2016 BENEFITS - Blue Shield of California€¦ · this spending account for 2016 Your Benefits At-A-Glance continues on the next page. BENEFIT UPDATES BENEFITS AT-A-GLANCE YOUR DCHS

BE WELL. WORK WELL. LIVE WELL.BODY, MIND & SPIRIT

DCHS Benefits Open Enrollment Monday, November 9 – Friday, November 20, 2015

2016 BENEFITS OPEN ENROLLMENT NEWSLETTER

BENEFIT UPDATESBENEFITS

AT-A-GLANCEYOUR DCHS BENEFITS

OTHER IMPORTANT INFORMATION

RESOURCES AND SUPPORT GLOSSARY

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Table of Contents

Welcome to 2016 DCHS Open Enrollment ................................................................................................. 3

Open Enrollment Action Checklist ............................................................................................................ 4

Benefit Updates for 2016............................................................................................................................ 5

Your Benefits At-A-Glance ........................................................................................................................ 6

Your DCHS Benefits ..................................................................................................................................... 8

Medical Plans ...................................................................................................................................... 8

Dental Plans ...................................................................................................................................... 10

Vision Plans (with Hearing Aid discounts) .............................................................................................. 11

Health Care Spending Account ...................................................................................................... 12

Additional Benefit Options .............................................................................................................. 13

Dependent Day Care Spending Account ........................................................................................ 14

Special Benefit Features ................................................................................................................ 15

Other Important Information .................................................................................................................... 16

Resources and Support ........................................................................................................................... 17

2016 Benefit and Wellness Open Enrollment Fair Schedule ......................................................... 17

Wellness Programs .......................................................................................................................... 17

Contact Information ........................................................................................................................ 18

Glossary .................................................................................................................................................... 19

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WELCOME TO 2016 DCHS BENEFITS OPEN ENROLLMENTIt’s that time of year again. Open Enrollment is your opportunity to review your personal information, current benefit elections and costs, and make any necessary changes to your benefits for the 2016 calendar year.

While the plans offered have not changed, the medical plan “payroll” contributions for the Blue Shield medical plans will increase for most associates, which may impact your decisions for 2016. The large number of claims processed under the Blue Shield medical plans combined with the costs associated with the Affordable Care Act, are driving much of the premium cost increases from Blue Shield.

Please review these contribution costs carefully; it may be worth considering a more cost-effective option for 2016. You can log on to your benefit account at www.myDCHSBenefits.com to review details about your 2016 plan options and costs.

As we move into a new phase, our benefits continue to be designed to support you as you travel your Path to Wellness – to help you improve and maintain you and your family’s health and well-being.

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http://www.myDCHSBenefits.com





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!In early December, you will receive a Confirmation Statement confirming your Open Enrollment benefits elections, including any Wellness Credit, if eligible. Please review this form carefully and report any discrepancy immediately to your Human Resources Department or DCHS Benefit Services at [email protected].

OPEN ENROLLMENT ACTION CHECKLIST REVIEW your current plan choices and finances, as the costs for many plans will increase in 2016

READ this newsletter for information about what’s changing for 2016, your benefit options and costs, and actions you need to take during Open Enrollment

ATTEND an Open Enrollment Benefits and Wellness Fair. See page 17 for the schedule

VISIT https://www.myDCHSBenefits.com, your personal benefits resource

USE these questions to help think through your needs for the upcoming year:

1. Are your current plans meeting your needs? Do you need more or less coverage? Please review the cost of the plans on your personal myDCHSBenefits.com account. The costs for your medical plan may increase for 2016, and as a result may impact your election decision for 2016.

2. Does your spouse’s/registered domestic partner’s employer offer health insurance for 2016? Some DCHS plans offer associates a cash back benefit for waiving medical plan coverage, upon verification of medical benefits.

3. Did you or your family enroll in the PPO/POS plan last year, but only used doctors in the HMO network? If so, you may want to consider choosing the HMO plan for 2016 and save money each paycheck.

4. Do you expect to have out-of-pocket costs (medical, dental and/or vision) for yourself or your family members this year? If so, have you considered a Health Care Spending Account?

5. Do you expect to have out-of-pocket costs (elder care, day care or baby sitting for children 12 years or younger) for your eligible dependents? If so, have you considered a Dependent Day Care Spending Account?

6. Did you know DCHS offers buy-up options for Vision, Life Insurance, Accidental Death and Dismemberment (AD&D), Long-Term Disability (LTD), and Voluntary Short-Term Disability (Vol. STD)?

REVIEW AND/OR CHANGE your benefit elections between Monday, November 9 through Friday, November 20, 2015.





