                                               5
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Medical

                                                   SelectHealth HDHP
                                              High Deductible Health Plan (HSA)
                                                     In-Network                                           Out-of-Network
   Network                                           SelectCare Plus
   Annual Deductible                                 $1,750 per Individual                                $3,500 per Individual
                                                     $3,500 per Family                                    $7,000 per Family

   Out-of-Pocket Max                                 $5,000 per Individual                                $10,000 per Individual
      No Lifetime Max                                $10,000 per Family                                   $20,000 per Family

   Preventive Services                               Covered 100%                                         Not Covered

                                                     Primary Care: $15 AD^
   Office Visits Copay                                                                                    You Pay: 40% AD
                                                     Specialist: $25 AD

   Urgent and Emergency                              Urgent Care: $35 AD                                  Urgent Care: 40% AD
   Care                                              Emergency Room: $75 AD                               Emergency Room: $75 AD

   Mental Health Services
   Inpatient                                         You Pay: 20% AD
                                                     You Pay: 20% AD                                      You Pay: 40% AD
   Outpatient
   Office Visits                                     You Pay: $15 AD

                                                              Preventive medications available prior to deductible*
                                                                              Tier 1: $7 Copay AD
   Prescription Drugs
                                                                                 Tier 2: $21 AD
      30 Day Supply
                                                                                 Tier 3: $42 AD
                                                                                Tier 4: $100 AD
                                                                                           Tier 1 $7 Copay AD
   Prescription Drugs                                                                        Tier 2: $42 AD
      90 Day Supply
                                                                                             Tier 3: $126 AD

    For Inpatient and Outpatient services you pay the full negotiated rate until the annual deductible is met,
                                           then you pay coinsurance.

   Coinsurance AD                                    You Pay: 20% AD                                      You Pay: 40% AD

  Please refer to the Summary Plan Document for full plan description
  ^AD = After Deductible
  *See Carrier Preventive Drug List for specifics

                                                           Employee Rates per Month
                                                                With ValleyFit                            Without ValleyFit
                                                                Participation                              Participation
                     Employee                                      $173.90                                     $226.10
                     Two-Party                                     $346.90                                     $451.00
                     Family                                        $537.70                                     $699.00

                                                                               6
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Health Savings Account
  What is an HSA?                                                                  HSA Funding
    »» A tax-advantaged savings account that belongs to you.                       In 2018, the maximum amount the IRS allows you to contribute
    »» Works in conjunction with your medical plan to provide                      to your HSA is $3,450 for single and $6,900 for family coverage,
       a tax free way to pay for medical costs both before and                     but you don’t have to contribute it as a lump sum. If you are
       after the deductible.                                                       over age 55, you are eligible to contribute an additional $1,000
    »» You are only eligible to contribute to an HSA if you are                    per year. You may contribute to your HSA through pre-tax
       covered by a qualified high-deductible health plan                          payroll deductions. The more you contribute, the more you
       (HDHP).                                                                     have available to pay for medical, dental, and vision expenses
    »» If you have secondary coverage that is not also a HDHP,                     on a tax favored basis. Your contribution combined with the
       you are not eligible to contribute to an HSA. This may                      contribution from Valley Behavioral Health cannot exceed
       include coverage with a spouse, Medicare, TriCare, etc.                     the IRS maximums without incurring penalties. Please plan
    »» Funds in the HSA can be used for Medical, Dental, or                        your contributions with the maximum limits in mind. Valley
       Vision expenses.                                                            Behavioral Health will match your contribution dollar for
    »» Funds deposited are not taxed as income and the                             dollar up to a maximum of $750 for an individual and $1,500
       account can grow income tax free.                                           for 2 or more parties enrolled.
    »» Can be used for yourself, your spouse, and tax dependent
       children.                                                                   Why HSAs?
  How to use an HSA                                                                Traditional health plans have high premiums. At the end of the
                                                                                   year, all of the money that you and your employer have spent
                                                                                   on premiums is gone. On the other hand, with a health savings
    »» Until you meet your deductible, you are responsible to
                                                                                   account (HSA)-qualified high-deductible health plan (HDHP),
       pay the provider the negotiated rate. This rate is typically
                                                                                   the premium is lower, and some of the money you would have
       lower than any price you could negotiate on your own.
                                                                                   spent on premiums can go into your HSA instead.
    »» Always show your Insurance Card as expenses won’t go
       towards the deductible unless you show your Medical
                                                                                   Additionally, you save money on taxes and are given more
       card
                                                                                   flexibility and control over your health care costs
    »» Some doctors may require that you pay the full amount
       or a portion of the bill upfront, but most will simply bill
       your insurance, and then bill you for the balance once the                  You Can Grow Your Account Through
       claim has been processed.                                                   Saving or Investing
    »» The insurance plan will apply all discounts that apply and
       credit your deductible.                                                     All of the money in the HSA remains yours, even if you leave
    »» Once the claim is processed you will receive an                             your job, leave your qualifying health plan, or retire. In other
       explanation of benefits (EOB) showing the amount you                        words, an HSA is not a “use-it-or-lose-it” type of account.
       are responsible for.                                                        You decide how to use the HSA money, including whether to
    »» When picking up a prescription from the pharmacy,                           save it or spend it for health care expenses. As your balance
       present your insurance card. The pharmacy will apply the                    rolls over from year to year, it may earn interest. When your
       carrier discount and then you pay the pharmacy using                        balance is large enough, you can invest it—tax-free—the same
       your HSA debit card. The amount you pay will then be                        way you can invest dollars from other retirement accounts.
       applied to your deductible.
    »» Once your single or family deductible has been satisfied,                   You Gain Triple-Tax Savings
       your physician visits, hospital claims, and pharmacy
       charges will be processed by your health insurance plan                       »» Contributions to the HSA are tax-free for you—whether
       and you will pay copays or coinsurance.                                          they come from you, your employer, or as gifts from
    »» You can pay these charges using your HSA debit card as                           friends or relatives.
       long as you have a balance in your HSA.                                       »» Your account and investment earnings are tax-free.
                                                                                     »» You can withdraw your money tax-free at any time, as
                                                                                        long as you use it for qualified medical expenses.

