Enrollment Guide - Centra Health...Your Benefits Enrollment Guide Page 7 Wellpower: A Wellness Program for Centra Employees Whether managing a chronic disease, choosing a doctor or

2017 BENEFITSEnrollment Guide

YOUR CENTRA REWARDS

Dear colleague,

I am pleased to provide you with the 2017 Centra Benefits Plan. Centra remains committed to providing a market-competitive benefits package that provides quality coverage for you and your family. Offering value and choices to employees is a guiding principle for the Centra Benefits Plan, and each year we listen carefully to your feedback in order to understand what’s important to you in terms of your medical coverage options. We share a common goal - - to continually assesses our benefit programs and make enhancements and adjustments which allow us to provide competitive benefits at a sustainable level.

Health and wellness decisions are very personal and require careful consideration. I encourage you to review the Centra benefits guide in its entirety and make the choices that best fit your needs. As you review these materials, you will find several enhancements pertain to Urgent Care and “Virtual Physician Visits.” You will also find details regarding enhanced vision and dental plans.

In 2017 you will again have the opportunity to participate in a variety of activities through the Human Resources’ Wellpower initiative. Be sure to review discounts and resources available to you in the Wellpower section of the Centra benefits guide. It’s all part of your Total Reward’s package as we continue this journey toward an ever-healthier workforce.

Log into the Lawson Benefits Employee Self Service (BESS) to find additional tools and resources to help make those important decisions for you and your family. If you have any questions, please contact a benefits representative in our HR offices.

Wishing you and your family a healthy and productive year in 2017! Sincerely,

Jan WalkerChief Administrative Officer & Senior Vice PresidentCentra

YOUR CENTRA REWARDS

TABLE OF CONTENTS

4 What’s Changing for 2017

6 YourCentraBenefitsandTheirValue

7 Wellpower

11 HowYourChoicesBenefitsWork—AnOverview

15 MakingBenefitChangesDuringtheYear

17 MedicalCoverage

19 EmployeeCostComparisonChart

20 MedicalPlanCoverageChart

22 2017Bi-WeeklyHealthInsuranceRates

23 DentalCoverage

25 VisionCoverage

26 LongTermDisability

27 VoluntaryShortTermDisability

28 Life&AccidentalDeath&Dismemberment(AD&D)Insurance

30 Long Term Care

31 FlexibleSpendingAccounts

36 PaidTimeOff

37 MatchingTaxDeferredSavingsPlan

39 OtherImportantInformation

40 DoYouHaveQuestions?

41 Non-DiscriminationNotice

Page 4Your Benefits Enrollment Guide

Centra continuously reviews its employee benefits package for opportunities to increase benefits and decrease costs. The 2017 annual open enrollment period is here, and we are pleased to share with you great news about several benefit enhancements for eligible Centra employees! As you give careful consideration to what you and your family will need in the coming year, think about how to use your benefits wisely and still take advantage of their value.

One question you may ask is, “Can I really save money leveraging my medical benefits?” Yes! Here are a few ideas:

STAY LOCAL:

One of the easiest ways to save money is to take advantage of services already available in the Central Virginia area whenever possible. You can avoid paying additional coinsurance for an out-of-network provider as well as save the medical plan expenses that are incurred at a more expensive

What’s Changing for 2017

facility. Outlying facilities that do participate in the PCHP network can also result in increased costs as rates can be as much as 40-50% higher than Centra.

USE URGENT CARE FACILITIES:

Avoid the Emergency Department by going to an urgent care facility! Several urgent care facilities are now available in the PCHP network with extended hours for your convenience with no appointments necessary. For a $50 copay, you can shorten your wait time and avoid the added expense of an emergency room visit. Centra’s new urgent care office is now available seven days a week, Monday through Thursday, 8 am – 8 pm and Friday and Saturday 8 am – 6 pm. X-ray services and treatment for a wide variety of conditions are available. Centra also offers urgent care at the Centra Danville and Centra Southside medical centers. Visit the “Find a Provider” list and search by type “Urgent Care” at www.PCHP.net for a full list of providers, locations, and hours.


TRY VIRTUAL PHYSICIAN VISITS:

Need an appointment immediately? Don’t want to miss time from work? Try using the new virtual visit service! For only a $20 co-pay, you can be treated for a variety of common illnesses and injuries through online access to a provider via a mobile device or computer, directly from the comfort of your own home or office. Providers of this convenient and time saving service can diagnose conditions, prescribe non-narcotic medications, and recommend further treatment when required. Watch for more information in January!

CHECK OUT CVS MINUTE CLINICS:

Traveling or living outside of Lynchburg? CVS Minute Clinics are now participating with PCHP! Members can be seen in any CVS Clinic, regardless of city or state location, for a PCP co-pay of $25. This is a convenient new option when care is needed outside the Centra Virginia area.

CHOOSE A CENTRA INFUSION CENTER:

The infusion centers at Virginia Baptist Hospital, Bedford Memorial Hospital, and Southside Community Hospital will be providing convenient infusion therapy at the lowest cost to Centra medical plan participants. As of 1-1-17, a visit to a Centra center will be available for a specialist co-pay of $50. All services at other non-Centra infusion centers/offices will be subject to deductible and co-insurance.

What other important changes are coming for 2017?

ENHANCED VISION PLAN:

Now’s the time to check out the enhanced benefits available to Centra employees under our new vision provider: EyeMed! Enjoy a huge selection of lenses and frames, virtual “try on” technology, a 40% additional pair discount, and discounts at

Sunglass Hut! The KidsEyes benefit includes 2 annual eye exams, 40% off replacement glasses, and lens exchange if vision changes within the same year. Several enhanced diagnostic evaluation services are available for diabetic patients. There’s even a discount benefit for hearing exams and hearing aids! All of these services are now available a premium increase of less than 20 cents per month!

ENHANCED DENTAL PLAN:

After careful review of market data for total member value for dental plan providers, Centra is now offering Anthem Dental. Advantages for participants thru this vendor change now include a $500 additional orthodontic benefit, a $250 “carryover” allowance for members who use less than half of their benefit in a calendar year.

NEW PHARMACY BENEFIT MANAGER:

Rising drug costs are a common trend in the U.S. In an effort to minimize increasing expenses, Centra reviewed several pharmacy benefit managers and will transition from Optum Rx to CVS Caremark (CVSC). Based on favorable financial results, there will be no change in co-pays for participants! Members will continue to enjoy the benefit of receiving a 90-day mail order discount at any participating pharmacy. Don’t forget - you can pay the lowest co-pay and save money by taking generic medications whenever possible. The Pearson Cancer Center (PCC) pharmacy will also be added to the CVSC specialty pharmacy network, providing a more convenient and time saving option for PCC patients.

MEDICAL PLAN PREMIUMS:

Despite the many ways Centra has found to minimize increases in expense to the plan and its 11,000 employee and dependent members, overall costs are expected to rise in 2017. While there will be a modest increase to premiums, Centra continues to pay 75% of total plan expense.


Your benefits add a significant amount to your total pay—more than 25 percent of your salary! Centra works hard to provide a comprehensive benefits program at market competitive premiums. We offer you the flexibility to meet your changing needs. Centra pays a large percentage of the cost of many of your Choices benefits.

For those Choices benefits that are not subsidized, we negotiate reduced group rates with our vendors and pass the lower rates on to you. In most cases, you do not have to prove that you or your dependents are healthy to elect a benefit. We also provide you the opportunity to pay for a majority of your benefits with tax-free dollars so you get the most from your paycheck.

The Centra benefits program enables you to choose among a variety of options (including whether to even have the coverage) based on your needs.

The Centra “Choices” benefits package includes:

• Medical • Dental • Vision • Voluntary Short Term Disability • Long-Term Disability • Basic Employee Life and Accidental Death

and Dismemberment (AD&D) Insurance • Voluntary Employee Life Insurance • Voluntary Accidental Death and

Dismemberment (AD&D) Insurance • Dependent Life Insurance • Long Term Care• Health Care Spending Account • Dependent Care Spending Account • Retirement Savings Plan

Your work status (full time or part time) will determine your eligibility for each option in this package.

YourCentraBenefitsandTheirValue


Wellpower:AWellnessProgramfor CentraEmployees

Whether managing a chronic disease, choosing a doctor or simply deciding what to eat, making smart choices about your health affects how you feel each and every day. Wellness is more than a choice, it’s your will to make healthy decisions each day. We want to help you find your Wellpower! Our focus is to provide programs and tools to help you take charge of your health and improve your quality of life through healthy habits.

For more information on the Wellpower program, please visit the Wellness tab on the HR homepage of CentraPeople or contact Employee Wellness Program Manager, Corrin McCloskey.