BENEFIT UPDATES FOR 2016These updates will be effective January 1, 2016

n Medical Plan Increases DCHS strives to manage health care costs in a way that is consistent with our Mission and Values, while

keeping costs reasonable for everyone. Medical costs continue to rise, which affects everyone, including us. For 2016, the amount you contribute toward your medical plan costs each pay-period, may increase substantially. Your portion of the medical plan contributions (the amount deducted from your paycheck each pay-period that goes toward the cost of your medical plan) for 2016 depends on:

> The type of plan you choose (POS/PPO vs HMO), and

> If you have completed your Wellness Program activities by the October 23 deadline (and if eligible, earned a credit toward your medical plan contribution for 2016)

It’s important to note that while your costs may increase for 2016, DCHS continues to pay the largest share of overall medical costs for associates and their dependents. In fact, on average DCHS continues to pay over 92% of the medical plan costs for associates, and therefore, absorbs the majority of the health care cost increases.

Please review the new cost of your medical plan options where applicable during Open Enrollment on your personal myDCHSBenefits.com account.

To determine if your current or future provider is an in-network preferred provider, contact Blue Shield or use the Provider Directory on blueshieldca.com. Remember: Effective January 1, 2016, if your current or future provider is out-of-network, your licensed provider will be reimbursed at the out-of-network benefit level and you will be responsible for the remaining balance.

n Hearing Aid Discounts DCHS associates who enroll in a vision plan with VSP will be eligible to receive a discount on hearing aids

from TruHearing®. Dependents and extended family members are also eligible to receive the discount. Parents, grandparents, children, grandchildren, and siblings are all considered extended family members and are eligible to receive the discount. TruHearing® is not offered as a stand-alone benefit. See page 11 for more details.

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http://myDCHSBenefits.com

http://www.blueshieldca.com





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YOUR BENEFITS AT-A-GLANCETake a moment to review the full array of benefits that DCHS offers below. DCHS pays the full cost of some of your benefits and shares the cost of others to help reduce the amount you will have to pay.

Benefit Key Features Requires Action During Open Enrollment

Medical Plans Each plan offers comprehensive coverage with varying networks, co-pays and out-of-pocket costs.

Only if you wish to make a change

Review your contributions carefully, as some scheduled increases may affect the cost of your medical plans

Dental Covers preventive care and other benefits for specialized procedures based on the carrier’s coverage tables.


Vision Each plan covers lenses, frames, contact lens and more. You can visit any licensed provider, but you will save if you choose in-network providers.


Health Care Spending Account

Provides the option to use pre-tax dollars to reimburse yourself for qualified health expenses for you and your family. Taking advantage of this benefit reduces your taxable income.

You must enroll/re-enroll to participate in this spending account for 2016

Employee Assistance Program

Provides free and confidential assessments, short-term counselling, referrals, and follow-up services to associates and their families up to certain annual maximums.

Associates and their dependents are automatically enrolled at no cost to you

Life Insurance Provides you and/or your beneficiaries with financial security in the event of your death. Dependent life insurance is also available for your spouse/registered domestic partner and child(ren).

Only if you wish to make a change or confirm/change beneficiaries. Certain changes may require evidence of insurability and approval.

Accidental Death and Dismemberment (AD&D)

Provides additional financial security if you are severely injured or killed in an accident.

Only if you wish to make a change or confirm/change beneficiaries

Voluntary Short-Term Disability (Vol. STD)

Provides short-term income replacement due to non-work related illness or injury.

Only if you are enrolling for the first time, or if you wish to make a change. Certain changes may require evidence of insurability and approval.

Dependent Day Care Spending Account

Provides the option to use pre-tax dollars to reimburse yourself for qualified out-of-pocket expenses. Taking advantage of this benefit reduces your taxable income.

Use this for qualified expenses related to care for a child, such as day or after school care, or care for other dependents who are physically or mentally incapable of self-care. Please refer to page 14 for more information on dependent care qualifications.

You must enroll/re-enroll to participate in this spending account for 2016

Your Benefits At-A-Glance continues on the next page





Benefit options can vary from LHM to LHM (and by associate group). Visit myDCHSBenefits.com to view the plans available to you for 2016.

!DEPENDENT ENROLLMENT AND VERIFICATIONMake sure you have the name and Social Security Number (SSN) of any newly added dependent(s) you wish to add to your benefits plans for 2016. Written evidence of the dependent relationship is required to be submitted to your local Human Resources Department by December 4, 2015, no exceptions. Please see page 14 for more details.

Continued from previous page

Benefit Key Features Requires Action During Open Enrollment

Long-Term Disability (LTD)

Provides long-term income replacement if you can’t work due to long-term illness or injury.

Only if you wish to make a change. Certain changes may require evidence of insurability and approval

Long Term Care (LTC) Provides reimbursement dollars for nursing home care, personal care, adult day care and care provided in an assisted living facility.

Not at this time. Look for more information mid year during the LTC Open Enrollment

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https://www.myDCHSBenefits.com





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YOUR DCHS BENEFITSMedical Plans

Medical Plan Comparison

The information below summarizes some of the key differences between the HMO, POS and PPO options. You will see that the type of medical plan impacts how care is managed, accessibility to doctors, and overall options for receiving care. These factors impact the cost of the plans.

