1. health and fitness

CARING FOR
YOUR FUTURE
Make Informed Choices
2015 ENROLLMENT GUIDE
MAKING SMART
CHOICES FOR YOU
AND YOUR FAMILY
Life is filled with important
decisions — like choosing which
benefit plan is right for you and
your family. We have introduced
changes for 2015, so it is
important that you carefully review
this enrollment guide and make
informed decisions about your
benefits program.
Annual Open Enrollment
for 2015 Benefits:
October 15 - 31, 2014
Benefits Website
www.sclhealthbenefits.org
Key Updates for 2015 Benefits:
Updated for 2015
• Increase to Medical Premiums and Plan Design – Due to market conditions and a rise in
medical claims, all three medical plan costs are increasing, including premiums, deductibles,
copays, co-insurance and out-of-pocket maximums. SCL Health invests in our associate medical
plans and pays over 80% of the total cost for medical premiums. The Cigna Consumer Driven
Health Plan (CDHP) has the lowest premium option in 2015. (Details on pages 2-3.)
• Use SCL Health Network (Tier 1) Providers and Save (Details on pages 10-16.)
SCL Health
HR Service Center
1-855-412-3701 or
303-813-5250
• Pharmacy – Maintenance Medications – All Cigna member maintenance medication
prescriptions (drugs you take on a regular basis to treat conditions such as high cholesterol,
diabetes and high blood pressure) will be required to be filled at an SCL Health pharmacy or
through the mail order service at Good Samaritan Medical Center. (Details on pages 17-19.)
Representatives are available Monday
through Friday,
7:30 a.m. - 5:00 p.m.
Mountain Time
• Pharmacy – Mail Order – Pharmacy Services at Good Samaritan Medical Center will be the
exclusive mail order provider for the Cigna PPO and CDHP plans. (Details on pages 17-19.)
Trouble logging into Lawson
Employee Self-Service (ESS)? Help
Desk 1-855-866-8282
SAVING FOR RETIREMENT
SCL Health offers convenient,
easy and tax-advantaged plans to help
you start saving and continue building
for your future.
Why Participate?
• Convenience
• Company contributions
• Tax benefits
• Investment options
• It’s easy to register as a participant
• New Vendor for Disability and Life Insurance – Beginning January 1, 2015, Cigna will
administer the Short-term Disability, Long-term Disability and Life Insurance programs. (Details on
pages 26-28.)
• Enhanced Eligibility Criteria for the Medical Premium Assistance Program – As part of
our mission, healing ministry and caring spirit, SCL Health offers financial assistance to help our
associates obtain medical insurance. The annual household income requirement will increase to
$35,000 for associate only and $40,000 spouse, child(ren) and family coverage levels. (Details
on page 20.)
“Passive” Enrollment – Except For FSAs
• If you do not make any changes during annual Open Enrollment, your benefits coverage will remain
the same as it was in 2014 (except for FSAs) at the new 2015 premium rates. (Details on page 2.)
• Even though this is a “passive” enrollment, we strongly encourage you to “actively” review this
material, weigh your benefit options and make choices that meet the needs of you and your family.
Learn More at www.sclhealthbenefits.com
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TABLE OF CONTENTS
SCL Health 2015 Benefit Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Benefit Plan Providers Contact List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
What Happens During Open Enrollment?. . . . . . . . . . . . . . . . . . . . . . . . . . 5
Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
How Do I Enroll?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Will I Receive ID Cards? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Know How Your Medical Plan Works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
– Cigna CDHP with HRA (Choice Fund Open Access Plus Plan). . . . . . . 13
– Cigna PPO (Open Access Plus Plan). . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
– Kaiser Permanente EPO (Denver Employed Associates Only). . . . . . . . 16
Pharmacy Plan Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
– Maintenance Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
– Mail Order Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Medical Premium Assistance Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Flexible Spending Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Life and AD&D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Disability Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Legal Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Long-Term Care Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Employee Assistance Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
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SCL HEALTH — 2015 BENEFIT RATES
Updated for 2015
Per pay period deductions taken twice monthly. There are 24 payroll deductions in 2015.
Full-Time Amounts
MEDICAL
Part-Time Amounts
Associate Pays*
Company Pays
Associate Pays*
Company Pays
Associate Only
$32.82
$200.06
$60.44
$172.44
Associate + Spouse
$65.63
$400.12
$120.89
$344.86
Associate + Children
$59.06
$360.12
$108.79
$310.39
Associate + Family
$91.89
$560.15
$169.25
$482.79
Associate Only
$64.61
$257.22
$110.73
$211.10
Associate + Spouse
$129.25
$514.41
$221.65
$422.01
Associate + Children
$116.32
$462.97
$199.48
$379.81
Associate + Family
$180.95
$720.17
$310.32
$590.80
Associate Only
$57.12
$241.06
$97.93
$200.25
Associate + Spouse
$114.24
$482.12
$195.86
$400.50
Associate + Children
$102.83
$433.90
$176.27
$360.45
Associate + Family
$159.96
$674.95
$274.20
$560.71
Associate Pays*
Company Pays
Associate Pays*
Company Pays
Associate Only
$2.64
$9.76
$3.97
$8.43
Associate + Spouse
$5.28
$19.51
$7.95
$16.84
Associate + Children
$5.28
$19.51
$7.95
$16.84
Associate + Family
$7.93
$29.26
$11.88
$25.31
Associate Only
$3.48
$10.90
$4.78
$9.60
Associate + Spouse
$6.96
$21.79
$9.57
$19.18
Associate + Children
$6.96
$21.79
$9.57
$19.18
Associate + Family
$10.45
$32.68
$14.38
$28.75
$8.34
$14.67
$10.91
$12.10
CIGNA CDHP
CIGNA PPO
Kaiser Permanente
DENTAL
Delta Core Plan
Delta EPO Plan
Delta Choice Plan
Associate Only
Associate + Spouse
$16.69
$29.32
$21.80
$24.21
Associate + Children
$16.69
$29.32
$21.80
$24.21
Associate + Family
$25.03
$43.99
$32.73
$36.29
VISION – EyeMed
Associate Pays*
Company Pays
Associate Pays*
Company Pays
$4.44
$0.00
$4.44
$0.00
Associate Only
Associate + Spouse
$8.21
$0.00
$8.21
$0.00
Associate + Children
$7.32
$0.00
$7.32
$0.00
Associate + Family
$11.55
$0.00
$11.55
$0.00
Rates do not reflect if you are eligible and are currently receiving Medical Assistance Premium Program.
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Per pay period deductions taken twice monthly. There are 24 payroll deductions in 2015.
*SUPPLEMENTAL ASSOCIATE LIFE + AD&D
Age Band
Monthly Rate per $1,000
<30
$0.042
30-34
$0.046
35-39
$0.058
40-44
$0.079
45-49
$0.131
50-54
$0.196
55-59
$0.317
60-64
$0.450
65-69
$0.922
>69
$1.584
Age 65 - 65%
Age 70 - 40%
Age 75 - 20%
The reduction applies to both Basic and Supplemental
Coverage.
