In 2019 Your benefits - Vidant Health
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Your benefits in 2019
2019 Benefits Enrollment
Important:
All benefit-eligible team members MUST
enroll online to obtain benefits.
Team members not enrolling are asked to
log on and decline benefits.
New hires and newly benefit-eligible team
members must enroll within 30 days of
date of hire or the date they become
benefit-eligible.
Go to the Vidant Employee Self-Service
page and click on “Benefit Details” and then
“Benefits Summary” to review your
statement. If you need assistance logging
in, contact the Benefits Department at (252)
847-4479.
Your 2019 Benefits
Your benefits are a valuable part of the rewards
of being a Vidant team member. Vidant reviews
current benefit offerings to ensure you have
choices and are able to have coverage that fits NOTE:
you and your family needs. Your feedback
about choices is also part of our review process.
Although the benefits described
in this booklet generally apply to
Each year, Vidant Health invests more than benefit-eligible team members,
$500 million in its team members through a all organizations may not offer
comprehensive package that represents much
more than just competitive pay and benefits. all of the benefits described.
To make the most of your benefits, use this Please note the benefits
guide to understand how they work. Benefits
enrollment is the time for you to take advantage
described in this booklet may
of those options that provide value and be changed at any time and do
protection for you and your family. not represent a contractual
obligation on the part of Vidant
This booklet provides an overview of the benefits
offered to team members of:
Health.
Vidant Beaufort Hospital
Vidant Bertie Hospital
Vidant Chowan Hospital
Vidant Duplin Hospital
Vidant Edgecombe Hospital
Vidant Health
Vidant Home Health
Vidant Medical Center
Vidant Roanoke-Chowan Hospital
The Outer Banks Hospital
Vidant Medical Group Staff
Vidant Medical Group Providers
The details of the benefit plans are contained in official plan documents as well as insurance contracts. The
benefit booklet will cover highlights of each plan and does not replace summary plan descriptions, official
documents, or other policies about the benefit plan. If there is a question about one of the benefit plans or if
there is a conflict between information in the benefits booklet and the formal language in official documents,
the formal wording in the official documents will prevail.
Vidant Health Human Resources annual required notices are located on the Vidant Intranet under Team Central
– REQUIRED NOTICES. The Intranet is accessible from any Vidant workstation including those on your unit,
department or public access computers such as those in each Human Resources location. The annual required
notices contain general information about benefits with Vidant Health and you should take the opportunity to read
and review. You may also request at any time printed copies of these annual required notices by contacting
Human Resources via email at Benefits@vidanthealth.com. By providing electronic access of annual required
notices, Vidant Health can be a better steward of resources such as time, people and paper.
1|Page
Our Mission, Vision and Values
Health Care Mission
To improve the health and well-being of Eastern North Carolina.
Health Care Vision
To become the national model for rural health and wellness by creating a
MISSION: premier, trusted health care delivery and education system.
The mission of Our Values:
an organization Integrity – Do the right thing
defines its Be honest and sincere
reason for Consistently support our shared principles
Be fair and ethical in all actions
existence,
Protect the confidentiality of work environment, especially patient
reveals information
its nature and Compassion – Connecting, caring and comforting unconditionally
expresses the Treat others in a culturally appropriate way
Show we understand through active listening
organization’s
Focus on the person in front of you and be present in the moment
commitment Demonstrate respect for all
and aim. Education – Learning, adapting, improving, and transforming
Learn from and apply best practices
Adapt to changing environments, expectations and knowledge
Use innovation and creativity to shape a better future
Stay up to date in your role
Take an active role in mentoring and educating others
VISION: Accountability – Taking responsibility for what we do
Give and receive honest feedback and coaching
A vision Work collaboratively
statement is a Equally shoulder individual, team and organizational goals
company's road Do what we say we will do
Own our work and rise above our circumstances to get it done
map, indicating
Safety - Achieving zero harm to patients, visitors, families and
both what the staff
company wants Provide an environment of safety
to become and When uncertain, stop and get help
guiding Anticipate and prevent potential harm
Follow Safety Habits and best practices
transformation Teamwork - Contributing to our goals
initiatives by Recognize the equal worth of each individual, including patients and
setting a families
defined Help each other do the right thing
Value what others have to offer
direction for the Identify and resolve inappropriate behaviors
company's Communicate effectively and openly
growth.
2|PageTable of Contents
Your 2019 Benefits ................................................................................................................................................................. 1
Our Mission, Vision and Values .............................................................................................................................................. 2
Table of Contents ................................................................................................................................................................... 3
Contact Information ................................................................................................................................................................ 4
Eligibility .................................................................................................................................................................................. 5
Dependent Eligibility ............................................................................................................................................................... 6
Benefit Cost Sharing and Deduction Information ................................................................................................................... 7
How to Enroll .......................................................................................................................................................................... 8
Enrollment Steps .................................................................................................................................................................... 9
Making Changes ....................................................................................................................................................................10
Medical Coverage ................................................................................................................................................................. 11
Preventive Schedule of Benefits ........................................................................................................................................... 17
Prescription Drug Benefit ...................................................................................................................................................... 18
Dental ................................................................................................................................................................................... 20
Vision .................................................................................................................................................................................... 21
Flexible Spending Accounts (FSA) ....................................................................................................................................... 22
Health Savings Account (HSA)………………………………………………………………………………………………………24
Life Insurance ................................................................................................................................................................ 26
Disability Benefits ................................................................................................................................................................. 28
Critical Illness/Whole Life……………………………………………………………………………………………………………………...29
Paid Time Off (PTO) ............................................................................................................................................................. 30
Employee Assistance Program (EAP) .................................................................................................................................. 31
Retirement Program Highlights ............................................................................................................................................. 32
Other Benefits & Services ..................................................................................................................................................... 33
3|PageContact Information
Benefit Provider Phone # Web Site Description
Critical Illness Allstate 800-521-3535 www.allstateatwork.com Individually owned critical
illness policy
Dental Plan CIGNA 800-244-6224 https://my.cigna.com/ Dental claims, EOB, Provider,
ID Card
Dependent Alight 800-725-5810 www.yourdependentverification.co Verification of dependent eligibility
Eligibility Vendor m/plan-smart-info
Disability – Short Lincoln 800-213-3805 www.mylibertyconnection.com Disability claims & covered
& Long Term Financial benefits
Discounts, On-Line BenePlace 800-683-2886 www.beneplace.com/vidanthealth Discounts for a variety
Team Member of merchants
Discount Program
Employee Assistance Vidant Health 877-843-7207 https://myvidanthealth.com/Empl Counseling Services, Behavioral
Program (EAP) or o yee_Assistance_Program/ health, Legal advice & Substance
252-847-4357 abuse issues
Employee Wellness Vidant 252-847-5590 https://myvidanthealth.com/empl Provides FREE health
oyeewellness/ coaching, disease
management, and wellness
challenges
FSA - Flexible Discovery 866-451-3399 https://www.discoverybenefits.com/ Flexible spending claims
Spending (Health and Benefits & covered benefits
Dependent Day Care)
Health Savings Discovery 866-451-3399 https://www.discoverybenefits.com/ Flexible spending claims & covered
Account (HSA) Benefits benefits
Leave of Absence Leave 252-816-8600 E-mail at: Leave of absence
Management LeaveManagement@Vidanthealth.