LOWEST COST PLAN

DCHS HMO PLAN n Select doctors within Blue Shield HMO Networkn You must designate a Primary Care Physician (PCP) and Independent Practice Association (IPA)

during the enrollment processn Offers the full range of medical services at little or no cost when you work with your PCP to

coordinate your care within the HMO networkn Does not cover care received from out-of-network providers, unless it is an emergencyn Provides 100% coverage after you pay a co-payn Does not have an annual deductible or lifetime maximum

BUY-UP PLAN

DCHS POS PLAN

Tier 1 HMO Network

n Select doctors within Blue Shield HMO Networkn You must designate a PCP and IPA during the enrollment processn Must choose and use a PCP in the Blue Shield HMO Networkn Provides 100% coverage after you pay a co-payn Does not have an annual deductible or lifetime maximum

Tier 2PPO Network

n Select doctors within Blue Shield PPO Networkn Ability to find doctors and make appointments without the need of a referraln Deductibles, co-insurance and co-pays may apply

Tier 3Out-of-Network

n Access to licensed providers outside of the Blue Shield Networkn Costs will increase significantly when you go out-of-network for services/caren Higher deductibles, co-insurance and co-pays will applyn The out-of-network provider may bill you for all or a portion of the services not covered by your

insurance

ONLY Available to CNA members in Northern California and all Saint Louise Regional Hospital associates

DCHS PPO PLAN

In-Network n Select doctors within Blue Shield PPO Networkn Ability to find doctors and make appointments without the need of a referral n Covers 100% of most hospital based services received from DCHS facilitiesn Deductibles, co-insurance and co-pays may apply

Out-of- Network

n Access to licensed providers outside of the Blue Shield PPO Networkn Costs will increase significantly when you go out-of-network for services/caren Higher deductibles, co-insurance and co-pays will applyn The out-of-network provider may bill you for all or a portion of the services not covered by your

insurance

Keep reading for Medical Plan details





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Considering Your Medical Plan Options

Here are a few key factors to consider as you review your medical plan options for 2016:

1. What are your and your family’s preferred network of doctors and overall benefit needs?

2. What are the medical plan contributions (per-pay-period cost) of your coverage in addition to the out-of-pocket annual expenses (for example, co-pays, deductibles)?

!TIPS FOR USING YOUR MEDICAL COVERAGE WISELY (and keeping costs down)1) Use emergency room care only for emergencies2) Review medical bills for accuracy3) Make sure you use in-network providers4) Be aware of unnecessary medical tests5) Use Generic Rx when possible

Keep reading for Medical Plan details

How are you using your POS Plan? Is the HMO worth another look?

The POS plan is a hybrid plan that gives you the option to use licensed providers in the PPO network, the HMO network or out-of-network. This flexibility makes the POS plan more expensive than the traditional HMO plan. So it’s worth thinking about how you’ve utilized the POS plan over the last couple of years. Are you receiving most of your care through the HMO network? If so, you may want to consider electing the HMO plan and saving yourself money in 2016. The HMO (at Saint Louise Regional Hospital the POS plan) is the lowest cost benefit option for our associates – and for some associates, the HMO is free.

Some features of the HMO plan:

n Typically, HMO members pay lower or no medical plan contributions out of their paycheck

n When you access care through your designated PCP, members are generally responsible for co-pays and the plan covers 100% of the costs thereafter, minimizing your out-of-pocket cost

n There are no separate deductibles

n You do need to get your care through the Tier 1 HMO Network. But if you’re already using this network under the POS plan you can see the same HMO Network providers and may be able to lower your out-of-pocket expenses.

If these considerations make sense, then the Blue Shield HMO may be a good choice for you.





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Mail Order Rx Program – PrimeMail

Cost Savings – DCHS offers a prescription drug program that provides associates with the option to purchase maintenance medications at a greater discount through the PrimeMail mail-order program. For most medications, you can receive a three month supply for the price of a two month supply. To use the mail-order program, follow these simple steps:

> Let your doctor know your interest in a the PrimeMail order program. He or she can provide you with the appropriate prescription and may be able to submit your prescription directly to PrimeMail electronically.

> Contact PrimeMail at www.myprimemail.com or phone number 866-346-7200 to set up your mail-order delivery.

Your myDCHSBenefits.com account

https://www.myDCHSBenefits.com is your personal resource to help you manage your health and benefits year round. Access this website anytime throughout the year if you have a qualifying event, to update your beneficiaries or just to review your current elections. This is also where you can confirm your Wellness Credit(s), if applicable and complete your benefits enrollment. Open Enrollment is your annual opportunity to make changes to your benefits for 2016, unless you experience a Qualifying Life Event (QLE) during the year.

During the year During the Open Enrollment Month of November

n Review your current coverage

n Access benefit summaries and resources

n Update Beneficiaries

n Review each plan’s medical plan contributions (the amount deducted from your paycheck per-pay-period)

n Verify your Wellness activity completion

n Enroll in and/or make changes to your benefits for 2016

Dental PlansDelta Dental and Cigna Dental options are designed to encourage you to take good care of your teeth by providing the highest level of coverage for preventive care. Make sure you are familiar with your dental plan and how it works.

