View
2
Download
0
Category
Preview:
Citation preview
Hea
lth,
Wel
fare
and
Sup
plem
enta
l Ben
efit
s
DiscoverDiscoverY O U R B E N E F I T
C
HO
I CE
S
Supplemental
B e n e f i t s
Health and Welfare
B e n e f i t s
Health and Welfare Benefits
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Discover Your Health and Welfare Options. . . . . . 3
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Cost Sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Benefits Administrator . . . . . . . . . . . . . . . . . . . 4
Your Medical Options . . . . . . . . . . . . . . . . . . . . 4
Medical Plan Comparison Chart . . . . . . . . . . . . 6
Aetna POS/HealthFund HRAAexcel Program . . . . . . . . . . . . . . . . . . . . . . . . . 8
Aetna POS/HealthFund HRA Moms-to-Babies . . . . . . . . . . . . . . . . . . . . . . . . . 8
Aetna Health Connections . . . . . . . . . . . . . . . . 9
Aetna Enhanced Medical Outreach . . . . . . . . . 9
Qualified Changes in Family Status . . . . . . . . . 9
Your Dental Options . . . . . . . . . . . . . . . . . . . . 10
Your Vision Care. . . . . . . . . . . . . . . . . . . . . . . . 11
Your Employee Life Insurance. . . . . . . . . . . . . 11
Supplemental Employee Life Insurance . . . . . 11
Business Travel Accident Insurance . . . . . . . . 11
Paid Time Off . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Flexible Spending Accounts (FSA) . . . . . . . . . 12
Glossary of Terms. . . . . . . . . . . . . . . . . . . . . . . 13
Supplemental Benefits
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Who’s Eligible . . . . . . . . . . . . . . . . . . . . . . . . . . 14
How to Enroll . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Supplemental Benefits Offered . . . . . . . . . . . . . . 14
Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Legal Services . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Pet Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Term Life Insurance . . . . . . . . . . . . . . . . . . . . . 15
How do youdecide.com SupplementalBenefits Work? . . . . . . . . . . . . . . . . . . . . . . . . . 15
Other Supplemental Benefits Offered . . . . . . . . . 15
Long-Term Care Insurance . . . . . . . . . . . . . . . . 15
Take it to Heart Program . . . . . . . . . . . . . . . . . 15
Adoption Reimbursement . . . . . . . . . . . . . . . . 16
Back-up Child Care . . . . . . . . . . . . . . . . . . . . . . 16
Educational Assistance Program. . . . . . . . . . . 16
Employee Assistance Program . . . . . . . . . . . . 16
MovePerks . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
How do the Edwards SupplementalBenefits Work? . . . . . . . . . . . . . . . . . . . . . . . . . 16
Table of
C o n t e n t s
1
When it comes to benefits, the needs of families
are far more unique than in the past. At Edwards
Lifesciences, we realize the importance of you
getting the most out of your Edwards benefits, and
it’s our goal to provide you with the necessary
resources to do just that. This brochure is aimed at
helping you determine which plans will best meet
your individual and family needs. At Edwards, the
opportunities are endless — and we invite you to
discover your benefit choices!
2
Health and Welfare
B e n e f i t s
Enrollment
For most health and welfare benefits, you have 31 days
from the date printed on your personalized enrollment
worksheet to enroll. If you do not enroll by the deadline
printed on your worksheet, you will not be able to enroll
until the next Open Enrollment period unless you have a
qualified change in family status. The plan year runs from
July 1 to June 30.
If you decide to waive coverage by the deadline
printed on your enrollment worksheet and later have a
qualified change in family status, you may be able to
enroll yourself and your dependents in some of the
insurance plans available in your location. See page 9 for
more information on qualified changes in family status.
There is no need to enroll in your company-paid
benefits. They will be automatically provided at no cost to
you and are effective as of your date of hire.
Here’s how you enroll for your optional benefits:
1. Using the personalized enrollment worksheet included
in your new hire benefits packet, select the types and
levels of coverage that interest you and your family.
2. Web enrollment is available 24 hours a day, 7 days a
week. You can enroll via the Web or through MyEW/My
Benefits on the Edwards intranet. Enter your user ID
and password and simply follow the online prompts to
make your benefit choices. For complete details on
how to enroll, refer to the instructions included in this
enrollment packet.
The cost for most of these benefits will be deducted
from your paycheck on a pre-tax basis. However, the
cost for some benefits, like supplemental life insurance,
will be deducted on an after-tax basis.
Discover Your Health and Welfare
O p t i o n s
3
Eligibility
All regular employees scheduled to work at least 20
hours per week are eligible for most health and welfare
benefits on the first day of the month following one
month of employment. As long as you enroll within the
specified time frame, coverage is effective on the date you
are eligible, except for Employee Life Insurance, Business
Travel Accident Insurance and Long-Term Disability.* You
are eligible for these company-paid benefits beginning on
your date of hire. You are also eligible for employee-only
vision benefits beginning on your date of hire.
Cost Sharing
The following table shows how you and Edwards share
the cost of your health and welfare benefits. Edwards
provides you with many company-paid benefits and gives
you the choice to pay for optional benefits through pre-
and after-tax payroll deductions.
* Subject to an elimination period.
Company-Paid OptionalBenefits Benefits
Employee Vision Medical
Employee Life Insurance Dental
Paid Time Off Family Vision
Business Travel Flexible Spending
Accident Insurance
Short- and Long-Term Supplemental Employee
Disability Life Insurance
balancebalance
HE
AL
TH
A
ND
W
EL
FA
RE
B
EN
EF
IT
S
The following table shows when each type of coverage
will go into effect after you enroll:
* If you enroll within 31 days of receiving your personalized enrollment form.** You may not enroll in your Health Care Spending Account until the start
of the plan year.
