2018 Annual Benefits Enrollment Guide - …

1 CoverChoices as unique as you are11/9/20172018 Benefits Guide Benefits OverviewIntroduction ..03 Coverage & Eligibility ..05 How to Enroll ..07 Provider Networks ..08 Medical, Dental and VisionMedical Benefits ..10 HRA Plan ..13 HSA Plan ..20 PPO Plan ..25 Compare the Plans ..29 Prescription Drug Benefits ..32 Flexible Spending Accounts ..36 Wellbeing Benefits ..40 Dental Benefits / Employee Premiums ..43 Vision Benefits / Employee Premiums ..45 Life and DisabilityLife Insurance / Employee Premiums ..47 Accidental Death and Dismemberment Insurance / Employee Premiums ..50 Disability Insurance / Employee Premiums ..52 Retirement, PTO and Other BenefitsRetirement Benefits ..55 Time Away from Work ..57 Other Programs & Benefits ..59 ResourcesWho to Contact ..64 Table of ContentsNavigate your Benefits by clicking on a link OverviewWelcomeAs an employer in the healthcare industry, we are committed to serving the needs of our communities, our patients and each other.

2 Because you are at the heart of our organization, we invest in programs to help you and your family stay healthy and are proud that the medical plans we offer are among the best of our healthcare OverviewThis Guide summarizes the programs and Benefits available to Baylor Scott & White Health employees and their eligible dependents. Official plan documents, policies and certificates of insurance that contain the details, conditions, maximum benefit levels and restrictions on Benefits govern our Benefits program. They re available on In case of a conflict between this Guide and the official documents, the official documents prevail. ( , 2017) The information in this Guide isn t a guarantee of Benefits . Baylor Scott & White reserves the right to modify or terminate its employee benefit plans and programs at any time and for any reason. More than 65,000 Our health plans are self-funded, which means we pay for the cost of your claimsLast year, under our plans:Participants received 100% coverage for preventive care employees and family members were covered by our health plans last year18,500+benefit-eligible employees were enrolled in the HRA plan 2,000+benefit-eligible employees were enrolled in the HSA plan8,000+ benefit-eligible employees were enrolled in the PPO plan20 16 Employees received more than $9 million in tuition reimbursementEmployees saved more than $3 million through the employee discount programOver 1,200 babies were bornOur Plan Scott and White Health Plan serves more than 200,000 Texans.

3 As part of Baylor Scott & White Health, the plan implements innovative medical programs and offers convenient access to high-quality care, increased coordination of patient care and improved patient Providers Baylor Scott & White Quality Alliance (BSWQA) is a clinically integrated organization of employed physicians, independent physicians, hospitals and other providers whose mission is to improve quality and reduce the overall cost of care for those served by Baylor Scott & exclusive Tier 1 network is always the best bet. Tier 1 providers commit to, and are accountable for, providing quality, efficient and cost-effective care. IntroductionClick here to read the summary plan descriptions5 Benefits OverviewCoverage & EligibilityOur coverage runs from Jan. 1 Dec. 31 of each year. Our Benefits program provides coverage to employees, spouses and children who meet certain requirements.

4 Waive Coverage You may waive coverage offered through Baylor Scott & White. However, once you waive coverage, you will not be able to enroll until the next scheduled Annual Enrollment period or within the deadline required for a qualifying life event, according to applicable federal and/or state laws or the plan & Eligibility6 Benefits OverviewEligible DependentsIf you cover yourself as an active employee, you may enroll your eligible dependents in certain Benefits as described in this Guide . Eligible dependents include your spouse or common-law spouse (as recognized by Texas state law), your children or your spouse s children up to the age 26,* including: Natural Step Legally adopted In the process of legal adoption Foster Covered by a Qualified Medical Child Support Order Child(ren) of whom you have legal guardianshipPlease note, you may be required to provide documentation through the dependent verification process to ensure family members meet the eligibility criteria described above.

5 If documentation is requested, it is important to submit it in a timely manner to ensure dependents remain covered. *Subject to approval, the age limit is waived if the child is unmarried, physically and mentally incapacitated and unable to earn an independent living; dependent on you for at least 50% of financial support; claimed by you as a dependent for federal taxes; and disabled and covered under the plan before age your Dependent also Work at Baylor Scott & White?If you and a dependent both work for Baylor Scott & White, only one of you can be covered as a dependent. Neither can be covered as both an employee and a dependent. Coverage & EligibilityEmployeesYou are eligible for medical, dental, vision, flexible spending accounts, long and short-term disability, life and AD&D insurance if: You are a full-time employee regularly scheduled to work at least 60 hours per pay period You are a part-time employee regularly scheduled to work 40 hours but fewer than 60 hours per pay period7 Benefits OverviewHow to EnrollHow to EnrollYou can enroll for your medical, dental, short-term disability and other Benefits on PeoplePlace.