For example, if your salary is $100,000 and you are
age 67, your Basic Life coverage would be
$100,000 x .65 = $65,000. At Age 70, coverage would
be $100,000 x .40 = $40,000 and at age 75, it would
be $20,000.
SUPPLEMENTAL ASSOCIATE LIFE + AD&D PREMIUM CALCULATION
•
•
•
•
Multiply your annual base salary by the level of coverage you select (1, 2, 3, 4 or 5)
Round the result to the next highest 1,000 then divide that amount by 1,000
Multiply that result by the “monthly rate” per “age band”
Divide that amount by 2 to give you your payperiod premium rate
Coverage
Per Pay Period
Example:
Your salary is $49,800, age 38 electing 2x
49,800 times 2 = 99,600
100,000 divided by 1,000 = 100
100 times $.058 = $5.80
5.80 divided by 2 = $2.90 per pay period
DEPENDENT LIFE AND AD&D INSURANCE
DISABILITY LTD BUY UP RATE
*SPOUSE LIFE
$0.372 per $100 of coverage per month
$25,000
$50,000
$100,000
$150,000
$200,000
$2.96
$5.93
$11.85
$17.78
$23.70
CHILD LIFE
Coverage
$5,000
$10,000
$25,000
Per Pay Period
$0.25
$0.49
$1.23
Per Pay Period Formula:
Annual base salary divided by 12 months, divided by
100, multiply by the rate
Example:
$49.800 divided by 12 = $4,150
$4,150 divided by $100 = $41.50
$41.50 times $0.372 = $15.44
$15.44 divided by 2 = $7.72 per pay period
LEGAL PLAN
Per Pay Period
$7.88
* 2015 Elections maybe subject to Evidence of Insurability (EOI) – Page 27
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MAKE INFORMED CHOICES
3
BENEFIT PLAN PROVIDERS
CONTACT LIST
The HR Service Center located in Denver, Colorado, is available to assist you with your benefit questions. They are available Monday through
Friday 7:30 a.m. - 5:00 p.m. Mountain Time at toll free 1-855-412-3701 or 303-813-5250.
Use this Resources at a Glance chart for quick reference.
Benefit
Administrator
Phone
Website
Cigna
1-800-CIGNA24
(1-800-244-6224)
www.cigna.com or www.mycigna.com
Kaiser Permanente
(Denver employed
associates only)
1-877-883-6698
www.kp.org
Cigna — Cigna CDHP with
HRA members
1-800-CIGNA24
(1-800-244-6224)
www.cigna.com or www.mycigna.com
National Pharmaceutical
Services (NPS) — Cigna PPO
1-800-546-5677
www.pti-nps.com
Kaiser Pharmacy — Kaiser
Permanente members
1-866-427-7701
www.kp.org/formulary
Mail Order - Pharmacy
Services at Good Samaritan
Medical Center
303-689-6121
1-855-235-4301
Dental
Delta Dental
1-800-610-0201
www.deltadentalco.com
Vision
EyeMed
1-866-723-0513
www.eyemedvisioncare.com
24HourFlex
1-800-651-4855
www.24hourflex.com
Cigna
1-800-36-CIGNA
(1-800-362-4462)
www.cigna.com/customer-forms
Cigna
1-888-84-CIGNA
(1-888-842-4462)
www.cigna.com or www.mycigna.com
Fidelity
1-800-343-0860
www.netbenefits.com/sclhs
Hyatt Legal Plans
1-800-821-6400
www.legalplans.com
Continental Casualty
Company
1-877-777-9072
www.cna.com/portal/site/groupLTC
New Directions
1-800-624-5544
www.ndbh.com
SCL Health
1-866-412-3701
303-813-5250
www.sclhealthbenefits.org
Medical
Pharmacy
Flexible Spending
Accounts (FSA)
Life Insurance
Disability
Retirement Plans
Pre-paid Legal Plan
Long-Term Care (Voluntary)
Employee Assistance Program
SCL Health HR Service Center
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WHAT HAPPENS DURING
OPEN ENROLLMENT?
Open Enrollment Reminder
Don’t forget — you must re-enroll in the Flexible Spending Accounts
(FSAs) if you want to continue participation in 2015. All of your other
2014 benefit elections will automatically roll over to 2015 if you choose
not to make changes during annual Open Enrollment.
Current Associates
New Associates
• Open Enrollment is your once-a-year opportunity to make
changes to your benefit elections and covered dependents. You
can make changes mid-year only if you have a qualifying event*.
During annual Open Enrollment, you may:
If you are benefits eligible, you must enroll within 31 days from your
date of hire by logging on to Lawson Employee Self-Service (ESS).
Coverage will begin for you and any covered eligible dependents on
the first day of the month after your date of hire.
• Change, add or drop benefit coverage for you and your
eligible dependents.
If you do not enroll, you will be defaulted into the following benefits:
• Enroll in Health Care and/or Dependent Care Flexible Spending
Accounts (FSAs) to save money on eligible out-of-pocket
expenses.
–– SCL Health utilizes the services of HMS Employer
Solutions to verify dependent eligibility. When you add
new dependents to SCL Health Medical, Dental, Vision or
Life Insurance coverage, you will receive a letter detailing the
verification process. Unverified dependents are removed from
coverage. Information on eligible dependents is on page 6.
If You Don’t Want to Make Changes to
Your Current Coverage
You do not need to log on to Lawson Employee Self-Service (ESS)
unless you are electing Flexible Spending Accounts for 2015. If you do
not make any changes during annual Open Enrollment, your benefits
coverage will remain the same as it was in 2014, at the new 2015
premium rates. Exceptions to this include FSAs.
The 2015 annual Open Enrollment period is October 15 –
October 31, 2014. The online benefit enrollment system will close at
midnight (CST) on October 31, 2014. When you enroll, keep in mind:
• You can log in to the system to elect 2015 benefits only from
a work computer. You cannot enroll from your home
computer.
• Do NOT use your browser’s back button. Use Previous and
Next buttons on the enrollment site. If you exit the enrollment site
during the process and before you confirm your final elections,
your elections to that point will NOT be saved.
Your coverage begins on January 1, 2015. If you choose not to
make changes to your benefits, most of your elections as of December
31, 2014 will continue for 2015. However, you must re-enroll
in the Flexible Spending Accounts if you want to continue
participation next year.
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• You will have only the basic Short Term and Long Term Disability,
Basic Life Insurance and AD&D benefits provided by SCL Health.
• You’ll miss out on tax savings because you won’t be enrolled in
the Health Care or Dependent Care Flexible Spending Accounts
(FSAs).
Rehired Associates
If you are rehired within one year, your service date will be reinstated.
You will not automatically be reinstated with your previous elections.
If you are benefits eligible and you wish to make benefit elections as a
Rehire or Newly Eligible, you must do so by completing an enrollment
form within 31 days of your rehire date.
Can I Make Changes or Add Benefit
Elections During the Year?
Outside of annual Open Enrollment, you can enroll or make changes
to your coverage only if you are experiencing a qualifying work or
family status event, such as becoming newly benefit eligible or a birth,
marriage or gain or loss of independent coverage. Otherwise, you
will not be able to enroll or make changes until the next annual Open
Enrollment period. You will have 31 days from the qualifying
work or family status event date to enroll or make changes to
your elections.