                                                                               7
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Flexible Spending Account
  What is a Flexible Spending Account?                                             How it Works
  A tax-advantaged plan that allows you to put money aside for                     During annual enrollment or your initial enrollment, you decide
  your plan year.                                                                  how much you want to deposit into your reimbursement
    »» Monies elected are not taxed, saving you from 10%-30%                       account(s). That amount is deducted evenly during the year
       or more on the money deposited, depending on your tax                       from your paycheck before taxes are taken out. When you have
       rate.                                                                       an expense that qualifies, you may use your FSA Card or you
    »» All money elected is available from the 1st day of the plan                 may pay the bill, submit a claim, and receive a reimbursement
       year.                                                                       with tax-free dollars from your account. It is important
    »» PICK APPROPRIATE                                                            to retain receipts whether you’re using your debit card or
    »» {Full} – You can elect up to the IRS allowed amount                         submitting claims for reimbursement in case of IRS audit or in
       annually, deducted on a per paycheck basis.                                 case substantiation is requested by National Benefit Services,
    »» Amounts can be used for Medical, Dental, and Vision                         LLC (NBS).
       expenses.                                                                   You can check your balance and view detailed claims history
    »» Generally, over the counter items are not eligible.                         by logging into your account at www.NBSbenefits.com.
    »» Receipts may be required for reimbursement.
    »» {Limited Purpose} – You can elect up to the IRS allowed                     What is a Dependent Care Reimbursement
       amount annually, deducted on a per paycheck basis.
    »» If you have a Qualified High Deductible Medical Plan
                                                                                   Account?
       coupled with an HSA, mounts can be used for Dental or
                                                                                   The Dependent Care Reimbursement Account lets you set aside
       Vision expenses.
                                                                                   up to $5,000 in pre-tax dollars to pay for eligible dependent
    »» You cannot use the FSA for medical expenses until you
                                                                                   care expenses so you and your spouse, if married, can work.
       have met your plan deductible.
    »» Generally, over the counter items are not eligible.
                                                                                   With the Dependent Care Account, you can set aside tax-
    »» Receipts may be required for reimbursement.
                                                                                   free income to pay for qualified dependent care expenses,
    »» Applies to both Full & Limited Purpose
                                                                                   such as day care, that you normally pay with after-tax
    »» Eligible expenses need to have been incurred during the
                                                                                   dollars. Qualified dependents include children under 13 and/
       plan year.
                                                                                   or dependents who are physically or mentally handicapped.
    »» {Rollover} – The plan will roll over up to $500 a year.
                                                                                   If your spouse is unemployed or doing volunteer work, you
    »» You have until March 1st to submit for reimbursement
                                                                                   cannot set up a reimbursement account.
       from the prior plan year.
    »» Any amount over $500 is forfeited.
                                                                                     »» You must meet the following criteria in order to set up
    »» {Grace} – You have until March 15th to incur eligible
                                                                                        this account:
       services from the prior plan year.
                                                                                          »» Your child is under the age of 13 or is mentally/
    »» Requests for reimbursement must be submitted by March
                                                                                             physically handicapped;
       30th.
                                                                                          »» You and your spouse both work;
    »» Any funds left in the account is forfeited.
                                                                                          »» You are a single head of household; or
                                                                                          »» Your spouse is disabled or a full-time student.
                                                                                     »» Each calendar year the IRS allows you to contribute the
                                                                                        following amounts, depending on your family status:
                                                                                          »» If you are single, the lesser of your earned income or
                                                                                             $5,000.
                                                                                          »» If you are married, you can contribute the lowest of:
                                                                                                »» Your (or your spouse’s) earned income.
                                                                                                »» $5,000 if filing jointly, or $2,550 if filing
                                                                                                   separately.