com
Life Insurance Lincoln 800-213-3805 www.mylibertyconnection.com Life claims & covered benefits
Financial
Medical Plan MedCost 800-795-1023 www.medcost.com Medical claims, EOB,
Plan Group Number- 7488 Provider Network, Temporary
ID Card
Pharmacy - MedImpact 844-513-6009 www.medimpact.com Pharmacy claims &
Prescription Drug covered benefits
Benefit
Physician IDI UNUM 800-633-7490 Supplemental Disability
Policy
Retirement – Pension* VidantPension 866-261-3573 Pension information for
Center eligible team members
Retirement Savings Fidelity 800-343-0860 http://www.netbenefits.com Online enrollment & customer
Plans: 401(k) Investments service assistance
Physicians 457b Voya 877-663-6565 Additional way to save for
retirement
SmartStarts MedCost 800-795-1023 http://www.medcost.com/CareMa Assigns experienced
Pregnancy Wellness nagement/MaternityManagement prenatal nurses to work with
Program expectant mother’s physician
Tuition Assistance Vidant Health 252-816-5893 E-mail at: The Vidant Health
Careers healthcareers@vidanthealth.com tuition assistance
program
Vision Superior 800-507-3800 www.superiorvision.com Vision claims & covered benefits
Vision
Whole Life Insurance UNUM 866-679-3054 www.unum.com Individually owned whole
life insurance policy
information
*Only for eligible team members hired prior to 1/1/2010 at a pension entity
4|PageEligibility – All Vidant Entities
Team members may make certain benefit changes during the announced annual enrollment period
Mid-year benefit elections or changes must be made within 30 days of a qualifying life event/status
change
Your eligibility and contributions are based on your Full-Time Equivalent (FTE) status
Please read each section carefully as there are waiting periods for some benefits
Benefit When do benefits start? When do benefits end? Who is eligible?
Medical and Prescription Drug First of the month following your 30th day End of the month in which you Team members 0.5
Coverage of hire or benefit-eligible status change are actively employed in a (FTE) or greater
benefit-eligible status
Dental Coverage First of the month following your 30th day End of the month in which you Team members 0.5
of hire or benefit-eligible status change are actively employed in a (FTE) or greater
benefit-eligible status
Vision Coverage First of the month following your 30th day End of the month in which you Team members 0.5
of hire or benefit-eligible status change are actively employed in a (FTE) or greater
benefit-eligible status
Life Insurance – Basic, First of the month following your 30th day Last day of active Team members 0.5
Supplemental, Spouse and of hire or benefit-eligible status change employment in a benefit- (FTE) or greater
Child eligible status
Flexible Spending Accounts First of the month following your 30th day Last day of active Team members 0.5
of hire or benefit-eligible status change employment in a benefit- (FTE) or greater
eligible status
Health Savings Account (HSA) First of the month following your 30th day Team members 0.5
of hire or benefit-eligible status change (FTE) or greater
Short-Term Disability (STD) First of the month following your 30th day Last day of active Team members 0.8
of hire or benefit-eligible status change employment in a benefit- (FTE) or greater
eligible status
Long-Term Disability (LTD) First of the month following your 30th day Last day of active Team members 0.5
of hire or benefit-eligible status change employment in a benefit- (FTE) or greater
eligible status
Retirement Savings Plans: Eligible to enroll in the 401(k) plan Payroll deductions will Team members 0.5
401(k) immediately upon hire – all team continue through your final (FTE) or greater
members hired in a benefit eligible status Vidant paycheck in a benefit-
will be automatically enrolled after 30 eligible status
days if no action is taken
Employee Assistance Plan Date of hire Last day of active All team members
(EAP) employment
Paid Time Off (PTO)* Benefits begin accruing your first day of Last day of active Team members 0.5
employment employment in a benefit- (FTE) or greater
eligible status
Adoption Assistance Twelve months of employment Last day of active Team members 0.5
employment in a benefit- (FTE) or greater
eligible status
Physicians 457b Date of hire Last day of active Team members 0.5
employment in a benefit- (FTE) or greater
eligible status
* VMG Providers and VMC Residents have separate leave plans
5|PageDependent Eligibility
Medical, Dental, and Vision Coverage
Eligible dependents may receive coverage under the medical, prescription drug, dental, and vision plans.
Eligible dependents:
Spouse/Domestic Partner
Children up to age 26
Losing Coverage
Coverage under the medical, prescription, dental, and vision benefits will terminate at the end of the month in which
the dependent child turns 26.
Life Insurance
Eligible dependents can also be covered under applicable life insurance policies.
If you and your spouse/domestic partner are benefit-eligible Vidant team members:
You are ineligible to cover your spouse/domestic partner under the Spousal Life insurance plan.
Only one parent is eligible to cover the child(ren) under the Dependent Child Life insurance plan.
Losing Coverage
Life insurance for children turning age 26 will end the on the date that the child turns 26.
Please note that an individual may not be covered under the medical, dental, vision or life insurance plans as
both a team member and a dependent. In addition, an individual may not be considered an eligible dependent
of more than one team member. Team members may not carry dual coverage under these plans for their
spouse/domestic partner and/or their dependent children.