If you experience a qualifying work or family status event during 2015,
please visit the benefits website www.sclhealthbenefits.org or contact
the HR Service Center at 1-855-412-3701.
*Qualifying events include, but are not limited to, marriage, divorce and
birth of a child.
Rehired Associates - Where do I get an enrollment form?
The benefits website, www.sclhealthbenefits.org, has the enrollment
form available; or contact the HR Service Center at 1-855-412-3701.
MAKE INFORMED CHOICES
5
ELIGIBILITY
Am I Eligible For Coverage?
• You and your family (“Associate + Family”).
For benefits eligibility and full-time associate rates, you must be 0.9
full-time equivalent (FTE) and scheduled to work at least 36 hours per
week. For benefits eligibility and part-time associate rates, you must
be regularly scheduled to work 20 - 35 hours per week.
• You and your legally domiciled adult and family (“Associate +
LDA Family”)
Can I Elect Coverage for My Family?
If you are eligible to elect coverage for yourself, you may also elect
coverage for your eligible dependents. Eligibility includes:
• Your legal spouse.
• Your common-law spouse if you live in a state that recognizes such
marriages (an affidavit is required).
• Legally domiciled adults and children (see page 7).
• A civil union as defined by the state of Colorado (Vision and Life
Insurance only).
• Your children and stepchildren from birth to age 26.
• Your adult child who depends solely on you for support because of
a mental or physical handicap (documentation is required).
For Medical, Dental and Vision benefits, you can choose from
these coverage levels:
• Yourself only (“Associate”).
• You and your spouse or common-law spouse
(“Associate + Spouse”).
• You and your legally domiciled adult (“Associate + LDA”).
You do not need to choose the same coverage level for
Medical, Dental, Vision or Supplemental Life Insurance. For example,
you can elect to cover you and your family for Medical and Dental,
you and your spouse for Vision and just yourself for Supplemental
Life Coverage.
Dependent Verification of Eligibility
Once you have enrolled in your benefits, you will be mailed a
letter to your home mailing address within 45-90 days from the
date you enrolled. The letter from HMS Employer Solutions will
ask you to provide documentation supporting eligibility for only
new dependents you add to the 2015 plans.
Examples of acceptable documentation include a marriage
certificate, birth certificate, recent tax filings, etc.
Reminder: Unverified dependents are removed from
coverage based on the requirements outlined in your letter
from HMS Employer Solutions. To check on the status of your
dependent audit:
• Call 1-855-819-5806
• Visit www.auditos.com
–– Upload required documents
–– Check status of your dependent audit
• You and your children (“Associate + Children”).
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2015 ENROLLMENT GUIDE
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Legally Domiciled Adults and Children
SCL Health recognizes Legally Domiciled Adults and Children (LDA) as eligible dependents for
benefits coverage. If you are eligible to enroll for benefits at SCL Health, you have the option
of enrolling an LDA and/or the dependent children of your LDA. In order to enroll, you will be
required to complete an affidavit, which is an official declaration confirming your relationship.
Who qualifies for coverage as a Legally Domiciled Adult?
A Legally Domiciled Adult (LDA) is an individual over age 18 who has for at least six (6) months lived
in the same principal residence as the associate and remains a member of the associate’s household
throughout the coverage period; and who either:
(A) has a close personal relationship or civil union partnership with the associate or civil union
partnership in the state of Colorado (not a casual roommate or tenant), shares basic living expenses
and is financially interdependent with the associate, is neither legally married to anyone else nor
legally related to the associate by blood in any way that would prohibit marriage, and is neither
receiving benefits from an employer nor eligible for any group coverage, or
(B) is the associate’s blood relative who meets the definition of his or her tax dependent as defined
by Section 152 of the Internal Revenue Code during the coverage period and is neither receiving
benefits from an employer nor eligible for any group coverage.
Open Enrollment
For those adding an LDA during
open enrollment, the notarized
LDA affidavit and supporting
documents must be submitted to
HR Service Center within 31 days of
the coverage effective date, which
is January 31, 2015. Your LDA will
not be enrolled in coverage until this
documentation is received.
New Hires / Newly Eligible
The notarized LDA affidavit and
supporting documents must be
submitted to HR Service Center
within your initial 31-day enrollment
period. Your LDA will not be
enrolled in coverage until this
documentation is received.
How do I add my LDA to my benefits?
You will need to submit a notarized Legally Domiciled Adult Affidavit to the HR Service Center and three (3)
forms of proof that your LDA meets the SCL Health criteria for coverage. The affidavit is available at
www.sclhsbenefits.com or by calling the HR Service Center at 1-855-412-3701 or 303-813-5250.
• O
pen Enrollment: For those adding an LDA during open enrollment, the notarized LDA affidavit
must be submitted by the end of the open enrollment period – November 4. Supporting
documents must be submitted within 31-days of the coverage effective date, which is January 31,
2015. If supporting documentation is not received by this date, your LDA will be removed from
coverage as of 1/1/2015.
• New Hires / Newly Eligible: The notarized LDA affidavit and supporting documents must be
submitted to the HR Service Center within your initial 31-day enrollment period. Your LDA will not
be enrolled in coverage until the supporting documentation is received.
What types of documentation / proof are needed to add my LDA to my benefits?
Following are examples of acceptable proof:
• Power of attorney (medical or financial)
• Civil union certificate
Are there tax implications for
enrolling an LDA?
Due to the regulations under
the Internal Revenue Code, only
associates with qualified tax
dependents (includes those who
are legally married and LDA – type
B) can pay benefits premiums with
pre-tax dollars. Associates with
LDA – type A partners will have to
pay the LDA portion of the premium
using post-tax dollars. Also, the
tax code requires SCL Health to
report the value of the benefit to
the LDA as imputed income on
the associate’s W-2 form, and
applicable taxes must be paid on
those dollars.
• Joint documents date a minimum of six (6) months prior to enrollment showing current relationship
status, such as a recurring household bill or statement of account. The documents must list the
associate and LDA partner’s name, the date and shared mailing address. Examples of joint documents:
— Car loan or lease
— Mortgage or lease
— Utilities bill
— Bank statements
— Joint credit cards
— Shared legal guardianship documents
— Primary beneficiary or executor designation
— Copy of driver’s license showing proof of shared residency.
• A
copy of the front page of the associate’s prior year federal tax return (Form 1040) confirming the
LDA is a qualified tax dependent as defined in Section 152 of the Internal Revenue Code.
For assistance with enrolling your LDA, contact the HR Service Center at 1-855-412-3701 or
303-813-5250, or visit the SCL Health benefits website at www.sclhealthbenefits.org.
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MAKE INFORMED CHOICES
7
HOW DO I ENROLL?
To enroll, follow these four easy steps:
Step 1: Learn
• Read this guide carefully to ensure that you make smart choices
about your 2015 benefit elections.
• Even if you are not planning to make any changes to your current
elections, review your benefit enrollment guide to ensure that
you and your family are getting the most out of your SCL Health
benefit program.
