2020 - amitahealth.org · • Government Issued Birth Certificate AND completed disabled child certification form (must be medically certified by a physician as disabled or by Social

2020BENEFIT GUIDE

What’s InsideKey TakeawaysBenefits at a Glance ............................................... p. 4

How to EnrollWhere to find Benefit InformationChanges to BenefitsReminders

Eligibility and Effective Dates ............................... p. 5Eligible DependentsAvailable Coverage LevelsPaid Time Off SnapshotCoverage Termination

Covering DependentsQualifying Life Events ............................................p. 6Proof of Dependent Relationship ........................p. 7

Accepted Forms for Proof of Dependent Relationship

Health Medical Plan .............................................................p. 8Prescription Drug Plan ...........................................p. 11Wellness Program ...................................................p. 12Diabetes Management, Simplified ......................p. 12Dental Plan ................................................................p. 13Vision Plan ................................................................p. 15Premiums for Medical, Dental, Vision ................p. 16Income SecurityBasic Life and Supplemental Life/AD&D ...........p. 17Spouse/Child Life and AD&D… ............................p. 18Short-Term Disability ..............................................p. 19Long-Term Disability ...............................................p. 19Voluntary Whole Life ..............................................p. 20Voluntary Accident ..................................................p. 20Voluntary Critical Illness ........................................p. 20Ascension Health Retirement Plan .....................p. 21

Additional BenefitsLegal Plan… ...............................................................p. 23Flexible Spending Accounts .................................p. 24Commuter & Transit Benefits ...............................p. 26Employee Assistance Program ............................p. 27

ResourcesMobile Information ..................................................p. 28Benefit Contacts ......................................................p. 29Important Notifications ...........................................p. 30Frequently Asked Questions (FAQs) ..................p. 31

This benefits material briefly describes the excellent benefits program that is available as part of employment with AMITA Health. This information is not a contract. Any of the benefits, policies or procedures may be changed as the organization requires, and nothing contained in this material shall be construed as creating an expressed or implied obligation or contract on the part of AMITA Health. Associate is responsible for monitoring work emails, understanding benefit information, how to enroll and premium payroll deductions review.

KEY TAKEAWAYS

BENEFITS AT A GLANCEThis guide provides general information regarding benefit options available to full-time and part-time associates including enrollment instructions for your convenience. You will see a few variances between the ministry benefit offerings. Your enrollment record in Benefit Express will indicate the benefits available to you at your work ministry.

How to Enroll• Log into Benefits Express via a work computer

www.AMITAHealthBenefits.com• After your initial login to a work computer,

enrollment can be completed from a personal computer or mobile device.

• You MUST enroll within 31 days of start date on the Benefits Express website.

Benefit Express

Logging into Benefit Express:STEP 1:• Your USERNAME and PASSWORD is the same

that you chose after logging into your network computer for the first time.

STEP 2:• Once you login to Benefits Express, choose

the option to accept the website’s terms and conditions.

• Click Next to proceed to your personalized Benefit Express welcome page.

• Choose the Enroll Now option to begin, or select the appropriate life event allowing you to make benefit changes outside of Open Enrollment.

Where to find Benefit Information• iAMITA Intranet Site:

My Life > Human Resources > Benefits• Benefit Express under Library:

www.AMITAHealthBenefits.com

Changes to BenefitsOutside of New Hire Enrollment or annual Open Enrollment, associates have 31 days from their qualified life event to make a change in benefit elections via the Benefit Express website.Examples of Typical Qualified Life Events:• Birth/Adoption of Child• Change in Job Status (FT, PT, or PRN)• Gain or Loss of other Coverage• Marriage/Divorce

REMINDERS• YOU MUST ENROLL FOR BENEFITS WITHIN 31

DAYS OF YOUR DATE OF HIRE, FIRST DAY IN A BENEFIT ELIGIBLE POSITION, OR A QUALIFYING LIFE EVENT. This includes uploading dependent verification document(s), and/or documentation to support your life event.

• YOU CAN ONLY MAKE CHANGES TO BENEFITS DURING NEW HIRE ENROLLMENT, OPEN ENROLLMENT, OR WHEN A QUALIFIED LIFE EVENT OCCURS.

Please note!! In the event you elect benefits in Benefits Express just to view costs, you MUST make sure to select WAIVE if you do NOT want the benefit BEFORE exiting system.

Any selections made are finalized during overnight processing regardless of completing your enrollment or clicking on the Submit button.

Always review and keep a copy of your benefit confirmation statement for your records!

Eligibility and Effective Dates• Full-Time is 36 – 40 standard hours per week• Part-Time is 20 – 35.99 standard hours per weekMedical, dental, vision, flexible spending accounts, life, and legal benefits are effective 1st of the month following 30 days of employment based on benefit eligibility date. Long-Term (LTD) and Short-Term Disability (STD) benefit effective dates are dependent on the ministry in which you work. When you access your enrollment record in Benefit Express, you will see one of the two effective dates below: • LTD/STD effective 1st of month following 90 days,

or • LTD/STD effective 1st of month following 30 days

Coverage Termination• For dependent child reaching age 26, all

coverage ends 11:59 pm day before 26th birthday• Coverage upon termination of employment: • Medical, dental and vision ends last day of the

month in which termination falls • All other coverages end on termination date• A status change to registry or benefit

ineligible will have coverage to last day of the month

See respective policies for additional information.

Available Coverage Levels• Employee Only • Employee + Children*• Employee + Spouse* • Employee + Family** You must click on the check box next to each dependent's name, within each benefit page to link dependents to each plan that you want them enrolled in. Select WAIVE if you do not want a benefit.

Paid Time Off (PTO) SnapshotExempt/Salary associates will receive a front-loaded PTO bank of 27 days per year, prorated based on FTE (Full-Time Equivalent). This PTO bank is “use it or lose it” meaning hours remaining in bank at end of year will be forfeited.Non-Exempt/Hourly associates accrue PTO based on years of service (prorated based on FTE) and eligible paid hours up to a maximum of 80 paid hours per pay period. First year associates can accrue up to 16 days. Medical Residents, Pharmacy Residents, Physicians, Hospitalists, Hospitals, Mid-Level Providers and contracted associates–refer to your agreement. Holidays during the course of the year consist of eight holiday’s including New Year’s Day, Martin Luther King, Jr. Day, Good Friday, Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas Day.

Benefits include - Health, Income Security and additional benefit offerings.Medical (Includes Prescription)* To see if your provider(s) are in plan, go to http://www.AMITAhealthprovider.org

Basic Life/AD&D 1x Salary Long-Term Disability

Dental Voluntary Life/AD&D Hyatt Legal PlanVision Spouse Life/AD&D VOYA Critical IllnessWellness Program / Diabetes Management Child Life/AD&D VOYA Accident InsuranceHealth Care Flexible Spending Account Short-Term Disability VOYA Whole LifeDependent Care Flexible Spending Account Wellness Program Paid Time Off

Employee Assistance Program Ascension Health Retirement Plan

QUESTIONS? Call 888.629.6424

KEY TAKEAWAYS

54

Qualifying Life EventsA qualifying life event is a change in your situation – like getting married, having a baby or a gain or loss of health coverage – that can make you eligible for a special enrollment period, allowing you to enroll or cancel some benefit coverages outside of the annual open enrollment period, which is generally in November. Qualifying events include:• Birth (including adoption)*• Death of dependent (spouse or child)• Entitlement to or loss of Medicare or Medicaid

(60 day enrollment window)• Gain of other coverage• Legal Separation• Loss of eligibility for participation in Dependent

Care Flexible Spending Account (DFSA)• Loss of other coverage• Marriage/DivorceA status change from full-time to part-time or a benefit ineligible to an eligible position will automatically trigger an enrollment event. You will need to access My Benefit Express to enroll in coverage(s) within 31 days of the change date.

All qualifying events must be entered into My Benefit Express within 31 days of the event date and required documentation uploaded.

For example, if your child is born on March 1st, you must enter the date of birth as the event date AND link the child to coverage(s) in

My Benefit Express no later than March 31st. This includes uploading dependent verification documents and/or applicable supporting life event documentation (i.e. proof of loss or gain of other coverage). If you do not, you will not be able to make a coverage change until the next annual open enrollment period.

All qualifying events require proof (e.g., marriage certificate, etc.) and must be uploaded into My Benefit Express when you enter your life event. If the document is NOT approved, you will receive a work email letting you know what else is needed, or if there is a problem with your enrollment. Adding a dependent will require a dependent verification supporting document to be uploaded and approved before your dependent information will be sent to the carrier(s). Link dependents to applicable cover as you are completing your life event.* For a birth or adoption event, you will be

able to add the dependent without the social security number. Once you receive his/her social security number, you must enter it into My Benefit Express as soon as possible. However, the newborn will not be marked as verified until you have provided a government issued birth certificate. The birth certificate MUST be provided within 31 days of the date of birth. If you do not provide the birth certificate within 31 days, your newborn will be removed from coverage. If there is a problem with your life event or supporting dependent verification, an email will be sent from Benefit Express to your work email. It is your responsibility to monitor work emails!

Proof of Dependent RelationshipIf you are adding a dependent to any of the benefit options, you are required to upload dependent verification documents within 31 days of the event date. Documents accepted for verification are listed below. Please note: Provide copies of the documents – not originals as these will not be returned to you. If you are submitting a copy of your most recent federal tax return, please upload the first page only which shows your dependents (blackout income information). Only government issued documents such as marriage certificate, birth certificate, or court ordered documents are accepted. Please upload documents into My Benefit Express for review and approval within 31 days of your life event. If approved, your eligible dependents will remain covered.

If your document is not uploaded and approved within 31 days, you and/or your dependent will be removed from coverage.Dependent verification document approval generally takes place within 24–72 hours. If you still have not received an email or do not see a dependent verified and linked to coverage within 72 hours, contact rHR immediately at 888.629.6424.