W H AT I F I D O N ’ T E N R O L L ?
If you don’t enroll, you will default to no medical and
dental coverage and be enrolled in the company paid
benefits listed on page 3. If you have default coverage
and have a qualified change in family status during the
plan year, you may be able to make a change depending
on the type of qualified event you experience.
Benefits Administrator
TRI-AD, a human resources administration firm, is the
benefits administrator for Edwards’ benefit programs.
TRI-AD will handle a variety of tasks related to your Edwards
benefits, including:
•• Your enrollment in Edwards’ benefit plans, as well as any
qualified changes in status you may have throughout
the plan year
•• Beneficiary designations for benefits such as life
insurance and the Stock Option Plan
Your Medical Options
You are eligible for medical benefits on the first of the
month following one month of employment. You may
choose from any of the medical plans offered in your
area. When deciding which plan is best for you, take into
consideration all of your needs, as well as the needs of
your family.
Edwards pays approximately 85% of the premium cost
for your health care coverage. This means your contribution
amount listed on your personalized enrollment worksheet
for each of your medical choices is approximately 15% of
the total cost.
Your personalized enrollment worksheet lists the
medical plans available to you in your area. You may
choose from the Aetna HealthFund HRA, a Health
Maintenance Organization plan (HMO) and a Point-of-
Service (POS) plan. In addition, there is a “passive Preferred
Provider Organization (PPO)” option for the Catastrophic
Plan. See the table on pages 6 and 7 for specific plan
features to help you make your decision.
4
Coverage Effective Date
Medical The first of the month following
one month of employment*
Dental The first of the month following
one month of employment*
Vision (Employee and Employee: Date of hire
Dependent(s)) Dependent(s): The first of the
month following one month of
employment*
Employee Life Insurance First day of work
Supplemental Employee The first of the month following
Life Insurance one month of employment*
Business Travel Accident Insurance First day of work
Short-Term Disability After completion of six months
of employment and 1,000 hours
worked
Long-Term Disability First day of work
Health Care Spending Account Beginning of next plan year**
Dependent Care Spending The first of the month following
Account one month of employment*
healthhealth
The Health Maintenance Organization (HMO)
The HMO offers members a range of health benefits,
including preventive care, for a monthly fee and set
copayments or coinsurance for the care that you receive.
When using an HMO, you will need to select a Primary
Care Physician (PCP). Your PCP will coordinate all of your
care, including referrals to specialists. If you see a provider
outside the network without a referral from your PCP, you
will be responsible for the total cost of the service, except
for emergency or urgent care services.
The Point-of-Service (POS) Plan
The POS offers two main options for health care: an
in-network plan that limits your access to a list of
providers and an out-of-network plan that gives you the
freedom to see any doctor you choose. With the POS plan
you do not have to choose a PCP, but it is recommended
you do choose one to coordinate your care. When you
choose in-network providers you pay a fixed, low copay
and/or low coinsurance. In contrast, the out-of-network
plan provides similar benefits, but you pay higher coinsurance
because you may go to any doctor you wish. In addition,
there are annual deductibles when you decide to go out-
of-network. Refer to pages 6, 7 and 8 for coverage amounts.
Contact the carrier for a list of network providers
near you.
The Aetna HealthFund HRA
This “consumer-driven health care plan” empowers you
to be an active, informed consumer of health care. It gives
you the freedom to choose the providers who deliver your
care and offers you more control over the cost of that care.
The Aetna HealthFund HRA blends the features of a
traditional health insurance plan with a fund benefit to help
you pay for covered medical expenses. In addition, it delivers
useful tools to help you make informed medical decisions.
Here’s how the plan works:
•• At the beginning of the year, Edwards provides you
with a certain amount of money to pay for eligible
medical expenses. This money is deposited into your
Health Reimbursement Account (HRA) and depends on
your coverage election — employee only, employee plus
spouse/child(ren) or employee plus family. In addition,
you also will have a plan deductible that corresponds to
your coverage election. New hires will receive a pro-
rated HRA based on their date of hire.
•• Once you deplete your HRA, you will be responsible for
your expenses until you meet your deductible. The
amount in your HRA is applied to your deductible.
•• Once you meet your deductible (and your HRA is de-
pleted), additional expenses are covered by traditional
health insurance. Refer to pages 6, 7 and 8 for coverage
amounts.
There are many advantages to the Aetna HealthFund
HRA. Under the plan preventive care is covered at 100%
(up to $500 per member per plan year) which is not
deducted from your HRA. Also, preventive and chronic
medications are not subject to your deductible.
If you don’t use your entire HRA in any plan year, the
remaining amount is added to the following plan year’s
HRA balance — allowing you to increase your fund and
use it toward future expenses as long as you remain
enrolled in the Aetna HealthFund HRA.