• Compare the costs of deductibles, copayments, coinsurance and
other details of the Plan options for which you are eligible.
Step 2: Plan
• Decide which eligible dependent(s) you will be covering, or if you
need to drop dependent(s) who are no longer eligible.
All of your 2014 benefit elections (except for FSAs)
will automatically roll over to 2015 if you choose not to
make changes.
Step 4: Review (Annual Open
Enrollment Only)
• Once Open Enrollment is complete, a confirmation statement will
be mailed to your home mailing address.
• If your elections are correct, you do not need to take any
further action.
• If there are any errors on your confirmation statement, you will
have the opportunity to make corrections. Your confirmation
statement will give details on the correction process you must
follow to complete your enrollment.
• Consider your own and your family’s 2015 medical, dental, vision,
life insurance and disability care needs, and then choose the
options that best meet your needs.
Need Help?
• Estimate your 2015 health care and/or dependent care out-ofpocket expenses to make a smart choice about your 2015 Flexible
Spending Account contribution
• I f you have questions or if you need assistance enrolling
in your benefits, please contact the HR Service Center at
1-855-412-3701 or 303-813-5250.
Reminder: You must re-enroll in Flexible Spending Accounts
each year.
Step 3: Act
Enroll for your benefits online within your enrollment period from
your work location. You are not able to log in and enroll for
benefits from home. Please follow these steps to use the Lawson
Employee Self-Service (ESS) enrollment system.
1. Navigate to the Lawson Portal Log In Page:
Open Enrollment/New Hire Enrollment:
• From a worksite computer, enter mysclhsbenefits in your web
browser and hit enter, or
• Go to www.sclhealthbenefits.org, or
• Visit The Landing
• I f you are unable to log in to Lawson Employee Self-Service
(ESS) during enrollment, you can contact the Help Desk at
1-855-866-8282.
Reminders:
• The preferred browser for enrollment is Internet Explorer.
• D
o NOT use your browser’s back button. Use Previous and
Next buttons on the enrollment site.
• If you exit the enrollment site during the process and before
you confirm your final elections, your elections to that point will
NOT be saved.
2. Enter your Lawson Employee Self-Service (ESS) user name, also
referred to as your “S-number” or “S-ID.” There will be a link for
associates to look up their S-ID.
3. Enter your network password (case sensitive) to log in. This is the
same as your network/computer login password. Click “Login.”
Call the Help Desk if you have difficulty with logging in at
1-855-866-8282.
4. Click on “Benefits” on the left of your screen, then:
• Open Enrollment: click on “Open Enrollment,” or
• New Hire Enrollment: Click on “New Hire Enrollment” if
you are enrolling as a New Hire. Read the information on the
Welcome page and follow the on-screen prompts.
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WILL I RECEIVE
ID CARDS?
• Medical — Cigna and Kaiser will distribute new ID cards to all
members for the new plan year.
–– If you need a replacement or additional ID cards, you
can log in to the secure member area of their sites, www.
mycigna.com (Cigna) or www.kp.org (Kaiser), to access your
personalized information to print a temporary card. If you have
not already done so, you will need to set up a user name and
password under the Members Sign On feature.
• Pharmacy — Pharmacy plan information will be included on the
medical ID card.
• Dental — Delta Dental of Colorado, our dental provider, will
distribute new ID cards only if you or your dependents enroll for
coverage for the first time or change coverage for 2015.
–– If you need replacement or additional ID cards, log in to
the secure member area of their site, www.deltadentalco.com,
click “Subscribers” and log in under Subscriber Login to access
your personalized information and print a temporary card. If you
have not already done so, you will need to set up a user name
and password under the Members Sign On feature.
• Vision — EyeMed, our vision care provider, will distribute new
ID cards only to newly enrolled participants.
–– You do not need your ID card in order to use your EyeMed
plan. If you have your card, we recommend you take it with you,
as it helps the provider correctly apply your discount or benefit.
To request a replacement ID card, you can log in to the secure
member area of their website and order a new one by going
to www.eyemedvisioncare.com, clicking “Members” and then
entering your user name and password.
• Health Care Flexible Spending Account Debit Card —
24HourFlex will distribute new debit cards only if you enroll for
2015 for the first time. If you are currently enrolled in the Health
Care and/or Dependent Care FSA and make a new election for
2015, you will use the most recently issued card from 24HourFlex.
If you need to replace a debit card for 2015, please contact
24HourFlex at 1-800-651-4855 after January 1, 2015.
Reminder
If you need to obtain health care services prior to receiving your
ID card, visit the website for the carrier (page 4) of the coverage
you elected or contact the HR Service Center. Many of our
administrators offer members the opportunity to register and:
•
•
•
•
•
print temporary ID cards
view eligibility
view claims status
track deductibles
iew your Health Reimbursement Account (HRA) and more.
v
You may enroll as a member on the website once the carrier has
received your eligibility and updated its system.
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9
Find a Doctor...
Provider Directory –
SCL Health Network (Tier 1)
To find out if your current doctor is in
the SCL Health Network (Tier 1), or to
select a new doctor, you can access
a custom network directory created
specifically for SCL Health. Just follow
these three easy steps:
1.Go to:
www.sclhealthbenefits.org.
2.Select “Find a Network
Provider” and choose the plan
you would like to search.
3.Search for your provider by name
or by specialty.
______________________________
Cigna OAP Network
As an option, you also can go to
mycigna.com to use the OAP
directory of primary care physicians
and specialists in the Cigna Open
Access Plus (OAP) network.
Keep in mind that if you go to
www.mycigna.com and use the
generic provider search, you must
be currently enrolled with Cigna
to see the SCL Health Network
(Tier 1) on mycigna.com.
Kaiser Permanente (Denver)
As an option, you can go to
www.kp.org and use “Locate Our
Services” to find a doctor and locate
a facility in your area.
MEDICAL
Make the Most of Your Medical Benefits by Making
Smart Choices
Choosing a medical plan option is one of the most important decisions for you and your family.
When selecting a medical plan, you should ask yourself several questions and carefully consider
each answer:
• How much health care will you and your family need next year?
• What will it cost you? Cigna’s website (www.cigna.com) and Kaiser’s website (www.kp.org)
have tools to help you estimate your health care costs.
• How do I find a doctor or find out if my current doctor is in the SCL Health? With Cigna
you can access a custom provider directory created specifically for SCL Health through
www.sclhealthbenefits.org. See sidebar for more details on how to access the custom
provider networks for Cigna and Kaiser Permanente.
• Are you more concerned about the cost of your monthly contribution or your out-of-pocket cost?
• How will you save for future health care costs?
Know Your 2015 Medical Plan Options by Name
In 2015, SCL Health offers all associates at least three medical plan options. During Open
Enrollment, it is up to you to enroll in the plan that best fits your needs and budget. Your options
(including their official names) are:
• “Cigna CDHP with HRA” (the Choice Fund Open Access Plus Network Plan).
• “Cigna PPO Plan” (the Cigna Open Access Plus Network Plan).
