Your Benefits at Avita Health Benefits at Avita Health System ... benefits at Avita Health System. Your health and well‐being are important to us. That’s

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  • 2016

    YourBenefitsatAvitaHealthSystem

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    Choosingtherightbenefitsforyouandyourfamily

    We are pleased to provide you with this updated benefit booklet summarizing thebenefitsatAvitaHealthSystem.Yourhealthandwellbeingareimportanttous.Thatswhywe provide employeeswith high quality benefit choices.We are committed toensuringourbenefitsare competitiveandaffordable.Therefore,AvitaHealthSystemcontinuestopayamajorportionofemployeehealthcareexpensesin2016.ThisbookletdescribesthefeaturesofyourBenefitPlan.Asyoulookthroughit,youwilllearnhowyoubecomeaPlanMemberandwhatyourbenefitsare.Sincebenefitscanchangeeachyear,pleasereadthisbookletcarefullyandshare itwithyourfamily. It isimportantthattheyareawareoftheirbenefits.Administrationhastherighttochangebenefitsastheneedarises.Ofcourse,itisimportantthatyoureadallcommunicationssenttoyoubyHumanResources.Inpreparing thisbooklet,wevedoneourbest toexplaineverything correctly. If youhavequestionsaboutyourbenefits,pleasecontacttheHumanResourcesoffice.Wewillbepleasedtohelpyou.

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    Helpingyouliveyourbestlife.Weunderstand thatyoudontcheckyour lifeat thedoorwhenyoucome towork.ThatswhyAvitaHealthSystemispleasedtoofferhighqualitybenefitchoicesthatnotonlysupportyouatwork,butalsoenrich your personal life.Our benefits are competitive and affordable, andAvitaHealth Systemwillcontinuetopayamajorportionofyourhealthcareexpenses.

    AboutthisguideThis guide summarizesbenefits available for the2016 calendar year. Youll findbriefdescriptionsofbenefitoptions,aswellaseligibilityrequirements.Please note that barring a qualified event (see table below), the next opportunity tomake benefitchangeswillbeduringOpenEnrollmentforthe2017planyear.Also,thissummarydoesnotcontainalloftheprovisionsandlimitationsthatapplytoAvitaHealthSystembenefits.Forcoveragedetails,seetheEmployeeHandbookandthebenefitplansSummaryPlanDescription(SPD),allavailableontheAvitaHealth System intranet (411).Allbenefits are subject to terminationormodificationbyAvitaHealthSystematanytimeatitssolediscretion.WhatbenefitscanIaddorchangeonlyduringOpenEnrollment?MedicalInsurance DentalInsurance VisionInsuranceFlexibleSpendingAccounts WhatbenefitscanIaddorchangeanytimeduringtheyear?LifeInsurance Beneficiaries 403(b)RetirementPlan

    (EmployeeContributions)Whatifmyfamilysituationchangesmidyear?InkeepingwithIRSrules,youmaymakemidyearbenefitchangesonlyifyouhaveaqualifyinglifeevent,likethefollowing:

    Marriage Divorce Birth,adoptionorplacementofachild Lossofspousesinsurancecoverage Lossofalovedone(spouse,dependentorotherfamilymember) Retirement

    Whenmakingachangetoabenefitenrollmentasaresultofalifeevent,thechangemustbeconsistentwiththelifeeventandmustbemadewithin31daysofthelifeevent.Properdocumentationofthequalifyinglifeeventisrequired.Thosedocumentsmayinclude:

    MarriageLicense/Certificate DivorceDecreePapers BirthCertificate/AdoptionPapers DeathCertificate Lossofinsurancecoverageletter/documentorCreditableCoverageCertificate

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    BenefitsEligibilityInformation

    Benefit

    RegularFullTime6080

    hours/pay

    RegularPartTime4859

    hours/pay

    PartTime1647

    hours/pay Casual WhenYoureEligible

    Medical/Prescription X X 31stdayofemployment

    Dental X X 1stdayofmonthafter31days

    Vision X X 1stdayofmonthafter31daysBasicLifeInsurance(ProvidedbyAvita)

