Associate Benefits Guide - Adventist Health
Associate Benefits Guide1
Benefits Guide Table of ContentsSection 1: Medical, Dental and Vision. . . . . . . . . . . . . . . . . . . . . . . . . . 4.Section 2: Employer Provided Benefits. . . . . . . . . . . . . . . . . . . . . . . . 14Section 3: Voluntary Insurance Benefits. . . . . . . . . . . . . . . . . . . . . . . 16Section 4: Flexible Spending Account. . . . . . . . . . . . . . . . . . . . . . . . . 19Section 5: Retirement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Section 6: Additional Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Founded on Seventh-day Adventist values, Adventist Health is afaith-based, nonprofit integrated health system headquartered inRoseville, California. We provide compassionate care in more than80 communities on the West Coast and Hawaii.2
Dear Adventist Health Associate,Caring for our communities begins at home — with you, our valued associate.Adventist Health offers comprehensive benefits which emphasize whole-person health, our long-held philosophy that encompassesthe mind, body and spirit. Our plans focus on providing access to high quality healthcare while supporting the health and wellness ofall our associates.This Benefits Guide includes helpful information and resources for evaluating the many benefits you can take advantage of. In thisguide you will find information on the medical, dental and vision plans; your Voluntary Insurance benefits (such as Pet Insurance,Auto and Home Insurance); your Flexible Spending Account benefit, retirement plans and additional benefits (such as paid time off,Life Insurance, associate discounts, and more).This year, we are pleased to highlight our enhanced, systemwide Employee Assistance Program (EAP) — Resources for Living. Offeredat no cost to you and your entire family, there are a wide variety of resources, programs and courses available, including counselingservices (via phone, video or in-person), daily life assistance, legal and financial advice, help for new parents, childcare services, onlineeducation courses teaching coping strategies, personal development, and so much more. Adventist Health’s Resources for Livingprogram is a completely confidential service, and has been designed to support and enhance your work/life balance. Look for theResources for Living section of the Benefits Guide to learn more.We encourage you and your family to take an active role in your wellbeing. The medical plan offers preventive care, a robust wellnessprogram, and one-on-one coaching to reduce your chance of serious illness. As a healthier team, we benefit from increased energy atwork and at home, and overall lower healthcare costs for you.Please carefully review and consider the information provided. Should you have any questions on any of the plan options, or needassistance enrolling or making changes, please call the Contact Center at 844-574-5686.Thank you for being an important member of the Adventist Health community. Together, let’s live the healthiest life possible!Your Adventist Health benefits team3
SECTION1Medical, Dental and Vision BenefitsTable of Contents2020 Plan changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Pharmacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10How to enroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Dental coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112020 Medical benefits-at-a-glance. . . . . . . . . . . . . . . . . . . . 7Vision coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Engaged! Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8All references to the Adventist Health Employee Health Plan and the Employee Health Plan also refer to the Adventist Health and Rideout Employee Health Plan.2020 Medical, Dental and Vision ChangesMany of you participated in the Benefits Optimization Survey. The results launched a number ofimportant changes to better meet your needs.2. Dental planALL MEMBERSAs we continue to align our services under ONE AdventistHealth, we have discovered an opportunity to have increasednetwork coverage by moving from regional dental plans to onestandard dental plan for all our associates — effective Jan. 1,2020. The contracted rates with Delta Dental are better thanwith our previous dental network, stretching your benefitseven further. View page 11 for more detailed information.Medical plan changesTo