6 After you log in, follow these simple steps:1. Click Benefit Details2. Click Benefits Enrollment3. Click Select to choose your 2018 Benefits and add or update your dependents and beneficiaries4. Click Save and Continue to accept your final choices or I have no changes if you prefer to make no election changes5. Click Submit to finalize your choices You only have 30 days to sign up for Benefits after you are first hired, or become Benefits Following Legal Notices are Available for Review on Under Resources: Medicare Part D Creditable Coverage Notice COBRA Initial Notice HIPAA Special Enrollment Rights Notice Children s Health Insurance Program Reauthorization Act of 2009 Notice If you would like a printed copy of these notices or any plan materials, please contact PeoplePlace at OverviewProvider NetworksRegardless of which plan you choose, you will have access to the following provider networks:A Texas-based network managed by Baylor Scott & White Quality Alliance (BSWQA), in conjunction with Scott and White Health Plan (SWHP).

7 Our Tier 1 Network is always the best bet, and it s easy to see why. Tier 1 providers commit to, and are accountable for, providing quality, efficient and cost-effective care. Their proven track record of improved quality and cost are why we can provide rich Benefits for Tier 1 national network, managed by Cigna, in conjunction with Scott and White Health who are not included in the Tier 1 or Tier 2 Networks. Choosing providers in Tier 3 will always be the most expensive or dependents who live 40 or more miles from the nearest Tier 1 hospital receive a higher out-of-area benefit (80% vs 50% after deductible) when they see a Tier 2 provider. If you or one of your dependents lives 40 or more miles from a Tier 1 hospital, contact SWHP at 844-843-3229 to activate the out-of-area (OOA) coverage. Or if you or your dependent had the OOA coverage activated but no longer live 40 or more miles from a Tier 1 hospital, contact SWHP to deactivate this coverage.

8 Provider NetworksTIER2 TIER1 TIER39 Benefits OverviewAbout Baylor Scott & White Quality Alliance (BSWQA)BSWQA is an accountable care organization (ACO) comprised of doctors and facilities located throughout Texas. BSWQA includes more than 5,000 primary and specialty care doctors, 48 hospitals, post-acute care facilities and other healthcare stakeholders all agreeing to be jointly accountable for improving quality of care, managing the health of entire patient populations ( those with chronic illness such as diabetes, congestive heart failure, asthma and/or COPD) and reducing healthcare is an Accountable Care Organization (ACO)?An ACO is a healthcare organization that ties payments to quality measures and the cost of care. ACOs are formed from a group of doctors that are committed to being accountable to patients and payers for the quality, appropriateness and efficiency of healthcare services that are delivered.

9 ACOs are all about doctors, hospitals, health plans, post-acute care facilities and others working together to make sure you get the right care at the right time and at the right cost. How does it work?Your primary care doctor leads a care team that includes physician assistants, medical assistants and registered nurses to help manage your health if you have been diagnosed with a complex illness and make sure your preventive services are up-to-date so that you stay healthy throughout the year. Your primary care doctor uses electronic health records (shared securely with other doctors and care managers throughout the health system) to help keep you and your care team on the same page in regard to other specialty doctors you may be seeing, what medicine(s) you re taking, your health history and your test results in real time. This also helps your doctors spot any gaps in your care. Need help finding a BSWQA doctor?

10 Call our HealthAccess Line at 844-BSW-QLTY (279-7589) to speak to a representative or download the MyBSWH ealth app from the Apple App Store or Google Play. Log in using the same user name and password you use for the Scott and White Health Plan Member Portal to search for robust Tier 1 Network includes specialists from Cook Children s Physician Network, University of Texas Southwestern Medical Center at Dallas, Texas Oncology, Texas Children s Hospital and more! You can access a complete list of Tier 1 providers by clicking here. Provider NetworksClick here to watch a short video about our provider networks 10 Benefits OverviewMedical BenefitsWe offer three different medical plans. Each plan has the same provider networks, pharmacy formulary and covered services. The main difference is how you pay for care. Medical Benefits11 Benefits OverviewHealth Savings Account (HSA) PlanClick here to learn more about the You Pay for Care: Baylor Scott & White contributes between $500 $1,000 to help jump start your HSA account.