2015-2016Cook Children’sbenefits guide for professional staff(M.D., D.O., D.D.S., D.M.D.)

How do I enroll?

Based on contractual agreement:

Your eligibledependents are:

Who is eligible for benefits?

Legal spouse

Children up to age 26 (regardless of student status or marital status)

• Natural children • Adopted children • Step children • Foster children • Children for whom you have legal documentation requiring insurance coverage

Dependent verification is required for ALL dependents. If this documentation is not received, coverage will be ended. Submit dependent verification to the Benefits Center by:

Faxing to 1-866-590-7365 Mailing to 1477 Barclay Blvd., Buffalo Grove, IL 60089 Emailing to cookchildrens@westlakefg.com

To verify receipt of your documents, log on to www.benefitstalk.com/cook and check under the DEV tab or call 1-866-375-0642.

Your benefits will begin on the first day of the month following your hire/re-hire date or date of status change.

Remember: You have 31 days from your hire/status change date to enroll in/make changes to your benefits.

Log on to

www.benefitstalk.com/cook

or call the Benefits Center at

1-866-375-0642.

Dependent verification

Full-time (with a full-time equivalent of .75 or higher)

Half-time (with a full-time equivalent of at least .5)

Children up to age 26 (regardless of student status or marital status)

• Natural children • Adopted children • Step children • Foster children • Children for whom you have legal documentation requiring insurance coverage

ALL medical plans

Medical plans – Aetna (HRA 1, HRA 2, EPO)

Cover the same services/procedures.

Same network of physicians (Aetna Choice POS II – Open Access).

Cover preventive services at 100 percent.

Differ only in how claims get paid by plan.

• Annual physical, annual well-woman, annual well-baby, etc.

Cover inpatient services performed at Cook Children’s at 100 percent for dependents enrolled on your plan*.

* A $3,000 surcharge will be applied to inpatient services not performed at Cook Children’s. This benefit: • Applies to age 14 and below. • Does not apply to mental health. • Does not apply to normal birth and delivery.

NEW - Medical and Pharmacy expenses count toward the out-of-pocket maximum. If your out-of-pocket maximum is reached, Cook Children’s will pay 100% of all eligible medical and pharmacy charges until the new plan year.

Medical Pharmacy Out-of-pocketmaximum+ =

HRA 1 HRA 2 EPO

Deductible

Copay

Pharmacy

Applies to all services $ 2,000 employee only $ 4,000 employee + dependent(s) HRA Fund Portion Full plan year $ 1,000 employee only $ 2,000 employee + dependent(s Your Portion of Deductible Full plan year $ 1,000 employee only $ 2,000 employee + dependent(s

80% Cook Children’s 20% Employee

70% Cook Children’s 30% Employee

85% Cook Children’s 15% Employee

Applies to all services $ 6,000 employee only $ 12,000 employee + dependent(s) HRA Fund Portion Full plan year $ 1,000 employee only $ 2,000 employee + dependent(s Your Portion of Deductible Full plan year $ 5,000 employee only $ 10,000 employee + dependent(s

Applies to non-routine/ non-diagnostic services $ 500 individual $ 1,000 family

* Routine/diagnostic services – Primary care visit $30 – Specialist visit $45 – Urgent care visit $50 – ER visit $200 (facility charge; deductible and coinsurance apply)

none

Retail Mail order/Retail maintenance (30-day supply) (90-day supply) Generic $9 co-pay $18 co-pay Preferred 20 percent coinsurance (max. $60) 20 percent coinsurance (max. $120) Non-preferred 50 percent coinsurance (max. $125) 50 percent coinsurance (max. $250) Specialty 10 percent coinsurance (max. $250) n/a

none

Coinsurance

$ 5,400 employee only $ 10,800 employee + dependent(s

$ 6,600 employee only $ 13,200 employee + dependent(s

$ 5,400 employee only $ 10,800 employee + dependent(s

Out-of-pocket maximum

Picking a medical plan

What is an EPO?With an EPO plan, you will pay a co-pay for routine services. The co-pay varies depending on the type of care needed. Your co-pays do not count toward your deductible, but they do count toward your out-of-pocket maximum. Non-routine services are subject to a deductible and coinsurance.

What is an HRA?The health reimbursement account (HRA) options are funded by Cook Children’s. This means that Cook Children’s pays the first portion of your eligible medical expenses. The money used from your HRA fund counts toward your deductible. There are no co-pays on these plans and you only pay for claims out of your pocket after the money in your fund is exhausted. If there is a balance in your fund at the end of the year, it rolls over to the following year (subject to a maximum cap).