better meet the needs and requests of our associates, thefollowing changes have been made to the medical, dental andvision plans effective Jan. 1, 2020:1. We’re moving to one health plan—The Engaged! PlanKey changes: Lower monthly contributions. Increased network of dental providers. Access to your benefit amount every calendar year. Major services are covered at 50 percent. Lifetime orthodontic maximum is 2,500.We’re providing all our benefits-eligible associates with thesame, robust medical plan — the Engaged! Plan — with noparticipation requirements. View page 8 for more detailedinformation. The 2020 Engaged! Plan will be similarly priced to theprevious Engaged! Premier Program. The Base Plan and the Engaged! Premier Program will nolonger be offered. There are no points requirements to be enrolled in theEngaged! Plan. The Engaged! Plan continues to provide our associates withexcellent coverage at a competitive monthly contribution. The spouse and dependent surcharge has been removed.4
3. Vision plan4. Flexible Spending Account (FSA)Our vision plan was identified as another opportunity to provideyou with an improved benefit at a lower premium with a newvision plan network, Vision Service Plan (VSP) — effectiveJan. 1, 2020. VSP will provide you with better coverage at alower cost to you. View page 12 for more detailed information.We’ve moved our FSA to a new administrator — EmployeeBenefits Corporation (EBC). Your benefit remains unchanged;however, you will now contact EBC with any questions regardingyour FSA enrollment and to submit claims. Additional informationcan be found on page 19.Key changes:5. Pharmacy benefits Lower monthly contributions. Increased network of vision providers. Individual benefit maximum is every calendar year with noIn order to allow for more choice in your pharmacy benefit,non-preferred medications will now be covered at Tier Threerates. These medications were previously excluded fromcoverage. Specific information will be included in your openenrollment packet. Also watch your mail for notification fromOptumRx that will provide you with preferred alternatives ifyou wish to change to a lower-cost option. Please refer to youropen enrollment packet for more detailed information.overall dollar maximum. 10 co-pay for vision exams. 25 co-pay for lenses.Tier Two: The California Foundation for Medical Care (CFMC)will be replacing the Blue Shield network for professionalservices. CFMC is one of California’s largest networks.C A L I F O R N I A M E M B E R S O N LYNew medical network for California members 80% coverage: Professional 30 co-pay: Provider office visitsWe have partnered with Incentive Health to build an expansivenetwork that combines Adventist Health facilities and providerswith the Incentive Health Provider Access Solution. The IncentiveHealth Provider Access Solution is built specifically to prioritizefirst class care at our facilities. Additionally, the CaliforniaFoundation for Medical Care (CFMC) will be replacing ourcurrent Blue Shield network for professional services.Tier Three: Out-of-network coverage has been addedto minimize any disruption in the transition from Blue Shieldproviders to CFMC providers. 80%* coverage: Out-of-network facility 60% coverage: Out-of-network professional 30 co-pay: Provider office visitsBelow is an overview of the new coverage tiers. Refer to page 8for a more detailed coverage explanation.* Prior Authorization (PA) required for any non-emergent facility admissions.Please refer to the plan description for a list of services that require priorauthorization.NEW! Incentive Health Provider Access SolutionTier One: Adventist Health for professional and facility. 100% coverage: Facility and professional 20 co-pay: Provider office visits5
Re-enrolling is requiredfor 2020 benefits: MedicalDentalVisionand Flexible Spending Account (FSA)How to Enroll1. Visit HP on Demand via Connect.During your enrollment2. Click on Self Service Access. Review each page carefully. If you leave the enrollment prior to completion, your3. Click on the orange 2020 Benefits icon.elections will not be saved. Once you receive your confirmation number, your4. You will be automatically signed in to ournew enrollment platform.enrollment is complete.5. Begin your enrollment. Pay attention to additional items that may beBefore your enrollmentTo print your confirmation statementrequired based on your elections.Have the following information available before youbegin your enrollment:Click “Confirmation Statement” in the Explore YourBenefits Portal section under Benefits. Social security numbers of enrollees and dependents. Dates of birth for enrollees and dependents.IMPORTANT: If you have completed your enrollment and need to change your elections, you can follow the processagain as long as it is during your enrollment window. Your new elections will be saved.6