Dependent Eligibility Verification
New team members, team members newly eligible for coverage (due to an increase in hours or a life event
such as marriage, birth, adoption, etc.) or team members electing a new benefit must provide documentation
regarding dependents you are adding on to the benefit plans.
Documentation (e.g. marriage license, temporary birth certificate, etc.) must be provided within 30 days of the date
of the event.
Your next opportunity to add your dependent to coverage will be during the next annual enrollment period or
qualifying life event, provided that proper documentation is submitted at that time.
Dependent Eligibility Verification
Medical, pharmacy and dental costs are shared between team members and Vidant Health. With
health and welfare plan costs continuing to rise and to remain good stewards of team members and
employer premiums, Vidant Health will verify dependent eligibility for health, dental, vision and life
insurance coverage. You will be required to provide social security numbers and other documents to
ensure the relationship meets benefit eligibility. Spousal employment verification form will be required.
You will be contacted by our third party administrator to assist you in providing the appropriate
documentation to complete the verification.
6|PageBenefit Cost Sharing and Deduction Information
Each pay period, deductions for your share of the benefit cost will be taken either as a pre-tax or post-tax
deduction. Pre-tax deductions lower your taxable income; therefore, you pay less in taxes. The chart below
highlights which benefit plans are offered pre-tax or post-tax.
Benefit Who pays the cost? Pre-tax or post-tax
Medical and Prescription Drug Coverage* Shared Pre-tax
Dental Coverage* Shared Pre-tax
Vision Coverage* You Pre-tax
Life Insurance – Basic Vidant No cost to team members
Life Insurance – AD&D Vidant No cost to team members
Life Insurance – Supplemental & Whole You Post-tax
Life Insurance – Supplemental AD&D You Post-tax
Life Insurance – Spouse You Post-tax
Life Insurance – Child You Post-tax
Flexible Spending Accounts – (Heath and You Pre-tax
Dependent Care)
Health Spending Account (HSA) Shared Pre-tax**
Short-Term Disability (STD) You Post-tax
Long-Term Disability (LTD) You Post-tax
Physician Individual Disability Insurance (IDI) You Post-tax
Critical Illness You Post-tax
Retirement Savings Plans: 401(k) Plan Shared Pre-tax
Physicians 457b You Pre-tax
Employee Assistance Plan (EAP) Vidant No cost to team members
Leave Time (Holiday, Sick, or Vacation) Vidant No cost to team members
Adoption Assistance Vidant No cost to team members
* IRS imputed income guidelines may apply
**Shared only when contributions are through Vidant payroll deductions
7|PageMeet ALEX!
How does ALEX know what plan is best for me?
ALEX takes the amount each plan would cost
you out of your paycheck (your premium) and adds that
to the amount it would cost for the services you said you
might use. Then he’ll recommend the least expensive
plan for your needs.
Can I use ALEX on my phone?
Oh yeah. ALEX is optimized for any device you’ve got.
Can I trust ALEX with my secrets?
Yes! Your ALEX experience is totally private. He
doesn’t maintain personal info or submit it back to your
employer (or anyone else), so it’s completely
anonymous.
ALEX is an online tool that will help
you select the best benefit plan for
you and your family. When you talk
to ALEX he’ll ask you a few
questions about your health care Meet ALEX at
needs, crunch some numbers, and
point out what makes the most
sense for you. And anything you tell
ALEX remains anonymous, so don’t
www.myalex.com/vidant-
be afraid to really let loose about health/2019
that weird tooth thing!
How long will this take?
Most users spend about 7 minutes
with ALEX, but it really depends how
much guidance you would like. And
ALEX can save your place, so you
leave to get some peanut brittle and
then pick up right where you left off.
How should I prepare?
You don’t need to do much of
anything.
Alex will ask you to estimate what
type of medical care you might need
this year (doctors’ visits, surgeries,
ER visits, prescriptions, etc.), so you
may want to tally those up and talk to
your family about their needs, but
ALEX can also help you come up with
some estimates.
8|PageHow to Enroll
Process
All team members will need to Additional Considerations
enroll online to obtain benefits You must enroll online to receive benefits.
during annual enrollment As part of enrollment you should:
Team members not enrolling are Determine if the spousal/domestic
asked to log on and decline partner additional premium applies
benefits Determine if the tobacco additional
New hires must enroll within 30 premium applies
days of the date of hire. Newly Determine if the wellness additional
benefit- eligible team members premium applies
must enroll within 30 days of the
date they become benefit eligible.
Please note once benefit elections
have been submitted, changes
Review Your
cannot be made until the next
annual enrollment period.
Benefit Summary
Once your elections have
What You Need been processed by Benefits,
Your Vidant Health Provider ID you can review your
and Password elections via Employee Self-
Social Security numbers and Service.
dates of birth for your covered
spouse and dependents Login to Employee Self-
Beneficiary information (name, Service, choose “Benefit
date of birth, address and Social Details”, then “Benefits
Security numbers of beneficiaries) Summary
You will need to identify whether
or not you or any of your family Benefit elections are final
members have other medical once submitted during new
coverage, and details about that hire/newly benefit eligible
other coverage (if applicable) enrollment.
You may log in and make
changes as often as you
need only during the
annual enrollment period.
9|PageEnrollment Steps
About Your Enrollment Session Step 1
Enrolling and accessing your benefit Please follow the on-screen
information is easy under Employee instructions to make or waive your In your internet
Self-Service. Employee Self-Service elections. Please note, your browser, type in:
saves all elections from each screen enrollment is complete only after
clicking “Submit”. www.vidanthealth.com
you have successfully completed.
To log in to your
Employee Self-
To access your Employee Self-Service Page from home, go to Service page, you
www.vidanthealth.com. Select the “Team members” link; then “Employee don’t have to be at
Self-Service” work! You can do
this from any
computer with an
internet connection.
Step 2
Click on “Team
members”.
Step 3
Choose “Employee
Quick link to Employee Self Service Self-Service”.
From there, you will
enter in your Provider
ID and Password for
access to your
Employee Self-
Service Account.
Step 4
Choose “Benefit Details”,
then “Benefits Enrollment” to
start electing your benefits.
Important – you must elect or
waive each benefit to
successfully submit
elections.