Delta Dental Cigna

n In- or out-of-network dentists

n Large network of dentists, however, you can access dentists outside of the Delta network and still receive coverage, but subject to higher out-of-pocket costs

n Save on out-of-pocket expenses if you use an in-network Delta Dental dentist

n Annual Maximum for Coverage Plan offerings vary by LHM and associate group. Review your plan options to see what your annual coverage allows per family member.

NOTE: Delta Dental does not send enrollment cards to plan participants

n Smaller network of dentists

n Use a dentist in the CIGNA HMO network only. You will not receive any benefit coverage if you visit a dentist outside the CIGNA HMO network

n No annual maximum for coverage. See Patient Coverage Schedule for costs for procedure

NOTE: Associates enrolling in Cigna Dental will receive an ID card in the mail

Be sure to take a moment to review your dental options and confirm if your dentist is part of your plan’s network.

> Log onto your myDCHSBenefits.com account > For Delta Dental, go to www.deltadentalins.com > For Cigna Dental, go to www.cigna.com

http://www.myprimemail.com

mailto:http://www.myDCHSBenefits.com?subject=


http://myDCHSBenefits.com

http://www.deltadentalins.com

http://www.cigna.com





Vision PlansDCHS offers the VSP Core Plan. Depending on your LHM (and associate group), you may also have the option to elect the VSP Plus Plan. This plan is a buy-up option. Both options allow you to visit a licensed provider, but you will save more when you use VSP in-network providers. Here is a summary of each plan:

VSP Core Plan (In-Network) Plus Plan (In-Network)**

WellVision Exam

$10 co-pay every 12 months* $10 co-pay every 12 months*

Prescription Glasses (Frames and Lenses)

$10 co-payLenses – every 24 months*

Frame – every 24 months*, $115 allowance for a wide selection of frames, $135 allowance

on featured frames brands, 20% off of the amount over your allowance

$10 co-payLenses – every 12 months*

Frame – every 12 months*, $150 allowance for a wide selection of frames, $170 allowance

on featured frame brands, 20% off of the amount over your allowance

or

Contact Lens No co-pay$105 allowance for contacts and the contact lens

exam (fitting and evaluation) every 24 months*

No co-pay$150 allowance for contacts and the contact lens

exam (fitting and evaluation) every 12 months*

*Benefit frequency calculated based on last date of service** CNA associates are not eligible for the benefit

NEW for 2016: Get Low Prices on Hearing Aids

For 2016, DCHS associates enrolled in a vision plan with VSP will have access to TruHearing®. TruHearing® is available to all VSP Vision Care members and can help you save up to $2,400 on a pair of hearing aids. Your dependents and extended family members are also eligible. Parents, grandparents, children, grandchildren, and siblings are all considered extended family members, which makes them eligible to receive the discount. Election of a VSP Plan will automatically make you eligible to take advantage of the TruHearing® cost savings.

TruHearing® provides you with:

> Three provider visits for fitting, adjustments, and cleanings > 45-day money back guarantee > Access to more than 90 digital hearing aids in 400 styles > Three-year manufacturer’s warranty for repairs and one-time

loss and damage > 48 free batteries per hearing aid > Access to a national network of more than 4,500 licensed

hearing aid professionals > Discounts on replacement batteries shipped directly to

your door

For more information, visit vsp.truhearing.com or call (877) 396-7194. TruHearing® is only available to DCHS associates who have elected a VSP Plan. TruHearing® is not available as a stand-alone benefit.

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HOW TRUHEARING® WORKS:1) Call. Call TruHearing® at

(877) 396.7194. You and your family members must mention VSP.

2) Schedule. Set up an exam with a local provider.

3) Order. During your appointment, your provider will order your new hearing aids through TruHearing and fit them for you.

http://vsp.truhearing.com/





Health Care Spending AccountDCHS offers the Health Care Spending Account to help you pay for qualified health care expenses while saving on taxes, too. This benefit allows you to set aside money each pay period on a pre-tax basis to pay for eligible IRS-approved expenses. The contributions you make to your Health Care Spending Account are deducted from your paycheck BEFORE your Federal, state and Social Security Taxes are calculated. Therefore, you are taxed on less income and you increase your spendable income.

Since you elect the dollar amount you set aside from your pay, you must enroll/re-enroll each calendar year to continue utilizing this account.

Associate Contributions for 2016

Minimum: $100 Maximum: $2,550

Use this account to pay for your and your family’s qualified medical, prescription drug and vision expenses. You’ll pay with your easy to use Health Care Debit Card. Note, there may be some instances where you may be required to submit receipts to WageWorks for reimbursement.

Things to Consider When Electing a Health Care Spending Account

Do you or your dependents have health care expenses not covered by other health plans? For example:

> Health plan deductibles or co-payments > Glasses or contacts > Major dental/vision expenses > visit www.myDCHSBenefits.com to find the Health Care Spending Account list of eligible expenses for 2016

Note: DCHS does not have a carryover provision with Spending Accounts because we have an extended benefit plan year for reimbursement.

If you elect to enroll in the Health Care Spending Account plan for 2016, it is important to note that only those eligible expenses incurred between January 1, 2016 and March 15, 2017 will be reimbursed. If you do not submit your claims for reimbursement on or before March 31, 2017, you will forfeit the remaining funds in your account.