2020 Employee Health Plan-at-a-glanceReceive the best coverage by staying within networkIn order to receive 100 percent coverage for any non-emergent hospital based service, you must utilize a hospital that is in theTier One Adventist Health network. We have an extensive network of services available for you to take advantage of throughout oursystem, and the facilities within our Adventist Health network are covered at 100 percent for members. By staying in our network,you will have a significantly lower co-pay, deductible and out-of-pocket (OOP).2020 Engaged! PlanMedical Out-ofPocket (OOP) andDeductibleTier OneTier TwoCaliforniaMembers OnlyDeductible(applies first-before OOP) 0AH Facility 500per individual 500per individualIndividual max: 1,700Individual max: 1,700Family max: 5,100Family max: 5,100Out-of-pocket (OOP)(applies after deductible) 0AH FacilityTier ThreeCommon Deductible and Out-of-PocketIndividual MaxFamily MaxMedical OOP Max 1,700 5,100Pharmacy OOP Max 3,700 4,500Total OOP Max 5,400 9,600OOP MaxMedical BenefitsPhysician Office VisitsPrimary Care Physician,SpecialistsPhysician ServicesOther (non-office visitssuch as minor surgery,x-rays, labs)100% 20 Co-pay*AH clinics100% — lab andx-ray only100% 30 Co-pay*100% 30 Co-pay*Refer to the Schedule of Benefits in the SummaryPlan Document for further details PRIOR to receivingservices and for additional benefits.Notes:80% (D)60% (D)(D) Deductible appliesDefinitions:90% (D)AH clinics: Adventist Health Physician Services entity andAdventist Health tax IDs. Applies to labs and x-ray services only.Preventive Health100%N/A100%Preventive Health100%100%100%MaternityFees/Provider100% (D)80% (D)60% (D)Oregon members: Adventist Health and Healthcare Resources NWMaternityHospital Care100%N/A80%Tier TwoCalifornia members: California Foundation of medical Care (CFMC)Emergency Care100% 100 Co-pay*100% (D) 100 Co-pay*100% (D) 100 Co-pay*Urgent Care (Includesout-of-network providerswho will be paid under theIncentive Health ProviderAccess Solution level ofbenefits)100% 20 Co-pay*100% 30 Co-pay*100% 30 Co-pay* 5 Co-pay 30 30Hospital ServicesProvider ServicesEmergency ServicesTelehealth (AdventistHealth OnDemand)Tier OneCalifornia members: Adventist Health and Incentive Health,also includes medical staff who participate in California Foundation ofMedical Care.Oregon members: First Choice* Fixed dollar co-payments apply to annual out-of-pocket maximums. Fixed dollar co-payments applyPER visIt/admission/occurrence.7Tier ThreeFor California only, out-of-network
The Engaged! PlanAdventist Health offers a comprehensive medical plan to support you wherever you fall within thespectrum of health.Engaged! PlanThe Engaged! Plan is designed to encourage benefits-eligibleassociates and their dependents to take an active role intheir wellbeing. Engaged! Plan members pay low monthlycontributions, deductibles and co-pays; and receive excellentcoverage.PREVENTION AND WELLNESS are part of Adventist Health’sEligibilityA “benefits-eligible associate” is any employee of Adventistculture. Screenings, immunizations and annual wellnessexams are covered at no cost to you.If you work full time or part time you may be eligible forbenefits. You can elect medical/pharmacy, dental and visioncoverage for yourself, your spouse or legal domestic partner,and dependents under 26 years of age. Documentation will berequired for newly added dependents.Health who works a regular schedule of at least eighteen (18)hours per week or more.Making changesEnrollmentYou may make changes during the plan year only if youexperience a qualifying life event (QLE). Examples includemarriage, divorce, birth or adoption of a child, or a spouse/domestic partner who loses or gains health coverage.For details, see the plan summary documents atAdventistHealth.org/employeehealthplan.If you are a new associate who qualifies for and wants coverage,you must