If you are having trouble obtaining required documentation for life event or dependent verification, you must contact rHR BEFORE the 31 day enrollment window closes.Verification documents must be uploaded and approved in Benefit Express prior to the 31 day close of life event window, life or dependent verification.

All qualifying events must be entered into My Benefit Express within 31 days of the event date and required documentation uploaded

COVERING DEPENDENTS

Accepted Forms of Dependent Verification (Relationship) DocumentationDEPENDENT TYPE DOCUMENTATION REQUIREMENTS

Legal Spouse • Government Issued Marriage Certificate and last year filed federal tax return OR• Government Issued Marriage Certificate and Proof of Joint Ownership Issued in last 6 months OR• Government Issued Marriage Certificate ONLY (if married in current calendar year).

Biological Child(Age 0 up to 26)

• Government Issued Birth Certificate ONLY.

Disabled Biological Child

• Government Issued Birth Certificate AND completed disabled child certification form (must be medically certified by a physician as disabled or by Social Security Disability (SSDI).

Step-Child(Age 0 up to 26)

• Government issued Birth Certificate AND Associate’s Government issued Marriage Certificate.

Disabled Step-Child • Government issued Birth Certificate AND Associate’s Government issued Marriage Certificate AND completed disabled child certification form (must be medically certified by a physician as disabled or by Social Security Disability (SSDI).

Adopted Child(Age 0 up to 26)

• Adoption Placement Agreement and Petition for Adoption OR• Adoption Certificate ONLY.

Disabled Adopted Child

• Adoption Certificate AND completed disabled child certification form (must be medically certified by a physician as disabled or by Social Security Disability (SSDI).

Legal Ward • Government Issued Birth Certificate AND Court Ordered Document of Legal Custody.

Disabled Legal Ward • Government Issued Birth Certificate AND• Court Ordered Document of Legal Custody AND• Completed disabled child certification form (must be medically certified by a physician as disabled or

by SSDI.

Qualified Medical Support Order

• Qualified Medical Child Support Order ONLY. Must be ordered for the associate or spouse.

PLEASE NOTE: Verified dependent's are covered ONLY, if you have clicked the check box in each plan next to their name.

COVERING DEPENDENTS

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AMITA Health Medical PlanAMITA Health offers associates a Preferred Provider Organization (PPO) plan administered by Automated Benefit Services (ABS) and consists of the BlueCross BlueShield’s National Provider Network (BCBS of Michigan, aka BCBSM). PPO plans allow associates to seek services from the provider of their choice. The AMITA Health Medical Plan is a ‘tiered’ network with three tiers:

1. SmartHealth Network (Tier 1) consisting of AMITA Health, Adventist Midwest Health, Alexian Brothers Health System and Presence Health System facilities and contracted providers; Providers can be found by going to the AMITA Health provider website at www.mysmarthealth.org.

2. BlueCross BlueShield National Provider Network (Tier 2); and

3. Out of Network (Tier 3) – facilities/providers not contracted with BlueCross BlueShield National Provider Network.

You and your family members will experience a significantly higher level of benefit coverage when receiving your care from a SmartHealth Network provider. If you choose to seek care outside of AMITA Health, you will have access to BlueCross BlueShield’s National Provider Network.

You and your family members will experience a significantly higher level of benefits when receiving your care from a SmartHealth Network provider.

Certain services may require satisfying a deductible. Once the deductible is satisfied by the member, the plan will begin paying a portion of your remaining charges known as co-insurance. AMITA Health PPO plan provides associates financial security by placing an out-of-pocket limit on health care expenses.Associates are free to seek services from the provider of their choice, however, associates’ out-of-pocket expenses will be significantly lower if services are received from a SmartHealth Network Provider.Detailed Plan documents are available in Benefit Express > Library.

2020 Schedule of Benefits: PPO 500 90/10 Plan

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SmartHealth Network

BlueCross BlueShieldNational Network Out-of-Network

Tier 1AMITA, Ascension,

and Adventist Health System

Tier 2Providers in the BCBS

National Network

Tier 3Providers not in the

BCBS Network

Least Expensive Most Expensive

Note: If you or your spouse are Medicare-eligible and continuing medical coverage through COBRA, your medical coverage through AMITA Health becomes secondary and Medicare is primary even if you are not enrolled in Medicare Part B. If you leave employment or lose benefit eligibility, contact your local Social Security office to enroll in Medicare Part B as soon as possible

• Claims questions, benefit questions, eligibility: Contact ABS Customer Service at 844.659.2519 • To view claims or order an ID card visit: www.abs-tpa.com • To find a doctor or view the provider directory at www.mysmarthealth.org

All eligible medical expenses apply towards all deductibles and out-of-pocket maximums.

Benefits Tier 1 AMITA Network Tier 2 National Network (BCBS) Tier 3 Out-of-Network*

Deductible • Individual • Family $500 / $1000 $1,500 / $3,000 $4,000 / $8,000

Coinsurance

• Plan Pays 90% after AMITA Network Deductible

70% after National Network Deductible

50% after OON Deductible

• You Pay 10% after AMITA Network Deductible



• Total out-of-pocket Maximum (Deductible plus coinsurance and copays) • All eligible medical / Rx expenses apply toward all out-of-pocket maximums

• Individual • Family $4,000 / $8,000 $6,000 / $12,000 $10,000 / $20,000

Lifetime Maximum Unlimited

Services AMITA Network National Network Out-of-Network* (OON)

Preventive Service Annual Routine Physical, Annual Sports Physical, Well Baby/Child Care, Routine Immunizations, Annual Gynecological Exam/Annual Mammogram, Screening Colonoscopy

$0 $0 50% coinsurance after OON Deductible

Outpatient/Diagnostic Services Physical/Occupational/Speech Therapy (Annual Maximum – 60 Visits), Lab, Pathology, Radiation and Chemotherapy, Radiology, Outpatient Surgery

10% after AMITA Network Deductible



High Tech Radiology • MRI, PET Scan, MRA

Pre-Certification Required 10% after AMITA Network Deductible

Pre-Certification Required 30% after National Network Deductible

Pre-Certification Required 50% after OON Deductible

• Dialysis 10% after AMITA Network Deductible



Office Visits Primary Care (Family Practice/General Internal Medicine/Pediatrics)

$20 Copay $40 Copay 50% after OON Deductible

• Specialist (Including OB/GYN) $40 Copay $60 Copay 50% after OON Deductible

• Pre/Postnatal Care $20 Copay $40 Copay 50% after OON Deductible

• Chiropractic Office Visit (Annual maximum – 60 visits) Ancillary services are subject to deductible/coinsurance


Mental Health • Individual Therapy/Group Therapy


• Inpatient Admission/Partial Day Treatment, Intensive Outpatient Therapy




Substance Abuse • Individual Therapy/Group Therapy


• Intensive Outpatient Therapy, Acute Inpatient Care




• Residential Treatment Center Pre-Certification Required 10% after AMITA Network Deductible



• Partial Hospital Program 10% after AMITA Network Deductible



Emergency Care • ER Visit – Copay waived if admitted

$200 Copay $200 Copay $200 Copay

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• Urgent Care $40 Copay $60 Copay 50% after OON Deductible

• Ambulance 10% after AMITA Network Deductible



• Medical Transfer/Transport (non-emergent)

Pre-Certification Required Pre-Certification Required Pre-Certification Required

Inpatient Services • Per Admission • Room and Board • Ancillary Services • Surgery • Anesthesia • Physician Charges




• Emergency Room Admission 10% after AMITA Network Deductible



• Extended Care Facility (Annual maximum – 120 days)




Other Services • Durable Medical Equipment (DME)




• Prosthetics & Orthotics (P&O) 10% after AMITA Network Deductible



• Foot Orthotics – 2 pairs every 3 years 50% after AMITA Network Deductible



• Hearing Aid ($2,000 max, every 3 years) 10% after AMITA Network Deductible



• Home Health Care (Annual max – 100 visits)




• Hospice 10% after AMITA Network Deductible



• Allergy Testing & Treatment 10% after AMITA Network Deductible



• Bariatric Surgery Pre-Certification Required 10% after AMITA Network Deductible



• Organ/Bone Marrow/Other Transplants Pre-Certification Required 10% after AMITA Network Deductible



• Wellness/Disease Management• Diabetic Education• Smoking Cessation

Counseling Intervention

$0 $0 50% after OON Deductible

2020 Schedule of Benefits: PPO 500 90/10 Plan (continued) Prescription Drug Coverage Associates enrolled in the Medical Plan automatically receive the Prescription Drug Coverage benefit which is managed through Cigna. Members (including dependents) will receive their own Pharmacy ID card. For a complete listing of medications covered, go to www.myCigna.com.

Use of AMITA Health In-House pharmacies, may reduce your medication expense.

Certain medications require Prior Authorization from Cigna before they are covered by the plan. If you are not sure a medication requires approval, please check on-line or call the toll-free number on the back of your Cigna ID card. In these cases, if your doctor feels that an alternative medication isn’t right for you, he or she can ask Cigna to consider approving coverage of your medication. In addition, certain high-cost medications are part of the Step Therapy program. Step Therapy encourages the use of lower-cost medications (typically generics and preferred brands) that can be used to treat the same condition as the higher-cost medication.

Please note: 90-day supplies must be filled by the AMITA Health pharmacies. Prescription drugs classified as specialty medications may only be filled through an AMITA Health pharmacy.