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Additional Benefit OptionsDCHS offers additional benefits to help you establish and maintain financial security and peace of mind. Here is an overview of your other benefit offerings for 2016.

n OptumHealth: Employee Assistance Program – Establishing Peace of Mind

OptumHealth (“Optum”) administers the Employee Assistance Program (EAP) benefit for associates and all members of their household at no cost to you. The EAP benefit is accessible 24/7, provides up to eight short-term counseling sessions with a licensed professional. All associates are automatically enrolled in this benefit at no cost.

Day-to-day stresses can have an impact on our overall health, and because we all experience stress differently, Optum offers support through its expansive, diverse network. Optum gives associates and their family members access to services ranging from, but not limited to:

Life Learning Chronic Condition Support Convenience Domestic Relocation

Resources

Assistance with child development, parenting skills, sick/back up care, caregiver support, personal struggles, work issues

Consultation and qualified, customized resources for people living with or caring for someone with a chronic condition

Research, information and referrals for virtually any household need including pet care, entertainment, dining and recreation

Practical tips and tools to facilitate moving logistics and acclimation to a new area, along with information on everything from grade schools to dry cleaners





Dependent Day Care Spending Account The Dependent Day Care Spending Account allows you to set aside money each pay period on a pre-tax basis to pay for eligible IRS-approved expenses. The contributions you make to the accounts are deducted from your paycheck BEFORE your Federal, state or Social Security Taxes are calculated. Therefore, you are taxed on less income and you increase your spendable income.

Since you elect the dollar amounts you set aside from your pay, you must enroll/re-enroll each calendar year to continue utilizing your Dependent Day Care Spending Account.

Associate Contribution for 2016

Minimum: $100 Maximum: $5,000

(or $2,500 for an individual who is married and files taxes separately)

Use this account to pay for qualified services for your eligible dependents — such as elder care, day care or baby sitting (child must be 12 years old or younger). You pay for services with your own money and submit claims to WageWorks for reimbursement.

Things to Consider When Electing a Dependent Day Care Account

Do you pay out-of-pocket expenses for childcare or elder day care so you (and your spouse, if applicable) are able to work? This might be a great benefit for you!

Visit www.myDCHSBenefits.com to find the Dependent Day Care list of eligible expenses for 2016

Note: DCHS does not have a Carryover provision with Spending Accounts because we have an extended benefit plan year for reimbursement.

If you elect to enroll in the Dependent Day Care Spending Account for 2016, it is important to note that only those eligible expenses incurred between January 1, 2016 and March 15, 2017 will be reimbursed. If you do not submit your claims for reimbursement on or before March 31, 2017, you will forfeit the remaining funds in your account(s).

Benefit plan options can vary by LHM to LHM (and by associate group). Visit https://www.myDCHSBenefits.com for more information and to view the plans available to you for 2016.

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Special Benefit FeaturesDCHS offers a comprehensive benefits program. There are a lot of valuable features in our plans, including some that may not be on your radar screen. Here is a summary of some that you may find beneficial.

n Preventive Care Good health starts with prevention. All the medical plans offered by DCHS cover many basic preventive care

services at 100% when you use in-network providers – this includes a free annual physical screening, well-baby care, and other scheduled services (depending on your age).

n Wellness Activities Program Participation The Wellness Activities program has a 92% participation rate at DCHS. Since the inception of the Wellness

Activities Program, DCHS facilities have moved to Smoke Free campuses, improved and added healthier food options in the cafeterias, and introduced healthy lifestyle tools like the Daily Challenge and Walkadoo.

n Waiving your plans with DCHS If you have access to benefits through your spouse or another employer, you may consider waiving some or

all of the benefit plans offered by DCHS. Select LHMs offer a cash back benefit every pay period for those who waive coverage. See your myDCHSBenefits.com account to see if you are eligible to receive benefit cash back dollars for waiving plan(s).

n Portability and Conversion You can elect to continue some of the income protection benefits we offer even if you leave DCHS. This

feature is called portability (continue with the coverage after you leave DCHS by paying premiums directly to the carrier) or conversion (converting the coverage DCHS offers to an individual policy, often with different terms).

Below are the plans that offer portability and/or conversion options. Please contact the carrier directly for more information. Refer to page 18 for contact information.