After You Enroll
When you receive
your first paycheck
after your coverage
becomes effective,
make sure that the
correct deductions
have been taken
based on the benefits
you selected. If the
cost of your benefits is
not deducted
accurately, contact the
Benefits Department
immediately. 9Making Changes
You may change your pre-tax benefit elections, as well as Qualifying Life Events Include:
your *life and disability elections during annual enrollment.
Marriage or divorce
To change your benefit elections during the plan year, you
must experience a qualifying life event as defined by IRS Birth, adoption or
guidelines. placement for
You must complete a Qualifying Life Event (QLE) within 30 adoption of an
days of the Qualifying Life Event. Follow-up documentation eligible child
will be required in most instances.
Death of a spouse or covered
If you do not complete a Qualifying Life Event within 30
child
days, you must wait until the next annual enrollment
period to make benefit changes, unless you have Change in your or your
another qualifying life event. spouse’s work status
affecting benefits eligibility.
*Life or disability elections during annual enrollment require
you to submit an Evidence of Insurability form to Lincoln Examples include starting a
Financial. Lincoln Financial will notify you of approval or new job, leaving a job,
denial. going from part-time to full-
time and starting or
Visit “Benefits & Life Events” then choose “Updating returning from an unpaid
Benefit Information” under Team Central for more
leave of absence.
information.
Change in your child’s benefit
eligibility
Becoming eligible for Medicare or
Medicaid during the year
Receiving a Qualified Medical
Child
Support Order (QMCSO)
11 | P a g eTerms You Need to
Know
Medical Coverage Coinsurance: The percentage of
Plan Options covered expenses that you pay
Vidant Health provides health and pharmacy coverage through three self-insured medical plans. Self- after you meet your deductible.
insured means that claims for health and pharmacy expenses are paid for by premiums from team Deductible: The amount (before
members and Vidant. Your plan determines your co-pay, deductible and coinsurance when you have a claim. coinsurance) you pay each year
For complete details, see the Summary Plan Descriptions as well as other relevant information available on for health care expenses such as
Team Central. inpatient hospital stays, radiology,
lab work, and other services.
Basic
Choice Out-of-Pocket (OOP) Maximum
for Medical: The most you pay
Medical Savings Plan under the medical plan. Includes
your deductible, medical
Coverage Categories coinsurance and medical plan co-
Single pays. Excludes charges beyond
usual and customary. Separate
+ Children pharmacy out-of- pocket
+ Spouse / Domestic Partner maximum.
Family (covers you, your spouse and dependent children) Pharmacy Co-Pay/ Coinsurance:
Your cost for a prescription. There
Cost Share are separate maximum dollar
Team members with an FTE of .5 to .79 share a larger portion of the premium than a .80 – 1.0 FTE amounts that you pay for each
prescription. Applies to your plan
pharmacy out-of-pocket maximum.
Does not apply to your medical
Medical Plan Provider Networks deductible.
In network will help you and the plan manage costs. You are strongly encouraged to select a primary care Physician Office Visit Co- pay: A
physician for you and each covered family member. You may go to any doctor you choose, but your cost savings flat fee you pay for a physician
office visit regardless of the actual
will be greater and out-of-pocket expenses are less when you seek services from in network providers. amount the provider charges.
Applies to your plan Out-of- Pocket
Medical Claims Administration Maximum but not your Deductible.
MedCost is our third party administrator and processes our medical claims. You may visit www.medcost.com to do
In Network: Group of physicians
the following: and hospitals that have contracted
Request Identification Cards with the plan to offer discounts for
Print and View Explanation of Benefits (EOB) participants who receive care
Find a Provider within the network.
Vidant MedCost Group # - 7488
Vidant Now
Skip the Trip! Use Vidant Now to see a doctor 24/7 via video or phone. If enrolled in Vidant Medical Basic or Choice plans, use group code “Vidant”
to receive services at a $20 copay. Visit www.vidantnow.com or download the VidantNow App for a convenient way to receive care whenever you
need it!
12 | P a g ePremiums for Medical/Dental/Vision
*Includes domestic partner (DP) and/or domestic partner children; imputed income applies to domestic partner and children of domestic partner
coverage.
Full-time Team Members – Bi-Weekly Deductions
Medical Dental
Tier MSP Basic Choice Basic Choice Vision
Single $31 $36 $48 $8 $16 $3.66
+Child(ren)* $118 $138 $160 $15 $28 $6.03
+Spouse* $185 $216 $242 $17 $33 $5.50
Family* $203 $237 $265 $24 $47 $9.19
Part-time Team Members – Bi-Weekly Deductions
Medical Dental
Tier Vision
MSP Basic Choice Basic Choice
Single $89 $103 $113 $8 $16 $3.66
+Child(ren)* $201 $235 $256 $15 $28 $6.03
+Spouse* $255 $298 $326 $17 $33 $5.50
Family* $301 $351 $378 $24 $47 $9.19
13 | P a g eMedical Coverage (continued)
Plan Benefit Levels - MedCost
Vidant Health medical plans will include tiered provider options. Here are some highlights of the coverage in each tier:
Preventive care medical services performed by an in-network provider are covered at 100% under each medical plan - no charge to you.
Tier A includes higher co-insurance coverage at 85%, lower copays and lower deductibles and out of pocket maximums.
Tier B includes co-insurance coverage at 70% or 80%, slightly higher copays and deductibles and out of pocket maximums.
When using providers and facilities not in the MedCost Network – Out of Network includes co-insurance coverage at 50%, higher copays and deductibles and
out of pocket maximums.
If you stay in-network, the plan pays a greater portion of the cost of your care, and you pay less.