PROGRAMOFFERINGS AND DISCOUNTS

Weight Watchers Discount

Weight Watchers provides information, knowledge, tools and motivation to help you make the decisions that are right for you about nutrition

and exercise. There are two options offered at a 50% discount for Centra employees: (1) Essentials Program On-Line or (2) Meetings Program with convenient meeting locations at work or in the community.

N.E.W. Healthy Lifestyles Discount

This eight week course teaches participants about nutrition, exercise and weight management. N.E.W. is based on the volumetrics eating plan. The program is offered to employees at a 50% discount. Employees are able to attend community classes or request their own class with eight participants.

Central Virginia YMCA Diabetes Prevention Program

If you’re at risk for type 2 diabetes, you can make small, measurable changes that can reduce your risk and help you live a happier, healthier life. Through the employee wellness program, medical plan participants may be eligible for reimbursement once completing the program. The program features 25 sessions delivered over the course of one year led by a trained Lifestyle Coach in a group setting that offers motivation and support. For more information about the Y at 434.582.1900.

YMCA Discount

The YMCA is a nonprofit organization focused on youth development, healthy living and social responsibility. Employees are eligible for a

25% discount at participating YMCA locations. View CentraPeople for a complete list. Contact your local branch for more information.

Bodymind App

The Bodymind App is designed to help you incorporate mindfulness and meditation into your daily life. Centra employees have access to hundreds of hours of guided meditation and mindfulness programs created to support you with stress, insomnia, pain, focus and much, much more. Sessions range from 3 minutes to 30 minutes. Each session is guided by expert teachers, psychologists, and doctors who talk you through each moment of the streaming meditations, as if you were in a private session. This resource is provided at no cost to you! Visit CentraPeople for more information.


Bowen Wellness Center at Lynchburg General Hospital

The Bowen Wellness Center is operated by the YMCA of Central Virginia and serves Centra employees by offer a variety of group fitness classes, a cardio area outfitted with treadmills, ellipticals and bicycles as well as a functional fitness space for personal training. For more information, call (434) 200-7097.

Fitness Challenges & Race Subsidies

Twice annually Centra holds organization wide fitness challenges: the Strive for Five Challenge to complete 30

minutes of exercise five days a week beginning April 1 and the 100-Mile Challenge to run or walk 100 miles in 90 days beginning July 1. As part of the 100-Mile Challenge, Centra subsidizes race participation in several local races.

Flu Shots and Vaccines

Centra provides annual flu shots and required vaccines to employees through Employee Health at no cost.

Women & Children’s Services Education Discount

Centra holds a variety of classes to help mothers and families. Classes include Baby

Basics, Breast Feeding, Infant Safety and Family Nutrition. Centra employees are provided a 20% discount for all classes. Please call (434) 200-4537 to receive the discount.

Employee Assistance Program

The EAP provides confidential, professional help to Centra employees and their families at no cost. EAP offers help with

substance abuse, legal problems, grief and loss, as well as stress related to medical problems, financial strain or the work place. EAP is available 24 hours a day, seven days a week at (800) 645-1246.

(800) 645-1246 (Nationally - Toll Free)

(434) 845-1246 (Within the Central VA area)


Tobacco free campus

Centra provides a healthy and tobacco-free environment to its employees, patients, and visitors. The sale and use of tobacco products is prohibited

on Centra property, including buildings, grounds, parking lots, sidewalks, vehicles, ramps and plazas.

Tobacco Cessation Education & Replacement Therapy

All Centra employees are eligible for a 100% reimbursement for a six-week supply of nicotine replacement therapy. Medical plan participants can access this though the medical plan. All other employees must complete and return the reimbursement form on CentraPeople. Centra also offers Be Tobacco Free classes and one-on-one counseling from a certified Tobacco Treatment Specialist at no cost. For information, call (434) 200-3812.

Preventative Check-ups and Screenings*

Participants are allowed one annual wellness visit and select health screenings at no cost. View prevention section of the

benefits guide for more information.

Waived co-pay for disease management*

Participants that have been diagnosed with high blood pressure, high cholesterol or diabetes can visit their Primary Care Physician without paying a copay.

Navigation Services through PCHP*

Confidential and personalized health counseling provided by a trained nurse navigator at no cost to benefit plan participants who qualify for services based on health needs.

BounceBack*

A new low back pain treatment created to improve the way low back pain is treated. For more information regarding this program, or to make an appointment, please call (434) 200-2102.

Healthy Families Center Discount*

This six-month program offers clinical, multi-disciplinary help to individuals and their families to help them achieve and maintain a healthy weight. This is a voluntary and confidential program designed as a resource to help those with chronic weight issues facing weight related illnesses and complications with a Body Mass Index greater than 35. For more information, call (434) 845-2270.

*Services for Medical Plan Participants Only. As part of the Centra Medical Plan, employees and their spouses and dependents are eligible for select wellness related benefits. For more information on medical plan coverage, view the complete medical plan document in Lawson.

CULTURE OF WELLNESS

In addition to our programs and discounts, we recognize the importance of creating a culture of wellness through environmental changes.

Our cafe, vending, facility and ground services are all committed to looking for opportunities to encourage wellness. Some of our current projects include:

• Salad bar punch cards at hospital cafes • Expanding walking paths at

large campuses • At least 35% healthy options in all

vending machines


PREVENTION

Each year as part of the Centra medical plan, health assessments and screenings are available at no cost to the employee. These tools identify potential health issues and provide resources to support any actions the employee chooses to take.

Preventive Guidelines for Adults

To stay healthy, adults need preventive checkups and screenings. With the Centra medical plan, all participants are entitled to one wellness visit annually at no cost to you. Additionally, if you have been diagnosed with high blood pressure, high cholesterol or diabetes you can visit your doctor without paying a copay.

The U.S. Department of Health & Human Services offers guidelines that describe the preventive services that most adults need. Depending on your personal health care needs or risk factors, your doctor may give you a different schedule. If you think you may be at risk for a particular condition, talk to your doctor.

Screenings for Men and Women

Ages 21 & Older

• Annual physical exam • Weight screening for obesity• Blood pressure: At least every 2 years if

blood pressure is less than 120/80 and every year if systolic measure is 120-139 or diastolic measure is 80-90

• Cholesterol: every 5 years for men and women ages 20 and older

• Diabetes: every 3 years for patients with select risk factors

• Colonoscopy every 10 years

Screenings for Women Only

• Breast cancer: routine screening every 2 years for women aged 50 to 74 years

• Cervical cancer: Pap smear every 3 years for ages 21-29; for women ages 30-65, Pap smear alone every 3 years OR a combination of Pap smear and HPV testing every 5 years

• Cystic Fibrosis carrier screening: for women of child-bearing age, preferably before conception

• Osteoporosis: Begin at age 65 or older for women at average risk

Screenings for Men Only

• Prostate cancer: discuss the possible benefits and harm of screening and treatment with your doctor.

• Aortic abdominal aneurysm: one-time ultrasonography for men ages 65 to 75 who smoke or have smoked.

Visit www.hhs.gov to see a complete list of preventative services covered under the Affordable Care Act. For more information about the Centra medical plan, view the complete plan document in Lawson or call Member Services at the phone number on your ID card to verify your benefits.


HEALTH CARE BENEFITS

The cost of your medical, dental and vision coverage varies depending on which benefit option and coverage level you elect.

The Choices program has five different coverage levels for your health care benefits so you have the flexibility to cover the family members you need to cover without more premium costs than necessary. You may choose from the following coverage levels:

• Employee only • Employee and child • Employee and children• Employee and spouse • Family coverage

The Choices Medical Plan offers three options—a Basic POS (Point of Service) option, an Open Access PPO (Preferred Provider Organization) Option, and a Consumer Driven Health Plan POS option. Your premiums and out-of-pocket expenses will vary depending on which option you choose.

ELIGIBILITY

You are eligible for coverage if you are a regular full-time or a regular part-time employee. Your eligible dependents also can be covered.

Your eligible dependents include:

• Your spouse (legally married wife or husband)

• Your child(ren) up to age 26• The term “children” shall include natural

children, step children, adopted children, children placed with a covered Employee by an authorized placement agency or by court order. If a covered Employee is the Legal Guardian of an unmarried child or children, these children may be enrolled in this Plan as covered Dependents.

• Your disabled child – your dependent child more than 26 years of age who is unable to earn a living and is dependent on you for support.

ImportantReminder:yourdependentsmustmeeteligibilityguidelinesinordertobecoveredunderyourplan(s).Whenyoumakeelectionson-linetocoverdependentsonCentrabenefitplans,youareconfirmingtheireligibility.Addingdependentsthatdonotmeeteligibilityguidelinesisaviolationoftherulesgoverningtheseplans.