Plan Carrier Options Coverage Available for Window to Apply

Life Insurance Unum Portable or Conversion Option

Associate, Spouse, Children

Within 31 days of last day worked

Accident D&D Unum Portable Option Associate Within 31 days of last day worked

Long Term Care Unum Portable Option Associate & Spouse Within 60 days of last day worked

Long Term Disability

Hartford Conversion Option Associate Within 31 days of last day worked






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OTHER IMPORTANT INFORMATIONn Health Care Spending Account You must re-enroll in your Health Care Spending Account for 2016, elections

do not carryover year to year. For more information, refer to page 12.

n Dependent Day Care Spending Account You must re-enroll in your Dependent Day Care Spending Account for 2016,

elections do not carryover year to year. For more information, refer to page 14.

n Qualifying Life Event If you experience a mid-year Qualifying Life Event (QLE) — marriage, divorce, birth/adoption of a child, etc., you

have 31 days from the time of the event to make your benefit changes on https://www.myDCHSBenefits.com and provide your local Human Resources or the DCHS Benefit Services Team with dependent eligibility documentation. If you do not provide your documentation within 31 days of the QLE, your newly added dependent will not take effect, and benefits will be retro-actively terminated back to the original effective date. Note, in the case of a newborn, a SSN is not immediately required to enroll the child. However, you must complete your enrollment within the 31 day window and then provide your local Human Resources/Benefit Services Team with a copy of the Social Security Card once received.

n Duplicate Coverage DCHS does not permit duplicate coverage on the medical, dental and/or vision plans. If you and your

spouse both work for DCHS and are eligible for coverage under each other’s medical, dental and/or vision plans, you will only be able to cover your respective dependents (spouse, children, etc.) under one associate’s medical, dental and/or vision plans. If you and your spouse are covering the same dependents on the medical, dental and/or vision plans effective January 1, 2016, and have not made changes to terminate duplicate coverage, DCHS will adjust your or your spouse’s benefits election based on the birthday rule. A confirmation statement will be sent to you reflecting the change.

Adding Dependents to your Medical, Dental and/or Vision Plans?

To add a new dependent to the medical, dental and/or vision plans for 2016, you must add them on to your myDCHSBenefits.com account during open enrollment and submit a dependent verification to your local Human Resources Department by the close of Open Enrollment (November 20, 2015).

> Your most recently filed tax return showing the dependent you want to add to your IRS tax dependents. DCHS does not need your entire tax filing.

> The dependent child’s birth certificate or adoption certificate > Marriage license/certificate > Domestic Partner Registry Certificate from the California Secretary of State > Qualified Medical Child Support Order (QMCSO) > Legal guardianship document approved by or filed in court

!If the dependent verification documentation is not received by the deadline of December 4, 2015, no exceptions, coverage for those dependents will not take effect and will be retroactively terminated back to the original effective date.

NOTE: The Dependent Day Care Account can help you pay for childcare

or elder day care so you (and your spouse, if applicable) are able to

work. It’s not for health care expenses.


http://www.myDCHSbenefits.com





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RESOURCES AND SUPPORT 2016 Benefits and Wellness Open Enrollment Fair ScheduleLearn more about your benefit choices and ask your questions directly to the benefit vendors at the 2016 Benefits and Wellness Open Enrollment Fairs. See the schedule below for details. This event is a great opportunity to get information about all of the DCHS benefits available to you and your family.

LHM Date Location Time

St. Vincent Medical Center Monday, November 2, 2015 Conference Rooms A&B 7:30 am – 3:30 pm

St. Francis Medical Center Tuesday, November 3, 2015 Auditorium 7:30 am – 1:00 pm

Seton Medical Center Tuesday, November 3, 2015 Cafeteria, 2nd Floor 10:00 am – 3:30 pm

Caritas Business Services Wednesday, November 4, 2015 Lunchroom, 8th Floor 10:00 am – 12:00 pm

Seton Coastside Wednesday, November 4, 2015 Dining room 2:00 pm – 4:00 pm

O’Connor Hospital Thursday, November 5, 2015 MOB 8:00 am – 2:30 pm

Saint Louise Regional Hospital Friday, November 6, 2015 Patio Area 8:00 am – 2:30 pm

Some of the vendors participating in the 2016 Benefit and Wellness Open Enrollment Fairs are:

> Blue Shield of CA > Vision Service Plan > Transamerica > Delta Dental > UNUM Life > WageWorks > Cigna Dental > The Hartford > OptumHealth

Wellness Programsn Blue Shield Health and Wellness Programs – At your fingertips Save yourself a phone call and go directly to the source, any time. The Blue Shield and Wellness Programs

found at http://www.blueshieldca.com/dchs give you access to your personalized medical benefits information, and allow you to find or change your provider, review your claims, or order a new ID card. In addition, visit the Wellness Portal – http://myWellvolution.com – to track your well-being. Complete your annual Well-Being Assessment here and sign up for other programs that help you create achievable goals by making small changes on a daily basis.

n Daily Challenge Doing something small for your health each day goes a long way! Sign up for the Daily Challenge community

through MeYouHealth, and discover the power of taking small actions. Once you are part of the community, you can connect with other members traveling the path toward improved well-being, earn points through the daily challenges, and find out how small actions can add up to big changes! Get started at http://myWellvolution.com.

n Walkadoo DCHS is proud to continue Walkadoo, a program to get you moving and help you manage your health.

All non-contractual associates who are required to earn 1,500 Daily Challenge points will have access to this program. Walkadoo makes walking more fun! Walkadoo helps you identify and make your own personalized step goals, connects you with a community that supports your efforts, and acknowledges your accomplishments along your journey! Find out more at https://walkadoo.meyouhealth.com.

http://www.blueshieldca.com/dchs

http://myWellvolution.com

http://myWellvolution.com

https://walkadoo.meyouhealth.com





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Contact InformationDCHS is committed to making your Path to Wellness as smooth and accessible as possible. If you have questions, concerns or need more information to help you make the most of your DCHS Benefits, please access the following resources.