In Network – Tier A In Network – Tier B Out of Network
Vidant Health and other select Select providers and facilities
providers and Vidant Health facilities in the MedCost Network
Medical Savings Plan
Wellness Covered at 100% Covered at 100% Plan pays 60%, you pay 40%
Plan Co-insurance Plan pays 85%, you pay 15% Plan pays 70%, you pay 30% Plan pays 50%, you pay 50%
Vidant PCP Visit Plan pays 95%, you pay 5% N/A Ded, then 50% co-ins
Vidant Specialty Visit Ded, then 15% co-ins N/A Ded, then 50% co-ins
Non-Vidant PCP Visit Ded, then 15% co-ins Ded, then 30% co-ins Ded, then 50% co-ins
Non-Vidant Specialty Visit Ded, then 15% co-ins Ded, then 30% co-ins Ded, then 50% co-ins
VidantNow Ded, then 15% co-ins Ded, then 30% co-ins Ded, then 50% co-ins
Med Deductible (Single/Family) $2,000 / $4,000 $2,500 / $5,000 $6,000 / $12,000
Med Max OOP (Single/Family) $6,000 / $12,000 $6,750 / $13,500 $12,500 / $25,000
Rx Max OOP (Single/Family) Inc with Med OOP Max Inc with Med OOP Max Inc with Med OOP Max
Combined OOP Max (Med + Rx) $6,000 / $12,000 $6,750 / $13,500 $12,500 / $25,000
Emergency Room Ded, then 15% co-ins Tier A Ded, then 30% co-ins Tier A Ded, then 50% co-ins
Urgent Care Ded, then 15% co-ins Ded, then 30% co-ins Ded, then 50% co-ins
Inpatient / Outpatient Hospital Ded, then 15% co-ins Ded, then 30% co-ins Ded, then 50% co-ins
Vidant Pharmacy Retail Pharmacy
Rx Deductible Included w/ Medical Included w/ Medical
Rx Max OOP (Single/Family) Included w/Medical Included /Medical
Generic (30 days) Ded, then 10% co-insurance Ded, then 20% co-insurance
Preferred Brand (30 days) Ded, then 20% co-insurance Ded, then 30% co-insurance
Non-Preferred Brand (30 days) Ded, then 30% co-insurance Ded, then 40% co-insurance
Generic (90 days) Ded, then 10% co-insurance Ded, then 20% co-insurance
Preferred Brand (90 days) Ded, then 20% co-insurance Ded, then 30% co-insurance
Non-Preferred Brand (90 days) Ded, then 30% co-insurance Ded, then 40% co-insurance
Preferred Brand Specialty Rx Ded, then 20% co-insurance Ded, then 30% co-insurance
Non-Preferred Specialty Rx Ded, then 30% co-insurance Ded, then 40% co-insurance
If cost exceeds $300 for all tiers and
number of day supply N/A N/A
14 | P a g eMedical Coverage (continued)
Plan Benefit Levels - MedCost
Vidant Health medical plans will include tiered provider options. Here are some highlights of the coverage in each tier:
Preventive care medical services performed by an in-network provider are covered at 100% under each medical plan - no charge to you.
Tier A includes higher co-insurance coverage at 85%, lower copays and lower deductibles and out of pocket maximums.
Tier B includes co-insurance coverage at 70% or 80%, slightly higher copays and deductibles and out of pocket maximums.
Out of Network includes co-insurance coverage at 50%, higher copays and deductibles and out of pocket maximums.
If you stay in-network, the plan pays a greater portion of the cost of your care, and you pay less.
In Network – Tier A In Network – Tier B
Vidant Health and other select providers and Vidant Select providers and facilities
Health facilities in the MedCost Network
Basic Choice Basic Choice
Wellness Covered at 100% Covered at 100% Covered at 100% Covered at 100%
Plan Co-insurance Plan pays 85%, you pay 15% Plan pays 85%, you pay 15% Plan pays 70%, you pay 30% Plan pays 80%, you pay 20%
Vidant PCP Visit $5 Copay $5 Copay N/A N/A
Vidant Specialty Visit $50 Copay $40 Copay N/A N/A
Non-Vidant PCP Visit $45 Copay $25 Copay $55 Copay $35 Copay
Non-Vidant Specialty Visit $65 Copay $45 Copay $75 Copay $55 Copay
VidantNow $20 Copay $20 Copay $20 Copay $20 Copay
Med Deductible
(Single/Family) $1,200 / $2,400 $800 / $1,600 $1,500 / $3,000 $1,200 / $2,400
Med Max OOP (Single/Family) $4,000 / $8,000 $3,200 / $6,400 $5,000 / $10,000 $4,000 / $8,000
Rx Max OOP (Single/Family) $2,500 / $5,000 $2,500 / $5,000 $2,500 / $5,000 $2,500 / $5,000
OOP Max (Med + Rx) $6,500 / $13,000 $5,700 / $11,400 $7,500 / $15,000 $6,500 / $13,000
$200 copay + ded/15% co- $150 copay + $200 copay + Tier A $150 copay + Tier A
Emergency Room ins ded/15% co-ins ded/30% co-ins ded/20% co-ins
Urgent Care $50 copay $40 copay $60 copay $50 copay
In / Outpatient Hospital Ded, then 15% co-ins Ded, then 15% co-ins Ded, then 30% co-ins Ded, then 20% co-ins
Vidant Pharmacy Retail Pharmacy
Basic and Choice Basic and Choice
Rx Deductible None None
Rx Max OOP (Single/Family) $2,500/$5,000 $2,500/$5,000
Generic (30 days) $10 copay $25 copay
Preferred Brand (30 days) $25 copay $50 copay
Non-Preferred Brand (30 days) $50 copay $100 copay
Generic (90 days) $30 copay $75 copay
Preferred Brand (90 days) $75 copay $150 copay
Non-Preferred Brand (90 days) $150 copay $300 copay
Preferred Brand Specialty Rx $50 copay $100 copay
Non-Preferred Specialty Rx $100 copay $300 copay
If cost exceeds $300 for all tiers and number of day supply 15% co-insurance 25% co-insurance
15 | P a g eMedical Coverage (continued)
Plan Benefit Levels - MedCost
Out of Network includes plan co-insurance coverage at a lower percentage than preferred (Tier A) or in-network
(Tier B), higher copays and deductibles and out of pocket maximums.