                                                                               8
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Dental

                                                                     MetLife
                                    In-Network                                                        Out-of-Network
   Network                          MetLife - PDP Plus
                                    $50 per Individual, $150 per Family
   Annual Deductible                The deductible is waived for preventive/diagnostic care and applies to basic
                                    and major expenses.

   Calendar Year
                                                                              $2,000 per Individual
   Maximum

                                    Plan pays 100% of covered services                                Covers up to 80% of MAC
   Preventive                          »»   Limited to one routine visits per six months
   services                            »»   Intra-oral complete series of x-rays or panoramic film x rays: once every 60 months
    Exams, Cleanings                   »»   Topical fluoride treatment: once every 12 months to age 14
                                       »»   Sealants: application provided to dependents to age 14 no more than once per tooth every 60
                                            months

   Basic Services                   You pay 20%                                                       Covers up to 60% of MAC
   Major Services                   You pay 50%                                                       Covers up to 40% of MAC
   Orthodontic Care                                                                   Not covered
   Orthodontic
                                                                                             N/A
   Lifetime Max

    »» Please refer to the Summary Plan Document for full plan description
    »» The Maximum Allowed Charge (MAC) means the lesser of the amount charged by the dentist or the maximum amount
       which the In-Network dentist has agreed to accept as payment in full for the dental service.

                                                           Employee Rates per Month
                                              Employee                                     $7.70
                                              Two-Party                                   $15.40
                                              Family                                      $24.50

                                                                               9
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Vision

                                                                     MetLife
                                                 In-Network                                             Out-of-Network
   Network                                       Vision PPO
   Exams - Every Plan Year                       You pay $10                                            $45 Allowance
   Lenses - Every Plan Year
      Single Vision                                                                                     $30 Allowance
      Lined Bifocal                              You pay $10                                            $50 Allowance
      Lined Trifocals                                                                                   $65 Allowance
      Lenticular                                                                                        $100 Allowance

   Frames - Every Plan Year                      $150 Retail Allowance                                  $70 Allowance
   Contacts - Every Plan Year
      Elective (Instead of                       $150 Retail Allowance                                  $150 Allowance
      Glasses)                                   Covered in full with maximum                           Applied to the contact lens
      Contact Lense Fitting                      copay of $60                                           allowance
      Standard

  Please refer to the Summary Plan Document for full plan description.

                                                           Employee Rates per Month
                                            Employee                                      $10.28
                                            Two-Party                                     $19.32
                                            Family                                        $27.51

                                                                               10
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Life Insurance
  Being a responsible adult means making sure loved ones                               filling out a MetLife Evidence of Insurability (EOI) form,
  who depend on you are financially safeguarded if you                                 which may include taking a physical examination, and
  unexpectedly leave them behind. The way you provide that                             you may be declined coverage. Future exams will be at
  protection is with life insurance.                                                   your cost.