Benefit Vendor Online Contact Phone Number

Medical Plans Blue Shield of California www.blueshieldca.com/dchs (888) 587-9503

Dental Delta Dental www.deltadental.com (888) 335-8227

Cigna Dental www.cigna.com (800) 244-6224

Vision Vision Service Plan www.vsp.com (800) 877-7195

Hearing Aids Vision Service Plan www.vsp.com (800) 877-7195

Employee Assistance Program OptumHealth Available 24/7 www.liveandworkwell.com (access code: DCHS)

(866) 248-4096

Wellness Blue Shield of California Available 24/7 www.MyWellvolution.com

(866) 304-1980

Health Care Spending Account WageWorks www.wageworks.com (877) 924-3967

Dependent Day Care Spending Account

WageWorks www.wageworks.com (877) 924-3967

Life Insurance UNUM Life Insurance of America www.unum.com (800) 421-0344

Accidental Death & Dismemberment

UNUM www.unum.com (800) 421-0344

Voluntary Short-Term Disability The Hartford www.TheHartfordatWork.com (866) 272-1229 (877) 588-4817 (fax)

Long-Term Disability The Hartford www.TheHartfordatWork.com (866) 272-1229 (866) 583-8237 (fax)

Long-Term Care UNUM www.unum.com (800) 227-4165

DCHS Benefits Support DCHS Benefit Services Team [email protected] (888) 333-1316

This document provides a summary of your benefit plans. It does not serve as a guarantee of continued employment or benefits. DCHS policies on hiring, discharge, layoff and discipline are in no way affected by the programs described here. In particular, nothing in this document alters DCHS’s at-will employment policy, which provides that employment with DCHS is not for a specified period of time and can be terminated by either DCHS or the associate at any time, with or without cause or advance notice.

In addition, DCHS reserves the right to amend or discontinue the DCHS plans or any part of them with or without notice, at any time at DCHS’ sole discretion. If there is a discrepancy between this document and the official plan documents, the provisions of the plan documents will govern.

Note: If your employment at a DCHS Facility is governed by a collective bargaining agreement, then the availability of, and the extend of your participation in, any benefit plan summarized in the SPD will also be governed by the terms of your collective bargaining agreement.

http://www.blueshieldca.com/dchs

http://www.deltadental.com

http://www.vsp.com

http://www.vsp.com

http://www.liveandworkwell.com

http://www.MyWellvolution.com

http://www.TheHartfordatWork.com

http://www.TheHartfordatWork.com

http://www.unum.com

mailto:DCHSBenefits%40dochs.org?subject=





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GLOSSARYAffordable Care Act (also known as the Patient Protection and Affordable Care Act)The Affordable Care Act (ACA or formally referred to as the Patient Protection and Affordable Care Act) is a law that was passed in March 2010 to increase the access, quality and affordability of health insurance for Americans.

After-Tax Dollars / DeductionsMoney (payroll deductions) associates elect to have deducted from their paycheck after taxes are deducted and paid.

Beneficiary A person(s) designated by the insured as the recipient of funds or other benefits upon the death, dismemberment and/or paralysis of the insured (Life Insurance/AD&D).

Benefits Eligible Dependent The following dependents are eligible for benefits on the DCHS Health & Welfare Plans: • Yourlegallymarriedspouse(asdefinedbytheState

of California) or your Registered Domestic Partner • Youroryourspouse/RegisteredDomesticPartner’s

unmarried biological children, adopted children, foster children or stepchildren who are under age 26

• Anypersonsunderage26whoareplacedwithyouor your spouse/Registered Domestic Partner for adoption

• Anypersonsunderage26whoisthebeneficiaryof a Qualified Medical Child Support Order (QMCSO)

• Anychildunderage26whomyouhavelegalguardianship

For purposes of electing dependent life insurance for (child(ren)), your eligible child must be under the age of 19. Or if you provide at least 50% of the child’s financial support for a child under the age of 24.

Benefit SlicksA benefits summary document describing some of the most commonly used benefits available under the DCHS sponsored medical plans with Blue Shield.

Birthday Rule Under the birthday rule, in the context of reviewing Duplicate Coverage (see page 16), the medical, dental and/or vision plan of the associate whose birthday comes first in the calendar year is designated as the primary plan. It does not matter which associate is older, because the year of birth is not a factor. For example, if your birthday is July 15, 1955, and your spouse’s is September 17, 1953, your health plan would be considered primary because your birthday comes first in the calendar year.

Buy-Up OptionThe opportunity to elect an enhanced level of coverage that is paid for by associates, DCHS or both.

Co-InsuranceThe percentage of the shared-cost of a covered healthcare service you are responsible to pay after meeting any applicable plan deductible.