5
HE
AL
TH
A
ND
W
EL
FA
RE
B
EN
EF
IT
S
6
Plan Feature Aetna Choice POS II Aetna Choice POS II Aetna HealthFund HRA Aetna HealthFund HRAIn-Network Out-of-Network In-Network Out-of-Network
None
$3,000,000; Pharmacy benefits are not included
$2,000 per individual,$4,000 per family
$20 copay✝✝
100% after $20 copayat initial visit
$20 copay
100% after $100 copay;copay waived if admitted
90% after $150 copay per day, $750 max. per plan year,
limit 30 days per plan yearcombined with substance abuse
$20 copay, limit 60 visits per plan year combined with
substance abuse
90% after $150 copay perday, $750 max. per plan year,
limit 30 days per plan yearcombined with mental health
$20 copay, limit 60 visits per plan year combined with
mental health
$20 per visit
Not covered
Not covered
$500 per individual,$1,000 per family
$3,000,000; Pharmacy benefits are not included
$6,000 per individual,$12,000 per family
60% after deductible✝✝
60% after deductible
60% after deductible
100% after $100 copay;copay waived if admitted
60% after $150 copay per day, $750 max. per plan year,
limit 30 days per plan yearcombined with substance abuse
60% after deductible, limit 60visits per plan year combined
with substance abuse
60% after $150 copay perday, $750 max. per plan year,
limit 30 days per plan yearcombined with mental health
60% after deductible, limit 60visits per plan year combined
with mental health
60% after deductible
Not covered
Not covered
$3,000,000
$3,500 per individual,$4,500 EE + spouse or child(ren),
$5,500 per family
90% after deductible✝✝
90% after deductible
90% after deductible
90% after deductible
90% after deductible, limit 30days per plan year combined
with substance abuse
90% after deductible, limit 60visits per plan year combined
with substance abuse
90% after deductible, limit 30days per plan year combined
with mental health
90% after deductible, limit 60visits per plan year combined
with mental health
90% after deductible
Not covered
Not covered
$3,000,000
$7,500 per individual,$10,500 EE + spouse or child(ren),
$13,500 per family
60% after deductible✝✝
60% after deductible
60% after deductible
90% after deductible
60% after deductible,limit 30 days per plan year
combined with substance abuse
60% after deductible, limit 60visits per plan year combined
with substance abuse
60% after deductible, limit 30days per plan year combined
with mental health
60% after deductible, limit 60visits per plan year combined
with mental health
60% after deductible
Not covered
Not covered
Medical Plan Comparison Chart
✝ Your deductible includes HRA amounts✝✝ See separate Aexcel chart for information about specialty copays and coinsurance
Annual Deductible
Lifetime Maximum Benefit
Out-of-Pocket Maximum
Office Visits
Prenatal Care
Chiropractic Care
Emergency Room
Prescription Drugs (Rx)
Generic
Brand Name
Mail Order(90-day supply)
Mental Health CoverageInpatient
Outpatient
Substance Abuse CoverageInpatient
Outpatient
Infertility CoverageTesting
In Vitro
Artificial Insemination
Generic Mandatory 30-day supply except Mail Order;Generic and brand name drugs: mandatory mail order for
maintenance medication after two fills at retail;pharmacy maximum $1,500 per member/year; specialty injectable
drugs must be filled through Aetna Specialty Pharmacy
$10 copay, 30-day supply
20% with $25 minimum and $75 maximum if generic notavailable for preferred; 30-day supply; 40% with $45 minimum
and $100 maximum for non-preferred
$20 generic: 20% with $50 minimum and $150 maximumfor Brand Preferred; 40% with $100 minimum and
$200 maximum for Brand non-preferred
Generic Mandatory 30-day supply except Mail Order;Generic and brand name drugs: mandatory mail order for
maintenance medication after two fills at retail; chronic andpreventive drugs are not subject to the deductible; specialty
injectable drugs must be filled through Aetna Specialty Pharmacy
$10 copay, 30-day supply
20% with $25 minimum and $75 maximum if generic notavailable for preferred; 30-day supply; 40% with $45 minimum
and $100 maximum for non-preferred
$20 generic: 20% with $50 minimum and $150 maximumfor Brand Preferred; 40% with $100 minimum and
$200 maximum for Brand non-preferred
HRA Deductible✝
Employee $500 $1,500Employee + Spouse $750 $2,000Employee + Child(ren) $750 $2,000Employee + Family $1,000 $2,500
Coverage after you meet deductible is below. Preventive care covered100% ($500 max. per member/year). HRA is prorated for new hires.
Up to $600 max.per plan year Up to $600 max.per plan year
If you would like more information about a specific plan, see your Vendor Contact card or theintranet for the appropriate phone number. If there is a conflict between this chart and theofficial Plan Documents that govern these plans, the official Plan Documents will prevail.