  Basic Life and Accidental Death and                                               Employee
  Dismemberment
                                                                                    You may purchase coverage in $25,000 increments up to
  Valley Behavioral Health is pleased to provide each full time                     $500,000, not to exceed 5 times your basic annual earnings.
  active benefits eligible employee with basic life insurance                       There is a Life Coverage Amount of $100,000 without
  and accidental death and dismemberment (AD&D) through                             providing proof of good health during the initial enrollment
  MetLife. This coverage is completely free to you as the                           period only.
  employee
                                                                                    Spouse
   Basic Employee Life                   1x salary up to $300,000
                                                                                    You may purchase Voluntary Life Insurance for your spouse.
   Basic AD&D                            1x salary up to $300,000                   Coverage is in increments of $5,000, up to $150,000, not to
   Basic Spouse Life                     $10,000                                    exceed 50% of the employee’s supplemental life insurance
                                                                                    amount. Anything up to $25,000 is available to your spouse
   Basic Child Life                      $5,000 (Benefit for children               without proof of good health during the initial enrollment
                                         age 15 days to less than 6                 period.
                                         months is $100)
                                                                                    Children
  Voluntary Life                                                                    Children’s insurance coverage is for unmarried dependent
                                                                                    children from 15 days of age to age 26, subject to eligibility
  Voluntary Life is additional protection you can purchase to                       requirements. Coverage for children age 15 days to less than
  provide more coverage for you and your family. This policy                        6 months is $100. From age 6 months to age 26, coverage can
  gives you the advantage of purchasing life insurance at                           be elected for $1,000, $2,000, $4,000, $5000, or $10,000 and
  group rates with the convenience of being payroll deducted.                       is inclusive for all children. This means that if you have one
  This benefit is not a pre-tax benefit option.                                     child or many, you pay one flat amount; however, each child
                                                                                    is covered individually for the selected coverage amount.
  Enrollment
                                                                                    Age Reductions
    »» When you first become eligible for our benefit program(s),
       you must either enroll or waive coverage for Voluntary                       The coverage you have or select as additional coverage will
       Life Insurance. If you do not enroll yourself and your                       reduce by 35% beginning at age 65, an additional 15% at age
       dependents for coverage the first time you are eligible                      70, and another 15% at age 75. Benefits will terminate at
       and you wish to enroll during a subsequent enrollment                        retirement.
       period, you will have to provide proof of good health by

                                                       Life Coverage                      Increments                    Maximum
                                                          Amount                                                         Amount
                  Voluntary Employee Life                    $100,000                         $25,000                      $500,000
                  Voluntary Spouse Life                       $25,000                         $5,000                       $150,000
                  Voluntary Child Life                        $10,000                          $1,000                       $10,000

  Voluntary AD&D
  Voluntary AD&D maximum amounts are equal to your                                  Benefits resulting from the accidental death are paid to the
  supplemental life insurance. No Evidence of Insurability is                       named beneficiary. Benefits resulting from a dismembering
  required to elect Voluntary AD&D. AD&D is a policy that pays                      injury are paid to the insured. The loss must occur 365 days
  benefits to your beneficiary if the cause of your death is due                    of the accident.
  to an accident. Fractional amounts of the policy will be paid
  out if you lose a bodily appendage or sight because of an                                              Maximum Amount                 Rate per $1,000
  accident. Additionally, AD&D generally pays benefits for the
                                                                                    Employee                  $500,000                       Included
  loss of limbs, fingers, toes, sight, and permanent paralysis.
                                                                                    Spouse                     $150,000                        with
  In the event of an accidental death, this insurance will pay
                                                                                                                                             Life rate
  benefits in addition to any life insurance.                                       Child(ren)                  $10,000
                                                                               11
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Short & Long Term Disability
  Short & Long Term Disability                                                      Short Term Disability Benefits
  How long would your savings last if you could not work for
  several weeks or even months? After a benefit waiting period,                     Weekly Benefit                         60% of your weekly salary
  Short Term Disability replaces a portion of your income by                        Maximum Weekly Benefit                              $1,000
  paying monthly benefits if you experience a covered Short-
                                                                                    Elimination Period - Injury                        14 days
  term illness or accident.
                                                                                    Maximum Benefit Period -                          11 weeks
  Short Term Disability insurance is designed to pay a monthly                      Injury
  benefits to you in the event you cannot work because of a                         Elimination Period - Sickness                      14 days
  covered illness or injury. This benefit replaces a portion of your
                                                                                    Maximum Benefit Period -                          11 weeks
  income, thus helping you to meet your commitments in a time
                                                                                    Sickness
  of need.