This is a brief summary of benefits, which are subject to change. In the case of a conflict between this summary and the official Summary Plan Description, the language in the Summary Plan Description will prevail. For further details about plan benefits, please contact ABS Customer Service at the number shown on the back of your ID card. Network Description: Tier 1 rep-resents the AMITA network, which is comprised of participating AMITA providers and facilities, as well as the broader Ascension AMITA network. Tier 2 represents BCBS participating providers. Members should make every effort to utilize a BCBS provider whenever an AMITA provider is not available in their area. Tier 3 represents Out-of-Network (OON) and any claim incurred could result in balance billing and/or additional charges to the member. Pre-certification Required - Failure to secure “Pre-certification” for services noted in the Summary Plan Description will result in no coverage/benefit paid under the Plan. For inpatient admissions, failure to obtain a pre-cert within (2) business days of admission will result in a $500 reduction in the facility pay-ment. Contraceptive Coverage: The U.S. Department of Health and Human Services, the Department of Labor and the Internal Revenue Service have jointly released final regulations regarding women’s preventive services under the Affordable Care Act (“ACA”). The ACA requires group health plans to provide coverage for “contraceptive services” as part of an array of women’s pre-ventive services that must be included in health plans without cost sharing to covered participants (for AMITA and Alexian Brothers ministries). Exclusions - See the Summary Plan Description for complete information regarding exclusions.

In-House Pharmacies Retail Pharmacies Out-of-Network*

Generic • 30 day • 90 day supply

$5 $10

$10 No coverage

No Coverage

Preferred Brand • 30 day • 90 day supply

15% ($25 Min / $50 Max) 15% ($50 Min / $100 Max)

25% ($40 Min / $80 Max) No coverage)

No Coverage

Non-Preferred Brand • 30 day • 90 day supply

20% ($50 Min / $100 Max) 20% ($100 Min / $200 Max)

25% ($80 Min / $160 Max)No coverage

No Coverage

Specialty Rx – 30 Day Supply • Available at AMITA

In-House Pharmacy15% ($50 Min / $100 Max) No Coverage No Coverage

Specialty medication administered by a healthcare provider or via infusion will be billed through medical and medical deductible/coinsurance will apply. Self-administered specialty medications will be billed through Cigna.

In-House pharmacy list is available at www.AMITAHealthproviders.org under Member Info Center/Pharmacy Self Service/AMITA In-House Pharmacy Directory.

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Benefit ElevationAMITA's Benefit Elevation Program expands our network for needed specialties by allowing you to use a National Network (Tier 2) provider and receive the Tier 1 benefit coverage when a Tier 1 provider is not available within 20 miles radius of participant’s zip code on record.

** Please note that it takes a minimum of 10 business days to process all benefit elevation requests.**

For more information, go to http://www.amitahealthproviders.org/provider/infocenter/member

1110

Wellness Program

Our goal at AMITA Health is to improve the quality of life of the patients and communities we serve, but too often we are so focused on taking care of others that we forget about our own health and wellness. That’s why the Wellness department is dedicated to inspiring, motivating and encouraging healthy behaviors in you! The Wellness team invites you to join Healthy Journey in 2020. This exciting, innovative program is designed to engage you all year long. Focused on choice and convenience, Healthy Journey offers a variety of programs with the chance to win prizes!

Who can participate in the Healthy Journey program?You are eligible to participate in Healthy Journey if you are eighteen (18) years of age and an AMITA Health associate or an Independent Contractor, Student, Intern, Volunteer, or otherwise employed at an AMITA Health facility. You do not have to be benefit eligible to participate! However, if you are not paying for your own medical coverage, you will not be eligible for the premium reduction. Coverage for spouse and children is not eligible for premium reduction.

What is the 2021 incentive?All participants can earn an entry into the Grand Prize Drawing for a chance to win one of ten $1,000 prizes.

Associates who pay for medical coverage can potentially earn a premium discount for plan year 2021.

The premium reduction applies to medical coverage only and cannot be applied to dental or vision premiums or combined with the Social Just Subsidy.

Each period, participants also have a chance to earn wellness merchandise items or enter the drawing for a chance to win one of the fifteen $300 prizes.

What do I need to do in order to be eligible for incentives?To be eligible for the grand prize drawing and 2021 medical insurance incentive, you must complete the following steps by September 30, 2020:

1. Complete the on-site biometric screening (see schedule in Wellness portal),

2. Complete the online Health Risk Assessment, and

3. Earn a minimum of 100 points on the Wellness portal.

Additional information on Wellness Program is available on iAmita under Departments>Wellness.

Diabetes Management, SimplifiedAMITA Health now offers Livongo® for Diabetes to you. It’s covered 100% by your health plan. This open enrollment period, register for Livongo® and receive a welcome kit in only 3-5 days. The program is available at no cost to you and your dependents who have diabetes and are covered through the AMITA Health medical plan.

Eligible Members: The program is available at no cost to you and your dependents who have diabetes and are covered through the AMITA Health medical plan.

Here are some of the benefits of this program:• More Than a Standard Meter: The Livongo®

meter is connected and provides real-time tips and automatically uploads your blood glucose readings, making log books a thing of the past.

• Unlimited Strips at No Cost to You: Get as many strips and lancets as you need with no hidden costs. When you are about to run out, Livongo ships more supplies, right to your door.

• Coaching Anytime and Anywhere: The Livongo® coaches are Certified Diabetes Educators who are available anytime via phone, text, and our mobile app to give you guidance on your nutrition and lifestyle questions.

To Learn More or Join: join.livongo.com/AMITA/hi

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Healthy JourneyTogether with CREATION Health

AMITA Health Dental Plan AMITA Health provides you with a choice of two dental PPO plans through Delta Dental—a “High” and “Low” Plan. Both are Delta Dental Preferred Provider Organization (PPO) plans, giving you the freedom to visit any licensed network or non-network dentist for covered services. You do not have to designate a primary care dentist. Plus, you can visit any dental specialist for covered benefits up to an annual limit without waiting for prior approval from the plan.

You will generally save on the cost of covered dental care when you use a dentist who participates in the Delta Dental PPO network.

For More Information:• Search Delta Dental’s online dentist directory at

http://www.deltadentalil.com

• AMITA Health is part of the Delta Dental PPO Plus Premier Network – meaning you can go to any dentist in the PPO or Premier Network

• The Delta Dental PPO toll free number is 800.323.1743

Preventative Dental Care Is Important! You may receive two in-network cleanings free-of-charge each plan year.Seeing a dentist regularly helps to keep your teeth healthy and allows your dentist to watch for developments that may point to health issues.Remember to visit your dentist for your exam and teeth cleaning.

*Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network dentists cannot charge you for costs exceeding the PPO fee. **Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. Premier den-tists may not charge you for costs exceeding the maximum plan allowance. ***Non-network dentists (non-Delta Dental PPO/non-Delta Dental Premier) do not agree to accept Delta Dental’s allowed fees as payment in full; payment is based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. These dentists can charge you for costs exceeding the maximum plan allowance.

Annual Deductible (applies to Basic and Major Services Only) $50/person; $150/family

Annual Maximum $1,500/person

Enhanced Benefits Program – Your plan provides additional cleanings and/or applications of topical fluoride to people with specific health conditions that put them at risk for oral health disease.

Lifetime Orthodontic Maximum $1,500/person

Delta Dental PPO Network Dentist

Delta Dental Premier® Network Dentist

Non- Network Dentist

PREVENTIVE/DIAGNOSTIC SERVICES Not subject to annual maximum • Routine exams (twice per benefit year) • Dental prophylaxis (twice per benefit year) • X-rays (bitewings-twice per benefit year; full mouth-every three years) • Fluoride treatments (once per benefit year to age 19) • Space maintainers (once per lifetime to age 14) • Sealants (to age 16) • Periodontal maintenance • Emergency exams and palliative treatment

100%* 100%** 100%***

BASIC SERVICES • Amalgam and composite resin (anterior) fillings • Posterior composites (tooth colored fillings on back teeth) • Non-surgical Periodontics • Surgical Periodontics • Endodontics • Oral surgery – simple extractions • Oral surgery – surgical extractions including general anesthesia • IV sedation • Denture repairs

80%* 80%** 80%***

MAJOR RESTORATIVE SERVICES • Implants • Cast restorations – crowns, onlays, post and core • Prosthodontics – bridges, partial dentures/complete

50%* 50%** 50%***

ORTHODONTICS – dependents to age 26 and Adults Treatment necessary for proper alignment of teeth

50%* 50%** 50%***

No TMJ Coverage 0% 0% 0%

High Plan Dental Highlights

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*Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network dentists cannot charge you for costs exceeding the PPO fee. **Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. Premier den-tists may not charge you for costs exceeding the maximum plan allowance. ***Non-network dentists (non-Delta Dental PPO/non-Delta Dental Premier) do not agree to accept Delta Dental’s allowed fees as payment in full; payment is based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. These dentists can charge you for costs exceeding the maximum plan allowance.

Annual Deductible (applies to Basic and Major Services Only) $75/person; $225/family

Annual Maximum $1,000/person

Enhanced Benefits Program – Your plan provides additional cleanings and/or applications of topical fluoride to people with specific health conditions that put them at risk for oral health disease.

Lifetime Orthodontic Maximum $1,000/person

Delta Dental PPO Network Dentist

Delta Dental Premier® Network Dentist

Non- Network Dentist

PREVENTIVE/DIAGNOSTIC SERVICES Not subject to annual maximum • Routine exams (twice per benefit year) • Dental prophylaxis (twice per benefit year) • X-rays (bitewings-twice per benefit year; full mouth-every three years) • Fluoride treatments (once per benefit year to age 19) • Space maintainers (once per lifetime to age 14) • Sealants (to age 16) • Periodontal maintenance • Emergency exams and palliative treatment

100%* 100%** 100%***

BASIC SERVICES • Amalgam and composite resin (anterior) fillings • Posterior composites (tooth colored fillings on back teeth) • Non-surgical Periodontics • Surgical Periodontics • Endodontics • Oral surgery – simple extractions • Oral surgery – surgical extractions including general anesthesia • IV sedation • Denture repairs

60%* 60%** 60%***

MAJOR RESTORATIVE SERVICES •Implants • Cast restorations – crowns, onlays, post and core • Prosthodontics – bridges, partial dentures and complete

50%* 50%** 50%***

ORTHODONTICS – dependents to age 26 and Adults Treatment necessary for proper alignment of teeth

50%* 50%** 50%***

No TMJ Coverage 0% 0% 0%

Dental Plan Highlights - Low Plan

Eyeconic Eyewear Store Convenient online shopping! Eyeconic is an online eyewear store for VSP members. You can visit Eyeconic to purchase eyewear or contact lenses with your VSP insurance – in network. Visit www.eyeconic.com and connect your VSP account to the Eyeconic store.