enroll within 30 days from your date of hire. Every fallduring open enrollment, you will have the opportunity to exploreoptions that are right for you and your family. If you are makingchanges or signing up for the first time, you can do so during theannual open enrollment period.Have questionsabout Adventist Health’s medical, pharmacy, dental and vision benefits? Call the Contact Center at844-574-5686, or visit AdventistHealth.org/employeehealthplan.Employee Health Plan BonusA bonus is offered to benefit-eligible associates enrolled in anymedical plan offered by Adventist Health to assist members withthe cost of coverage.Upon proof of income level (as illustrated in the table to theright), associates may be eligible for an Employee Health Planbonus of 1,000 per year. Associates with a hire date of July 1,2019 or later may be eligible for a health plan bonus of 500.To apply for the Employee Health Plan bonus, please visit theContact Center Online via Human Performance On Demand.When you apply for the Employee Health Plan bonus, beprepared to provide a copy of the first page of your federal taxes(IRS Form 1040) from the previous year with the first five (5)digits of your social security number(s) redacted.8Persons in Household2018 AnnualHousehold Income Limit1 (associate only)up to 18,0002 (associate plus onedependent) 24,0003 30,5004 36,5005 43,5006 49,5007 55,5008 61,500
Note:All three examples are for illustrative purposes only andassumes compliance with all plan requirements. Please contactEmployee Health Plan customer service at 800-441-2524for specific questions.Medical ScenariosExample 1: Outpatient ServicesMark schedules an office visit witha specialist to discuss a knownissue with his knee. The specialistrecommends an outpatientprocedure in office to resolve.ServicesTier Three ProviderTier One ProviderTier Two Provider 20 30 3022Office VisitOutpatient Professional ServicesCalifornia Members OnlyBilled Charges 1,200 1,500 1,700Allowable Charges 1,100 1,100 1,500 0 500 500 1,000 600 1,000100%80%60% 1,000 480 600 0 120 400Billed Charges 3,000 3,800 4,000Allowable Charges 2,400 2,400 2,800100%80%80% 2,400 1,920 2,240Patient Responsibility 0 480 560TOTAL Patient Responsibility 20 1,130 1,490Tier One ProviderTier Two ProviderTier Three ProviderAnnual DeductibleBalance after DeductibleCovered PercentageCovered AmountPatient ResponsibilityOutpatient Facility ChargesCovered PercentageCovered AmountExample 2: Inpatient ServicesMary needs to schedule aninpatient stay for the removal ofher gallbladder. Here is how thedifferent facility options wouldcompare.ServicesInpatient Facility Fees2 27,000 27,000 30,000Allowable Charges 20,000 22,000 24,000 0 500 500 20,000 21,500 23,500100%80%60% 20,000 17,200 14,100 0 4,800 9,900(After applying 1,700 annualout-of-pocket (OOP) maximum) 0 1,700 1,700TOTAL Patient Responsibility 0 2,200 2,200Tier One ProviderTier Two ProviderTier Three ProviderTelehealth(Adventist Health OnDemand)* 5 30 30Primary Care 20 30 30Urgent Care 20 30 30Emergency 100 100 100Coverage for additional outpatientservices beyond the office visit100%80% after deductible60% after deductibleBalance after DeductibleCovered PercentageCovered AmountPatient Responsibility(Before applying 1,700 annualout-of-pocket (OOP) maximum)Patient ResponsibilityJohn is concerned about hischild's fever. He is consideringdifferent options for care. Here isan overview of potential venuesfor assistance.2Billed ChargesAnnual DeductibleExample 3: Service OptionsCalifornia Members OnlyServicesCalifornia Members Only* When utilizing Adventist Health OnDemand. Usage of other telehealth services will result in a higher co-pay.9
Pharmacy BenefitsCommunity partner savingsThe medical plan includes pharmacy coverage,administered by OptumRx, our pharmacybenefit manager. Save money by using in-houseand community partner pharmacies.If unable to access one of Adventist Health’s in-housepharmacies, filling your prescriptions at one of our CommunityPartner Pharmacies will provide the greatest savings. As with ourin-house pharmacies, you may fill up to a 90-day supply of yourmedicines.In-house pharmaciesRetail network and home deliveryCo-pays are lowest at an Adventist Health in-house pharmacy.You may fill up to a 90-day supply of your medicines at thesepharmacies:If unable to access in house and Community PartnerPharmacies, you may use the pharmacy