• Kaiser Permanente EPO Plan (for Denver employed associates only).
______________________________
Designate Your PCP in 2015
The objective of a PCP is for you to have
a specific care center to help you make
the most of the health care system.
Simply visit your plan’s website
(www.mycigna.com or
www.kp.org) and choose your
provider. Typically you’ll want to pick
your primary care physician (PCP) or
the place you go for routine care.
Please note:
Specialist referrals are still not required
under our medical plans.
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Understand the Networks in Your Plan
The SCL Health medical plans are “Point of Service” plans. Each
provider network tier has a different arrangement for sharing costs.
You and your covered family members choose which tier to use
each time you seek care.
One of the best ways to make your health care dollars go further
is to use the SCL Health Network (Tier 1) whenever possible to take
advantage of its:
• Lower copays for physician/specialist office visits, where
applicable.
• Lower deductibles
To enjoy all these cost-savings, you first need to know which
hospitals and doctors are in the SCL Health Network and which
ones are not, as shown in the chart below.
Why SCL Health Network (Tier 1) is Your Best Choice
At SCL Health, we are in the health care business. That
allows us to offer our associates both exceptional care
and the opportunity to control costs.
All three medical plan options offer the highest level
of benefits when you use SCL Health Network (Tier 1)
providers and facilities.
Remember, you can access a custom provider
directory created specifically for SCL Health. Just follow
the three easy steps on the previous page to locate
SCL Health Network (Tier 1) providers and facilities or visit
www.sclhealthbenefits.org (page 9).
• Lower coinsurance.
• Lower out-of-pocket maximums.
Network Tiers
SCL Health Network
(Tier 1)
Hospitals
Cigna
• SCL Health facilities
• Children’s Hospital Colorado
(facility charges only)
Cigna Network or
Kaiser Network (Tier 2)
Cigna
• Hospital facilities that are
part of the Cigna Open
Access Plus (OAP) network
Kaiser Permanente (Denver)
• Saint Joseph Hospital
• Good Samaritan Medical Center
• Children’s Hospital Colorado (facility charges only)
Doctors
Cigna
• Primary care and specialists
ith privileges at an SCL Health
w
facility
• All SCL Health employed
p
rimary care physicians and
specialists
• Physician Network (SCLP)
primary care and specialists
Cigna
• All Cigna Open Access Plus
(OAP) network physicians and
specialists
Kaiser Permanente (Denver)
• All Kaiser Permanente network physicians and specialists
Out-of-Network
(Tier 3)
Cigna
• All other hospital facilities
Kaiser Permanente
(Denver)
• Not available
Cigna
All other doctors who are:
• Not employed by SCL Health
or
• Not part of the Cigna Open
Access Plus (OAP)
Kaiser Permanente (Denver)
• Not available
*The SCL Health Network (Tier 1) pays the highest level of benefit for both doctors and facilities.
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11
KNOW HOW YOUR MEDICAL PLAN WORKS
SCL Health medical plan options at a glance:
Pre-certification is required
for all hospital admissions.
• Preventive Care — All SCL Health medical plan options cover in-network preventive care at
100% (this includes annual physical checkups, recommended screenings for your age, and
immunizations).
SCL Health Medical Plan Options
• Cigna CDHP with HRA
(Choice Fund Open Access
Plus Plan)
• Cigna PPO Plan
(Cigna Open Access Plus Plan)
• Kaiser Permanente EPO Plan
(for Denver employed
associates only)
• Deductible — All of the SCL Health medical plans have a deductible that you must meet
before the plan begins to pay coinsurance. The deductible is lower at the SCL Heath Network
(Tier 1) level.
• Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket
during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your
eligible medical expenses for the rest of the plan year. Please note: For those enrolled in the
Cigna PPO plan or the Kaiser Permanente EPO (Denver) plan, prescription out-ofpocket maximum is separate from the medical out-of-pocket maximum.
Quick Glance — Medical Benefit Options
Cigna CDHP with HRA
SCL Health
Network
(Tier 1)
Cigna
Network
(Tier 2)
Out of
Network
(Tier 3)
Updated for 2015
Cigna PPO
SCL Health
Network
(Tier 1)
Cigna
Network
(Tier 2)
Kaiser Permanente EPO (Denver)
Out of
Network
(Tier 3)
Out of
Network
Associate
Associate + Spouse
Associate + Children
Associate + Family
$500
$750
$750
$1,000
$1,000
$1,500
$1,500
$2,000
$2,000
$3,000
$3,000
$4,000
$3,000
$4,500
$4,500
$6,000
$500/
person;
$1,000 family
$2,000/
person;
$4,000 family
$3,000/
person;
$6,000/family
Coinsurance
for Most
Services
After
deductible:
Plan pays
85%; you pay
15%
After
deductible:
Plan pays
70%; you
pay 30%
After
deductible:
Plan pays
50%; you
pay 50%
After
deductible:
Plan pays
85%; you pay
15%
After
deductible:
Plan pays
70%; you pay
30%
After
deductible:
Plan pays 50%;
you pay 50%
Primary Care
Office Visit
After
deductible:
Plan pays
85%; you pay
15%
After
deductible:
Plan pays
70%; you
pay 30%
After
deductible:
Plan pays
50%; you
pay 50%
$50 copay
After
deductible:
Plan pays 50%;
you pay 50%
$25 copay
N/A
Specialist’s
Office Visit
After
deductible:
Plan pays
85%; you pay
15%
After
deductible:
Plan pays
70%; you
pay 30%
After
deductible:
Plan pays
50%; you
pay 50%
$40 copay
$75 copay
After
deductible:
Plan pays 50%;
you pay 50%
$40 copay
N/A
100%
100%
After
deductible:
Plan pays
50%; you
pay 50%
100%
100%
After
deductible:
Plan pays 50%;
you pay 50%
After
deductible:
Plan pays
85%; you pay
15%
After
deductible:
Plan pays
70%; you
pay 30%
After
deductible:
Plan pays
50%; you
pay 50%
After
deductible:
Plan pays
85%; you pay
15%
After
deductible:
Plan pays
70%; you pay
30%
After
deductible:
Plan pays 50%;
you pay 50%
HRA Employer
Contribution
Not applicable. The CDHP is the
only medical plan option that offers
HRA with annual funding from
SCL Health.
Kaiser Network
Not applicable. The CDHP is the
only medical plan option that offers
HRA with annual funding from
SCL Health.
Deductible
Associate
Associate + Spouse
Associate + Children
Associate + Family
Preventive
Care
Hospitalization
$25 copay
$500/ person;
$1,000 family
After
deductible:
Plan pays
85%; you
pay 15%
Plan pays
70%; you
pay 30%
100%
After
deductible:
Plan pays
85%; you
pay 15%
Plan pays
70%;
you pay
30%
N/A
N/A
N/A
N/A
Continued on next page...