Out of Network
Basic Choice
Wellness Deductible, then 50% co-insurance Covered at 100%
Plan Co-insurance Plan pays 50%, you pay 50% Plan pays 60%, you pay 40%
Vidant PCP Visit N/A N/A
Vidant Specialty Visit N/A N/A
Non-Vidant PCP Visit Deductible, then 50% co-insurance Deductible, then 40% co-insurance
Non-Vidant Specialty Visit Deductible, then 50% co-insurance Deductible, then 40% co-insurance
VidantNow N/A N/A
Med Deductible
(Single/Family) $4,500 / $2,400 $3,000 / $6,000
Med Max OOP (Single/Family) $10,000 / $20,000 $7,500 / $15,000
Emergency Room $200 copay + ded/15% co-ins $150 copay + ded/15% co-ins
Urgent Care Deductible, then 50% co-insurance Deductible, then 40% co-insurance
In / Outpatient Hospital Deductible, then 50% co-insurance Deductible, then 40% co-insurance
16 | P a g ePreventive Schedule of Benefits
Recommended Preventive Screenings
Well-baby care Office visits and immunizations – 0 through 24 months
All immunizations are covered for adults and children. Recommended to
Immunizations have one tetanus booster every 10 years, influenza annually,
pneumococcal, one dose at age 65 or older.
Routine diagnostic tests Labs for screenings such as cholesterol and glucose
Women of average risk for breast cancer should begin conversations with
their provider at age 40, discussing the risks and benefits of mammography
and making an informed decision about regular screening. Women at high
Routine mammograms risk for breast cancer due to family history of cancer or certain genetic
mutations should talk with their provider about a breast cancer screening
plan.
Routine physical exams Annually age 2 and up
Routine pap, pelvic and breast exams Women of average risk for cervical cancer should begin conversations with
their provider at age 21, discussing the risks and benefits of pap testing and
making an informed decision about regular screening.
Men of average risk for prostate cancer should begin conversations with
their provider at age 50, discussing the risks and benefits of psa testing
Routine PSA test and prostate exam and making an informed decision about regular screening.
African American men and men with a family history of prostate cancer
should talk with their provider about psa testing beginning at age 45.
Colon cancer screening Women and men of average risk for colorectal cancer should begin
conversations with their provider between the ages of 45 and 50,
discussing the risks and benefits of colorectal cancer screening and
making an informed decision about method of screening. There are
several types of screening for colorectal cancer, from simple take home
tests to colonoscopies. In 2018, American Cancer Society released
updated recommendations to start colorectal cancer screening at age 45.
Other guidelines continue to recommend screening starting at age 50.
Lung cancer screening Women and men who meet certain criteria should begin conversations with
their provider starting at age 55, discussing the risks and benefits and lung
cancer screening and making an informed decision about regular screening.
Eligibility for lung cancer screening includes individuals aged 55 to 74 in fairly
good health who currently smoke or have quit smoking in the past 15 years.
Individuals must have at least a 30 pack-year smoking history.
Preventive Screenings
The table above is not a complete list; for complete details, see the Summary Plan Descriptions as well as other relevant
information available on the Team Central website. Your provider must code services as wellness and preventive if
applicable. Most wellness and preventive screenings are covered at 100% while in- network without any out-of-pocket
expense to you. If these services are not considered routine at the time of service, they may be subject to co-pays,
deductibles and coinsurance. Also, if during a routine exam, a non- routine component is added (additional test,
procedure or lab work), the non-routine/non-preventive care component may be subject to co-pays, deductibles and
coinsurance. If you have questions regarding how your claim was processed, please contact MedCost at 800-795-1023.
17 | P a g ePrescription Drug Benefits
Prescription drug coverage for you and your covered dependents is included with the Vidant Medical Plan.
MedImpact administers the prescription drug benefit for all Vidant Medical Plan participants. If you enroll in one
of the medical plans, your prescription drug coverage is provided.
When you or a family member need a prescription filled, you may use your medical/prescription identification
card at the Vidant Employee Pharmacy or a retail pharmacy that participates in the pharmacy network. You
pay a share of the cost of your prescription in the form of a co-pay or coinsurance. The amount you pay
depends whether you receive a generic, preferred brand, or non-preferred brand name drug and which
pharmacy you choose. Questions about Vidant prescription drug benefits? Contact MedImpact at 844-513-
6009 or www.medimpact.com.
Generic Drugs (lowest co-pay) are chemically and therapeutically equivalent to brand-name drugs, but are
available at a lower price.
Preferred Brand Drugs (middle co-pay) do not have less-costly generic equivalents because they are sold
only under a trademarked name. Preferred drugs are the most cost-effective brand drugs when a generic is not
available.
Non-Preferred Brand Drugs (highest co-pay) often have either a generic equivalent or a preferred-name brand
alternative.
Prior Authorization Requirements alternative is available, you will pay the appropriate
To ensure that drugs covered by your prescription brand co-pay or coinsurance plus the difference in
drug benefit are used safely and appropriately, cost between the brand-name drug and the generic
certain medications require that your physician alternative.
obtain prior authorization from MedImpact before
they are covered. To determine if a medication Drug Quantity Limits
requires prior authorization, contact MedImpact at The Vidant Medical Plan prescription drug benefit
877-559-2955 or online through includes quantity limits on certain medications as
www.medimpact.com. Other drugs may be added recommended by the FDA. These limits are applied
based upon safety, efficacy and FDA-approved to address the problem of overuse of medications
therapies. that may be unsafe for the patient. To determine if
a medication that has been prescribed for you has
Wellness Program quantity limits, you may contact MedImpact at 877-
Eligible participants may receive FREE medications 559-2955 or online through www.medimpact.com.
from Vidant Health by participating in Free: 1-on-1
disease management services with a Vidant Step Therapy Program
Employee Wellness Nurse Case Manager or Health Step therapy is a clinical tool used to promote
Coach available for Vidant Health team members effective, clinically appropriate medications that
and covered spouses who have high risk factors may be less costly. This program requires the
and/or complex medical conditions such as high member to try a clinically appropriate, lower cost
blood pressure, diabetes, high cholesterol, obesity, medication first, or requires that their doctor has
asthma, congestive heart failure or coronary artery documented why the patient is not a good
disease. Call Employee Wellness at 252-847-5590 candidate for the clinically appropriate, lower cost
for more information. medication, or therapy. Step therapy is an
automated program that the pharmacist uses to
Mandatory Generic Drug Program review a patient’s medication history. Step
The prescription drug benefit limits payment for therapy will often recommend an alternative
brand medication when a generic version is medication (sometimes a generic medication) to
available to the public. If either you or your doctor replace the more costly medication.
requests a brand medication when a generic
18 | P a g eMedical Coverage (continued)
Coordination of Benefits (COB)
Coordination of benefits applies when you or your dependent(s) on the medical plan have additional coverage.