Vision Care through Vision Service Plan (VSP) AMITA Health vision benefits are administered by Vision Service Plan (VSP). You can go to any eye care professional you choose but if you use a VSP network provider you’ll pay less.

To use your VSP benefit:• Create an account at www.vsp.com to review

your benefits.• To find a doctor who is right for you, visit

www.vsp.com or call 800.877.7195.• At your appointment, tell your provider you have

VSP. There is no ID card necessary. If you’d like a card as a reference, you can print one from www.vsp.com.

• That is it! There are no claim forms to complete when you see a VSP provider.

Coverage with participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information subject to change. In the event of conflict between this information and your organization’s contract with VSP, the terms of contract prevails. Based on applicable laws, benefits may vary by location. In state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.

Benefit Description Copay Frequency

Your Coverage with a VSP Provider

WellVision Exam • Focuses on your eyes and overall wellness $10 Every 12 months

Prescription Glasses $15 See frame and lenses

Frame • $160 allowance for a wide selection of frames• $180 allowance for featured frame brands• 20% savings on the amount over your allowance• $90 Costco® frame allowance

Included in Prescription Glasses

Every 12 months

Lenses • Single vision, lined bifocal, and lined trifocal lenses• Polycarbonate lenses for dependent children

Included in Prescription Glasses

Every 12 months

Lens Enhancements • Scratch Resistant Coating • Standard progressive lenses• Premium progressive lenses • Custom progressive lenses• Average savings of 20-25% on other lens enhancements

$0 $55$95-105$150-$175

Every 12 months

Contacts (instead of glasses)

• $160 allowance for contacts; copay does not apply• Contact lens exam (fitting and evaluation)

Up to $50 Every 12 months

Diabetic Eyecare Plus Program

• Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.

$20 As needed

Extra Savings

Glasses and Sunglasses • Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details.• 20% savings on additional glasses/sunglasses, including lens enhancements, from VSP provider within 12 months of WellVision Exam.

Retinal Screening• No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam • Laser Vision Correction• Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

Your Coverage with Out-of-Network Providers

Get the most out of your benefits and greater savings with a VSP network doctor. Your coverage with out-of-network providers will be less or you’ll receive a lower level of benefits. Visit vsp.com for plan details.Exam…up to $45 • Lined Bifocal Lenses...up to $50 • Progressive Lenses...up to $50 • Frame...up to $70 • Contacts…up to $105Lined Trifocal Lenses…up to $65 • Single Vision Lenses…up to $30

HEALTHHEALTH

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Per Pay Period (Bi-Weekly)Full-Time Standard Premium

Salary Banding Associate Associate + Spouse

Associate + Children

Family

$0 – $14.42 $62.66 $125.99 $118.07 $181.40$14.43 – $28.85 $69.64 $144.15 $134.84 $209.34 $28.86 – $48.08 $74.30 $156.26 $146.01 $227.97$48.09+ $78.96 $168.36 $157.19 $246.60

Full-Time Wellness Premium

$0 – $14.42 $39.58 $102.91 $94.99 $158.32 $14.43 – $28.85 $46.57 $121.07 $111.76 $186.26$28.86 – $48.08 $51.22 $133.18 $122.93 $204.89$48.09+ $55.88 $145.29 $134.11 $223.52

Part-Time Standard Premium

$119.73 $220.23 $198.97 $323.65

Part-Time Wellness Premium

$96.65 $197.16 $175.90 $300.57

Dental HIGHFull-Time Premium

$5.47 $10.95 $13.29 $20.61

Dental HIGHPart-Time Premium

$15.66 $31.32 $38.02 $58.98

Dental LOWFull-Time Premium

$4.46 $8.92 $10.85 $16.83

Dental LOWPart-Time Premium

$12.76 $25.52 $31.06 $48.17

Vision $4.21 $6.73 $6.88 $11.10

Legal Plan $3.81 NA NA $5.54

2020 Medical, Dental and Vision Premiums

Premiums for Life, Supplemental Life, Supplemental Accidental Death & Disability (AD&D), disability benefits, and voluntary benefits will be available during the enrollment process in Benefit Express website.

There are 26 pay periods in the calendar year. It is an associate’s responsibility to confirm payroll accuracy, including benefit deductions. Any missed deductions will automatically be collected.

HEALTH

Basic LifeAssociates are automatically enrolled in Basic Life and AD&D. AMITA Health provides this benefit at no cost to benefit eligible associates. All full-time and part-time benefit eligible associates are provided employer paid Basic Life/AD&D coverage at 1x annual earnings to a maximum of $1,000,000. The Prudential Insurance Company of America provides this insurance.

Basic Life – Key Provisions• If you are terminally ill, you can get a partial

payment of your group life insurance benefit. You can use this payment as you see fit. The payment to your beneficiary will be reduced by the amount you receive with the Accelerated Benefit Option.

• Payment of premium can be waived if you are totally disabled for 6 months, you are less than 60 years old when disability begins, and you continue to be totally disabled. The waiver terminates at normal social security retirement age. This provision may vary by state.

• Coverage will be reduced as you age – 50% at age 70.

Supplemental Life* 100% Associate Paid• You can elect a coverage from one to seven

times your covered base annual earnings, not to exceed $2,500,000. Rates for this insurance are determined by your use of tobacco and age. Premiums are deducted on an after tax basis from your paycheck.


Basic Accidental Death & Dismemberment (AD&D)* – Key Provisions• Basic AD&D pays you and your beneficiary a

benefit for loss of life or other injuries resulting from a covered accident. 100% is paid for loss of life. A lesser percentage is paid for other injuries such as loss of sight or speech, paralysis, and dismemberment of hands or feet.

• Basic AD&D benefits are paid regardless of other coverages in place.

• You are automatically enrolled for an amount equal to your Basic Life coverage amount.


Supplemental AD&D* 100% Associate PaidAll benefit eligible associates can purchase supplemental life coverage for one to ten times your covered base annual earnings up to a maximum of $2,500,000. Premiums are deducted on an after tax basis from your paycheck. Coverage will be reduced as you age – 50% at age 70.

When Coverage EndsLife and disability coverages end date of termination of your employment, or if you transfer to a benefit ineligible position. You may port (continue) your group coverage in an amount equal to or lower than your current benefit amount (exclusions and limits apply, see SPD for details).

PLEASE NOTE!Changes to salary will impact Life, AD&D, and disability elected levels of coverage.

Refer to any benefit Summary Plan Document (SPD) located on the intranet, or in the Benefit Express Library for detailed Plan information.

INCOMESECURITY

Life and Disability Benefits

*SEE NEXT PAGE1716

* Evidence of Insurability (EOI) is a questionnaire that insurance companies use to ask about the health of an associate and/or dependent spouse. Depending on responses, this may lead into further questions about your/your dependent’s health.

Insurance companies will request EOI to approve limits of insurance beyond the Guaranteed Issue amount and, if you waived coverage upon initial offer. If coverage is approved, the effective date will be the date the carrier approves coverage.

Spouse* Term Life AD&D

Eligibility May purchase only if associate elects Supplemental Life. May purchase only if associate elects Supplemental AD&D.

Coverage and Limits • Coverage amount cannot be greater than 50% of the associate Supplemental Life coverage amount.

• May elect in increments up to $250K.

Spouse AD&D must not exceed 65% of the associate’s Supplemental AD&D.

Evidence of Insurability (EOI)

At time of hire may elect up to 25K without EOI. If increased or elected any other time, EOI will be required.

There are no health requirements.

Age Reduction 50% at age 70 50% at age 70

Portability Coverage will end at the termination of your employment or if an associate transfers to a benefit ineligible position. You may port (continue) your group coverage in an amount equal to or lower than your current coverage level only if associate coverage is ported (exclusions and limits apply, see SPD for details).

Coverage will end at the termination of your employment or if an associate transfers to a benefit ineligible position. May be ported only if associate coverage is ported.

Child Term Life AD&D

Eligibility May purchase only if associate elects Supplemental Life. Coverage may begin from live birth up to age 26.

May purchase only if associate elects Supplemental AD&D. Coverage may begin from live birth up to age 26.

Coverage and Limits • Coverage amount elected cannot be greater than 50% of the associate Supplemental Life coverage amount.

• May elect either $5,000 per $10,000 per child.

Child AD&D must not exceed 25% of the associate’s Supplemental AD&D.

Evidence of Insurability (EOI)

There are no health requirements. There are no health requirements.

Portability Coverage will end at the termination of your employment or if an associate transfers to a benefit ineligible position. You may port (continue) your group coverage in an amount equal to or lower than your current coverage level only if associate coverage is ported (exclusions and limits apply, see SPD for details).

Coverage will end at the termination of your employment or if an associate transfers to a benefit ineligible position. May be ported only if associate coverage is ported.

Spouse - Dependent Life* (100% associate paid)

Child Dependent Life (100% associate paid)

INCOMESECURITY

Dependent Life*

Short-Term Disability* (STD) Benefit STD is a benefit with coverage amounts and eligibility varying depending on the Ministry where you work. When you access Benefit Express, you will be able to see Plan details, eligibility, coverage effective date, costs and coverage amounts specific to your Ministry.• This plan provides a benefit for disability,

illness or injury that is not work-related, including pregnancy.