Unused amounts can rollover into future years• $2,000 max for employee only. • $4,000 max for family.

Pro-rated during the first year (based on effective date).HRA fund

$1,000 for employee only in a full plan year.

$2,000 for family coverage in a full plan year.

Pharmacy plan – CVS Caremark

Asthma

Heart conditions

Cholesterol

Diabetes

Hypertension

(List can be found on the intranet.)

Vision plan – UnitedHealthcare®

Out-of-network: pay full price at time of service and submit claim for reimbursement.

In-network: co-pay for exam and co-pay for materials.

Laser eye surgery discount.

Frames once every two plan years.

Vision exam once every plan year.

Pair of lenses for glasses or contact lenses once every plan year.

Covers

All maintenance medications must be obtained via mail order or at a CVS pharmacy.

NOTE: Step therapy is required for all prescriptions. This means you must try a generic prescription before a brand name.

REMEMBER: If you sign up for a medical plan, pharmacy and vision plans are included in the pricing to the right.

Free generic maintenance

medications for these conditions

Pricing – medical/pharmacy/vision plans

Half-time employees age 50 and over with at least one year of service will pay the full-time medical rates.

$ 85

$ 47

$ 229

$ 327

$ 256

$ 635

$ 270

$ 200

$ 574

$ 527

$ 364

$ 984

Employee onlyFull-time

Half-time

Employee +spouse

Employee +child(ren)

Employee +family

HRA1

HRA 2

EPO

$ 170

$ 95

$ 458

$ 654

$ 509

$ 1,268

$ 539

$ 400

$ 1,147

$ 1,049

$ 730

$ 1,965

Employee only

Employee +spouse

Employee +child(ren)

Employee +family

HRA1

HRA 2

EPO

50 percent coverage for adult and child orthodontics.

$1,500 lifetime orthodontia maximum/participant.

Dental plans

50 percent major services following deductible.

80 percent basic services following deductible.

100 percent diagnostic and preventive services.

$50 individual deductible/$100 family deductible.

$1,500 maximum benefit/plan year.

Co-insuranceplan

Delta Dental preferred provider organization (PPO)

With Delta Dental PPO, you can see any dentist, but an in-network provider will be more cost efficient.

With the DHMO, you must select a dentist at the time of enrollment at deltadentalins.com. Select DeltaCare USA as the network. You can change dentists at any time, but you must notify DeltaCare before scheduling an appointment. If you need a specialist, your dentist will make a referral. Refer to the intranet for a DHMO summary and schedule of benefits and co-pay amounts.

You must select a primary care dentist from the national network, and you can change your dentist within network at any time (must be on roster prior to appointment).

Adult and child orthodontics coverage.

You have a co-pay for all services.

No limit to services.

Co-pay plan

DeltaCare dental health maintenance organization (DHMO)

To find an in-network dentist, visit deltadentalins.com. Dentists in the Delta Dental PPO and Premier networks will be in-network with our PPO plan. If searching for a dentist in the DeltaCare DHMO network, be sure to choose the DeltaCare USA network (if you choose this plan, you will be required to provide a Facility ID for your dentist upon enrollment).

• Can be used for the following for you and/or your family members (whether covered on our plan or not):

• Can be used for eligible daycare expenses.

• Medical, dental, vision and pharmacy expenses (deductibles, co-insurance, co-pays, etc.). • Eligible over-the-counter items (bandages, diabetic supplies, etc.).

Flexible spending accounts – TaxSaver Plan

Plan year is Oct. 1-Sept. 30. “Use it or lose it” with a grace period for claims until Dec. 14. All reimbursement requests must be submitted by March 14.

Pre-tax plan thatallows you to set

aside moneyinto two accounts

Medical expense spending account (maximum $2,550)

Dependent care spending account (maximum $5,000/family)

NOTE: Eligible medical expenses are those which normally would be deducted for federal income tax purposes.

$ 11.81

$ 6.26

$ 26.44

$ 10.73

$ 28.19

$ 10.80

$ 46.51

$ 15.57

PPO

DHMO

$ 10.50

$ 5.56

$ 23.50

$ 9.54

$ 25.06

$ 9.60

$ 41.34

$ 13.84

PPO

DHMO

Pricing – dental plans

Employee only

Full-time

Half-time

Employee +spouse

Employee +child(ren)

Employee +family

Employee only

Employee +spouse

Employee +child(ren)

Employee +family

Disability plans - The Hartford

Available forpurchase by

full- andhalf-time employees

Supplemental life* – 1x to 4x salary (maximum $750,000;

guaranteed issue amount = $200,000)

Child life insurance – Coverages of $2,000, $5,000 or $10,000 (for children under age 19)

Spouse life insurance – Coverages of $10,000, $20,000 or $30,000

* Half-time employees must purchase supplemental life in order to have spouse and/or child life.