7
HE
AL
TH
A
ND
W
EL
FA
RE
B
EN
EF
IT
S
Kaiser HMO Aetna HMO SelectHealth HMO Aetna HMO Catastrophic California only California only Utah only Select areas in Pennsylvania Option Plan
None
Unlimited
$1,500 per individual,$3,000 per familyper calendar year
$15 copay
$5 copay
$10 copay,30 visits per calendar year
$100 per visit;copay waived if admitted
Up to 100-day supply,closed formulary
$10 copay
$20 copay
$10 generic/$20 brand
100%, limit 30 days per calendar year
$15 individual or $7 groupper visit, limit 20 visits
per calendar year
$100 copay, residentialtreatment deductible,100%for detox, limit 60 residential
days per calendar year
$15 per individual or $5 per group visit,
unlimited
$15 per visit
Not covered
$15 per visit, limits apply
$100 per individual,$200 per family
per calendar year
$2,500,000
$1,000 per individual,$2,000 per family**
$15 PCP/$20 for specialist
$15 copay/first visit, deliverycovered 90% after deductible
Not covered
$75 after deductible forparticipating facilities;
$125 after deductible fornon-participating facilities
Generic Mandatory30-day supply except
Mail Order
$10 copay, 30-day supply
$25 copay for preferred, 30-day supply;
$45 non-preferred
$10 copay for generic;$50 copay for preferred;
$135 copay for non-preferred
$100/$200 mental healthdeductible; 90% after mental
health deductible
$15 copay per visit after mentalhealth deductible; all other
services 90% after deductible
90% after mental healthdeductible
$15 copay per visit after mentalhealth deductible; all other
services 90% after deductible
50% cover after deductible,limit $1,500 per calendar year,
$5,000 lifetime max.(select services)
Not covered
Not covered
None
Unlimited, see plandocument for details
$1,500 per individual,$3,000 per familyper calendar year
$15 per visit
Outpatient:$15 copay/first visitonly; Inpatient: $100 copay
Not covered
$75 per visit;copay waived if admitted
30-day supplyexcept Mail Order
$15 copay for formulary, up to30-day supply; $35 non-formulary
$20 copay for formulary,up to 30-day supply;$35 non-formulary
2x 30-day copayfor 31- to 90-day supply
$100 copay, limit 35 daysper plan year for inpatient
services other thanSMI and SED*
$25 per visit fornon-SMI/SED, limit 20 visits
per plan year
$100 copay; 100% forrehab., limit 30 days per plan
year, 90-day lifetime max.
$15 per visit, limit 60 visits for rehab. per
calendar year
$15 per visit
Not covered
Not covered
None
Unlimited, see plandocument for details
$1,500 per individual,$3,000 per familyper calendar year
$15 per visit
Outpatient:$15 copay/first visitonly; Inpatient: $100 copay
Not covered
$75 per visit;copay waived if admitted
30-day supplyexcept Mail Order
$15 copay for formulary, up to30-day supply; $35 non-formulary
$20 copay for formulary,up to 30-day supply;$35 non-formulary
2x 30-day copayfor 31- to 90-day supply
$100 copay, limit 30days per calendar year for
inpatient services otherthan SMI and SED*
$25 per visit fornon-SMI/SED, limit 20 visits
per calendar year
$100 copay; 100% forrehab, limit 30 days per
calendar year
$15 per visit, limit 20 visits for rehab. per
calendar year
$15 per visit
Not covered
Not covered
*SMI is Serious Mental Illness; SED is Serious Emotional Disturbances of a child. Inpatient/Outpatient benefits for SMI and SED are paid the same as medical inpatient/outpatient services.**Separate $1,000 individual/$2,000 family out-of-pocket maximum for mental health and substance abuse coverage.
$5,000 per individual,$10,000 per family
$3,000,000; Pharmacy benefits are not included
$5,000 per individual,$10,000 per family
100% after deductible
100% after deductible
$600 plan year benefit max.after deductible
100% after deductible
Generic Mandatory100% after deductible
100% after deductible
100% after deductible
Not available
100% after deductible,30 days per plan year;
combined with substanceabuse
100% after deductible,60 visits per plan year;
combined with substance abuse
100% after deductible,30 days per plan year;
combined with mental health
100% after deductible,60 visits per plan year;
combined with mental health
100% after deductible
Not covered
Not covered
Aetna POS/HealthFund HRA Aexcel Program
If you are a member of the Aetna Choice POS II or the
HealthFund HRA, and live in Orange or Los Angeles County,
it’s easier than ever to find the most effective specialists for
your care. The Aetna Aexcel program identified specialists in
12 areas, focusing on a number of performance criteria and
their level of cost effectiveness. Top performing specialists in
these areas were designated by Aetna as Aexcel physicians
for providing superior care to members.
Aetna Aexcel Specialty Areas
Aexcel Specialists — the Best of the Best
For each specialty, Aetna evaluated the performance of
each physician using standards consistent with leading
associations like the American Heart Association, Agency
for Health Research and Quality, American College of
Obstetricians and Gynecologists, and the Society of
Thoracic Surgeons. Physicians were rated on standards
such as 30-day hospital readmission rates, rates of health
complications during hospital stay and other specialty-
specific performance measures.
When you use Aexcel-designated specialists, not only are
you getting top care, but you’re also getting it at the most
efficient price. Now that’s being a wise health care consumer.
Aetna Aexcel Coverage Levels
Regular copay and coinsurance amounts apply to
regular doctor’s office visits and specialty areas not identified
by the Aexcel program. In addition, if you live outside of the
Orange or Los Angeles County area and utilize in-network
providers, your office visit copay will remain at $20 and your
coinsurance will be 10%. See the Medical Plan Comparison
Chart on pages 6 and 7 for more details.
Finding an Aexcel Provider
For now, the Aexcel program is available only to
employees located in Orange and Los Angeles Counties. If
this applies to you, find Aexcel-designated specialists by
using the DocFind directory at www.aetna.com. Aexcel-
designated physicians are uniquely identified for your
convenience. Just look for the blue stars! If you live in
Orange or Los Angeles County and do not utilize an Aexcel
designated provider in the 12 specialty areas, your office visit
copay will increase from $20 to $40 and your coinsurance
will increase from 10% to 30%.
Aetna POS/HealthFund HRA Moms-to-Babies
If you are a member of the Aetna Choice POS II plan
or the HealthFund HRA, you are eligible to participate in
the Moms-to-Babies program. The program offers a
wealth of information for expectant mothers, and includes
a $500 gift card for members who enroll and complete a
health assessment during the first trimester.