    X X 31stdayofemployment

    VoluntaryLifeInsurance X X 1stdayofmonthafter31daysDependentLifeInsurance(spouse/dependent) X X 1

    stdayofmonthafter31days

    ShortTermDisability(ProvidedbyAvita)

    X X Afteroneyearofemployment

    LongTermDisability(ExemptEmployeesonlyProvidedbyAvita)

    X X 31stdayofemployment

    FlexibleSpendingAccount(FSA) X X 31

    stdayofemployment

    VoluntaryShortTermDisability X X 1stdayofmonthafter31days

    LongTermCareInsurance X X 1stdayofmonthafter31days

    CancerInsurance X X 1stdayofmonthafter31days

    CriticalIllnessInsurance X X 1stdayofmonthafter31days

    EducationAssistanceProgram X X Afteroneyearofemployment403(b)RetirementPlanEmployeeContributions X X X X 31

    stdayofemployment

    403(b)RetirementPlanEmployer(Avita)Contributions X X * *

    Afteroneyearofemployment*Mustwork1,000hours

    RothIRA X X 31stdayofemployment

    EmployeeAssistanceProgram X X X X 1stdayofemployment

    CafeteriaPayrollDeductions X X X 1stdayofemploymentAvitapatientbillsforservicesdiscountforpromptpayment X X X X 1

    stdayofemployment

    YMCAreducedmembershipsforGalion&Bucyrus X X X 1

    stdayofemployment

    GalionCountryClubcorporatememberships X X X X 1

    stdayofemployment

    SnowTrailsinMansfieldcorporatemembership X X X X 1

    stdayofemployment

    GreatWolfLodgeinSanduskycorporatediscount X X X X 1

    stdayofemployment

    CedarPointcorporateprogramdiscountedtickets X X X X 1

    stdayofemployment

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    HealthPlans

    MedicalCoverageWhether youare sickor injured, yourmedical coverage isoneof yourmost valuablebenefits.AvitaHealthSystempaysamajorportionoftheexpensesforyourmedicalcoveragethroughtheTraditionalHealthPlanandHealthSavingAccount(HSA)Plan.BothplansareselfinsuredthroughAvita.Whilebothplanshave thecoveredservicesand feature innetworkandoutofnetworkcoverage, themaindifferencearethestructuresoftheplans.BothplansutilizetheMedicalMutualofOhio(MMO)network.TraditionalPlan(PPOPlan)A Preferred Provider Organization (PPO) Plan gives you flexibility. You can go to any health careprofessionalyouwantwithoutareferralinsideoroutsideofyournetworks.Staying inside theAvitaHealthSystemnetworkandinnetworkprovidernetworkmeansthatyouwillhavesmallercopaysandfullcoverage.Ifyouchoosetogooutsidethesenetworks,youwillhavehigheroutofpocketcostsandnotallservicesmaybecovered.HealthSavingsAccount(HSA)PlanAhealth savings account (HSA) combines ahighdeductiblehealth insuranceplanwith a taxfavoredsavingsaccountcreated for thepurposeofpayingmedicalexpenses.AvitaHealthSystemhelpsbuildthisaccountforyoubydepositingmoneyeachpayperiodintoyourestablishedsavingsaccountthroughUnitedBank.Themoneyinthissavingsaccountcanhelppayforyourdeductibleoritcanbeleftintheaccounttogrow.Onceyourdeductibleismet,theinsurancestartspaying.Themoneyleftinthesavingsaccountisyourstokeep.BelowaresomeadvantagestoHealthSavingsAccounts:

    TaxdeductibleContributionstotheHSAare100%deductible(uptothelegallimit)justlikeanIRA.

    TaxfreeWithdrawalstopayqualifiedmedicalexpenses,includingdentalandvision,arenevertaxed.

    TaxdeferredInterestearningsaccumulate taxdeferred,and ifused topayqualifiedmedicalexpenses,aretaxfree.