• Your plan also includes Rehabilitation benefits that provide services and support targeted at helping you return to active work.

• Pre-existing Condition clause: STD and LTD benefits will not be paid for a disability that begins within 3 months of your coverage effective date and due to a pre-existing condition. A pre-existing condition is an injury or sickness (including pregnancy) for which you received medical treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for which you followed treatment recommendations during the 12 months prior to your effective date of coverage.

Long-Term Disability* (LTD) Benefit LTD is a benefit with coverage amounts and eligibility varying depending on the Ministry where you work. When you access Benefit Express, you will be able to see Plan details, eligibility, coverage effective dates, costs and coverage amounts specific to your Ministry.• Provides coverage for on–and-off-the-job

accidents, and benefits may be reduced if receiving other income.

• Pre-existing Condition clause: STD and LTD benefits will not be paid for a disability that begins within 3 months of your coverage effective date and due to a pre-existing condition. A pre-existing condition is an injury or sickness (including pregnancy) for which you received medical treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for which you followed treatment recommendations during the 12 months prior to your effective date of coverage

Remember to review Plan information and coverage options in Benefit Express.

Benefit Express uses the same network user ID and password that you use to access a computer at work. The enrollment site is available for Plan information review from any location with internet access 24 hours / 7 days a week. You can also access Benefit Express through rAMITA.

* Evidence of Insurability (EOI) is a questionnaire that insurance companies use to ask about the health of an associate. Depending on response, this may lead into further questions about your health. Insurance companies will request EOI to approve limits of insurance beyond the Guaranteed Issue amount and, if you waived coverage upon initial offer. If coverage is approved, the effective date will be the date the carrier approves coverage.

INCOMESECURITY

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For more information, call Voya at 800.537.5024 or visit www.voya.com. You can view plan information in Benefit Express under the Library category.

Voluntary Permanent Whole Life – Voya Voluntary BenefitVoluntary Permanent Whole Life Insurance through VOYA Financial is an associate paid benefit available to benefit eligible full-time and part-time associates. To supplement your Basic Life AD&D insurance provided by AMITA, you may purchase additional life insurance coverage for yourself, your spouse and dependent children through Voya.

Voluntary Permanent Life insurance provides a financial benefit that your family can depend on and getting it at work is easier, more convenient and more affordable than doing it on your own.

If you have financial dependents - a spouse, children or aging parents, having life insurance is a responsible and smart decision. Premiums never increase due to an increase in age and the coverage is fully portable. Accelerated Life Benefit Included: A lump sum benefit is paid to you if you are diagnosed with a terminal condition, as defined by the plan.

No medical questions asked, if you enroll when initially offered the coverage unless you elect over the guarantee issue amount.• Spouses and Children are limited to 50% of the

associate face amount for amounts in excess of $5,000

• Age reduction rules apply. Contact Voya for details.

Accident Insurance – Voya Voluntary BenefitHave you ever dislocated a joint or gotten a deep cut? How about something more severe, like a concussion or broken bone? Most of us have experienced an accident that needed medical attention as least once in our lives. Accident Insurance can help relieve some of the financial stress that goes along with an accidental injury.

Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident that occurs while you are not at work, on or after your coverage effective date.

The benefit amount depends on the type of injury and care received. You have the option to elect Accident Insurance to meet your needs. Accident Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

Critical Illness Insurance – Voya Voluntary BenefitDo you know someone who has had a serious illness like a heart attack or stroke? You probably do but don’t expect to ever experience one yourself. The problem is, no one thinks it could happen to them and when it does, they may not be prepared for the financial ramifications.

On top of the medical bills, there are still everyday expenses to pay for, which can be challenging during recuperation. Plus, you may need help with day-to-day tasks like house maintenance, child care and transportation. That’s where Critical Illness Insurance can help.

For more information, call Voya at 800.537.5024 or visit www.voya.com.

Employer Automatic Contribution and the Matching Contribution are subject to plan vesting requirements. Descriptions of plan features and benefits are subject to the plan document, which will govern in the event of any inconsistencies between this newsletter and the formal plan documents.

Retirement Planning Consultants are registered representatives of Transamerica Investors Securities Corporation (TISC), member FINRA, 440 Mamaroneck Avenue, Harrison, NY 10528. Investment advisory services are offered through Transamerica Retirement Advisors, LLC (TRA), registered investment advisor. All Transamerica companies identified are affiliated, but are not affiliated with your employer.

INCOMESECURITY

Ascension Healthcare Retirement Savings Program— Alexian Brothers/Presence Health

INCOMESECURITY

Features How It Works

2020 retirement plan components• Your pretax contribution• Employer Matching Contribution• Employer Automatic Contribution (EAC)

This is the amount you elect to contribute to the plan.See Employer Matching Contribution below.See EAC information on page 2.

Your pretax contribution• Ascension Healthcare 403(b) Retirement Savings Plan

(not-for-profit ministries)

• You can make pretax salary deferrals (a percentage of pay or a flat dollar amount) up to 80% of salary or IRS dollar limit ($19,500 in 2020). A catch-up provision allows associates age 50 and older to contribute an additional $6,500.

• Standard investment lineup for all plans• Loans – 403(b). No more than two loans per plan.• Hardship withdrawals – 403(b) only• In-service withdrawal at age 59½• Variety of distribution options at termination or retirement

Employer Matching Contribution • Eligibility: 40 standard scheduled hours per pay period• 50% of the first 6% of earnings you contribute each pay period to the

Ascension Healthcare 403(b) Retirement Savings Plan• If you are an eligible associate with at least one paid hour of service prior

to January 1, 2020, you are 100% vested.• If you were hired on January 1, 2020 or later, you are vested after three

years of service. A year of vesting service is granted for each calendar year in which you have at least 1,000 hours of service.

• You can take full advantage of the match by saving at least 6% of your earnings per pay period.

Plan Features How It Works

Employer Automatic Contribution (EAC)• For those eligible, your employer will put an annual contribution into

your retirement account.• How much you receive is based on years of benefit service or $600

(for full time 2,080 hours) — whichever is greater.

Years of Contribution Benefit Service PercentageLess than 5 years...........................................................2.0% of earnings5–9 years..........................................................................2.5% of earnings10–14 years.......................................................................3.0% of earnings15 years or more..............................................................3.5% of earningsOR if greater, $600 (prorated for less than 2,080 hours)

Eligibility• You are initially eligible to receive an EAC the first calendar year in which

you have at least 1,000 hours of service.• Thereafter, the EAC is earned in any calendar year in which you are a

participant and have at least 500 hours of service.• You must be employed on December 31 to receive an EAC for the year,

unless you leave employment after age 55 and are vested.

Vesting• A year of vesting service is granted for each calendar year in which you

have at least 1,000 hours of service.• Vesting in your account requires at least five years of vesting service.• Active participants who reach age 65 are vested with one year of

vesting service.

Timing of Contribution• Generally, the EAC is deposited in the spring after the end of each

calendar year.• For example, the 2020 EAC will be deposited in late March/early April 2021.

FeesThe following fees are charged in the Retirement Program:• Investment management fees — Pay for fund management, investment research, and other investment-related expenses. Fees differ by investment option.• Administrative fees — Pay for core services provided to all participants. The annual administrative fee is $36 per account, charged monthly at

$3 per account.More information on investments and fees can be found at transamerica.com/portal/ascension.

Need help? Contact Transamerica. • Meet with your onsite Retirement Planning Consultant.• Call Transamerica at 877.346.7284, and say “Yes” when prompted to

access your Retirement Savings Program account.• Visit transamerica.com/portal/ascension.

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Employer Automatic Contribution and the Matching Contribution are subject to plan vesting requirements. Descriptions of plan features and benefits are subject to the plan document, which will govern in the event of any inconsistencies between this newsletter and the formal plan documents.

Retirement Planning Consultants are registered representatives of Transamerica Investors Securities Corporation (TISC), member FINRA, 440 Mamaroneck Avenue, Harrison, NY 10528. Investment advisory services are offered through Transamerica Retirement Advisors, LLC (TRA), registered investment advisor. All Transamerica companies identified are affiliated, but are not affiliated with your employer.

Adventist Midwest Health Retirement Savings ProgramFeatures How It Works

2020 retirement plan components• Your pretax contribution• Employer Matching Contribution• Employer Automatic Contribution (EAC)

This is the amount you elect to contribute to the plan.See Employer Matching Contribution below.See EAC information on page 2.

Your pretax contribution• Adventist Midwest Health 403(b) Retirement Savings Plan

(not-for-profit ministries)

• You can make pretax salary deferrals (a percentage of pay or a flat dollar amount) up to 80% of salary or IRS dollar limit ($19,500 in 2020). A catch-up provision allows associates age 50 and older to contribute an additional $6,500.

• Standard investment lineup for all plans.• Loans – 403(b). No more than two loans per plan.• Hardship withdrawals – 403(b) only.• In-service withdrawal at age 59½.• Variety of distribution options at termination or retirement.

Employer Matching Contribution • Eligibility: 40 standard scheduled hours per pay period.• 50% of the first 6% of earnings you contribute each pay. period to the

Adventist Midwest Health 403(b) Retirement Savings Plan.• If you were hired prior to January 1, 2020, you are 100% vested.• If you were hired on January 1, 2020 or later, you are vested after three

years of service. A year of vesting service is granted for each calendar year in which you have at least 1,000 hours of service.

• You can take full advantage of the match by saving at least 6% of your earnings per pay period.

Plan Features How It Works

Employer Automatic Contribution (EAC)• For those eligible, your employer will put an annual contribution into

your retirement account.• How much you receive is based on years of benefit service or $600

(for full time 2,080 hours) — whichever is greater.