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Quick Glance — Medical Benefit Options, Continued
Cigna CDHP with HRA
SCL
Health
Network
(Tier 1)
Urgent Care
Hospital ER
Diagnostic
Lab and X-ray
Cigna
Network
(Tier 2)
Out of
Network
(Tier 3)
Cigna PPO
SCL Health
Network
(Tier 1)
Kaiser Permanente EPO
(Denver)
Cigna
Network
(Tier 2)
Out of
Network
(Tier 3)
Kaiser Network
Out of
Network
N/A
After deductible: Plan pays 85%;
you pay 15%
$50 copay, then the plan pays 85% and
you pay 15% of balance
$50 copay, then the
plan pays 85% and
you pay 15% of balance
After deductible: Plan pays 85%;
you pay 15%
$150 copay, then the plan pays 85% and
you pay 15% of balance
$150 copay, then the plan pays 85%
and you pay 15% of balance
After
deductible:
Plan pays
85%; you
pay 15%
After
deductible:
Plan pays
70%; you
pay 30%
After
deductible:
Plan pays
50%; you
pay 50%
Physician's
office: After
office visit copay,
Plan pays 100%;
Outpatient: Plan
pays 85%; you
pay 15%
$2,500
$4,500
$6,000
$2,500
Associate + Spouse /
Associate + Children
$6,750
$3,750
$9,000
Physician's
office: After
office visit copay,
Plan pays 50%
you pay 50%;
Outpatient: After
deductible: Plan
pays, 50%; you
pay 50%
$9,000
$3,000
$2,500/person
$5,000/family
$3,000/person
$6,000/family
$5,000
$5,000/person
$10,000/family
Associate + Family
$12,000
$2,500/person
$5,000/family
Cigna CDHP with HRA (Choice Fund
Open Access Plus Plan) — Step by Step
SCL Health funds a Health Reimbursement Account (HRA) for you to
use to cover initial out-of-pocket expenses. If you use all the funds in
your HRA, you will then pay the full cost of your medical expenses,
including prescriptions, until you meet your annual deductible. The
HRA amount and annual deductible increase when you cover your
children, spouse or full family.
After you meet your annual deductible, the plan pays a portion of your
medical costs, known as coinsurance, based on network tier. If you meet
your annual out-of-pocket maximum, the plan then pays 100% of your
eligible medical expenses for the remainder of the plan year.
$3,000/person
$6,000/family
Plan pays 85%;
you pay 15%
N/A
Associate
Associate + Spouse /
Associate + Children
Associate + Family
$5,000
Physician's
office: After
office visit
copay, Plan
pays 100%;
Outpatient: After
deductible: Plan
pays, 70%; you
pay 30%
Associate
Associate
Annual Outof-Pocket
Maximum
Updated for 2015
$2,500
N/A
Associate + Spouse /
Associate + Children
$5,000
N/A
Associate + Family
$5,000/person
$10,000/family
$5,000
N/A
• Once you meet your annual deductible, the plan begins to
pay benefits.
• If you have money left in your HRA at the end of the year, it rolls over
to the next year (if you enroll in a CDHP option for the next year).
• Prescription drugs apply to your out-of-pocket maximum. Once
you meet your out-of-pocket maximum, your prescriptions are
covered at 100%.
• Online tools on www.mycigna.com that enable you to check
your claims, explanation of benefits (EOBs) and tracking of your
deductible and your Health Reimbursement Account (HRA) funds.
What Are the Advantages of the Consumer Driven Health Plan?
The CDHP option is designed to encourage you to be more aware
of your health care expenditures. It also offers a number of special
features, for example:
• It has the lowest per-paycheck cost.
• You have access to a Health Reimbursement Account (HRA) that is
funded by SCL Health.
• Your out-of-pocket expenses are paid from the HRA. Once
the money in your HRA is exhausted, you pay the full medical
expenses until you reach the annual deductible.
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Take a look at how the Cigna CDHP with HRA (Choice Fund Open Access Plus Plan) works.
STEP 1
Each year, SCL Health funds your Health Reimbursement Account (HRA). The amount depends on the coverage level you choose, as shown
below.
Associate
$500
Associate + Spouse
$750
Associate + Children
$750
$1,000
Associate + Family
STEP 2
The CDHP is the only medical plan option that offers
an HRA with annual funding from SCL Health.
Updated for 2015
Funds from your HRA are first applied to your deductible. Once your HRA balance is zero ($0), you pay 100% of your expenses until you meet
the annual deductible.
Annual Deductible — Included in Your HRA Dollar Amount
Annual Deductible
Maximum Annual Deductible You Pay
Tier 1
Tier 2
Tier 3
HRA Dollar Amount
Included in Deductible*
Tier 1
Tier 2
Tier 3
Associate
$1,000
$2,000
$3,000
$500
$500
$1,500
$2,500
Associate + Spouse
$1,500
$3,000
$4,500
$750
$750
$2,250
$3,750
Associate + Children
$1,500
$3,000
$4,500
$750
$750
$2,250
$3,750
Associate + Family
$2,000
$4,000
$6,000
$1,000
$1,000
$3,000
$5,000
* If you have money in your HRA at the end of 2014, it will roll over into the 2015 HRA.
STEP 3
Updated for 2015
After you meet the annual deductible, you and the plan each pay a portion of your medical costs until you reach the annual out-of-pocket
maximum. (The annual maximum includes the deductible.)
SCL Health Network (Tier 1)
Cigna Network (Tier 2)
Out of Network (Tier 3)
Primary care
office visit
The plan pays 85% of the cost;
you pay 15%
The plan pays 70% of the cost;
you pay 30%
The plan pays 50% of the
cost; you pay 50%
Specialist
office visit
The plan pays 85% of the cost;
you pay 15%
The plan pays 70% of the cost;
you pay 30%
The plan pays 50% of the
cost; you pay 50%
Hospital ER
The plan pays 85% of the cost;
you pay 15%
The plan pays 85% of the cost; you pay 15%
Urgent care facility
The plan pays 85% of the cost;
you pay 15%
The plan pays 85% of the cost; you pay 15%
Coinsurance for
most services
The plan pays 85% of the cost;
you pay 15%
The plan pays 70%;
you pay 30%
The plan pays 50%;
you pay 50%
Annual Out-of-Pocket Maximum*
Associate
$2,500
$4,500
$6,000
Associate + Spouse
$3,750
$6,750
$9,000
Associate + Children
$3,750
$6,750
$9,000
Associate + Family
$5,000
$9,000
$12,000
* Out-of-pocket costs including pharmacy will cross-accumulate for SCL Health Network (Tier 1) and Cigna Network (Tier 2). Out of Network (Tier 3) does not
accumulate to any other Tiers.
STEP 4
Once you reach the out-of-pocket maximum, the plan pays 100% of the cost for covered services and prescriptions through
December 31. The deductible is included in the out-of-pocket maximum.
NOTE: If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible
out-of-pocket expenses, such as annual deductible and coinsurance responsibility. Visit www.sclhealthbenefits.org for more FSA details.
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Cigna PPO Plan (Cigna Open Access Plus Plan) — Step by Step
Under the Cigna Choice PPO, you may choose the providers that fit your needs and receive different levels of coverage based on the network tier.
You are not required to select a primary care physician (PCP) or obtain a referral to see a specialist. However, you are able to select a PCP and provide
ongoing health care to you and your family.