For example, you may have your family on both your Vidant MedCost plan and your spouse’s plan. COB
applies to medical only; it does not apply to prescription drug benefits.
Tobacco Additional Premiums
Additional medical premiums of $40 per pay period will be charged if anyone covered under your MedCost plan
is a tobacco user. Tobacco users include smoking, chewing, dipping, e-cigarettes, etc.
Tobacco users that have enrolled in a tobacco cessation program may apply to have the additional tobacco premium
waived. Team members must complete a certification stating that they are actively enrolled in a cessation
program. To find out more about the tobacco cessation program, please contact Employee Wellness at 252-
847-5590.
Spousal/Domestic Partner Additional Premiums
If you cover your spouse under one of the medical plan options offered by the organization, you will pay an
additional $50 premium if your spouse or domestic partner is eligible for medical coverage through his or her
employer. This addition will be added to premiums you pay for your medical coverage.
It does not apply when:
You and your spouse are both team members of Vidant Health
Your spouse has no group medical coverage available
Your spouse is enrolled for Medicare coverage
Your spouse is enrolled in TriCare
Wellness Additional Premium
Team members enrolled in the medical plan who opt not to complete their new hire/annual WellScreen exam and/or
Health Risk Assessment (HRA) will pay an additional premium of $25 per pay period.
WellScreen exams may be completed by Occupational Health or a Primary Care Physician within the fiscal year
(October 1st – September 30th). If you receive your WellScreen exam from your Primary Care Physician, all necessary
paperwork must be submitted and approved by Employee Wellness prior to the fiscal year deadline.
Health Risk Assessments are offered during the fiscal year. New team members hired after the close of Annual
Enrollment for 2019 that opt to not complete the WellScreen exam described above will pay an additional premium of
$25 per pay period.
If you are unable to participate in any of the health related activities or achieve any of the health outcomes required to
earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a
reasonable accommodation or an alternative standard by contacting Occupational Health to initiate the request for
accommodation.
19 | P a g eDental
The Vidant Dental Plan, administered by Cigna, has been designed for team members to see any licensed
dentist; however the benefits (i.e. lowest out-of-pocket cost to you) are greatest when services are received
from a Cigna provider. Using a Cigna provider will eliminate the potential of charges exceeding usual and
customary guidelines. Dental implants are covered when medically necessary at the Major benefit level. You
can obtain a listing of providers at my.cigna.com or by calling Cigna at 800-244-6224.
Summary of Dental Coverage
Vidant Dental Plan
Basic Choice
In-Network Out of Network In-Network Out of Network
You pay 20% You pay 20% Covered at 100% Covered at 100%
Preventive (deductible (deductible (deductible (deductible
waived) waived) waived) waived)
Deductible:
$50/$100 $75/$150 $50/$100 $75/$150
Individual/Family
You pay 40% after You pay 50% after You pay 20% after You pay 30% after
Basic
deductible deductible deductible deductible
You pay 40% after You pay 50% after You pay 40% after You pay 50% after
Major
deductible deductible deductible deductible
Annual Maximum
$1,000 per person $750 per person $2,000 per person $1,500 per person
Dental Benefit
Orthodontia You pay 40% You pay 50% after
No Coverage No Coverage
(Under Age 19) (deductible waived) deductible
Orthodontia Lifetime
No Coverage No Coverage $1,000 per person $1,000 per person
Maximum
*You may also be required to pay any amounts an out-of-network dentist charges that are over the
Maximum Plan Allowance.
Coordination of Benefits (COB)
Coordination of Benefits applies if you or any family members are covered by another dental plan in addition to
the Vidant Dental Plan. If you are insured by two dental plans, you should advise your dental office so that
benefits can be coordinated accordingly. Please see the Vidant Dental Plan summary plan description located
on Team Central.
20 | P a g eVision
The Vision Care Plan is designed to encourage you to maintain your vision through regular exams and to help
with expenses for prescription glasses and contact lenses. Superior Vision is the vision plan provider. With this
voluntary plan, you may use in or out-of-network providers, but the level of benefit is higher when you receive
care from an in-network provider. A listing of in-network providers can be found at www.superiorvision.com or
by calling Superior Vision directly at 800-507-3800.
Superior Vision Superior Vision
In Network Benefit Coverage Out of Network Benefit Coverage
Benefit Description Copay Benefit Description
Focuses on your eyes and overall Well Focuses on your eyes and overall
Well wellness Vision wellness Covered up
$20
Vision Every calendar year Exam Every calendar year to $44 retail
Exam
Prescription Glasses $20 Prescription Glasses
$150 allowance for a wide selection of Every calendar year
frames Included in Covered up
Frame 20% off amount over your allowance Prescriptio Frame to $77 retail
Every calendar year n Glasses
Single vision, lined bifocal, and lined Included in Single vision, lined bifocal, and lined
trifocal lenses Prescriptio trifocal lenses* Covered up
Lenses Lenses
Every calendar year n Glasses Every calendar year to $64 retail*
Scratch Coat $13
Ultraviolet coat $15
Tints, solid or gradients $25
Lens Anti-reflective coat $50**
Option
s Polycarbonate $40**
High index 1.6 $55**
Photochromics $80**
Contacts $150 allowance for contacts; copay does not Contacts $100 allowance for contacts; copay does not
(instead of apply (instead of apply Contact lenses
glasses) Contact lens exam (fitting and evaluation) Up to $50 glasses) Contact lens exam (fitting and evaluation) fitting co-pay not
Every calendar year Every calendar year covered
30% off any non-covered exam, frames and prescription
lenses
20% off lens options, contacts and other prescription
materials
10% off disposable contact lenses
Extra Extra
Savings and Savings and *Discounts may not be available for out of network providers
Laser Vision Correction
Discounts Discounts
Discount on LASIK – Discounts range from 15% to 50;
discounts only available from contracted Superior Vision
facilities.
*Single covered up to $34 retail; bifocal covered up to $48 retail; trifocal covered up to $64 retail
**Prices reflected are for single lenses. Bifocal and trifocal lenses have a 20% discount available
Coverage with a retail chain affiliate may be different. Once your benefit is effective, visit
www.superiorvision.com for details.