    HSAmoneyisyourstokeepUnlikeaflexiblespendingaccount(FSA),unusedmoneyinyourHSAisntforfeitedattheendoftheyear;itcontinuestogrowtaxdeferred.

    SupplementalHospitalConfinementPolicyAvitaHealthSystemprovidesandpays for thisadditionalpolicy ifyouareon theHSAPlan. Itpays a cashbenefitdirectly to you for eachday you arehospitalized as a resultof illnesses,accidents or injuries, providing you with additional financial support in a variety ofcircumstances.Thismoneycanbeusedforanythingyouchoose.Itsyourmoney,yourdecision.

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    AnnualWellnessAtAvitaHealth Systemwe value employeewellness especially through preventativemeasures.As aresult,we implementedaseriesofteststhatarebasedonageandgenderthatmustbeperformedbytheendofeachyearinordertoavoida10%premiumsurcharge.Belowisthelistofannualtests.

    RecommendedTest Gender FrequencyWellnessExam Male&Female>18Years EachYear

    Cholesterol Male&Female>18Years 5Years

    Colonoscopy Male&Female>50Years 10Years

    Mammography Female>40Years 12Years

    PapSmear Female>18Years 12Years

    Testicular&ProstateCancer(ClinicaltesticularexamateachphysicalvisitwithinformeddecisionmakingregardingPSAScreeningdependingonrisk.)

    Male>45Years EachYear

    Todetermineifyouarecompliantwithanyoralloftheabovewellnesscriteria,youcancontactMMOat(800)3673762ext.19781duringnormalbusinesshours. PrescriptionDrugCoverageYou probably know from your own experience that the cost of prescription drugs continues to risedramatically.Tohelpkeepyourmedicalexpensesas lowaspossible,bothplans includeaprescriptiondrugprogramadministeredbyExpressScripts.Whenyouenroll ineitherplan,youwillautomaticallyreceiveprescriptiondrugcoverage.ForthePPOPlan,AvitaHealthSystemusesathreetiered(Generic,Formulary,BrandName) preferreddrug list.Drugs areplacedon a formularybasedon their clinicaleffectivenessandsafety,aswellascost.Therearetworetailpharmaciesthatarecoveredundertheplanformaintenancedrugs:AvitaOntarioPharmacyandQuaysDrugs(Galion).Ifthesetworetailpharmaciesarenotusedformaintenancedrugs,youmustuseExpressScriptsMailOrder.Also,ofnote,thereisa25%lessbenefitpaidbyAvitaHealthSystemwhenyouutilizetheAvitaOntarioPharmacy.Under theTRADITIONALPLAN, the followingOverTheCounter (OTC)medicationswillbe coveredat100%.Youmustreceiveaprescriptionfromyourphysicianforthesemedicationsinordertobecoveredat100%.Simply,takethemedicationoffthedrugstoreshelf,take ittothepharmacyalongwithyourprescriptionandhealth insurance card to receive yourmedications.nomoneywillexchangehands!Thefollowingwillneedtobelistedontheprescriptionforthesemedications:

    DatePrescriptionisWritten; PatientsFullName; CompleteNameoftheMedicine;

    QuantityDispensed; DirectionsforUse; AnyRefills; SignatureofPrescribingPhysician.

  • BelowisthelistofOTCmedicationsthatcanbeusedinplaceofregularprescriptions.

    OvertheCounterMedicationsAbrevaAlawayAllegraAllegraDClaritinClaritinDZyrtecZyrtecD

    Prevacid24PrilosecSloNiacinZaditorZegerid

    SpousalRuleAtAvitaHealthSystem,spousesmaybecoveredunderthemedicalandprescriptionplans,however,a$75permonthsurchargewillapply.Exceptionsforthespousetobeontheplanandnothavetopaythesurchargeareasfollows:

    SpouseiscoveredunderMedicare; Spouseisselfemployedorunemployed; Spousedoes