  Chances are you already purchase home, auto and life
  insurance to protect yourself against the threat of loss. And
  you probably have health insurance to guard against costly                        Long Term Disability Benefits
  medical bills. So, what steps have you taken to help shield
  yourself, your lifestyle and those who count on you from an
  unexpected loss of income? Would you be able to meet your                         Weekly Benefit                         50% of the first $20,000 of
  financial obligations if you became disabled and unable to                                                                 predisability earnings
  work? Group Short Term Disability insurance is designed to                        Maximum Monthly Benefit                            $10,000
  pay a monthly benefit to you in the event you cannot work
                                                                                    Elimination Period - Injury                        90 days
  because of a covered illness or injury. This benefit replaces a
  portion of your income, thus helping you to meet your financial                   Maximum Benefit Period -                            SSNRA
  commitments in a time of need. By sponsoring group Short-                         Injury
  Term disability insurance through MetLife, your employer offers                   Elimination Period - Sickness                      90 days
  you an excellent opportunity to help protect yourself and your
                                                                                    Maximum Benefit Period -                            SSNRA
  lifestyle. The advantages to you include: Convenience – with
                                                                                    Sickness
  premiums deducted directly from your paycheck, you do not
  have to worry about mailing monthly payments; and Peace of
  Mind – you can take comfort and satisfaction in knowing that
  you have taken a step toward securing your income during a
  period of a covered disability.

                                                                               12
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
401(k)

  401(k) Retirement Savings Plan
  Eligibility
  There is no age requirement to participate in the 401(k). Employees are eligible to participate following one year of employment,
  and must have completed 1000 hours of service.

  Employer Match
  Valley Behavioral Health will make a safe harbor matching contribution equal to 100% of your elective deferrals that do not
  exceed 5% of your compensation.

  Vesting
  Your “vested percentage” in your account attributable to qualified safe harbor contributions is determined under the following
  schedule. You will always, however, be 100% vested in your qualified safe harbor contributions if you are employed on or after
  your normal retirement age or if you terminate employment on account of your death, or if you terminate employment as a
  result of becoming disabled.

  Vesting Schedule

  Qualified Safe Harbor Contributions

   Years of Service Percentage
   Less than 2           0%
   2 years               100%

  Automatic Enrollment
  If you do not take action to enroll or opt out of participation then you will be auto-enrolled for a 3% pre-tax contribution. Your
  contribution rate will increase 1% annually until you reach 6%.

  Get More Information
  Visit the web site at www.empower-retirement.com/participant, or call the Voice Response System, toll free, at 1-800-338-
  4015 for more information. The web site provides information regarding your plan, as well as financial education information,
  financial calculators, and other tools to help you manage your account.

  Investment Options and Allocation Changes
  A wide array of core investment options are available through your plan. Once you have enrolled, investment option information
  is available through the web site or Voice Response System.

  Use your Personal Identification Number (PIN) and username to access the web site, or you can use your Social Security Number
  and PIN to access the Voice Response System. You can move all or a portion of your existing balances between investment
  options (subject to plan rules) and change how your payroll contributions are invested.

  Withdrawals
  Qualifying distribution events are as follows:
   »» Retirement
   »» Permanent disability
   »» Financial hardship (as defined by the Internal Revenue Code and your Plan’s provisions)
   »» Severance of employment (as defined by the Internal Revenue Code provisions)
   »» Attainment of age 59 1/2
   »» Death (your beneficiary receives your benefits)

                                                                               13
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Disclosure Notices
  Privacy Policy                                                                      »» All stages of reconstruction on the breast on which the
                                                                                         mastectomy was performed
                                                                                      »» Surgery and reconstruction of the other breast to
  Summary of Privacy Practices                                                           produce a symmetrical appearance
                                                                                      »» Prostheses and treatment of physical complications of
  This Summary of Privacy Practices summarizes how medical                               the mastectomy including lymphedema
  information about you may be used and disclosed in the
  administration of your claims, and of certain rights you have.                    Under WHCRA, coverage of mastectomies and breast
                                                                                    reconstruction benefits are subject to deductibles, co-
                                                                                    payments, and coinsurance limitations consistent with those
  Our Pledge Regarding Medical Information                                          established for other benefits under your plan. Following the
                                                                                    initial reconstruction, any additional modification or revision
  We are committed to protecting your personal health                               is covered only to the extent that it is not otherwise limited
  information. We are required by law to (1) make sure that any                     or excluded from coverage by your plan. Revisions requested
  medical information that identifies you is kept private; (2)                      as the result of the normal aging process will not be covered.
  provide you rights with respect to your medical information;
  (3) give you a notice of our legal duties and privacy practices;                  Michelle’s Law
  and (4) follow all privacy practices and procedures currently
  in effect.                                                                        A new federal law allows continued coverage for seriously ill
                                                                                    college students. A college student will be able to maintain
                                                                                    health care eligibility for up to one year after full-time student
  How We May Use and Disclose Medical                                               status is lost due to a medically necessary leave of absence
  Information About You                                                             from school.