For more information, including plan limitations, exclusions and discounted services; please refer to the Vision
Care summary plan description located on the Team Central website. Your provider will verify eligibility of your
vision benefits. Go to www.superiorvision.com for details.
21 | P a g eFlexible Spending Accounts (FSA)
Flexible Spending Accounts are an easy way for you to keep more of your take-home pay by using “pre-tax”
dollars for eligible expenses. Simply present your FSA debit card for the purchase of eligible services and goods.
Using the debit card allows you to directly tap into your Health Care and Dependent Day Care FSA, meaning
better cash flow for you and no waiting for reimbursement.
Types of Eligible Expenses* & Guidelines
$2,650 annual maximum
Medical plan office visit co-pays, deductibles and coinsurance
Certain over-the-counter (OTC) items prescribed by your provider
Dental plan co-pays, deductibles and coinsurance
Health Care Orthodontia expenses
Flexible Vision care expenses including contacts, glasses, & LASIK surgery
Spending Expenses can be for you or anyone you claim as a dependent on your
Account Federal tax return**
Your entire election is available immediately regardless of actual payroll
deduction amounts
Carry over up to $500 for the following calendar year
Expenses must be incurred by December 31 and submitted for
reimbursement by April 30th of the following year
$5,000 annual maximum
Dependent Used for dependent day care expenses while you and your spouse work, look for
Day Care work or attend school full-time
Flexible Dependents include children under age 13 or dependents that are physically or
Spending mentally unable to care for themselves
Account Can only be reimbursed up to what you have had payroll deducted (pay as you go)
Expenses must be incurred by March 15 of the following year and submitted for
reimbursement by April 30th of the following year
* This is only an example of eligible expenses.
**Visit www.irs.gov for definition of eligible tax dependent
How it Works:
Estimate your expenses and make an annual election for the accounts that apply to you
Your annual election is calculated on a per pay period basis and deducted from your paycheck and
deposited into your personal account. Payroll deductions begin from the effective date of your election and
continue through the end of the calendar year.
A debit card will be issued to new participants.
When you incur expenses throughout the year, present your debit card for payment.
Eligible expenses are only reimbursable if they occur on or after the date of benefit eligibility
Filing Claims & the Reimbursement Process:
Keep all receipts. IRS requires documentation for many expenses to confirm they are eligible under the
plan.
Use your debit card at the time of service or submit your receipts with a completed reimbursement
claim form. Some debit card transactions may still require a receipt
For more information on the FSA accounts, visit www.discoverybenefits.com or call 866-451-3399
22 | P a g eLimited Purpose Flexible Spending Accounts (Limited Purpose FSA)
The Limited Purpose FSA is for team members who are enrolled in the Medical Savings Plan and contributing to
a Health Savings Account (or whose spouse is contributing to a HSA) in which case the regular Flexible
Spending Account is not allowed.
The Limited Purpose FSA can be used for any non-medical health related expenses such as dental and vision.
Types of Account Eligible Expenses & Guidelines
$2,650 annual maximum
Dental plan co-pays, deductibles and coinsurance
Orthodontia expenses
Vision care expenses including contacts, glasses, & LASIK surgery
Expenses can be for you or anyone you claim as a dependent on your
Federal tax return
Limited Purpose FSA Your entire election is available immediately regardless of
actual payroll deduction amounts
Carry over up to $500 for the following calendar year
Expenses must be incurred by December 31 and submitted for
reimbursement by March 31 of the following year
How it Works: Filing Claims & the Reimbursement
Estimate your expenses and make an annual Process:
election for the accounts that apply to you Please consider enrolling in direct deposit;
it’s FREE and the fastest way to get
Your annual election is calculated on a per pay reimbursed
period basis and deducted from your paycheck
and deposited into your personal account. Keep all receipts. IRS requires
Payroll deductions begin from the effective date documentation for many expenses to
of your election and continue through the end of confirm they are eligible under the plan.
the calendar year.
Use your debit card at the time of service or
A debit card will be issued to new participants. submit your receipts with a completed
reimbursement claim form. Some debit card
When you incur expenses throughout the year, transactions may still require a receipt.
present your debit card for payment.
Eligible expenses are only reimbursable if they
occur on or after the date of benefit eligibility
For more information on the FSA accounts, including available balance, savings calculator, expense planning
worksheets, reimbursement claim forms, and IRS publications, www.discoverybenefits.com or call 866-451-
3399
23 | P a g eHealth Savings Accounts (HSA)
If you are enrolled in the Medical Savings Plan, you may elect to open a HSA.
HSA is an optional savings account used to pay for qualified medical expenses directly with your HSA
debit card or to reimburse yourself at any time for medical expenses you paid out of pocket. There is no
time limit to reimburse yourself.
You can contribute to a HSA only if you are enrolled in the High-Deductible Plan and you are not covered
by any other medical plan (including spouse’s plan or Medicare) or flexible spending account.
Vidant will make a contribution to all HSAs for 2019: up to $600 for single coverage or up to $1,200 for
“family” coverage, based upon your enrollment date. Family coverage for this plan is defined as any
coverage other than single.
Maximum contributions set by the IRS. For 2019, the maximum contribution is $3,500 if single
coverage, or $7,000 if “family” coverage. An annual catch-up amount of $1,000 is available for team
members ages 55-65.
In order to contribute to a HSA starting January 1, 2019, you cannot maintain a Flexible Spending
Account (FSA) except for a Limited Purpose Flexible Spending Account. If you have a balance of $500
or less in your FSA as of December 31, 2018, your account will be converted to a Limited Purpose FSA
for 2019. Any amounts over $500 in your FSA as of December 31, 2018 will be forfeited.
In future years, if you change medical plans and are no longer enrolled in the High-Deductible Plan, you
can no longer add to your HSA, but you can still use any funds in your HSA to pay for qualified medical
expenses.
Discovery Benefits
www.discoverybenefits.com
866-451-3399
Triple tax advantage – money saved is pre-tax, grows tax-free and withdrawn tax free if used
to pay for qualified medical expenses
You own your HSA! Your account carries over from year to year and goes with you if
you take another job.
24 | P a g eYou can also read