If you enroll for coverage during your initial enrollment process, you are given the coverage without evidence of insurability (up to guaranteed issue amount). Enrollment at any later time will require an evidence of insurability review.

Life insurance – The Hartford

Basic life/accidental death and dismemberment coverages are provided at no cost for all full-time employees. Cook Children’s provides a policy equal to 3x annual salary (maximum

$1,000,000).

Can purchase a 60 percent of base pay plan.

• Maximum benefit is $10,000/month.

• 180 day elimination period.

• “Disability” is determined by ability to perform any physician’s role, not necessarily your area of specialty.

Benefits

Long-term disability

Can purchase a voluntary short-term disability (STD) plan.

• Coverage available immediately for an accident/injury.

• Coverage after seven days for illness/maternity.

• The maximum weekly benefit is 60 percent up to $3,000.

• Coverage continues up to 25 weeks.

Benefits

Short-term disability

• Legal marital status • Number of dependents • Dependent satisfies or ceases to satisfy eligibility requirements • Judgment, decree or order

• Employment status • Residence • Medicare, Medicaid, COBRA or CHIP • Cost/coverage changes

*All qualified event change requests must be made through the Benefits Center (WestLake) at 1-866-375-0642. You will have 31 days from the effective date of the event to contact the Benefits Center and provide all required supporting documentation and dependent verification.

Benefit changes and qualified events*

Benefit elections, by federal regulation, may not be changed until the next plan year’s open enrollment. Exceptions are made if an employee has a qualified event, which means changes to the following:

• LifeSynch Employee Assistance Program • Tuition reimbursement

• Adoption assistance • Educational Employees Credit Union (EECU) membership

Other benefits

NEW - Bright Horizons Care Advantage Program

Subsidized back-up care: Do you ever need last-minute care for your child or elderly family members? This program provides an option for child and/or adult care at home or at one of their centers. All caregivers are screened. Consultants are available to make arrangements 24-hours a day, seven days a week, 365 days a year. • Center-based care: $15/child per day; $25/family per day • In-home care: co-pay $6/hour for up to three children, 4-hour minimum • Maximum 15 uses per employee per year

Employee-sourced care and services: This program allows employees to self-select and pay to receive unlimited access to Bright Horizon’s online national database, powered by Sittercity.

For more information, contact 877-BH-CARES (877-242-2737) or visit careadvantage.com/cookchildrens.

• Access to before/after-school care • Child/elder caregivers• Nannies

• Pet care • Senior advising • Tutoring programs

Retirement plans – Fidelity

* Pre-tax deferrals allow you to reduce your taxable income for the current calendar year. However, when you take the money out of your retirement plan, you will pay taxes at that time. The taxes will be due on the contributions and investment earnings at the time of withdrawal.

* Roth deferrals allow you to pay taxes on your contributions today. That means when you take the money out of your retirement plan, they will be tax-free if you meet two qualifications: 1) Your first Roth deferral was made more than five years prior to the withdrawal date AND 2) You are over the age of 59-1/2 at the time of the withdrawal. If you don’t meet both qualifications, you will only owe taxes on the investment earnings.

*

403(b) plan

401(a) plan

All employees are eligible to participate in the 403(b) retirement plan. Your deferral options include pre-tax*, Roth** (after-tax) or a combination of both. You can save up to the IRS deferral limit ($18,000 for 2015). Additionally, participants who are at least 50 years old can save an additional $6,000 for 2015.

All contributions made into the 403(b) plan are always 100 percent vested by the participant. This means that everything you put into the plan is yours, no matter what. If you leave Cook Children’s, you can rollover the balance into another savings plan or request distribution of the entire balance of your 403(b) account.

You will automatically be enrolled in the 403(b) plan at 4 percent (pre-tax) approximately 30 days following your hire date, unless you make a different election. You can change your deferral rate at any time during the year.

Cook Children’s also provides a 401(a) matching account to all employees who participate in the 403(b) plan. Full- and half-time employees contributing to the 403(b) will receive an employer-matching contribution into their 401(a) account each pay period.

You become 100 percent vested in the employer-matching account on your third anniversary with Cook Children’s.

Part-time, PRN and pool employees may receive an employer-matching contribution in January for the prior calendar year if:

1) You worked more than 1,000 hours during the prior calendar year AND 2) You were employed on December 31 of the prior year.