Years of Benefit Service Contribution PercentageLess than 5 years...........................................................2.0% of earnings5–9 years..........................................................................2.5% of earnings10–14 years.......................................................................3.0% of earnings15 years or more..............................................................3.5% of earningsOR if greater, $600 (prorated for less than 2,080 hours)

Eligibility• You are initially eligible to receive an EAC the first calendar year in which

you have at least 1,000 hours of service

• Thereafter, the EAC is earned in any calendar year in which you are a participant and have at least 500 hours of service

• You must be employed on December 31 to receive an EAC for the year, unless you leave employment after age 55 and are vested.

Vesting• A year of vesting service is granted for each calendar year in which you

have at least 1,000 hours of service.

• If you were hired prior to January 1, 2020, vesting in your account requires at least three years of vesting service.

• If you were hired on January 1, 2020 or later, vesting in your account requires at least five years of vesting service.

• Active participants who reach age 65 are vested with one year of vesting service.

Timing of Contribution• Generally, the EAC is deposited in the spring after the end of each

calendar year.• For example, the 2020 EAC will be deposited in late March/early April 2021.

FeesThe following fees are charged in the Retirement Program:• Investment management fees — Pay for fund management, investment research, and other investment-related expenses. Fees differ by investment option.• Administrative fees — Pay for core services provided to all participants. The annual administrative fee is $36 per account, charged monthly at

$3 per account.More information on investments and fees can be found at transamerica.com/portal/home.

Need help? Contact Transamerica. • Meet with your onsite Retirement Planning Consultant.• Call Transamerica at 800.755.5801, and say “Yes” when prompted to

access your Retirement Savings Program account.• Visit ransamerica.com/portal/home.

INCOMESECURITY

Legal Plan – Hyatt Legal ServicesLegal matters, both planned and unplanned, are part of life. Enrolling in a Hyatt Legal Plan gives you the financial and emotional peace of mind to know you will be covered for expected and unexpected legal events.

Receive fully covered legal advice and representation for a wide range of legal matters. You can consult with your attorney on the phone or in person.

You can also use an out-of-network attorney and get reimbursed for covered services according to a set fee schedule.

The Hyatt Legal Plan provides you, your spouse and dependents with fully covered legal services from attorneys experienced in estate planning documents, civil suits, adoption, creditor issues and much more. For more information, visit: info.legalplans.com and enter the access code that belongs to your ministry, listed below.

9900669 – Adventist Midwest Health Employee Only Plan 9900670 – Adventist Midwest Health Family Plan 9900665 – Alexian Brothers Health System Employee Only Plan 9900666 – Alexian Brothers Health System Family Plan 9901680 – Presence Health Employee Only Plan 9901681 – Presence Health Family Plan

QUESTIONS?

Call 800.821.6400 Monday–Friday 8 am–8 pm (EST)

ADDITIONALBENEFITS

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Flexible Spending Accounts As part of the wide range of choices the AMITA benefits program offers, you may also elect to set up a Flexible Spending Account to help save income taxes on eligible health and/or dependent care expenses.

You may choose to set up either or both:• A Health Care Flexible Spending Account• A Dependent Daycare Flexible Spending

Account *Only if you have dependent child or disabled spouse

How a Health Care Flexible Spending Account (HFSA) WorksEstimate how much you expect to spend on eligible health care expenses with in the enrollment plan year. Consider medical, dental, vision, and hearing expenses not covered by the benefit plans, such as copays and deductibles, as well as other eligible expenses. The maximum contribution you may elect for plan year 2020 is $2,750. The minimum is $120 per plan year.

• Pay for eligible health care expenses out of your own pocket and submit a claim for reimbursement, with a copy of any necessary documents (receipts, explanation of benefits, etc.) to Connect Your Care at the address listed on the claim form. This can include expenses for child and/or spouse

• Pay using a VISA debit card. Automatically records purchase online and no need to pay upfront and wait for reimbursement but keep a copy of your receipt for your records in case verification is requested.

HFSA Qualifying ExpensesAny health care expenses qualifying under the IRS Code for income tax purposes also qualify for reimbursement through the HFSA. If you use the account for these expenses, you cannot take an income tax deduction as well. Eligible expenses include, but are not limited to:• Deductibles, coinsurance, copays for medical,

dental, pharmacy, vision for you & your child/spouse;

• Amounts you pay in excess of plan limitations for allowed charges;

• Expenses not covered or not fully covered by your plan; and

• Certain over-the-counter medications if prescribed by a physician.

Dependent DAYCARE Flexible Spending Account (DFSA) Qualifying ExpensesAny expenses qualifying for a Federal Child and Dependent Daycare Tax Credit for income tax purposes also qualify for reimbursement through the DFSA. If you use the account to reimburse yourself for eligible expenses, you cannot take the Federal Tax Credit for the same expenses. Eligible expenses include those services provided inside or outside your home while you work by anyone other than your spouse or your dependents to care for eligible dependent children (under age 13) or dependents (child or spouse) who are physically or mentally unable to care for themselves for whom you contribute more than half of their support.

DFSA Qualifying ExpensesEstimate your eligible expenses for dependent day care while you work, or other dependent care expenses. The maximum you may elect is based on your tax filing status for plan year 2019 is $5,000 (if you are single or married and filing a joint return) or $2,500 (if you are married and filing a separate return). Pay for eligible dependent care expenses out of your own pocket and submit a claim for reimbursement, with a copy of receipts. No debit card is available for this benefit.

Reimbursement for HFSA and DFSAConnect Your Care can direct deposit your reimbursement into your designated account within 24–48 hours after processing your claim (Monday – Friday) for HFSA. For DFSA, you must have an available balance. If not your DFSA claim will be processed once a contribution is received. If you do not set up direct deposit, the reimbursement will be sent through regular U.S. Mail delivery.

To learn more about expenses eligible under Flexible Spending Accounts, go to IRS Publications 502 and 503 at www.irs.gov/publication.Limits are subject to change based on IRS guidelines

ADDITIONALBENEFITS

FSA General Plan RulesThe IRS imposes the following rules and regulations on pre-tax DFSA Flexible Spending Accounts:• You can take the credit or the exclusion if all five

of the following apply:– Your filing status may be single, head

of household, qualifying widow(er) with dependent child, or married filing jointly. If your filing status is married filing separately, see Married Persons Filing Separately.

– The care was provided so you (and your spouse if filing jointly) could work or look for work. However, if you didn’t find a job and have no earned income for the year, you can’t take the credit or the exclusion. But if you or your spouse was a full-time student or disabled, see the IRS regulations before enrolling.

– The care must be for one or more qualifying persons.

– The person who provided the care wasn’t your spouse, the parent of your qualifying child, or a person whom you can claim as a dependent. If your child provided the care, he or she must have been age 19 or older by the end of 2019, and he or she can’t be your dependent..

– You report the required information about the care provider and, if taking the credit, the information about the qualifying person is documented on your tax return.

– Generally, married persons must file a joint return to claim the credit. If your filing status is married filing separately and all of the following apply, you are considered unmarried for purposes of claiming the credit on Form 2441.• You lived apart from your spouse during the

last 6 months of 2019.• Your home was the qualifying person’s main

home for more than half of 2019.• You paid more than half of the cost of keeping

up that home for 2019.• If you meet all the requirements to be treated

as unmarried and meet items listed earlier, you can take the credit or the exclusion. If you don’t meet all the requirements to be treated as unmarried, you can’t take the credit.

• You lose any money left in your account at the end of the plan year. However, there is a 90-day grace period after the end of the plan year to submit eligible health care and dependent daycare expenses incurred during the plan year.

• You may be eligible for a Federal Child and Dependent Daycare Tax Credit and/or to deduct certain health care expenses on your tax return.

Be sure to talk to a tax advisor to see whether the tax credits and deductions or the Flexible Spending Accounts are the best choice for you.• For the Health Care Flexible Spending Account,

you can be reimbursed up to the full amount you elect to contribute for the plan year even if funds are not yet deposited into your account. However, you can only be reimbursed up to the amount deposited into your Dependent Daycare Flexible Spending Account at the time of your claim.

• You cannot use money in your Health Care Flexible Spending Account to be reimbursed for dependent day care expenses, and you cannot use money in your Dependent Daycare Flexible Spending Account to be reimbursed for health care expenses. You also cannot transfer money from one account to the other.

• Flexible spending accounts (medical) allow $500 per year to be rolled over (not lost) as long as you continue to be employed with the same employer.

USE IT OR LOSE IT!Spend your FSA dollars by December 31

ADDITIONALBENEFITS

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Commuter & Transit BenefitsNow you can reduce your commuting expenses with Commuter Benefits. Not only does the benefit save you money on work-related transit and parking expenses by allowing you to use pre-tax money for these items, it is also simple to use!

Associates are responsible for assuring deductions are accurately taken. If there is an issue, contact Human Resources. Audits are conducted throughout the year, if any deductions were missed may result in additional deductions and/or repayment via payroll.

Important Timelines

Please keep in mind that you must place your order by the order deadline (generally the 10th of the month) for the following month. Orders received by the 10th of the month are processed and mailed no later than the 23rd of that month. Example: Passes ordered by June 10th are for July and are mailed no later than June 23rd. Please check online to verify your order deadline.

Ordering: Where to BeginOrdering eligible commuter products is easy. Log in to Benefit Express and click on the link for Commuter Benefits where you can register your account, order your parking or transit passes or vouchers, and they will be mailed directly to you. Or, if you elect, you may choose to pay your parking provider directly. The total amount of your purchases will be deducted from your paycheck–tax free–up to the IRS limit!1. Log in to Benefit Express and click on the link for

Commuter Benefits. If you have not registered before, follow instructions to set your user name and password. Click on the Transit tab to access the Commuter Portal.