8
optionsoptionsIn-Network In-Network Non- Out-of-Network
Plan Aexcel Provider Aexcel Provider Provider
Choice POS II Plan Pays 90% Plan Pays 70% Plan Pays 60% $20 specialist copay $40 specialist copay
HealthFund* Plan Pays 90% Plan Pays 70% Plan Pays 60%
* After you have depleted your HRA and met your deductible.
• Cardiology
• Cardiothoracic Surgery
• Gastroenterology
• General Surgery
• Neurology
• Neurosurgery
• Obstetrics and Gynecology
• Orthopedics
• Otolaryngology
• Plastic Surgery
• Urology
• Vascular Surgery
choicechoice
Aetna Health Connections
Aetna Health Connections is a confidential disease
management program designed to help Choice POS II and
HealthFund HRA members get the right treatment and
learn more about preventive care. Through this program,
members can get support for 30 common medical
conditions, such as diabetes, hypertension, asthma,
rheumatoid arthritis, various forms of cancer, chronic
hepatitis, migraines and low back pain.
This program includes a wealth of on-line educational
materials and tools, nurse case managers and a 24-hour,
toll-free phone number that you can call whenever you
have a question. Also included is ActiveHealth Management
CareEngine, a tool that can identify potentially dangerous
drug interactions, drug-disease interactions and more. If you
are enrolled in the Choice POS II or HealthFund and need
assistance in managing a chronic condition or if you think
you are at risk for one, contact Aetna at (866) 269-4500
to enroll.
Aetna Enhanced Medical Outreach
The Enhanced Medical Outreach program is designed
to provide Choice POS II and HealthFund HRA members
involved in a significant health care episode with education,
guidance and tools necessary for them to better handle
their condition and improve their overall quality of care.
Because this program is designed to strengthen Aetna’s
standard patient management program and expand on
their commitment to members, an Aetna nurse will contact
covered members before and after a scheduled overnight
hospital stay and provide information on what to anticipate
before and after the procedure, counseling to help the
member and their dependents through the procedure and
educate on how to avoid post surgery complications
through medication and treatment plan compliance.
Q U A L I F I E D C H A N G E S I N FA M I LY S TAT U S
In addition to the annual Open Enrollment period, you
may also enroll and/or make changes to your elections if you
have a qualified change in family status. A qualified change in
family status is an event that would impact certain benefits,
such as marriage, divorce, the birth or adoption of a child and
losing or gaining coverage provided by a spouse’s employer.
The change you make to your coverage must be consistent
with your qualified change in family status. For example:
• If you get married, you can add your spouse and your
spouse’s children to your health coverage and you can enroll
in the dependent care reimbursement account or make
changes to the dependent care reimbursement account.
• If your spouse loses medical coverage and you were
enrolled in your spouse’s plan, you can choose any
Edwards medical option that is available in your area.
• If your dependent becomes ineligible for coverage, you
can stop coverage for that dependent.
• If your dependent goes through Open Enrollment at their
company at a different time than Edwards’Open Enrollment,
you can make changes within 31 days from the time your
new benefits go into effect.
• If you move to a location where your medical plan is no
longer available, you can change medical options for you
and your dependents.
If you have a qualified change in family status, you may
make changes to certain benefit elections within 31 days of
the event. If you do not make changes within 31 days, you
will have to wait until the next Open Enrollment period.
9
HE
AL
TH
A
ND
W
EL
FA
RE
B
EN
EF
IT
S
Your Dental Options
Edwards offers three different dental plans — Basic,
Basic Plus and the Dental Maintenance Organization (DMO).
You are eligible for dental benefits on the first day of the
month following one month of employment.
The Basic and Basic Plus plans allow you to see the dentist
of your choice and provide coverage for most dental services,
but Dental Basic Plus covers some services at a higher level of
benefit. Therefore, your contribution costs may be higher,
but your copays will be lower overall. In addition, there is a
“passive Preferred Provider Organization (PPO)” for these
two options as well. This means that if you choose a provider
in the Aetna PPO network, you will receive the benefits of
provider discounts that Aetna has negotiated with members
of the network.
The DMO is a prepaid managed care plan — the
dental equivalent of an HMO. You must see a dentist in
the DMO network. However, there is no annual benefit
maximum, no deductible and the copayments range
depending on the type of service.
Your dental costs are outlined on your personalized
enrollment worksheet. Edwards pays approximately 70%
of the premium costs of dental coverage for the plans.
This means the amount you will have to pay (listed on your
enrollment worksheet) for each of your medical choices is
approximately 30% of the total cost.
The dental plans are administered by Aetna Dental.
However, you are free to use non-network providers for
the Basic and Basic Plus plans and still receive the same
level of reimbursement based on contracted fees. You are
required to select a Primary Dentist for the DMO. Contact
Aetna to obtain a list of network providers near you.
The following chart lists the coverage available to you
under each plan.
* Refer to the cost chart available on the Edwards intranet.** Available in most states.
*** Lifetime maximum.
If you would like more information about a specific
plan, see your Vendor Contact card or the intranet for the
appropriate phone number.