Note: Designating a PCP assists in your health care being coordinated through a key provider, to ensure you receive any necessary treatment, when
and where you need it, in a manner you can understand. The objective of designating a PCP is for you to have a specific care center to help you make
the most of the health care system (page 10).
Take a look at how the Cigna PPO Plan (Cigna Open Access Plus Plan) works.
STEP 1
Updated for 2015
After you meet the annual deductible, you and the plan each pay a portion of your medical costs until you reach the annual out-ofpocket maximum.
If you seek care at an SCL Health facility or with an SCL Health Network provider, you pay a lower deductible.
Annual Deductible
Associate
Associate + Spouse
Associate + Children
Associate + Family
STEP 2
SCL Health Network (Tier 1)
Cigna Network (Tier 2)
Out of Network (Tier3)
$500/person;
$1,000/family
$2,000/person;
$4,000/family
$3,000/person;
$6,000/family
Updated for 2015
You and the plan each pay a portion of your medical costs until you reach the annual out-of-pocket maximum.
SCL Health Network (Tier 1)
Cigna Network (Tier 2)
Out of Network (Tier3)
Primary care
office visit
$25 copay
$50 copay
The plan pays 50% of the cost;
you pay 50%
Specialist
office visit
$40 copay
$75 copay
The plan pays 50% of the cost;
you pay 50%
Hospital ER
You pay a $150 copay, then the plan pays 85% of the remaining expense and you pay 15%
Urgent care facility
You pay a $50 copay, then the plan pays 85% of the remaining expense and you pay 15%
Coinsurance for
most services
The plan pays 85%;
you pay 15%
After deductible, plan pays 70%;
you pay 30%
The plan pays 50%;
you pay 50%
$2,500/person;
$5,000/family
$3,000/person;
$6,000/family
$5,000/person;
$10,000/family
Out-of-Pocket Maximum*
Associate
Associate + Spouse
Associate + Child
Associate + Family
* The Medical out-of-pocket maximum is separate from the Pharmacy out-of-pocket maximum (pg. 17).
STEP 3
Once you reach the out-of-pocket maximum, the plan pays 100% of the cost for covered services through December 31, 2015.
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Kaiser Permanente EPO Plan (Denver employed associates only) — Step by Step
Participants in this plan can receive care from Tier 1 and Tier 2 providers with varying levels of coverage. The plan does not pay benefits for care
received from out-of-network (Tier 3) providers except in the case of a true emergency. The Deductible does apply to the out-of-pocket maximum.
Take a look at how the Kaiser Permanente EPO Plan (Denver employed associates only) works.
Updated for 2015
STEP 1
Annual Deductible
Kaiser Network
Out of Network
$500/person;
$1,000/family
N/A
Associate
Associate + Spouse
Associate + Children
Associate + Family
STEP 2
You and the plan each pay a portion of your medical costs until you reach the annual out-of-pocket maximum.
Kaiser Network
Physician’s
Office Visit
$25 copay
Specialist’s
Office Visit
$40 copay
Out of Network
Hospital ER
After you pay a $150 copay (waived if patient is admitted),
the plan pays 85% of the remaining expense
Urgent Care
Facility
After you pay a $50 copay (waived if patient is admitted),
the plan pays 85% of the remaining expense
Coinsurance for
Most Services
The plan plays 85%;
you pay 15%
Coinsurance for Lab/
Radiology
You pay 100% of the cost.
The plan pays NOTHING for
out-of-network services, except
in case of emergency.
The plan pays 70%;
you pay 30%
The plan plays 85%; you pay 15%
Out-of-Pocket Maximum
Associate
Associate + Spouse
Associate + Children
$2,500/person;
$5,000/family
N/A
Associate + Family
*The Medical out-of-pocket maximum is separate from the Pharmacy out-of-pocket maximum (pg. 17).
STEP 3
Once you reach the out-of-pocket maximum, the plan pays 100% of the cost for covered services through December 31, 2015.
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PHARMACY PLAN INFORMATION
Pharmacy Vendors
Updated for 2015
Reminder
• Cigna PPO: National Pharmaceutical Services (NPS)
• Cigna CDHP with HRA: Cigna
• K
aiser Permanente EPO (Denver employed associates only):
Kaiser Permanente
• Mail Order to Pharmacy Services at Good Samaritan Medical Center
Cigna CDHP with HRA
aintenance medications (30-to-90 day supplies) must be filled
• M
at a SCL Health Outpatient Pharmacy (St. James, St. Vincent, Saint
Joseph and Good Samaritan) or through the mail order program
at Pharmacy Services at Good Samaritan Medical Center.
ll mail order for the Cigna CDHP and PPO plans will be filled
• A
through Pharmacy Services at Good Samaritan Medical Center.
Cigna PPO
Kaiser Permanente EPO
$17 copay
$17 copay
25% of full price
($35 minimum,
$75 maximum copay)
$35 copay
50% of full price
($50 minimum, no maximum)
Not covered
$20 copay
$34 copay
$90 copay
$70 copay
50% of full price
($125 minimum,
$250 maximum copay)
Not covered
25% of full price ($250
maximum per prescription)
25% with $250 maximum
per prescription
Retail (30-Day)
Generic
Formulary
Non-Formulary
• Prescriptions first apply to your
HRA.
Mail Order (90-Day)
Generic
• Once your HRA is exhausted,
you pay 100% of the cost until
you meet the deductible.
Formulary
Non-Formulary
• Plan pays 80% after deductible
until you meet the out-ofpocket maximum.
Specialty
Generic
• Once out-of-pocket maximum
is met, plan pays 100%.
Formulary
Non-Formulary
High-Cost pharmacies (30-Day) (Walgreens, CVS and Rite Aid)
Generic
Formulary
• Prescriptions apply to SCL
Health Network Tier 1
deductible and the out-ofpocket maximum.
$25
25% + $5 of full price
($35 minimum,
$80 maximum copay)
Non-Formulary
50% + $8 of full price
($50 minimum, no maximum)
Out-of-Pocket Maximum
$3,000/person; $6,000/family
N/A
Prescriptions must be filled at a
Kaiser Permanente Pharmacy.
$3,000/person; $6,000/family
SCL Health Pharmacy (30-Day)
Generic
$10 copay
Formulary
$45 copay
Non-Formulary
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50% of full price
($50 minimum,
$125 maximum)
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N/A
Prescriptions must be filled at a
Kaiser Permanente Pharmacy.
MAKE INFORMED CHOICES
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NEW IN 2015
PAY LESS FOR PRESCRIPTION DRUGS
Updated for 2015
Cigna Plan Members – Maintenance Medications
to be filled at an SCL Health Pharmacy
Beginning January 1, 2015, associates and family members enrolled in
a Cigna medical plan will be required to fill all maintenance medication
prescriptions at an SCL Health pharmacy or through the mail order
service at Pharmacy Services at Good Samaritan Medical Center.
New Prescriptions – your first maintenance medication prescription
(30-day supply) may be filled at any network retail pharmacy (i.e. King
Soopers, City Market, Walmart, etc.), thereafter you must transfer your
prescription to an SCL Health pharmacy.