HowYourChoicesBenefitsWork—AnOverview


SPOUSALSURCHARGEON MEDICALCOVERAGE

If your spouse is eligible for employer sponsored group medical coverage through another employer, and you choose to cover them on your Centra medical plan, you will pay an additional $50 bi-weekly for medical insurance. This charge will not apply if your spouse is 1) self-employed, 2) unemployed, 3) employed at Centra, or 4)covered under a private medical insurance policy, retiree medical, COBRA, Medicare, or Tricare.

TOBACCOSURCHARGEON MEDICALCOVERAGE

If you are a tobacco user, you will pay an additional $24.92 bi-weekly for medical coverage. However, Centra is committed to helping you achieve your best health status. If you think you might be unable to meet a standard for a discount, you might qualify for an opportunity to earn the same discount by different means. Contact us at 200-5249 and we will work with you to find a wellness program with the same discount that is right for you in light of your health status.

NEWLYELIGIBLEEMPLOYEES–ENROLLMENT DEADLINE

If you are a new hire or newly eligible for benefits, you must make your benefit elections no later than 31 days from your hire or transfer date. If you do not make your elections within those 31 days, the only benefits you will receive will be long-term disability coverage, if eligible, and basic life insurance, if eligible.

IFYOUANDYOURSPOUSEBOTHWORKFOR CENTRA

If you and your spouse both work for Centra and you both are eligible for benefits, please keep the following points in mind when you enroll for health coverage:

• You can each be covered as an employee or as a dependent, but not both.

• If each of you is covered as an employee, your dependent children may be covered by either of you, but not by both.

LIFE,AD&DANDLONG-TERM DISABILITY BENEFITS

The Choices benefits program provides basic life, AD&D and long term disability benefits at no cost to you. You may choose to buy additional life, AD&D or disability benefits if you need additional insurance. Your AD&D and long-term disability premiums are paid on a before-tax basis, which puts a little more money in your paycheck than if you purchased the added coverage with after-tax dollars.

If you elect additional employee life insurance or dependent life insurance coverage, your premiums will be paid on an after-tax basis. By paying these premiums with after-tax dollars, you avoid the additional taxes that the IRS requires on life insurance coverage in excess of $50,000.


FLEXIBLESPENDINGACCOUNTS

The Choices flexible spending account program offers you a chance to use part of the money you would normally pay in taxes to pay certain health care and/or dependent care expenses. If you choose to participate, you elect an amount for Centra to take out of your paycheck – before federal, state and Social Security taxes are withheld – and deposit into your Health Care and/or Dependent Care Spending Account. Then when you file claims during the year, you are reimbursed with tax-free dollars. Setting aside before-tax dollars in a spending account lets you typically save 25% to 35% in taxes on your out-of-pocket costs.

ENROLLMENT CONSIDERATIONS

As you make your Choices benefit elections, keep these important questions in mind and look at how each plan option covers these circumstances.

• Am I a tobacco user who is ready to quit?• Will I add any dependents to my

coverage during the year?• Do I, or any of my family members, have

any chronic health conditions?• How do we use health care? Do we tend

to have serious illnesses or accidents? Do we primarily have easily treated short-term illnesses, like colds and flu?

• Will any of us need planned hospital care this year?

• Are our health care needs different than they were in the past?

• What were my total out-of-pocket expenses last year?

• Do any family members have other coverage?

EFFECTIVEDATES

If you are a new hire, your medical, dental, vision, spending accounts, life, AD&D, and group disability benefits begin the first of the month on or after your date of hire. If you are newly eligible due to a status change, your benefits begin the first of the month following the date you return your enrollment forms. If you don’t enroll within 31 days of your hire or transfer date, you’ll have to wait until the next annual enrollment to enroll - unless you have a qualified status change.

Your annual open enrollment Choices benefit elections go into effect on January 1 each calendar year, and remain in effect for the entire year - unless you have what’s known as a qualified change in status. (See “Making Benefit Changes During the Year” for more information.)


Benefit Full-TimeCoverage Part-TimeCoverageNewlyEligibleCoverage

(full-timeonly)

MedicalCurrentbenefitelectionlevelatthetobaccouserandspousalsurchargerate

Currentbenefitelectionlevelatthetobaccouserandspousalsurchargerate

None

DentalCurrentbenefitelectionandcoveragelevel

Currentbenefitelectionandcoveragelevel

None

VisionCurrentbenefitelectionandcoveragelevel

Currentbenefitelectionandcoveragelevel

None

VoluntaryShortTermDisability

Currentbenefitelection None None

LongTermDisability Currentbenefitelection None 60%Option

BasicLifeandAD&D Currentbenefitelection None 1xBasePay

VoluntaryLife Currentbenefitelection None None

VoluntaryAD&D Currentbenefitelection None None

DependentLife Currentbenefitelection None None


Currentbenefitelection None None

Long Term Care* Currentbenefitelection None None

HealthCareFlexibleSpending

None None None

DependentCareFlexibleSpending

None None None

IF YOU DO NOT ENROLL

If you don’t enroll for benefits upon hire and during annual enrollment each year, and don’t complete your Annual Open Enrollment Affidavit, your benefit coverages will default to the following:

ElectingLongTermCareinsuranceasanemployeemorethan31daysafterhirerequiresproofofgoodhealth.Spouseelectionsalwaysrequireproofofgoodhealth.


The enrollment decisions you make during the Choices open enrollment will stay in effect from January 1 to December 31. You may change certain coverage elections during the year only if you have a qualified change in status, as defined by the IRS, and your election change is consistent with your change in status. Generally, your election change must correspond with you or a family member gaining or losing eligibility for coverage as a result of a change in status. You must make election changes within 31 days of your change in status.

Change in status rules are briefly summarized below.

RULESFORCHANGINGYOURBENEFITSDURINGTHEYEAR

During the year, you can change your medical, dental, vision, voluntary AD&D insurance coverage, and your contributions to your Health Care and/or Dependent Care Spending Account, for any of the following reasons:

• Marriage • Birth, placement for adoption or

adoption of a child • Start of your spouse’s or an eligible

dependent’s employment • Increase or decrease in hours worked

by you, your spouse or your eligible dependent that affects your, or your family’s, eligibility for benefits

• Going on or returning from some types of unpaid leaves of absence (applies to you or your employed spouse)

• Issuance or cancellation of a Qualified Medical Child Support Order

• Loss of coverage under a spouse’s plan due to their termination of employment

• Divorce, legal separation or annulment • Death of your spouse or a child

• Child’s loss of eligibility due to age or marital status

• Entitlement to Medicare or Medicaid

Unless you are changing to or from full-time status, you cannot change the following coverages during the year:

• Basic Employee Life and AD&D Insurance

• Voluntary Employee Life Insurance • Long-Term Disability Insurance

Unless you are changing to or from full-time status or you are gaining dependents for the first time (such as through marriage or birth of a child), you cannot change your dependent life election during the year.

SPECIALRULESFORVOLUNTARY LIFE INSURANCE

You will be able to increase your level of voluntary coverage by one option at each annual enrollment. For example, if you have one times pay basic coverage and one times voluntary life insurance coverage, you can elect only two times pay in voluntary coverage.

CHANGINGFROMPART-TIMETOFULL-TIME STATUS

If you had previously been a full-time employee and you are now changing from a part-time status back to full-time, there’s a special rule that applies. If you have had part-time status for more than one year, you can make new life and long-term disability elections without any limitations. If you have had part-time status for less than one year, you can only elect the level of life and long-term disability coverage you had in effect when you were previously a full-time employee.

MakingBenefitChangesDuringtheYear


For example, you are full-time in February and have 60% of pay disability coverage, and one times pay in basic life insurance, and two times pay in voluntary life insurance. At that point you decide to go to part-time status, so you are not eligible for life or disability coverage as a part-time employee. You are limited to the 60% of pay disability, one times pay basic life insurance, and two times pay voluntary life insurance, if you return to full-time in less than one year.

OTHERRULESCONCERNINGENROLLMENTOPTIONS

Listed below are other rules that affect your choices after the plan year begins:

• If you are rehired within 60 days of your termination of employment, your prior plan elections must be reinstated. You cannot make new benefit elections (unless you missed an annual open enrollment event). If you are rehired after 60 days, you can make new elections.

• If you involuntarily lose other health coverage, you get married, or you gain a dependent due to marriage, birth or adoption, you can add all your dependents to your medical, dental or vision coverage at the time of the status change event.

• If you don’t enroll in Long Term Care insurance within 31 days of hire, proof of good health will be required to enroll in this benefit later.