10
flexibleflexible
Plan Dental Dental Feature Basic Basic Plus DMO**
Annual Deductible
Individual $150 $125 $0
Family $300 $250 $0
Annual Maximum
Individual $2,000 per $2,000 per $0
Family person/year person/year $0
Exam and 100% 100% 100%
Cleaning covered
X-rays (two bitewings per plan year, full mouth every three years)
100% 100% 100%
Restoration (including fillings and stainless steel crowns)
and Repairs 65% 80% *
Root Canal 65% 80% *
Simple Extraction 65% 80% *
Porcelain Crowns,
Dentures 50% 50% *
Oral Surgery 65% 80% *
Orthodontia Not covered 50% up to You pay
$1,500*** $2,000
If you have… You will receive…
1-4 years of service 2 weeks per year
5-9 years of service 3 weeks per year
10-19 years of service 4 weeks per year
20 or more years of service 5 weeks per year
Business Travel Accident Insurance
Business Travel Accident Insurance provides a benefit
to you or your beneficiaries if you are injured or die during
work-related travel. The benefit is equal to four times your
eligible compensation (up to a $250,000 maximum). This is
an automatic benefit provided by Edwards at no cost to you.
Paid Time Off
Edwards provides a valuable Paid Time Off program to
help you achieve that important balance in your work and
personal life. You receive time off for vacation, holidays and
illness as part of your health and welfare benefits.
Vacation Time
The following chart shows how you begin to accrue
vacation time on your first day of hire.
It’s important that you work with your supervisor to
make sure your job duties are covered while you are away.
You will need to be flexible and schedule vacations well in
advance to coordinate with co-workers in your department.
Sick Days
You are eligible to receive up to 10 paid sick days each
calendar year.
Family Medical Leave
When you have been employed with Edwards for 12
months and worked 1,250 hours during the 12 months
prior to the request for leave, you are eligible for Family
Medical Leave. You may take up to 12 weeks unpaid time
off during a rolling 12-month period for your own serious
medical condition, the birth or adoption of a child or to care
for a family member who has a serious medical condition.
11
HE
AL
TH
A
ND
W
EL
FA
RE
B
EN
EF
IT
S
Plan Feature Annual Cost
Eye Exams $15 copay*, covered every 12 months
Contact Lenses $25 copay*, contact lenses or regularor Eyeglasses lenses covered every 12 months;
frames covered every 24 months
* When services are obtained through a VSP provider.
Your Vision Care
All employees are eligible for vision coverage free of
charge. Because this is an automatic benefit, you will be
covered on your date of hire. If you choose to purchase
additional coverage for your dependents, their coverage
will begin on the first of the month following one month
of employment.
The vision benefit includes coverage for eye exams
and contact lenses or eyeglasses. The following chart
provides some details of the plan.
Coverage is provided by Vision Service Plan (VSP). Access
www.vsp.com for the providers available in your area, or
call (800) 877-7195.
Your Employee Life Insurance
Employee Life Insurance is provided by Edwards at
no cost to you at a benefit equal to one times your
eligible compensation. This benefit is provided to your
beneficiaries in the event of your death.
This is an automatic benefit, so there is no need to
enroll. However, you will need to designate a Beneficiary
in MyEW. The Beneficiary Designation feature provides
the option to list different beneficiaries for basic life,
supplemental life and business travel accident insurance.
Supplemental Employee Life Insurance
You may purchase supplemental life insurance for
yourself for up to five times your eligible compensation to
a maximum of $1,000,000. This benefit, like Employee
Life Insurance, provides a benefit to your beneficiaries in
the event of your death. Refer to your personalized
enrollment worksheet for pricing. Payroll deductions for
supplemental life insurance will be after-tax.
Short-Term Disability
Edwards provides short-term disability insurance at no
cost to you. If you need more than 7 calendar days to
recover from an illness or injury, you may be eligible for
short-term disability as long as you have been employed by
Edwards for at least six months and have worked more
than 1,000 hours. Exempt employees will receive 100%*
of eligible compensation for up to 28 weeks for qualified
disabilities. Hourly and salaried non-exempt employees are
eligible to receive 662/3%* of annual base pay for up to 28
weeks for qualified disabilities.
Long-Term Disability
Edwards provides long-term disability insurance at
no cost to you. If you are unable to work for more than 28
weeks, you may qualify for long-term disability. This
benefit will pay 60% of your eligible compensation, up to
a maximum of $12,000 a month until you are no longer
disabled, return to work or reach the maximum age.
Flexible Spending Accounts (FSA)
Edwards offers two reimbursement accounts — the
Health Care Spending Account and the Dependent Care
Spending Account. These accounts allow you to set aside
pre-tax dollars for eligible expenses. By paying for eligible
expenses with pre-tax dollars, you save money because
you avoid paying most federal, state and Social Security
taxes on that money.
These accounts work on a plan-year basis. Before you
decide how much money you would like to set aside for
each account, estimate how much you will need for the
remainder of the plan year. Only allocate to your accounts
as much money as you plan to spend. Any funds not used
during the plan year will be forfeited.
Health Care Spending Account
The Health Care Spending Account is an account
established in your name to pay for you and your
dependents’ eligible medical, dental and vision expenses,
such as deductibles, copays, coinsurance and other
expenses not covered by your health plans. You may
allocate up to $5,000 into the Health Care Spending
Account each plan year. You may enroll in the Health Care
Spending Account at the start of the plan year.
Aetna is our administrator for the Health Care
Spending Account. Aetna offers streamlined submission
of expenses payable under their medical or dental plans.
Expenses such as coinsurance and deductibles will be
automatically applied to the spending account. No
separate claims submission is needed. FSA reimbursements
for all non-pharmacy related expenses will be made directly
to you. You will be responsible for directly reimbursing the
provider. If you are enrolled in one of the HMO Plans, you will
need to complete a claim form to receive reimbursement
for your copays. Any out-of-pocket prescription drug
payments will automatically be deducted from your FSA at
the time of purchase and paid directly to the pharmacy if
you are enrolled in one of the Aetna medical plans.