2. Take Action – You may choose to place an order, edit and order, delete an order, update your account, view FAQs, try out the savings calculator, or see important notices. Your options are presented in a helpful dashboard.

PLEASE NOTE:Deductions are taken on the paycheck prior to the beginning of the benefit month.

ADDITIONALBENEFITS

AMITA Health Employee Assistance Program offered through Employee Resource Center (ERC)

SOME OF THE AVAILABLE SERVICES INCLUDE:

Confidential Counseling

Anxiety / DepressionGriefStress Effective CommunicationSubstance Abuse

Legal–Financial Fitness

Credit Report Review Debt Management Divorce and Custody Issues Financial Counseling Financial Planning Resources

Work-Life Balance

Career Resources Education ResourcesHome Health Resources Parenting Resources Senior Housing Resources

Let Us Help Professional counselors are available to speak with you. Our team of caring professionals helps clarify the nature of your concern and presents the best options available. We offer consultations to Human Resources, Associate Health Services, as well as access to customized care for health care professionals. Our clinicians are available to assist with crisis debriefing at our AMITA ministries after employee trauma occurs on units.

ConfidentialYour confidentiality is protected by federal and state law as well as our professional ethical standards. With very limited exceptions, disclosure of information to any source without prior written consent is prohibited.

ResponsiveProfessional counselors are available to speak with you. Our team of caring professionals helps clarify the nature of your concern and presents the best options available. We offer consultations to Human Resources, Associate Health Services, as well as access to customized care for health care professionals. Our clinicians are available to assist with crisis debriefing at our AMITA ministries after employee trauma occurs on units.

EligibilityERC’s services are available to associates and their dependents, as well as the eligible associate’s household members.

An Extensive Network of Licensed Providers ERC sponsors an extensive network of counseling providers both internal and external to AMITA Health. With nearly 300 providers enrolled, you can be assured of a location and provider type to meet your specific needs.

24/7 AccessWe offer support 24 hours a day, 7 days a week. You can access the ERC M–F 8:30–4:30 pm by calling 800.890.7932. After 4:30 pm M–F and on weekends, our Crisis Hotline Service is available at 708.681.HELP (4357) for additional support.

CostThere is no cost to you or your family members to utilize ERC’s services. The overall goal of the Employee Assistance Program provided by the ERC is to assist associates in functioning at an optimum level with a stable work-life balance.

ADDITIONALBENEFITS

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RESOURCES

Mobile ApplicationsSeveral of AMITA’s benefit partners have mobile applications available for download. These applications contain information to help you understand and navigate your benefits (see below):

AMITA Health PPO PlanNeed a copy of your medical card, or want to see claims, or find a provider? Use ABS Mobile App! Once you download the app onto your mobile device, you can try logging in to view the features of the app.

Important message regarding registrationIf you are already registered on the ABS online portal, you’re ready to use the app. You do not need to re-register. Simply log in to the app with your current member portal username and password, and start enjoying the convenience of our mobile app. If you are not registered on the ABS online portal, you must register to access both the app and the online portal.

To register on the app:• Tap Create account on the login page and check

the Accept box and tap Next• Fill in all fields on registration page, and tap

Next. You are now ready to use online portal and mobile app.

• Download the app today for your ios™ or Android™ device.

VSP • Available on the App Store and Mobile Site

Connect Your Care • Available for Android, iOS and Windows devices. • View account balance, alerts and transaction

history, submit a new claim, make payments with Online Bill Pay and Click-to-Pay, and tap to call Customer Service, upload claim documentation with your device’s camera.

Delta DentalAccess these features without logging in: • Find a network dentist • Brush for the recommended 2 minutes with our

Toothbrush Timer tool • View a mobile ID card (Log in to save your ID card

to the app home screen for easy access. When saved, the “My ID Card” icon will appear in purple.)

When you log in with your Delta Dental account: • Estimate treatment costs with the Dental

Cost Estimator • View your dental benefits • View coverage and claims information • Schedule an appointment with a network dentist

Hyatt Legal • Available on iTunes® App store and Google Play • Quickly access coverage details and

find attorneys • Provides informative articles, videos and a

Legal Needs Test

Perkspot – Associate Discount ProgramLog into AMITAHealth.perkspot.com to create your personal account. You can subscribe to weekly emails to make sure you never miss a deal!

Welcome to Your AMITA HealthDiscount Program

Save on thousands of your favorite brands

RESOURCES

RESOURCE VENDOR NAME TELEPHONE WEBSITE

Benefit Enrollment Website Benefit Express www.AMITAHealthBenefits.com

Ascension & AMITA Health HR Central / Ministry Service Center

Ascension & AMITA Health 888.629.6424 Access Service-Now in rAMITA to create a case

Employment Verification Use Code 18366 800.367.5690

HEALTHHEALTH

AMITA Health Medical PPO Plan Automated Benefit Services (ABS) 844.659.2519 Member Portal: www.abs-tpa.com

Provider Lookup: www.AMITAHealthproviders.org

Prescription Drugs Cigna 800.622.5579 www.mycigna.com

Presence Mail-Order Pharmacy Specialty Pharmacy Medications

P: 855.270.0532F: 855.270.0533 [email protected]

AMITA Health In-House Pharmacywww.AMITAhealthproviders.org (under Member Info Center/Pharmacy Self-Service/AMITA In-House Pharmacy Directory)

Dental PPO Plan Delta Dental 800.323.1743 www.deltadentalil.com

Vision Plan VSP 800.877.7195 www.vsp.com

Wellness Program Healthy Journey 224.273.3387 www.AMITAHealthWellness.com

Livongo join.livongo.com/AMITA/hi

Employee Assistance Program ERC 800.890.7932 Crisis Hotline: 708.681.HELP (4357)

LIFE and DISABILITYLIFE and DISABILITY

Life Claims Prudential 800.524.0542 www.prudential.com

Life Conversion Prudential 877.889.2070 www.prudential.com

Life Portability Prudential 800.778.3827 www.prudential.com

Disability and Claims–FT Associates Sedgwick 855.224.4899 www.claimlookup.com/AscensionCares

Disability and Claims–PT Associates Prudential 800.842.1718 www.claimlookup.com/AscensionCares

Report a Leave of Absence Sedgwick 855.224.4899

INCOME PROTECTIONINCOME PROTECTION

Commuter Benefit Connect Your Care 833.799.1780 www.connectyourcare.com/AMITA

Flexible Spending Accounts Connect Your Care 833.799.1780 www.connectyourcare.com/AMITA

Legal Services Hyatt MetLaw 800.821.6400 info.legalplans.com

Voluntary Critical Illness Voya 877.236.7564 www.voya.com

Voluntary Accident Insurance Voya 877.236.7564 www.voya.com

Voluntary Whole Life Voya 800.537.5024 www.voya.com

RETIREMENTRETIREMENT

Transamerica–Say ‘YES” when prompted to access your Ascension Retirement Plan program

Transamerica 877.346.7284 www.transamerica.com/portal/ahtransitions/

BENEFIT CONTACTS

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This benefits material briefly describes the excellent benefits program that is available as part of employment with AMITA Health. This information is not a contract. Any of the benefits, policies or procedures may be changed as the organization requires, and nothing contained in this material shall be construed as creating an expressed or implied obligation or contract on the part of the AMITA Health. All Plan documents prevail should there be any errors or discrepancies in this document.Ministries may have variances between benefits for Long-Term and Short-Term Disability offerings. You must review plan documents in Benefit Express which will show the specific plan information for your ministries plan benefits. All Ministry Plan documents prevail should there be any errors or discrepancies in this document, on the intranet, or in distribution.

Important NotificationsFederal regulations require that plan sponsors, such as AMITA Health, provide various notices to their associates. In keeping with these requirements, we are providing copies of the following Notices which are available in Benefit Express under Library > Important Notices. • General Notice of COBRA Continuation Rights • HIPAA Special Enrollment Notice • HIPAA Privacy Notice • Medicare Part D Notice • Medicaid and the Children’s Health Insurance

Program (CHIP) Notice • Women’s Health and Cancer Rights Notice • Newborns’ and Mothers’ Health Protection Act

of 1996

• Genetic Information Non-discrimination Act of 2008

• Uniform Service Employment & Reemployment Rights Act (USERRA)

• New Health Insurance Marketplace Coverage Options and Your Health Coverage

• Notice Regarding Wellness Program • The Mental Health Parity and Addiction Equity Act

of 2008

If you have questions regarding any of theseNotices, please contact the Human Resources at:Contact: AMITA Health - Benefits Department Address: 2601 Navistar Dr., Lisle, IL 60532Phone: 888.629.6424Email: [email protected]

RESOURCES

Frequently Asked Questions (FAQs)AMITA Health PPO Medical Plan Benefit Plan QuestionsQ: HOW DO I KNOW IF I ENROLLED

SUCCESSFULLY? WILL I RECEIVE VERIFICATION OF MY ENROLLMENT ELECTIONS?

A: You will have the ability in Benefit Express to email or print your own Confirmation Statements. It is strongly recommended that your review the statement, keep a copy for your records and monitor your payroll to assure deductions are accurately taken.

Q: WHERE CAN I FIND BENEFIT PLAN DOCUMENTS?

A: Benefit plan documents, also referred to as Summary Plan Documents (SPD), can be found on iAMITA intranet and in the Benefit Express Library.

Q: WHEN WILL MY BENEFIT DEDUCTIONS BEGIN?A: The activation of benefit deductions is

dependent on when you complete your enrollment and when the benefit becomes effective. Typically, the deduction will begin in the pay period that the deductions go into effect. However, the longer you wait to enroll, the higher the likelihood of having catch up deductions for missed pay periods. In order to avoid this, enroll in benefits as quickly as possible.

Q: HOW CAN I VIEW MY MEDICAL BENEFIT INFORMATION?