  We must obtain your written authorization for any use and                         Genetic Information Nondiscrimination Act
  disclosure of your medical information. We may use and                            (GINA)
  disclose your personal health information without your
  permission to facilitate your medical treatment, of payment                       Under this Federal law, group health plans are prohibited
  for any medical treatments, and for any other health care                         from adjusting premiums or contribution amounts for a group
  operation. We may also use and disclose your personal health                      based on genetic information. A health plan is also prohibited
  information without your permission as allowed or required                        from requiring an individual or his/her family member to
  by law. We cannot retaliate against you if you refuse to sign an                  undergo a genetic test, although the plan may require that a
  authorization or revoke an authorization you had previously                       voluntary test be taken for research purposes.
  given.
                                                                                    Mandatory Insurer Reporting Law
  Your Rights Regarding Your Medical                                                This law took effect 01/01/2009 and is part of the Medicare,
  Information                                                                       Medicaid, and SCHIP Extension Act of 2007 (MMSEA). Under
                                                                                    this Federal law, providers of group health plans are required
  You have the right to inspect and copy your medical                               to report certain information to the Secretary of Health and
  information, request corrections of your medical information                      Human Services to determine Medicare entitlement. As such,
  and to obtain an accounting of your medical information.                          employees are required to provide social security numbers for
  You also have the right to request that additional restrictions                   all dependents enrolled in the medical plan. You will be asked
  or limitations be placed on the use or disclosure of your                         to enter social security numbers for all dependents you cover
  medical information, or that communication about your                             on your medical plan.
  medical information be made in different ways or at different
  locations.                                                                        Waiving Coverage

  Women’s Health and Cancer Rights Act                                              If you decide that you and/or your dependents have
                                                                                    appropriate benefits from an alternate source, you may
  In accordance with the Women’s Health and Cancer Rights                           choose to waive your existing coverage. If you are declining
  Act (WHCRA), we will cover the following for the treatment of                     enrollment for yourself and/or your dependents (including
  breast cancer:                                                                    your spouse) because of other health insurance coverage,
                                                                                    you may in the future be able to enroll yourself and/or your
                                                                                    dependents in this plan, providing that you request enrollment
  Mastectomies                                                                      within 30 days after your other coverage ends. If you have a
  Reconstructive Surgery                                                            new dependent as a result of your marriage, birth, adoption,
                                                                                    or placement for adoption, you may be able to enroll yourself
  If you are receiving benefits in connection with a mastectomy,                    and your dependents provided that you request enrollment
  coverage will be provided according to the carrier Utilization                    within 30 days after the event.
  Management criteria and in a manner determined in
  consultation with the attending physician and the patient for
  the following:

                                                                               14
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Disclosure Notices
  Premium Assistance Under Medicaid and                                             Medicare Part D Creditable Coverage
  the Children’s Health Insurance Program                                           Notice
  (CHIP)
                                                                                    Please read this notice carefully and keep it where you
  If you or your children are eligible for Medicaid or CHIP and                     can find it. This notice has information about your current
  you’re eligible for health coverage from your employer, your                      prescription drug coverage with Valley Behavioral Health
  state may have a premium assistance program that can help                         and about your options under Medicare’s prescription drug
  pay for coverage, using funds from their Medicaid or CHIP                         coverage. This information can help you decide whether
  programs. If you or your children aren’t eligible for Medicaid                    or not you want to join a Medicare drug plan. If you are
  or CHIP, you won’t be eligible for these premium assistance                       considering joining, you should compare your current
  programs but you may be able to buy individual insurance                          coverage, including which drugs are covered at what cost,
  coverage through the Health Insurance Marketplace.                                with the coverage and costs of the plans offering Medicare
  For more information, visit www.healthcare.gov                                    prescription drug coverage in your area. Information about
                                                                                    where you can get help to make decisions about your
  If you or your dependents are already enrolled in Medicaid or                     prescription drug coverage is at the end of this notice.
  CHIP and you live in a State listed below, contact your State
  Medicaid or CHIP office to find out if premium assistance is                      There are two important things you need to know about
  available.                                                                        your current coverage and Medicare’s prescription drug
                                                                                    coverage:
  If you or your dependents are NOT currently enrolled in
  Medicaid or CHIP, and you think you or any of your dependents                     1.   Medicare prescription drug coverage became available
  might be eligible for either of these programs, contact your                           in 2006 to everyone with Medicare. You can get this
  State Medicaid or CHIP office or dial 1-877-KIDS NOW or                                coverage if you join a Medicare Prescription Drug Plan
  www.insurekidsnow.gov to find out how to apply. If you                                 or join a Medicare Advantage Plan (like an HMO or PPO)
  qualify, ask your state if it has a program that might help you                        that offers prescription drug coverage. All Medicare
  pay the premiums for an employer-sponsored plan.                                       drug plans provide at least a standard level of coverage
                                                                                         set by Medicare. Some plans may also offer more
  If you or your dependents are eligible for premium assistance                          coverage for a higher monthly premium.
  under Medicaid or CHIP, as well as eligible under your employer
  plan, your employer must allow you to enroll in your employer                     2.   Valley Behavioral Health has determined that the
  plan if you aren’t already enrolled. This is called a “special                         prescription drug coverage offered by the Benefit Plan
  enrollment” opportunity, and you must request coverage                                 is, on average for all plan participants, expected to pay
  within 60 days of being determined eligible for premium                                out as much as standard Medicare prescription drug
  assistance. If you have questions about enrolling in your                              coverage pays and is therefore considered Creditable
  employer plan, contact the Department of Labor                                         Coverage. Because your existing coverage is Creditable
                                                                                         Coverage, you can keep this coverage and not pay a
  Utah Medicaid and Chip information:                                                    higher premium (a penalty) if you later decide to join a
  Website: http://health.utah.gov/upp                                                    Medicare drug plan.
  Phone: 1-866-435-7414
                                                                                    When Can You Join A Medicare Drug Plan?
  Newborns and Mothers Health Protection
  Act                                                                               You can join a Medicare drug plan when you first become
                                                                                    eligible for Medicare and each year from October 15th to
  The Newborns’ and Mothers’ Health Protection Act of 1996                          December 7th.
  (NMHPA) affects the amount of time you and your newborn
  child are covered for a hospital stay following childbirth.                       However, if you lose your current creditable prescription
  In general, health insurers and Health Maintenance                                drug coverage, through no fault of your own, you will also
  Organizations (HMOs) may not restrict benefits for a hospital                     be eligible for a two (2) month Special Enrollment Period
  stay in connection with childbirth to less than 48 hours                          (SEP) to join a Medicare drug plan.
  following a vaginal delivery or 96 hours following a delivery
  by cesarean section.                                                              These are only summaries. Full statements
                                                                                    are available from Human Resources.
  If you deliver in the hospital, the 48-hour (or 96-hour) period
                                                                                    ACA
  starts at the time of delivery. If you deliver somewhere other
  than the hospital and you are later admitted to the hospital in                   Pursuant to the Affordable Care Act, Valley Behavioral Health
  connection with the childbirth, the period begins at the time                     has adopted a 12-month lookback measurement period in
  of admission.                                                                     order to determine the full-time status of new and ongoing
                                                                                    part-time, variable hour, or seasonal employees. According
  Also, a health insurer or HMO cannot require you or your                          to the ACA, any employee who is employed for, on average,
  attending provider to obtain prior authorization for your                         at least 130 hours of service a month during that lookback
  delivery or show that the 48-hour (or 96-hour) stay is                            period must be considered full time and offered health
  medically necessary. However, a health insurer or HMO may                         insurance benefits during a subsequent stability period. The
  require you to get prior authorization for any portion of stay                    applicable stability period for Valley Behavioral Health is 12
  after the 48 hours (or 96 hours)                                                  months. This offer of coverage is being made because you met
                                                                                    this definition of a full-time employee during your applicable
                                                                                    lookback period.
                                                                               15
This information is designed to help you choose a benefit plan for 2018. Please refer to the Plan Documents provided by the carrier for information regarding
coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
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