ADDITIONALRULESFORCHANGINGYOURBEFORE-TAXDEPENDENT CARE ELECTIONS

You may make mid-year changes to the amount you contribute to your Dependent Care Spending Account if you have an increase or decrease in the cost of day care coverage because of a fee increase or decrease (not applicable if your day care provider is your or your spouse’s parent, sibling or child) or if you change day care providers.

IMPORTANTFAMILYSTATUS CHANGEREMINDER!

If you experience a qualified change in family status such as the birth of a new baby, or a child who reaches age 26 and is no longer your dependent, be sure to contact Human Resources to inform them of the change. You have 31 days from the date of your status change to make new benefit elections consistent with your qualified family status change. After 31 days, no benefit changes will be accepted until the next annual enrollment.


Medical coverage is one of the most important benefits available through the Choices benefits program. This coverage can help protect you and your family from extremely high, and very often unexpected, medical expenses.

As Centra focuses more on integrated and collaborative healthcare among physicians, as coordinated by a patient’s primary care provider, we stress how important a significant relationship with a primary care provider can be to your overall wellbeing. Every Centra employee is encouraged to engage a primary care physician and take a more active role in monitoring and maintaining good health.

SPECIALISTREFERRALS

Both the Basic POS and the CDHP PPO options require a referral from a Primary Care Physician (PCP) in order to see a specialist and still receive in-network benefits. If you don’t coordinate your care through your PCP, you will still receive coverage, but your benefits will be lower and you’ll pay more out of your own pocket.

The Open PPO option allows benefits for specialist visits without requiring a referral from a Primary Care Physician. While the deductible is lower for this option, you will pay a much higher premium for this privilege. Our focus on integrated and collaborative care may impact this plan provision in the future.

PCHP’SSERVICEAREA

Staying inside the PCHP network helps Centra provide a reasonable cost sharing model and market competitive benefits. Centra must ensure a predictable and sustainable benefit plan model is maintained in order to offer and manage care on a long term basis. Unless you live in a zip code outside the PCHP service area, you must see in-

network providers that have contracted with PCHP in order to receive the highest in-network benefits possible. Going outside the network for non-emergency treatment or for care that can be provided by a PCHP network provider results in a significant increase in the medical plan’s expenses for both Centra and plan participants. PCHP’s Medical Management department will be closely reviewing requests for out of network care authorization and only approving those that are necessary for the wellbeing of the participant.

COVERAGEOPTIONS

The Choices Medical Plan includes three coverage options - a Basic Point of Service (POS) option, an Open Preferred Provider Organization (PPO) option, and a Consumer Driven Health Plan (CDHP) (PPO) option. All three medical options cover the same services; however, deductibles, out-of-pocket maximums and premium costs will vary.

Basic POS Coverage

The Basic POS option is for individuals who want a basic level of medical coverage. Premiums are lower than the Open plan, but deductibles are higher. Are you relatively healthy? Do you not require a lot of medical care? You may want to elect the Basic option to ensure you pay the lowest premiums while taking the risk of having to meet a higher deductible if you experience a high cost medical event.

Open PPO Coverage

The Open PPO option offers the same coverage levels as the Basic POS option, but you don’t have to coordinate specialist care through a PCP. The deductibles for this option are lower than the Basic POS & CDHP options; however, if you elect this option, you pay a significantly higher premium.

MedicalCoverage


2017 HSA Limits

AnnualHSAContributionMaximum:$3,450forsinglecoverage,$6,750forfamilycoverage

AnnualCatch-UpContributionMaximum:$1,000(forHSA-eligibleindividualsage55orolder)

HDHPMinimumDeductible:$1,300forsinglecoverage,$2,600forfamilycoverage

HDHPOut-of-PocketMaximum:$6,550forsinglecoverage,$13,100forfamilycoverage

Consumer Driven Health Plan (CDHP) POS Coverage

The CDHP PPO option is the medical plan you must elect if you choose to participate in a Health Savings Account (HSA). It is structured in order to meet the IRS guidelines of a high deductible health plan for HSA participation. Although you will lower premiums, you will pay higher amounts in deductible expenses and office visit coinsurance. Also, there is no prescription drug coverage before meeting your deductible. Essentially, you are taking the risk of paying higher medical expenses now in order to get the triple tax savings from an HSA.

HEALTHSAVINGSACCOUNTS

A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a medical plan that qualifies as a high-deductible health plan. The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual, and funds may be used to pay for qualified medical expenses at any time without federal tax liability or penalty. However, OTC (over the counter) medications cannot be paid with HSA dollars without a doctor’s prescription. Withdrawals for

non-medical expenses are treated very similarly to those in an individual retirement account (IRA) in that they may provide tax advantages if taken after retirement age, and they incur penalties if taken earlier.

An HSA account can be opened at most financial institutions. Centra offers direct deposit of contributions for accounts held at Bank of the James. You will need to complete the HSA payroll deduction form each year to continue direct deposit.

FormoreinformationaboutHealthSavingsAccounts,visitwww.treasury.gov


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CentraMedicalPlanCoverageChartPlanFeature YourIn-NetworkCost YourOut-of-NetworkCost

HospitalServices

Inpatient 20% after deductible40% after deductible and additional $500 per admission deductible

Outpatient 20% after deductible 40% after deductible

Ambulance Service 20% after deductible 40% after deductible

Emergency Room (if admitted) 20% after deductible40% after deductible and additional $500 per admission deductible

Emergency Room (if not admitted) $100 co-pay + deductible + 20% coinsurance $100 co-pay + deductible + 40% coinsurance

PhysicianServices

Primary Care Physician (PCP) Office Visit $25 co-pay 40% after deductible

Allergy Injections $5 co-pay 40% after deductible

Inpatient Care 20% after deductible 40% after deductible

Specialist Visit (in office) $50 co-pay 40% after deductible

Outpatient Surgical Care (in office) $50 co-pay 40% after deductible

Outpatient Surgical Care (in facility) 20% after deductible 40% after deductible

Labs/X-rays (office and independent facility)

20% after deductible 40% after deductible

Wellness Visits $0, as defined in the Summary Plan Description 40% after deductible

PrescriptionDrugProgram

Retail (31 day supply)

Generic - $10 co-pay No coverage

Brand Name Formulary - $35 co-pay No coverage

Brand Name Nonformulary - $60 co-pay No coverage

Mail Order (32 - 60 day supply)




Mail Order (61 - 90 day supply)




PsychiatricServices

Inpatient Services 20% after deductible 40% after deductible and additional $500 per admission deductible

Outpatient Services (in office) $25 co-pay 40% after deductible

Outpatient Services (in facility) 20% after deductible 40% after deductible

SubstanceAbuseServices

Inpatient Services 20% after deductible 40% after deductible and additional $500 per admission deductible

Outpatient Services (in office) $25 co-pay 40% after deductible

Outpatient Services (in facility) 20% after deductible 40% after deductible

MedicalPlanCoverageChart

The following chart is a partial list of what’s covered under the Basic POS and Open PPO options of the Choices Medical Plan. Refer to the Medical Plan Employee Cost Comparison Chart for how the CDHP previsions would change the listing for that option. Refer to the SPD for detail.


MASTECTOMYCOVERAGE

In accordance with the “Women’s Health and Cancer Rights Acts of 1998,” the Choices Medical Plan coverage for mastectomies includes procedures such as reconstructive surgery of the breast on which the mastectomy is performed, treatment to produce a symmetrical appearance following a mastectomy and prostheses. The manner of coverage will be determined by the plan in consultation with the patient and the attending physician. This coverage will be paid according to the normal provisions of the plan. These provisions apply to mastectomies received while either you or your dependent is covered under the plan.

PRESCRIPTIONDRUGCOVERAGE

If you elect one of the Medical Plan coverage options, your prescription drugs are covered automatically under the Choices prescription drug program, as long as you use an in-network pharmacy. The prescription drug program does not provide a benefit if you use an out-of-network pharmacy.

Prescription drug coverage is separated into three tiers. You pay less out-of-pocket when you use

generic drugs or formulary brand name drugs. The generic and formulary medications meet industry standards for quality, safety, efficiency and cost. All drugs have passed through rigorous medical review in terms of quality and accessibility. This list of formulary drugs is updated and reviewed on a regular basis.

Through the convenient mail order program, as well as retail network pharmacies, you can get up to a three-month supply of maintenance medication for 2 1/2 times the cost. This means you save money on your routine and maintenance medications.

To allow you to be sure a prescription drug works for you, the first maintenance medication prescription plus two refills can be filled at the retail pharmacy for a 30 day supply. After those are filled, all future refills for that medication must be filled through the mail order or 90 day retail program. Your prescription will have to be written for a 90 day supply.

Refer to the Medical Plan Employee Cost Comparison Chart and Summary Plan Description for more details on prescription drug coverage under the CDHP option.