A: For full medical benefit details, please refer to the plan documents available in the Benefit Express Library. Once enrolled, you can register on the Automated Benefit Services (ABS) website, under member portal, to view your benefit information, claims and access Explanation of Benefits (EOBs). 1. Go to the Automated Benefit Services (ABS)

website at www.abs-tpa.com and select “I’m a Member”

2. You will need to Create an Account when logging in for the first time and in order to access an account

3. Next you will need to “Agree” to the terms of use after reading the licensing agreement. If you “Disagree,” this will take you back to the login page

4. Fill in and verify your information and follow the steps to create

5. Once you are logged in, choose any option6. You can set your preferences to obtain

Explanation of Benefits electronically. In order to change this, please go to the Profile Section in order to start receiving an email notification when the new EOB has posted. You can change this feature at any time

Q: WHAT ARE THE MEDICAL PLAN NETWORKS?A: The AMITA Health medical plan is a ‘tiered’

network with three tiers:• SmartHealth Network (Tier 1): Consisting of

AMITA Health, Ascension and Adventist Health system facilities and contracted providers

• Blue Cross Blue Shield National Provider Network (Tier 2): Consisting of providers in the BCBS of Michigan National Network

• Out-of-Network or OON (Tier 3): Providers not contracted in the BCBS National Network

You and your family members will experience a significantly higher level of benefits when receiving care from an AMITA Health provider.

Q: HOW DO I FIND A DOCTOR IN THE NETWORK?A: To find a doctor in the SmartHealth Network

(Tier1) or the BCBS National Network, (Tier 2), please refer to the AMITA provider finder at AMITAHealthproviders.org.

Q: WHEN DO I NEED PRE-AUTHORIZATION FROM MY MEDICAL PLAN ADMINISTRATOR, ABS?

A: The Schedule of Benefits for the PPO 500 90/10 plan is on iAMITA and/or in Benefit Express under the Library category. Services requiring pre-certification are noted on the document. For more detail, you can also find the pre-authorization requirement list and form on www.AMITAHealthproviders.org, in the Provider Information Center.

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Delta Dental of Illinois Benefit PlanQ: WHAT ARE MY DENTAL PLAN NETWORKS?A: With your dental benefit program, you are free

to go to any licensed dentist. However, you will save the most money by visiting a dentist in the Delta Dental PPO network.• Delta Dental PPO: Dentists agree to accept

Delta’s allowed PPO fees as payment in full, which means they can’t charge the difference between their usual fee and the allowed fee. On average, patients save 30 percent on the fee a Delta Dental PPO dentist would typically submit for a claim

• Delta Dental Premier: The safety net for the Delta Dental PPO network. You will pay more out-of-pocket with a Delta Dental Premier dentist compared to a Delta Dental PPO dentist. However, you may save more money with a Delta Dental Premier dentist compared to a non-network dentist. Delta Dental Premier dentists agree to our maximum plan allowances as payment in full, which may be lower than what a dentist would typically charge

• Non-Network: Dentist not contracted in the Delta Dental Network

Q: WILL EACH COVERED MEMBER RECEIVE THEIR OWN MEDICAL AND PRESCRIPTION CARD?

A: Medical will only provide one card with your name on it. You may request more cards to give to your dependents by calling Automated Benefit Services at 844.659.2519, or going online to request a card or, the easiest way, by using the ABS Mobile Application. The provider will check for your dependent’s coverage through your medical ID card. This is another reason why it is extremely important to have accurate information for each dependent covered in Benefit Express (includes social security number, gender, and date of birth). If any of this information is not correct your dependent will not be found as covered under the plan.

For prescription coverage, you WILL receive a separate card for each dependent with their name on it. Your pharmacy will require you to use the correct card to fill and pick up a prescription for your dependent.

RESOURCES

Q: HOW DO I FIND A NETWORK DENTIST?A: To find a dentist in the Delta Dental Network,

please follow the below steps:• Visit deltadentalil.com and select “Find a

Provider” at the top of the page and click on “Dental”

• Enter the required fields, search criteria either network (PPO or Premier)

Vision Benefit PlanQ: WHAT ARE THE VISION PLAN NETWORKS?A: The AMITA Health Vision plan utilizes the VSP

Choice Network. If you see a non-network provider, you are eligible for reimbursements through VSP. Please refer to the plan summary available in the Benefit Express Library for more details.

Q: HOW DO I FIND A DOCTOR IN THE NETWORK?A: To find a doctor in the Network, please follow the

below steps or call 1.800.877.7195 to speak to representative.1. Visit www.vsp.com and select “Find a Doctor”

at the top of the page2. Enter the required fields, search criteria and

select “Choice” network

Q: AM I GOING TO RECEIVE A NEW VISION ID CARD?A: No, there is no ID card necessary. At your

appointment, tell your provider you have VSP. Once enrolled, if you’d like a card as a reference, you can print one on www.vsp.com.

Connect Your Care – Flexible Spending Account (FSA)Q: WHAT IS A FLEXIBLE SPENDING ACCOUNT (FSA) AND WHY SHOULD I ENROLL IN ONE?A: A Flexible Spending Account is a tax-advantaged

account that allows you to use pre-tax dollars to pay for qualified healthcare or dependent care expenses. You choose how much money you want to contribute to an FSA at the beginning of each plan year and you can access these funds throughout the year.

Q: HOW CAN I ACCESS THE FUNDS IN MY HEALTHCARE FSA (HFSA)?

A: Funds in the account are easily accessed with the payment card. Your account balance is available at any time online, through the mobile app, or over the phone.

Q: HOW MUCH CAN I CONTRIBUTE TO MY HEALTHCARE FSA?

A: Healthcare FSA contributions are limited in 2020 to $2,750 pending IRS changes.

Q: WHAT ARE HEALTHCARE FSA ELIGIBLE EXPENSES?

A: There are hundreds of eligible expenses for your HFSA funds, including prescriptions, some over-the-counter items, doctor office copays, health insurance deductibles and coinsurance. FSA funds may even be used for eligible expenses for your spouse or federal tax dependents. More information is available on the Connect Your Care website at www.connectyourcare.com.

Q: HOW DO I SUBMIT A CLAIM FOR REIMBURSEMENT?

A: Paying for an HFSA expense is easy when you use your HFSA debit card. If you do not use your card, you can quickly and easily create a claim online. Reimbursement is available via US Mail or through Direct Deposit. Always keep your receipts in case Connect Your Care sends a receipt required request to you.

Q: WHEN WILL I GET MY HFSA DEBIT CARD?A: You will receive your HFSA debit card after

you have completed your enrollment and the deduction has been taken on your pay statement.

Q: WHAT IS A DEPENDENT CARE FSA?A: A Dependent Care Account is an alternative

to the Dependent Care Tax Credit and covers dependents and certain elder care expenses while you are at work (special requirements apply). If you work and have children, or a disabled spouse, you know how important it is to have reliable and affordable care for them while you are at work. A Dependent Care Account allows you to pay for these expenses and get a tax break at the same time. Expenses must be for qualifying dependents.

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Q: HOW MUCH CAN I CONTRIBUTE TO MY DEPENDENT CARE FSA?

A: A: Dependent Care FSA contributions are limited by the IRS to $5,000 per year if you are married and filing a joint return, or if you are a single parent. If you are married and filing separately, you may contribute up to $2,500 per year per parent. You can only be reimbursed up to the amount deposited into your DFSA at the time of your claim.

Q: WHAT ARE DEPENDENT CARE ELIGIBLE EXPENSES?

A: Typical expenses under this account include charges for day care, nursery school, and certain elder care for your legal dependents. You cannot submit claims for medical, dental, vision services, etc. as these types of claims are for a Health Care FSA (HFSA). More information is available on the Connect Your Care website at www.connectyourcare.com.

Q: WHAT ARE THE ELIGIBLITY REQUIREMENTS FOR A DEPENDENT CARE ACCOUNT?

A: To be reimbursed through your Dependent Care Account for child and dependent care expenses, you must meet the following conditions: • You must have incurred the expenses in order

for you and your spouse, if married, to work or look for work, unless your spouse was either a full-time student or was physically or mentally incapable of self-care

• You cannot have made the care payments to someone you can claim as your dependent on your federal tax return or to your child who is under age 19

• Your filing status must be single, qualifying widow(er) with a dependent child, married filing jointly, or married filing separately

• You and your spouse must maintain a home that you live in for more than half the year with the qualifying child or dependent

Legal Plan BenefitQ: WHAT IS COVERED BY MY LEGAL PLAN?A: The Hyatt legal plan provides fully covered

attorney services for the most frequently needed personal legal matters, in addition to advice and consultations on an unlimited number of personal legal matters.

Q: WHAT MATTERS ARE EXCLUDED?A: The following matters are excluded from all plans:

• Employment-related matters, including company or statutory benefits

• Matters involving the employer, Network Attorneys, MetLife and affiliates

• Matters in which there is a conflict of interest between the employee and spouse or dependents, in which case services are excluded for the spouse and dependents

• Appeals, class actions, patent, trademark and copyright matters

• Farm and business matters, including rental issues when the plan member is the landlord

• Costs, fines, frivolous or unethical matters or matters for which an attorney-client relationship exists prior to the participant becoming eligible for plan benefits

This benefits material briefly describes the excellent benefits program that is available as part of employment with AMITA Health. This information is not a contract. Any of the benefits, policies or procedures may be changed as the organization requires, and nothing contained in this material shall be construed as creating an expressed or implied obligation or contract on the part of the AMITA Health. All Plan documents prevail should there be any errors or discrepancies in this document.Ministries may have variances between benefits for Long-Term and Short-Term Disability offerings. You must review plan documents in Benefit Express which will show the specific plan information for your ministries plan benefits. All Ministry Plan documents prevail should there be any errors or discrepancies in this document, on the intranet, or in distribution.

RESOURCES

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