benefit manager’s retailnetwork and home delivery pharmacies. You may fill up to a30-day supply at a network retail pharmacy, or a 90-day supplythrough home delivery. Adventist Health Feather River Adventist Health Glendale Adventist Health Howard Memorial Adventist Health Lodi Memorial Adventist Health Sonora Adventist Health St. HelenaTraditional Co-paysTier Two (preferred brand)Tier Three (non-preferred)1-30 days supply31-90 days supply1-30 days supply31-90 days supply1-30 days supply31-90 days supplyAdventist Health In-HousePharmacy 7 14 35 70 60 120Community PartnerPharmacy 12 24 40 80 65 130OptumRx NetworkPharmacy 171 341 45 90 70 140Specialty Co-pays(All specialty medications areSpecialty Tier One(generic)Specialty Tier Two(preferred brand)Specialty Tier Three(non-preferred)Adventist Health In-HousePharmacy 3520% – 180 Max20% – 205 MaxCommunity PartnerPharmacy 4020% – 190 Max20% – 215 MaxBriovaRx Pharmacy(Optum Specialty Pharmacy) 4520% – 200 Max20% – 225 Maxall limited to a 30-day supply.1Tier One (generic)Simi Valley and Portland members pay 12 for a Tier 1 co-pay (1-30 day supply) at retail or 24 (31-90 day supply) at home delivery. All other co-pays are as indicated on the table.We take your privacy seriously.No personally identifiable health information will be shared with your employer,including the Human Performance department, managers, supervisors or other non-Employee Health Plan staff. The EmployeeHealth Plan data base is separate and apart from our IT services and, to ensure your privacy, is hosted by a vendor outsid
Founded on Seventh-day Adventist values, Adventist Health is a faith-based, nonprofit integrated health system headquartered in Roseville, California. We provide compassionate care in more than 80 communities on the West Coast and Hawaii. Benefits Guide Table of Contents
Adventist Health Hanford, Hanford, CA C McMillan, C Gomez, J Romero, M Raju, S Chopra, S Kaur and V Bezwada Adventist Health Howard Memorial Hospital, Willits, CA N Harding-Jackson Adventist Health Lodi Memorial, Lodi, CA D Fernandez and J Miller Adventist Health Napa Valley, Saint Helena, CA K Chase Adventist Health Ukiah Valley, Ukiah, CA K .
Whole-person health—optimal wellbeing in mind, body and spirit—reflects our heritage and guides our future. Adventist Medical Center-Hanford and Adventist Medical Center - Selma are part of Adventist Health, a faith-based, nonprofit health system serving more than 75 communities in California, Hawaii, Oregon and Washington.
Adventist Health’s Central Valley Network — including Adventist Medi-cal Center – Hanford, Adventist Medical Center – Reedley, Adventist Medical Center – Selma and Central Valley General Hospital — a new program is working to change that mindset. Faith and Health Connect was created by Charles Sandefur, vice
2 ADVENTIST HEALTH'S GUIDE TO COMPLIANCE AND ETHICS Adventist Health's Mission Living God's love by inspiring health, wholeness and hope. Being Adventist Health Values Be Love Love matters. Treat yourself with love and care so that you are free to love and care for
The Seventh-day Adventist philosophy of education is based on certain fundamental principles which shape not only educational procedures, but which blend into the basic message and mission of the Seventh-day Adventist Church. The following factors are inherent in the principles which provide the structure of Seventh-day Adventist education.
ii April 9, 2013 PREFACE The Accrediting Association of Seventh-day Adventist Schools, Colleges, and Universities is the accrediting body established by the Seventh-day Adventist Church to provide coordination, supervision, and quality control of its education system. It is responsible for evaluating the implementation of the Seventh-day Adventist philosophy
MAKING OUR YOUTH ALIVE ONE YEAR ADVENTIST YOUTH SOCIETY PROGRAM FORMAT PREPARED BY ARDEN JUNE GUILLERMO DUMPASAN . 3 ADVENTIST YOUTH SOCIETY The Adventist Youth Society is a department of the church through which the church works for and through her youth. OBJECTIVES: 1.
Scrum is a framework that allows you to create your own lightweight process for developing new products. Scrum is simple. It can be understood and implemented in a few days. It takes a lifetime to master. “Scrum is not a methodology – it is a pathway” – Ken Schwaber (Boulder, Co, Nov. 2005) What is Scrum? Sonntag, 19. Februar 12