MedicalPremiums-increasedbyconditioninredbox

TOBACCO USERS WILL PAY $24.92 MORE PER PAY PERIODSPOUSAL SURCHARGE IS $50.00 MORE PER PAY PERIOD

Basic Full-Time Part-TimeA

Employee Only $34.08 $52.90Employee + 1 Child $76.81 $93.85Employee + Children $100.68 $112.92Employee + Spouse $109.40 $125.17Employee + Family $162.87 $176.60

OpenAccess


CDHP


DentalPremiums Full-Time Part-TimeA


VisionPremiums Full-Time Part-TimeA


ScheduledHoursPerWeektoQualifyforM/D/VBenefits: Full-Time Part-TimeA

Centra 32-40 24-31Long Term Care Division 30-40 22.5-29

Centra is committed to helping you achieve your best health status. If you think you might be unable to meet a standard for a discount, you might qualify for an opportunity to earn the same discount by different means. Contact us at 200-5249 and we will work with you to find a wellness program with the same discount that is right

2017Bi-WeeklyHealthInsuranceRates


PlanFeature In-NetworkBenefits

AnnualDeductible

PerPerson $50

PerFamily $100

PlanFeature

AnnualBenefitMaximum* $1,000

DiagnosticandPreventativeServices

100%ofallowablecharges;nodeductiblerequired100%ofallowablecharges;nodeductiblerequired

BasicServices 80%afterdeductible

Crown,ProstheticandOtherCoveredMajorServices 50%afterdeductible

OrthodonticServices 50%afterdeductible;uptoa$1,500lifetimemaximum

*The annual maximum benefit excludes orthodontia. There is a separate lifetime maximum benefit of $1,500 for orthodontia for each covered member.

The Choices program offers dental coverage separate from your medical plan election. You also can elect to cover your dependents at a different level under the Medical Plan than the Dental Plan.

WHATTHEPLANCOVERS

The following is a list of the services covered under the Choices Dental Plan. For a complete list of what each service covers, refer to the Summary Plan Description.

• Diagnostic and Preventive Services including cleaning, fluoride treatments, exams and X-rays

• Basic Services including fillings, extractions, root canals, oral surgery, denture repair and periodontics

• Crown Services including inlays, onlays, and crowns when teeth cannot be restored with another filling material

• Prosthetic Services including bridges, and partial and complete dentures

• Orthodontic Services including treatment and procedures required for teeth straightening

• Members with certain health conditions are also eligible for additional services. If you are pregnant, diabetic, have certain high risk cardiac conditions, or have cancer and are being treated with radiation and/or chemotherapy you are eligible for one additional cleaning and exam beyond the ordinary limit per year. Cancer patients are also eligible for an additional fluoride application beyond the ordinary limit.

Here’s an overview of your out-of-pocket costs and how benefits are paid.

DentalCoverage


DENTALPLANMAXIMUMS

The easiest way to understand the maximum carryover provision is to think about the montey sitting in its own account separate from any funds available to you through the plan benefits. The terms in the chart will help you understand the maximum carryover provision. The amounts in the chart are benefit year maximums.

DENTALPLANCARRYOVEREXAMPLE

Here’s an example of how your account might work over a period of several years.

TermPlanAnnual Maximum

ClaimThresholdAmount

CarryoverAmountCarryoverAccount

Maximum

DefinitionTheamounttheplanprovidesforcoveredservices.

Thetotalamountofclaimsamembercanfileinonebenefityeartogetthecarryoverreward.

Theamountgivento thememberwhenclaimsare$500or lessfortheyear.

Thetotalamountamembercanbuildupfromcarryoverrewards.

Amount $1,000 $500 $250 $1,000

Year 1 Year 2 Year 3 Year 4 Year 5

Ginastartstheyear

with$0inhercarryover

account.Duringthe

year,shesubmits$325

inclaims.Thisamount

doesnotgooverthe

claimthresholdof

$500,soGinagetsthe

$250carryoverreward

depositedintoher

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casesheneedsitfor

futuredentalservices.

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and$50istakenfrom

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PlanFeature In-NetworkBenefits Out-of-NetworkBenefits

Service/Frequency

VisionExam 12 months

Lenses 12 months

Frames 12 months

ContactLenses* 12 months

VisionExam $10co-payforofficevisit

byanOphthalmologist Planpaysupto$50

byanOptometrist Planpaysupto$50

StandardLenses** $25co-pay

SingleVision Planpaysupto$35

Bifocal Planpaysupto$50

Trifocal Planpaysupto$65

Progressive (tieredschedule) Planpaysupto$65

ContactLenses*

MedicallyNecessary Planpaysupto$120 Planpaysupto$100

Frames

Planpaysupto$100 Planpaysupto$50

The Vision Plan offers better benefits on vision services if you use one of the plan’s preferred providers, listed below as in-network benefits. The following chart is a partial list of what’s covered under the Choices Vision Plan. For a complete list of covered services, refer to the Summary Plan Description.

*EyeMed provides virtual “try on” technology, a 40% additional pair discount, and discounts at Sunglass Hut. The KidsEyes benefit includes 2 annual eye exams, 40% off replacement glasses, and lens exchange if vision changes within the same year. Several enhanced diagnostic evaluation services are available for diabetic patients. Hearing exams and hearing aids are also discounted. See the detailed documents posted in Lawson Benefits Employee Self Service for more information.

**You will pay out of pocket for non-standard features such as tinting.

VisionCoverage


which begins in the first 12 months after your coverage effective date. “Pre-existing condition” means a sickness or injury for which you received treatment within 3 months prior to your coverage effective date. “Treatment” means consultation, care or services provided by a Physician. It includes diagnostic measures and the prescription, refill of prescription, or taking of any prescribed drugs or medicines.

Similarly, if you increase your long-term disability option during a future annual enrollment and you become disabled during that first year due to a pre-existing condition, your disability benefit will be paid under the coverage option in effect in the prior year.

Centra believes it is important to offer protection against the financial impact of an extended illness or injury that prevents you from working. That’s why the Choices program provides eligible employees with a basic level of long-term disability (LTD) coverage equal to 60% of your base pay, at no cost to you. You can also elect a 66 2/3 option by paying the additional cost of that coverage.

Long-term disability benefits are paid after you have been disabled for 90 days. LTD benefits are payable after the 90-day elimination period if you’re unable to perform the regular duties of your job and assuming you have no pre-existing condition. This policy will not cover any total or partial disability which is caused or contributed to by, or results from a pre-existing condition and

CoverageOption CoverageLevel CostofCoverage

1 60%ofbasepay** 100%Company-paid

2 662/3%ofbasepay** Youpaytheadditionalcostofthiscoverage.

LongTermDisability

NOTE:YoucannotchangeyourLTDelectionduringtheyear,evenifyouhaveafamilystatuschange.

EligibilityforLongTermDisabilitybenefitsasafulltimeemployeeisdeterminedbyactualhoursworkedinthe3monthsprior tobecomingdisabled.

**For the purposes of these benefits, the cost of your coverage is based on your base pay as of September 15, 2016 or hire date if after that date. It does not include overtime, Bonuses, commissions or other forms of pay. However, should you become disabled, your benefit will be paid based on your base pay in effect at that time.

Please note: The maximum monthly benefit under both of the long term disability (LTD) options is $10,000.


OptionName: VS14 VS30

WaitingPeriod: 14days 30days

BenefitPeriod: 11weeks 9weeks

Cost: $.713per$10ofweeklybenefit $.485per$10ofweeklybenefit

Benefit: 60%ofbasesalary 60%ofbasesalary

WeeklyBenefitMax: $1,500 $1,500

PreExLimit: 3/6* 3/6*

NOTE: You may not be eligible for benefits if you have received treatment for a condition within the past 3 months until you have been covered under this plan for 6 months. (This also applies to maternity leave!)

Also, if you change your plan from the 30 day wait to the 14 day wait during an open enrollment, and become disabled during the first 6 months of coverage, benefits will be paid at the 30 day wait level.

*For the purposes of these benefits, the cost of your coverage is based on your base pay as of September 15, 2016 or hire date if after that date. It does not include overtime, Bonuses, commissions or other forms of pay. However, should you become disabled, your benefit will be paid based on your base pay in effect at that time.

Short term disability is intended to protect your income for a short duration if illness or injury prevents you from working. (Maternity leave also qualifies.) Benefits can be received during the 90 day long term disability waiting period, but are only paid for the period in which you are disabled (i.e. maternity benefit = 6 weeks for standard delivery and 8 weeks for c-section.) Two benefit options are available:



We don’t like to think about the financial impact an accident or our death could have on our families. But it makes sense to prepare for the unexpected. Your Basic Life and AD&D Insurance coverage is provided by Centra at no cost to you. If you need more coverage, the Choices program offers a variety of additional life and AD&D coverage options to make your family’s future more secure.