Conversion Conversion offers associates the ability to elect to convert the DCHS group policy coverage into an individual policy when benefit coverage is lost due to a change in status or termination of employment. If you elect to convert coverage, your benefit coverage shifts from a group to an individual policy. You pay premiums directly to the carrier at new individual policy rates. There may be some differences in benefits, terms and conditions between the DCHS group policy coverage and the new individual policy coverage. There is a very short period of time, specified in the policy, to elect to convert your coverage. Please see policy for details.

Co-Pay or Co-Payment The fixed dollar and/or percentage amount you pay for covered services in a health plan.

Deductible The initial amount you pay in a calendar year or per admission, for covered services before a health insurance vendor would begin to pay for benefits.





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Evidence of Insurability (EOI) Health information questionnaire and corresponding medical history required by an insurance administrator to help determine if certain coverage will or will not be approved.

Imputed IncomeA term the IRS applies to the value of any benefit or service that would be considered taxable income for the purposes of properly withholding income and employment taxes from your wages.

In-NetworkDoctors, hospitals and other providers that are contracted with the health insurance plan to provide services for plan members at a specified pre-negotiated discounted rate. When you see a provider “in the network,” the Plan typically pays a higher benefit level.

Mail Order Prescriptions purchased in bulk (i.e. 90 day supply) through the mail ordered program, delivered to your home.

Maintenance MedicationsMedications that a physician has prescribed for regular (i.e. daily) use over a prolonged period of time.

Medical Plan Contribution The payroll contributions made by associates each pay period to help cover a portion of the cost of medical insurance provided by DCHS. The amount you pay is based on the type of medical plan you elect, whether you enroll eligible dependents or not, and if you completed any required Wellness Activities and are eligible to earn a Wellness Credit.

Out-of-Network Doctors, hospitals and other providers that are not contracted with the health insurance plan. When you see a provider “outside the network,” the Plan typically pays a lower benefit or no benefit.

Out-of-Pocket LimitThe maximum dollar amount you may have to pay for certain covered services in a calendar year. NOTE: Some types of covered expenses can be excluded from this limit. Deductibles may or may not apply toward this limit.

Personal Information This includes reviewing your• Name• Birthdate• LHM• HomeaddressIf your personal information is incorrect or requires updating, please contact your Local Human Resources Department.

Portability Portability gives associates the ability to elect to continue DCHS coverage when benefit eligibility is lost due to a change in status or termination of employment. This feature allows you to continue your coverage under the same group insurance contract, which means in many cases; your benefits will be similar if not the same. A significant change is you pay premium payments directly to your carrier instead of DCHS. There is a very short period of time, specified in the policy, to elect to “port” your coverage. Please see your policy for details.

Pre-Tax Dollars / DeductionsThe money (payroll deductions) an associate elects to have taken from an eligible associate’s pay before taxes are deducted and paid. This results in a reduction of the associate’s taxable income and an increase in take-home pay.

Primary Care Physician (PCP)A health care provider who coordinates a member’s health care services and who refers, authorizes, supervises and coordinates that member’s medical care.





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Qualifying Life Event (QLE)The IRS recognizes a QLE as an event in your life that allows you to make benefit election changes outside of the annual open enrollment. Examples of QLE are: • Marriage,BirthofaChild,Adoption,Divorce

or Death• Increaseorreductioninhoursofemployment

resulting in a gain or loss of benefits eligibility

Registered Domestic Partner A legal relationship recognized by the State of California and available to same-sex couples, or to certain opposite-sex couples in which at least one party is at least 62 years of age and has met the eligibility criteria under Title II of the Social Security Act.

Spouse A person who is legally married under State law to an eligible associate, but may not include a person separated from the eligible associate under a legal separation decree. This also includes any same-sex spouse that was lawfully married in a jurisdiction that recognized the marriage, regardless of the couple’s state of domicile. This does not include same-sex couples in domestic partnerships or civil unions, whether registered or otherwise.

Tax Penalty Under the Affordable Care Act, the amount you may owe starting January 1, 2014, for every month you do not carry minimum affordable medical insurance coverage. The tax penalty, if accessed, is payable to the IRS when filing your annual tax return.

Wellness Activities Annual activities required by DCHS and your Local Health Ministries in order for an eligible associate to receive a Wellness Credit through the overall DCHS Wellness Program.

Wellness Credit A dollar amount credit towards your medical plan premium contribution for annual participation in certain Wellness Activities if eligible.

Wellness Period A designated period of time during which associates are encouraged to complete Wellness Activities to raise awareness about their health and, if eligible, earn a Wellness Credit toward their Medical Plan Contributions for the following plan year.

BENEFIT UPDATES BENEFITS AT-A-GLANCE YOUR DCHS BENEFITS OTHER IMPORTANT INFORMATION

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Caritas Business ServicesO’Connor Hospital

Saint Louise Regional HospitalSeton Coastside

Seton Medical CenterSt. Francis Medical CenterSt. Vincent Medical Center

System Office

Documents

2016 BENEFITS - Blue Shield of California€¦ · this spending account for 2016 Your Benefits At-A-Glance continues on the next page. BENEFIT UPDATES BENEFITS AT-A-GLANCE YOUR DCHS