Dependent Care Spending Account
The Dependent Care Spending Account is an account
established in your name to pay for eligible dependent
care expenses, such as care provided for a dependent
while you (and your spouse, if married) work. You may
allocate up to $5,000 to your account each plan year. If
you are married and you and your spouse file separate
income tax returns, the most each of you can contribute
to the account is $2,500. In addition, your contributions to
the Dependent Care Spending Account (if you are married)
cannot exceed the income of the lower-paid spouse.
U S E I T O R L O S E I T !
Any money left over in either of your Reimbursement
Accounts at the end of the plan year is forfeited, so be
sure to estimate as accurately as possible the amount
you will need for the remainder of the plan year.
12
* Coordinated with state disability insurance, if applicable for your location.
Aetna HealthFund HRA A medical plan option that
blends the features of a traditional health insurance plan
with a fund benefit to help you pay for covered medical
expenses.
Aexcel An Aetna program that identifies top doctors in
12 specialty areas.
Annual Deductible The amount you need to pay each
year for applicable expenses before you will receive benefits
from your plan.
Coinsurance This is your share of the cost of coverage
under any given plan.
Copay Some services require you to pay a minimal set
amount before receiving care or prescription drugs. This is
a copay.
DMO Dental Maintenance Organization. A DMO is a type
of prepaid managed care plan — the dental equivalent of a
medical HMO. You must see a dentist in the DMO network.
There is no annual benefit maximum, no claim forms to fill
out, and the copayments range, depending on the type of
service. There are no benefits payable if you are enrolled in
the DMO and use out-of-network dental providers.
Eligible Compensation Generally includes your base
salary plus overtime and commissions. Definition varies for
the 401(k) Savings & Investment Plan.
HMO Health Maintenance Organization. An HMO provides
a high level of coverage when you use an in-network
provider, and no coverage if you use an out-of-network
provider, except if you require emergency or urgent care
services. HMOs are usually less expensive than other types
of plans, but are limited to only those providers in their
network. You will also need to use a Primary Care Physician
(PCP) to receive the highest level of coverage with an
HMO. This physician will give referrals if you need care from
a specialist.
In-network Some plans provide higher levels of coverage
if you use a provider from a specified group. When you
use a provider from this group, you are using an in-
network provider. Usually in-network providers have an
agreed upon schedule of benefits that states how much
they will charge for specific services. These providers have
agreed not to charge more than the agreed upon amount
for each service they provide.
Lifetime Maximum Benefit This is the total amount of
money you can receive from an insurer for all eligible
expenses during your lifetime. This includes breaks in
coverage, which means that if you exit a plan and then re-
enroll at a later date, your past benefits paid will still be
counted toward your maximum. However, pharmacy
benefits are not included.
Out-of-network Some plans provide lower levels of
coverage if you use a provider outside of a specified
group. When you use a provider from outside of this group,
you are using an out-of-network provider. When you go
out of network, you have more flexibility in the providers
you may choose, but you will usually receive a lower level
of coverage than if you used an in-network provider.
POS Point-of-Service plan. A POS is similar to an HMO in
that you receive a higher level of coverage if you use an
in-network provider. The main difference with a POS is that
you may see out-of-network providers. You will receive a
higher level of coverage when you see in-network provider
than when you see an out-of-network provider.
PPO Preferred Provider Organization (Catastrophic Plan). A
PPO allows you to use any licensed doctor or health care
facility. If you choose a physician within the network, you
receive a higher level of benefits. You also have the freedom
to choose a physician outside the network and receive
coverage at a lower reimbursement percentage than if you
have received care within the network. You pay a large
deductible when you receive coverage outside the network.
1313
Glossary of
Te r m s
Supplemental Benefits
H i g h l i g h t s
Who’s Eligible
All Edwards employees who work more than 20 hours
per week are eligible for supplemental benefits. Many
of the supplemental benefits are offered through
youdecide.com, our Supplemental Benefits provider, and
you can enroll at any time.
How to Enroll
Here’s what you need to do to enroll in the
youdecide.com supplemental benefits:
1. Read through the following Supplemental Benefits
information to decide which of these benefits
interest you.
2. Call the youdecide.com hotline (specifically for Edwards
employees) anytime at (877)326-5231. Edwards’ Unique
Client ID is ELS362. This hotline is a toll-free, auto-
mated system that is open 24 hours a day, 7 days a
week. Simply follow the prompts to navigate through
the system. Or, register to enroll online through the
Edwards intranet.
3. Your new benefits will go into effect on the date you
agree to start with the carrier of each benefit once
your enrollment is processed.
Working together to strengthen our organization means
supporting each other in our work and personal lives.
The additional after-tax benefits described here are
designed to help you balance these important aspects of
your life and enrich your overall benefits package.
The following are supplemental benefits you can
purchase after-tax, offered to you at a group rate and
provided directly through youdecide.com. If you have any
questions regarding these benefits or for complete pricing
information, contact youdecide.com’s advisors by phone
at (877) 326-5231 or online. Edwards employees’ Unique
Client ID is ELS362.
Insurance
This is a multi-provider platform for insurance. You will
enjoy competitive rates regardless of risk tier, driving record,
geographic location or personal needs. For maximum savings,
youdecide.com offers numerous insurance products to meet
any individual’s needs.