For the purposes of these benefits, the cost of your coverage is based on your pay as of September 15, 2016, or your hire date if after that date. It does not include overtime, bonuses, commissions or other forms of pay. However, should you die, your benefit will be paid based on your base pay in effect at that time.

Centra automatically provides life insurance coverage equal to one times your base annual pay, rounded up to the nearest $1,000. If you want more life insurance, you can elect additional Voluntary coverage and pay a small premium.

If you die in an accident, your basic life insurance benefit is doubled. All coverage is rounded up to the next $1,000. This benefit will be paid to your beneficiary. If you suffer dismemberment, such as the loss of an eye or limb, all or part of your coverage amount (depending on your loss) is paid to you. When you reach age 65, the amount of your life insurance benefit is reduced by 35%. At age 70, your benefit is reduced by 50%. See the Summary Plan Description for details.

Because Centra pays for your Basic Life Insurance, the “value” of any life insurance coverage over $50,000 (based on Internal Revenue Service [IRS] tables) will result in taxable income to you. The taxable amount is known as “imputed income.” If applicable, “imputed income” amounts will be taxed on your paycheck.

BASICEMPLOYEELIFEAND AD&D INSURANCE

Your basic employee life and AD&D options are as follows:

CoverageOption 1

CoverageLevel 1timesbaseannualpay

CostofCoverage100%Company-paid- nocosttoyou.

VOLUNTARYLIFEINSURANCE

If you want more life insurance coverage than what’s provided by Centra, the Choices program offers four voluntary life insurance coverage options. You can also waive voluntary life insurance.

CoverageOption

CoverageLevel CostofCoverage*

11 times base annualpay

Youpaythecost ofcoverage







5 Nocoverage

When you reach age 65, the amount of your life insurance benefit is reduced by 35%. At age 70, your benefit is reduced by 50%.

Life&AccidentalDeath&Dismemberment (AD&D)Insurance


VOLUNTARYAD&DINSURANCE

The Choices program allows you to elect voluntary AD&D coverage in addition to the coverage provided by Centra. Your voluntary AD&D options are as follows (all employees can elect #1-5):

CoverageOption Benefit

1 $25,000

2 $50,000

3 $100,000

4 $150,000

5 $200,000

6 $300,000

7 $400,000

8 $500,000

9 NoCoverage

You can elect options 6, 7, or 8 as long as your coverage amount does not exceed 10 times your base annual earnings (determined on September 15, 2016 or hire date if after that date). Any benefit received is in addition to benefits received through your basic and voluntary life insurance coverage.

Voluntary AD&D coverage is also available for your family (same options above). If you elect family coverage, dependent coverage is based on the members of your family at the time of the accident, as follows:

CoverageOption Benefit

SpouseOnly 50%ofemployeebenefit

Spouse&ChildrenSpouse-40%ofemployeebenefit EachChild-5%ofemployeebenefit

ChildrenOnlyEachChild-10%of employeebenefit

If you die in a car accident while wearing a seat belt, the carrier pays an additional 10% of the benefit to your beneficiary (up to $10,000). The Voluntary AD&D Plan does not pay a benefit if you die while: piloting an airplane, on non-prescribed drugs or alcohol, committing a felony, or participating in a riot.

When you reach age 70, the amounts of your AD&D benefits are reduced by 35%. At age 75, your benefit is reduced by another 20%. Further reductions occur as you get older.

DEPENDENTLIFEINSURANCE

While we don’t like to think about the death of a family member, Centra does offer you the option to purchase a limited amount of life insurance for your spouse and dependent children. If you and your spouse both work for Centra, either of you can elect Dependent Life Insurance Coverage for your child, but not both of you. You pay the cost of this coverage on an after-tax basis.

Your dependent life options are as follows:

CoverageOp-tion

Spouse Children

1 $5,000 $2,500

2 $10,000 $5,000

3 $15,000 $7,500

4 $20,000 $10,000

9 No Coverage No Coverage

NOTE: Children may be covered from birth to 19 years (25 years if a full-time student). Spouse coverage will terminate when the Spouse attains age 70.


Plans: Plan1 Plan2 Plan3 Plan4 Plan5 Plan6

BenefitDuration: 3 Years 5 Years 3 Years 5 Years 3 Years 3 Years

FacilityBenefitAmount: $3,000 $3,000 $6,000 $6,000 $3,000 $6,000

AssistedLivingFacility%: 100% 100% 100% 100% 100% 100%

LifetimeMaximum: $108,000 $180,000 $216,000 $360,000 $108,000 $216,000

ProfessionalHomeandCommunityCare:

100% 100% 100% 100% 100% 100%

InflationProtection: N/A N/A N/A N/A Compound Compound

* If you selected an inflation option, and you terminate that inflation option at a future date, you can purchase the inflated coverage amount at your original age.

All active full-time and part-time employees working at least 24 hours per week are eligible for Long Term Care insurance. Newly hired employees can enroll with guaranteed standard issue (no proof of good health) during the first 31 days of employment. Spouses enrolling during this initial enrollment period, as well as all employees enrolling after this initial period, will be required to provide proof of good health to obtain coverage. The benefit waiting period is 90 days, but can be accumulated over a period of 730 days and needs to be satisfied only once during the life of your plan. Benefit options include up to $6,000 and a Facility Benefit Duration of 3 or 5 years.

Long Term Care

EnrolldirectlythroughUNUMbycalling(800)227-4165orlogonto:https://w3.unum.com/enroll/centrahealth/enrollment.aspx


The Choices benefits program offers flexible spending accounts, a tax-advantaged way to pay for qualified out-of-pocket health care expenses, and day care expenses for working parents. This benefit allows you to pay your expenses with “pre-tax” dollars, which means you get a tax deduction for these expenses before you ever file your tax return.

Authorized by the IRS, these accounts let you set aside money from your pay before taxes are withheld. As you incur health care expenses or dependent day care expenses throughout the year, you submit a claim for those expenses and are reimbursed with tax-free dollars from your account. A convenient debit card feature is also available.

The Health Care Account reimburses you for out-of-pocket health care expenses for medical, dental, vision, hearing and prescription drug expenses that are not covered under any of your group health coverages with Centra. You may contribute a minimum of $260 (or $10 per bi-weekly pay period) to a maximum of $2,600 to this account annually.

The Dependent Day Care Account reimburses you for dependent day care expenses you incur in order to allow you and, if married, your spouse to work. When you use these accounts, you reduce your taxable income, so you will pay less in income taxes. You may contribute a minimum of $260 (or $10 per bi-weekly pay period) to a maximum of $5,000 to this account annually.

CLAIMPERIOD:

Both Health Care and Dependent Day Care Spending Account services can be incurred until March 15 of the following year to be eligible for reimbursement, and you have until April 30 to file for reimbursement. Your Flexible Spending Account Claims Kit provides more information.

HOWTHEACCOUNTSWORK

You decide if you want to use the Health Care and/or the Dependent Day Care Account.

• You estimate the amount you will spend on out-of-pocket healthcare expenses and/or day care expenses during the year. Estimate conservatively, and review prior year’s expenses to help you determine what to anticipate for this year. Plan only for predictable expenses.

• You decide how much you wish to set aside into your Health Care Account and/or your Dependent Day Care Account and make that benefit election each year.

• The amounts you wish to set aside into your accounts will come out of your paycheck in equal amounts each paycheck.

FlexibleSpendingAccounts

IMPORTANTNOTE:Yourdebitcardshouldnotbeusedtopaythetotalchargesincurredatyourprovider’sofficeorpharmacy.OnlytheexpensesNOTCOVEREDbyyourinsuranceplan(s)canbepaidfromyourFlexibleSpendingAccount.Useofyourdebitcardforineligibleexpenseswillresultinthedeactivationofyourcarduntilyouvalidateallchargesorrepayineligiblecharges.


• As you incur health care or day care expenses throughout the year, you submit a claim form along with any required documentation of your expenses. You may file claims as often as you wish. Reimbursements may be sent to your home address via check or by direct deposit to a bank account of your choice. You may also choose to use the debit card to pay for eligible Health Care expenses at the time they are incurred.

• Dollars left over in your account at the end of the year are forfeited. You can avoid forfeitures if you plan carefully (review prior year’s expenses to estimate what you will have the next year, be conservative, and plan only for predictable expenses).

THETAXADVANTAGE

Remember, the advantage of using flexible spending accounts is that you don’t pay federal income, state income or Social Security taxes on this money before it goes into your account, and you don’t owe taxes on it when it is paid out to you.