Years of service Cook Children’s will match:

If you contribute at least this percentage:

< 5 years 5-6 years 6-10 years 11+ years

4 percent 5 percent 5 percent 5 percent

4 percent 5 percent

6.25 percent 7.5 percent

• Aflac® supplemental insurance (Group No. 21828): https://cookchildrens.e.paylogix.com or 1-800-433-3036 • ASPCA pet insurance (priority code: EB11CC): aspcapetinsurance.com/cookchildrens • Legal Shield (pre-paid legal): legalshield.com/info/cookchildrens

Voluntary benefits

These benefits can be purchased/cancelled at any time. You will arrange payment directly with the provider. See intranet or enrollment site for more details.

Retirement plans – Fidelity – continued

457(b) retirement plan

Our 457(b) plan is a non-qualified retirement plan for physicians that allows you to save an additional $18,000 pre-tax each calendar year. A non-qualified plan is a deferred compensation plan. There are more than 270 investment options, covering all areas of the investment risk spectrum, available through Fidelity for this plan.

Because this is a deferred compensation plan, it’s important to understand the following before participating in this plan:

1) Risk: There is a risk associated with this type of plan. The 457(b) assets are among the Cook Children’s assets that are eligible for payment of legal and/or bankruptcy settlements. 2) Taxation: A lump sum payment will be made to you based on your payment election (90 days from separation of service or 12 months from separation of service). Taxation on this income will occur in the tax year you receive your payout.

Contact information

Aetna Medical plansMember service #:

Group #: Claims address:

Website address:

Network:

1-800-824-6317 620374 P.O. Box 981106 El Paso, TX 79998-1106 aetna.com – prior to enrolling in the plan myaetna.com – after enrolling in the plan Aetna Choice POS II (Open Access)

CVS Caremark Pharmacy plan

Member service #: Group #:

Rx mail order address:

Claims address:

Website address:

1-888-208-9624 RX7342 P.O. Box 659541 San Antonio, TX 78265-9541 P.O. Box 52196 Phoenix, AZ 85072-2196 caremark.com

UnitedHealthcare® Vision planMember service #:

Group #: Claims address:

Claims fax #: Website address:

1-800-638-3120 7565 P.O. Box 30978 Salt Lake City, UT 84130 248-733-6060 myuhcvision.com

Contact information – continued

Delta Dental plan

Member service #: Group #:

Claims address:

Website address: Network:

1-800-336-8264 04230 P.O. Box 1809 Alpharetta, GA 30023-1809 deltadentalins.com PPO or Premier

Delta Care DHMO Dental planMember service #:

Group #: Claims address:

Website address: Network:

1-800-422-4234 76985 P.O. Box 1803 Alpharetta, GA 30023-1803 deltadentalins.com DeltaCare USA

Contact information – continued

TaxSaver Flexible spending accountsMember service #:

Claims address:

Claims fax #: Claims email:

Website address:

Email address:

214-559-0472 or 1-800-328-4337 P.O. Box 609002 Dallas, TX 75360 214-528-8122 Send PDF to claims@taxsaverplan.com Claims can be submitted online at taxsaverplan.com. You must log in to your account to submit a claim through the secure website. csr@taxsaverplan.com

The Hartford Short-term disability Long-term disability Life insurance

Member service #: 877-936-5336

Contact information – continued

LifeSynch Employee assistance program (EAP)Member service #: 1-866-219-1232

The EAP customer service/helpline is accessible 24 hours a day, seven days a week.

The EAP is a company-sponsored, company-paid program designed to provide immediate professional assistance for all personal or emotional problems at no cost to you. These services are provided for employees and their dependents to include assistance with marital and family problems, work-related conflicts, emotional distress and alcohol or drug abuse. Please see the intranet for additional information on our EAP.

Fidelity

Do you need to:

– View your accounts, change your deferral rates, update your beneficiary info, etc.? If so, log on to 401k.com.

– Schedule a free, on-site 30-minute financial planning session with our Fidelity rep? Contact fidelity.com/atwork.

– Ask John Wells, our dedicated Fidelity representative, a question? You can email him at john.wells@fmr.com.

Member service #: 1-800-343-0860

Contact information – continued

Benefits enrollment information

Contact:

Address:

Member service #:

Fax #: Website address:

Cook Children’s Benefit Center 1477 Barclay Blvd Buffalo Grove, IL 60089 1-866-375-0642 (7 a.m.-6 p.m., CST, Mon-Fri) 1-866-590-7365 www.benefitstalk.com/cook

Have questions?Email: askbenefits@cookchildrens.org Call: 682-885-3875

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