Current insurance products include:
Legal Services
Legal services include legal advice, tax advice and
financial counseling. With this program, you pay a monthly
fee for access to legal help as needs arise. You can choose
the level of service that you need — from basic to full-
service to specialty plans.
Supplemental Benefits
O f f e r e dThrough youdecide.com
14
• Auto Insurance
• Home Insurance
• Renters Insurance
• Motorcycle Insurance
• Recreational Vehicle Insurance
• Watercraft Insurance
• Roadside Assistance Plan
• Travel to Mexico Insurance
Pet Insurance
Insurance for your best friend! You choose the plan that
best fits your needs. All plans include the following:
•• Covers thousands of medical problems and conditions
for dogs, cats, birds, ferrets, rabbits, reptiles and other
exotic pets
•• Vaccination and routine care coverage is available
•• Multiple pet discounts available, in addition to the
premium discount offered through youdecide.com
•• Fast and efficient claims processing
•• Easy enrollment and payment options!
Term Life Insurance
Term Life Insurance offers many packages of additional
life. You choose the plan, price, payment options and
portability that best suits your needs.
How do youdecide.com Supplemental
Benefits Work?
When you would like to take advantage of any
youdecide.com benefit in which you have already enrolled,
contact youdecide.com at (877) 326-5231.
Long-Term Care Insurance
Long-Term Care (LTC) insurance, offered separately
from your medical plan, protects you if you have an illness
or injury and need help with day-to-day living, including
bathing, eating and dressing. LTC insurance helps pay for
care at home, in an adult day care center, assisted living
facility, nursing home or hospice. The most common
conditions requiring LTC include Alzheimer’s disease, cancer,
stroke, Parkinson’s disease and arthritis. You can enroll in
LTC at any time during the plan year.
Take it to Heart Program
Edwards is committed to helping employees make
wellness a part of their everyday lives and providing them
with the tools and resources to become healthy, smart
consumers of health care. That is why we created the Take
it to Heart program, which is dedicated to doing just that.
The Take it to Heart program consists of various wellness/
health improvement programs such as monthly wellness
seminars and periodic screenings that focus on prevention,
and the Discover workshops series which educates
employees on the tools and resources available to help
them make the most of their medical and dental benefits.
Employees can visit the Take it to Heart website located
on the Edwards Intranet under the EW Gallery. Here you
can find information about upcoming wellness events, get
useful tips on how to live healthy and learn more about
the features of our benefits plans that help you achieve
your wellness goals.
15
SU
PP
LE
ME
NT
AL
B
EN
EF
IT
S
Other Supplemental
B e n e f i t sOffered Through Edwards Lifesciences
securitysecurity
Adoption Reimbursement
This benefit will provide coverage when you adopt
a child, reimbursing up to $2,500 for adoption-related
expenses for each adopted child. If you use this program,
your reimbursement will be treated as taxable income and
is included in your paycheck.
Back-up Child Care*
We offer back-up child care through Bright Horizons, a
comprehensive back-up child care center located approx-
imately two miles from our Corporate Office. When your
primary child care arrangements fall through, Bright
Horizons offers specialized care for children ages three
months to 13 years. The benefit covers up to 20 visits per
child per year. You are charged a minimal copay, paid
through payroll deduction, per child per visit. For more
information, you can contact Bright Horizons at
www.brighthorizons.com /backup, user name: Edwards,
Password: backup care or via telephone at (866) 273-2773.
Educational Assistance Program
If you take courses in pursuit of a bachelor’s or master’s
degree, that are work related, the company may reimburse
you up to $5,250 per year. If you are considering education,
you should contact the Edwards Benefit Service Center
(EBSC) to determine if you will be eligible for educational
reimbursement.
Employee Assistance Program
We offer an Employee Assistance Program (EAP)
through Aetna Behavioral Health. It’s designed for anyone
who can use a little help in managing demanding
everyday situations. The program gives you access to a
wide range of supportive services for issues involving elder
care, child care, legal and financial matters and more.
Whether you need counseling support for stress or family
issues, or help in locating child or adult care providers, or
legal or financial consultants, your EAP is available to you
24 hours a day, 7 days a week. Trained professionals can
assist you in identifying appropriate resources to meet
your needs. You can contact the EAP at (888) 238-6232.
MovePerks
MovePerks offers free assistance to you if you are
buying or selling a home. The service will help you manage
the entire real estate process and offer you the opportunity
to receive a cash back dividend* — MovePerks will pay
$5 per $1000 based upon the contracted sale and /or
purchase price of your home, within 30 days of closing. To
participate in either the buying or selling process through
MovePerks, you must not have listed your house with
or engaged the services of a broker. You can contact
MovePerks at (866) MOV-PERK or www.moveperks.com.
How do the Edwards Supplemental Benefits Work?
When you would like to take advantage of any Edwards
supplemental benefit, call the appropriate contact. See your
Vendor Contact card or visit the Edwards Intranet under
Inside EW/HR for the appropriate phone numbers.
* Available in most locations.
16
planningplanning
* Available at Corporate location only.
Edwards Lifesciences LLC • One Edwards Way • Irvine, CA 92614 • 800.424.3278 • www.edwards.com
Note: This brochure only summarizes the key provisions ofyour Health and Welfare Plans and your SupplementalBenefits. More details are in the summary Plan Description(SPDs). If there is a conflict between this brochure andofficial Plan Documents that govern these Plans, theofficial Plan Documents will prevail.
© Rev. 7/2007 Edwards Lifesciences LLC. All rights reserved.
Recommended