By paying your out-of-pocket health care and day care expenses through the spending accounts, you can lower your taxable income and that means you lower your income taxes. In this way, you add

dollars to your spendable income and that means you have more take-home pay and more money in your pocket!

Visit the Savings Calculator at www.mypayflex.com to estimate your annual spendable income and assist you as you make your decision to participate in a Flexible Spending Account.

* Your increase in spendable income may vary based on withholding elections and state income tax. This illustration assumes 15% federal tax, 3% state tax and 7.65% Social Security/FICA tax.

Without PayFlex

With PayFlex

TotalAnnualIncome $30,000 $30,000

AnnualHealthCareExpenses 720

AnnualDependentDayCareExpenses 3,600

TotalIncomeSubjecttoTaxes $30,000 $25,000

LessDeductions

Federal/StateTaxes $5,400 $4,622

SocialSecurity/FICA 2,295 1,965

AfterTaxIncome $23,305 $19,093

LessDeductions

AnnualHealthCareExpenses 720

AnnualDependentDayCareExpenses 3,600

AfterTaxIncome $17,985 $19,093

AnnualIncreaseinSpendingIncome *$1,108

MonthlyIncreaseinSpendingIncome *$92


MAKINGCHANGES:

If you have a qualified change in your status during the year, you can stop, start, increase or decrease your contributions to either spending account provided the election change is consistent with the qualified status change. For more information see “Making Benefit Changes During the Year.”

HEALTHCAREEXPENSES

Health care expenses include amounts paid for the diagnosis, cure, treatment, or prevention of disease, and for treatments affecting any part or function of the body. You may be reimbursed for qualified health care expenses that meet certain requirements as described below. The entire amount you set aside for your Health Care Spending Account is available to you on January 1st!

• The expenses must be incurred for services rendered after the effective date of your election and during the plan year to which it applies. Expenses are treated as having been incurred when you are provided with the care that gives rise to the expense, and not when you are formally billed, charged for, or pay for the care.

• Each individual for whom you incur the expense is:

• A child under age 26 • A spouse or, • A child over age 26 who is physically or

mentally incapable of self-care.

• The expenses must be for services incurred and already provided, not for services to be provided in the future.

• The expenses cannot have been reimbursed, and must not be reimbursable by insurance or any other source; and you cannot claim the same expenses as a deduction on your annual income tax return.

• Individual insurance premiums, other group insurance premiums, and long-term care expenses are not eligible.

QUALIFYINGHEALTHCAREEXPENSES

You can use your Health Care Spending Account to pay for expenses not paid by any health care plans, including:

• Medical, dental and vision deductibles, co-payments and coinsurance amounts.

• Expenses over plan limits, such as hearing exams and hearing aids, orthodontia and vision expenses (exams, eyeglasses and contact lenses).

• Some (OTC) medications including pain relievers, antacids and allergy and cold medicines such as Claritin – only if you have a prescription for that particular (OTC) medication. Examples of items not accepted for reimbursement include items merely beneficial for good health such as dietary supplements/vitamins. Also excluded are cosmetics and toiletries

• Reimbursements for Insulin do not require a prescription.

NOTE:Youdonothavetosubmitareceiptwhenyourtransactiontotalequalsaco-paymentforamedical,dental,orvisionprovideroraprescriptionco-payment.


Generally, any health expenses that are considered tax deductible are eligible expenses under the Health Care Spending Account. See the PayFlex website for detailed information on reimbursement guidelines.

Note: Ineligible Health Care Expenses

• Cosmetic procedures and medications• Insurance premiums, long term care• Health club memberships/ dues• Home exercise equipment for

general health• Payment of service not incurred during

the period of coverage• Vitamins and dietary supplements for

general health• Over the counter drugs and medicines

for which you do not have a prescription

DEPENDENTDAYCAREEXPENSES

You can be reimbursed for qualifying dependent care expenses that meet certain requirements as described below. Reimbursements can be made up to the amount actually contributed to your account, less prior reimbursements.

1. The expenses must be incurred to enable you to be gainfully (earning income) employed. Gainful employment does not include unpaid volunteer work, or work for a nominal salary. The expense must be incurred for services rendered after the effective date of this election and during the plan year to which it applies. Expenses are treated as having been incurred when you are provided with the care that gives rise to the expense, and not when you are formally billed, charged for, or pay for the care.

2. The expenses must be for a qualifying individual. This includes a dependent of yours under age 13 when the care is provided; or a spouse or other dependent of yours who is physically or mentally incapable of self-care and for whom you can claim an exemption.

3. The services must be provided by an eligible provider of child-care. This includes a licensed day care facility that complies with applicable state and local laws; and any individual who is not a tax dependent of yours, or a child of yours age 19 or older.

4. The expense must be for services incurred, not for services to be provided in the future.

5. The annual expense reimbursement may not exceed the lesser of:

a. your earned income,

b. if married, your spouse’s earned income; or,

c. $5,000 ($2,500 if married, filing separate income tax returns).

6. You must file Form 2441 annually with your individual tax return identifying all your dependent care providers.


QUALIFYINGDEPENDENT CAREEXPENSES

• Work-related expenses incurred so that you and, if married, your spouse can work

• Custodial care for qualified tax dependents; before/after school care

• Preschool/nursery school for pre-kindergarten; day care center expenses for custodial care

• Au pair or nanny dependent care expenses; adult day care expenses

Note: Ineligible Dependent Care Expenses

• Educational/tuition - kindergarten, first grade or higher

• Activity fees or fees for supplies or materials/field trip expenses

• Overnight camp (not even the portion attributable to the daytime cost)

• Payment of services not yet provided (advance payments)

• Payment of services while you are off work due to illness, maternity or other leave, or vacation

PAYFLEXDEBITCARD

As a participant in the Flexible Spending Account (FSA) program, you will be receiving a PayFlex Debit Card to be used to pay for eligible expenses in conjunction with your Healthcare Spending Account. This is a debit card only and in no way will it have an effect on your credit rating. You will be issued one card at no charge. Additional cards can be requested through PayFlex at no additional charge.

The PayFlex Card is designed to allow you a more convenient way to use your Healthcare Spending Accounts at the point of service, reducing the need to file paper claim forms and pay for eligible expenses out of your pocket. Some examples of ways you can use your PayFlex Card are: office visit co-payments, prescription drug co-payments, eligible over-the-counter medicines, dental and vision care that is not covered by the plan such as deductibles and coinsurance.

When using the PayFlex Card, it is very important to remember to keep your receipts for services that you purchase with your PayFlex Card and keep your eligible FSA purchases separate from all other purchases you make at the same location.

You may choose not to use the PayFlex Card and still submit claims via paper or you can use the PayFlex Card for some purchases while submitting paper claims for other purchases.

IMPORTANTNOTE:Yourdebitcardshouldnotbeusedtopaythetotalchargesincurredatyourprovider’sofficeorpharmacy.OnlytheexpensesNOTCOVEREDbyyourinsuranceplan(s)canbepaidfromyourFlexibleSpendingAccount.Useofyourdebitcardforineligibleexpenseswillresultinthedeactivationofyourcarduntilyouvalidateallchargesorrepayineligiblecharges.


Regular full time and regular part time employees are eligible for Paid Time Off (PTO).* PTO starts accruing on the first hour worked and is available for use after three months of employment. PTO can be used for vacation, holidays, illness, and personal time, and can also be used for a Centra recognized holiday in the first three months of employment.

PTO is accrued on each paid hour up to a maximum of 80 in a two week pay period. The maximum amount of PTO that may be accrued throughout the year is 300 hours. Accrual rates are based on years of service per the following schedule:

Years of Service

AccrualRate

Hours Accruedper

80 Hours Paid

PTODaysperYearbasedon80HoursPaid

Biweekly

0–5 0.0923 7.3846 24

5–10 0.1115 8.9231 29

10–15 0.1231 9.8462 32

15–20 0.1308 10.4615 34

20–25 0.1346 10.7692 35

25+ 0.1385 11.0769 36

PTO/EARNEDTIMEBUYBACK

Employees may sell back a portion of their accrued PTO or Earned Time in a calendar year per the following schedule. The on-line request form can be found on the HR homepage.

Lessthan5years 16hoursper12monthperiod

5yearsto10years 40hoursper12monthperiod

Morethan10years 80hoursper12monthperiod

PTODONATION

Employees may donate PTO or Earned Time from their unused balance to their co-workers who may have a personal or family crisis requiring them to take time off from work even when all their

accrued time is exhausted or not available. The donation of time is strictly voluntary and subject to certain guidelines. Please see the Earned Time/Paid Time Off Donation Policy for the guidelines and procedure. Employees may also donate PTO or Earned Time to the United Way and the Centra Foundation during their respective annual campaigns.

CENTRARECOGNIZEDHOLIDAYS

New Year’s Day, Easter, Memorial Day, Independence Day (July 4), Labor Day, Thanksgiving Day, and Christmas Day. PTO must be submitted in order to be paid for a holiday on which an employee does not work.

EXTENDEDILLNESSBANK(EIB)

Centra offers a voluntary program of paid leave time for extended illnesses. Time is not accrued in the EIB, but employees may voluntarily build their EIB account by converting up to 40 hours in a 12-month period to the account. Centra will provide an additional match day-for-day. For example: 5 PTO days convert to 10 EIB days. The on-line PTO to EIB Conversion Request Form can be found on the HR Homepage. EIB time may only be used for an employee’s own illness after an employee initially misses five consecutive days (maximum of 40 hours) of regular scheduled work. This five day wait period is waived in cases of hospitalization requiring an overnight stay or surgery (inpatient or outpatient) when the employee will be out for more than 5 days. It is the employee’s responsibility to request to use their EIB time for a qualified absence.

*Certain Centra employees are eligible for Earned time and Sick time, rather than PTO. And some have a different accrual schedule, usually based on an employment contract. See the Centra Paid Time policy for details.

PaidTimeOff


The Centra Health Matching Tax Deferred Savings Plan is a valuable employee benefit and one of the most powerful ways to build your retirement savings.

AUTOMATIC ENROLLMENT

All employees eligible to participate in the plan may make elective deferrals, and may enroll in the plan at any time following the beginning of employment. The plan includes an automatic enrollment provision, and if you do not opt out of participation, 3% of your pay will be contributed automatically after 30 days of employment. Please see the Automatic Enrollment Notice for more information at centra.trsretire.com.

DEFERRAL LIMITS

You may choose to make pre-tax contributions up to the maximum allowed by law, and you may increase, decrease, or stop your contributions at any time. An annual IRS dollar limit of $18,000 applies for 2017. If you are age 50 or older (or you reach age 50 during the current calendar year), you can make additional catch-up contributions up to $6,000 in 2017. This is not automatic. To take advantage of the catch-up, you must increase your contribution with Transamerica. Both of these limits are indexed annually by the IRS.

EMPLOYERCONTRIBUTIONS

Participants become eligible for matching contributions after 6 months of employment. Centra provides matching contributions on 100% of the first 3% of pay that you contribute, and you are immediately vested in those contributions. Centra may also make an annual discretionary contribution of up to 4% of your base pay on your behalf, based on the performance of the organization. Employees eligible for this base contribution become fully vested after 3 years of employment.

INVESTMENTS

You decide how your account will be invested among the available investment options. You may change your investment allocation at any time. Your contributions under the automatic enrollment provision will be invested in T Rowe Price Target Date Funds based on the year in which you were born. Please see the Automatic Enrollment Notice for more information. Transfers among investment options may be made at any time and may be subject to certain restrictions.

MatchingTaxDeferredSavingsPlan

PortfolioXpressisalsoofferedasaninvestmentservice.Usingthefundsinyourplanandtheretirementyearyouchoose,youwillbepresentedwithadiversifiedinvestmentmixfortodayanda“glidepath”ofadjustmentsfortomorrow.Theserviceautomaticallyadjustsyourmixtobecomemoreconservativeovertimeandrebalancesyourportfolioeachquartertomaintainyourmixofinvestments.


BENEFICIARYDESIGNATION

It is very important that you designate at least one beneficiary for your retirement account so that your assets can be distributed according to your wishes upon your death. You may designate your beneficiary through the Lawson Benefits Employee Self Service (BESS) system.

Keep in mind this is simply a quick overview of the benefits you may be eligible for. For complete plan details or updates, please refer to your Summary Plan Description (SPD). Questions? Visit centra.trsretire.com.

OTHERTAXDEFERREDSAVINGSPLANS

457b Deferred Compensation Plan

Members of a select group of management or key highly compensated employees may also be eligible for this non-qualified savings plan. Centra does not make employer contributions to this plan. For complete plan details or updates, please refer to your Summary Plan Description (SPD). Questions? Visit centra.trsretire.com.

Piedmont Community Health Plan 401k

Employees of Piedmont Community Health Plan are eligible to participate in this plan. Centra provides a 3% matching contribution and may also make an annual discretionary contribution of up to 4% of your base pay on your behalf based on the performance of the organization. This plan does not include an automatic enrollment provision, but the same IRS deferral limits apply. For complete plan details or updates, please refer to your Summary Plan Description (SPD). Questions? Visit PCHP.trsretire.com.


The information in this guide gives you a brief summary of the benefits you can currently choose through the Centra Choices Benefits Program. Centra may change benefits in whole or in part at any time.

All benefits are governed by legal documents and insurance contracts. If there is any discrepancy between this description and the official plan documents and contracts, the documents and contracts will determine the benefits. For purposes of ERISA, this brochure serves as a Summary of Material Modification for all the applicable Summary Plan Descriptions.

MEDICAL,DENTAL,ANDVISION GROUPINFORMATION

Insurance ID cards are mailed approximately 3 – 4 weeks after you enroll.

If you must go to a doctor – or fill a prescription – prior to receiving your ID card you can give your provider the group ID information below, and they can verify you are a participant by contacting the applicable vendor.

OtherImportantInformation

InsuranceIDInformation

BenefitProviderAddress&GroupNumber

Website/Phone/TemporaryID

Medical

PiedmontCommunityHealthPlanPOBox14408Cincinnati,OH45250-0408

Group#5200701

www.pchp.net(800)400-7247TollfreeEmployeeSSNuntilIDcardreceived

PrescriptionDrug

CVS/caremarkP.O.Box52136Phoenix,Arizona85072-2136 RxBIN:004336;RxPCN:ADVRxGRP:RX6925

www.cvscaremark.com(844)460-8768TollfreeEmployeeSSNuntilIDcardreceived

Dental

AnthemBlueCrossandBlueShieldPOBox1115Minneapolis,MN55440-1115

Group#843294

www.anthem.com/mydentalvision(866)956-8607TollFreeEmployeeSSNuntilIDcardreceived

Vision

EyeMedP.O.Box8504Mason,OH45040-7111

Group#1008295

www.eyemed.com(866)800-5457TollFreeEmployeeSSNuntilIDcardreceived


More detail can be found in the Summary Plan Description for each benefit posted in Lawson Benefits Employee Self Service.

If you have questions about enrollment or need help completing forms, you can contact the Benefits Office in Human Resources. If you have questions about a specific benefit, you may want to contact the provider directly:

DoYouHaveQuestions?

Benefit Provider Telephone WebsiteAddress

MedicalPiedmontCommunity HealthPlan

(888)674-3368 www.pchp.net

PrescriptionDrugCoverage

CVS/Caremark (844)460-8768 www.cvscaremark.com

Dental AnthemBlueCrossand BlueSheild

(866)956-8607 www.anthem.com/mydentalvision

Vision EyeMed (866)800-5457 www.eyemed.com

Life/AD&D LincolnFinancialGroup (800)423-2765 www.LincolnFinancial.com

VoluntarySTD LincolnFinancialGroup (800)423-2765 www.LincolnFinancial.com

Long-TermDisability LincolnFinancialGroup (888)238-4840 www.LincolnFinancial.com

Long Term Care UNUM (800)227-4165w3.unum.com/enroll/centrahealth/enrollment.aspx

SpendingAccounts PayFlex (800)284-4885 www.mypayflex.com

403(b)SavingsPlan Transamerica (800)755-5801 centra.trsretire.com

401(k)SavingsPlan Transamerica (800)755-5801 pchp.trsretire.com


Discrimination is Against the Law

The Centra Medical Benefits Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Centra Medical Benefits Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

THECENTRAMEDICALBENEFITSPLAN:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters

o Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:

o Qualified interpreters

o Information written in other languages

CentraMedicalBenefitsPlanNon-DiscriminationNotice

If you need these services, contact Brenda Johnson.

If you believe that the Centra Medical Benefits Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Brenda Johnson, Benefits Manager, 1920 Atherholt Road, Lynchburg, VA 24501; phone 434-200-7668, fax 434-200-7410, email [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Brenda Johnson is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1–800–868–1019, 800–537–7697 (TDD).

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html



Every attempt has been made to ensure the accuracy of this information. Legal Plan Documents will govern Centra Benefit Plans in the event of any discrepancy. This document summarizes in non-technical terms certain benefits offered by Centra. It does not take the place of the plan documents, and does not constitute an employment contract with Centra. Centra reserves the right to amend or terminate benefit plans, in whole or in part, at any time.

Address:1920AtherholtRoad,Lynchburg,VA24501Phone:434.200.4907