SCL Pharmacies:
• St. James Healthcare / Medical Arts Pharmacy (Butte, MT)
• Saint Joseph Hospital Outpatient Pharmacy (Denver, CO)
• Pharmacy Services at Good Samaritan Medical Center
(Lafayette, CO)
• St. Vincent Healthcare Outpatient Pharmacy (Billings, MT)
Kaiser Permanente members – In addition to the Kaiser
Permanente pharmacies, outpatient prescriptions can be filled at St.
Joseph Hospital and Good Samaritan Medical Center pharmacies.
Mail Order prescriptions must be filled through Kaiser Permanente.
Maintenance medications are drugs you take on a regular basis to
treat conditions such as high cholesterol, diabetes, high blood
pressure, heart disease, asthmas arthritis and allergies. To identify if
any of the drugs you take are considered a maintenance medication,
go to www.sclhealthbenefits.org.
Those who do not have local access to an SCL Health
Pharmacy, maintenance medications will be required to
be filled through the mail order service at Good Samaritan
Medical Center. (See page 19 for instructions on how to
transition your prescription(s) to mail order.) As a benefit,
having your maintenance prescriptions delivered through mail order
will save you time and money!
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2015 ENROLLMENT GUIDE
Cigna Pharmacy - Mail oder services at the Pharmacy at
Good Samaritan Medical Center
• Available Monday - Friday 8:30 a.m. - 10 p.m. at 303-689-6121 or
855-235-4301 (toll free)
• Specific medication related questions and consultations available
7 days a week.
Kaiser Permanente EPO Pharmacy
• All Kaiser Permanente EPO prescriptions must be filled at a Kaiser
Permanente pharmacy.
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Mail Order Pharmacy for 2015
The Pharmacy Services at Good Samaritan will begin filing
ALL Cigna PPO and CDHP Mail Order prescriptions starting
January 1, 2015. No matter where you are located using the mail
order services through Good Samaritan you can take advantage of
medications at a lower cost by utilizing SCL Health’s group purchasing
program. In addition Good Samaritan pharmacists are available to
answer your questions and assist you with your prescription order.
Your prescriptions will be sent confidentially with personal care and in
a timely delivery. Transferring your mail order prescriptions is easy.
What kind of prescriptions can I receive through mail order?
The types of prescription medications that can be ordered through the
mail are those for more than one month in a row (called maintenance
medications) and those you expect no changes to be made in the
dosing or dosing schedule. Some examples that should not be
ordered through mail order are an antibiotic for an ear infection or pain
medication for a broken arm.
What quantities are dispensed through mail order?
Please have your doctor write your prescription for a three month or a
90-day supply. The prescription must display the quantity that you and
your doctor want to be dispensed.
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How and when do I order refills?
You should order refills when you have about 14 to 21 days’ supply
left. Although it usually does not take this long, it serves as a safety net
so you do not run out of medicine.
How do I transfer my prescriptions or start the process?
Done through your physician, they can;
• Fill out the attached Mail Order Form (This only needs to be filled
out once to set-up your profile)
— Mail, or
— Fax to 303-689-6126, or
• Call in to 303-689-6121 or 855-235-4301 (toll free), or
• Use the e-Prescription service
Reminder:
Include payment with your order to avoid possible delays in
processing your order. Your medications will be sent via U.S. Postal
Service or FedEx.
MAKE INFORMED CHOICES
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MEDICAL PREMIUM ASSISTANCE PROGRAM
As part of our mission, healing ministry and caring spirit, SCL Health
offers financial assistance to help our associates obtain insurance for
medical needs through our Medical Premium Assistance Program. This
program is one way that we continue to carry on the good work of the
Sisters of Charity of Leavenworth to foster God’s healing love and to
improve the health of the people, communities and associates we serve.
To be eligible, you must:
• Be a regular, full-time, benefit-eligible associate;
• Have a total household adjusted gross income of $35,000 or
less for associate only coverage level or total household adjusted
gross income of $40,000 or less for spouse, child(ren) and family
coverage levels, as reported on the most recent IRS Form 1040
income tax return; and
Updated for 2015
You can apply at any time in the plan year. If you are applying for the
first time, your benefit will start the first of the following month once
your completed application is received and continue through the last
deduction in December. If you are still eligible after December you will
have to reapply for the new year by sending in the proper application.
Learn More
For an application, go to the benefits website
www.sclhealthbenefits.org or contact the HR Service
Center at toll free 1-866-421-3701 or 303-813-5250.
• Submit the application to the HR Service Center (Denver) at any
time of the year.
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DENTAL BENEFITS
Know Your 2015 Dental Plan Options
It is important to note that benefit coverage levels vary by plan,
depending on the dental plan option you choose for 2015 and which
type of dentist you use.
• If you belong to the Choice Plan… You receive a higher level of
benefits if you choose a PPO Network dentist. You can use a Premier
or out-of-network dentist, but your benefit coverage will be lower.
• If you belong to the EPO Plan… You receive benefits ONLY if you
choose a PPO Network dentist. You receive NO coverage if you use
a Premier or out-of-network dentist.
• If you belong to the Core Plan… You receive the same level of
benefits whether you use a PPO, Premier or out-of-network dentist.
However, there is NO coverage for major services or orthodontia in
this option.
See the table below for details.
Choice
EPO
Core
PPO Network
Premier or Out-ofNetwork Only
PPO Network Only**
PPO, Premier or
Out-of-Network
$25/$50
$25/$50
$0
$0
Preventive*
100%
100%
100%
100%
Basic care
85%
75%
85%
75%
Major care
55%
45%
55%
0%
Ortho
Deductible
Individual/Family
Coinsurance (plan pays)
55%
45%
55%
0%
Annual Maximum
(per covered individual)
$1,200
$1,200
$1,200
$1,200
Lifetime Ortho Maximum
(per covered individual)
$1,200
$1,200
$1,200
$0
* Oral Exams & Cleanings — The frequency for exams and cleanings is
once every six months (with a 15-day grace period prior to the six-month
anniversary for scheduling flexibility). More frequent cleanings will be allowed
if periodontal disease is diagnosed. If you have service charges in excess of
the annual maximum, while they will not be covered under the plan, you will
continue to receive discounted pricing from in-network providers.
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**For care received outside the PPO Network, you pay 100% of the cost. The
plan pays NOTHING for out-of-network services.
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Prevention First
Updated for 2015
as long as you stay in network for all claims — which allows you
to stretch those dollars. This could be useful if you need additional
treatment. So be sure to see a Delta Dental PPO or Premier dentist
for a checkup at least once a year!
Regular visits to the dentist can improve your overall health. With
Prevention First, diagnostic and preventive services like exams, X-rays
and cleanings do not count against your annual maximum –
Delta Dental Pays
You Pay
Annual Maximum Remaining
Without Prevention First
With Prevention First
$350
$350
$0
$0
$850
$1,200
Plan benefits and dentist charges vary. Sample assumes two routine checkups with PPO dentist and $1,200 annual maximum.
Find an In-Network Dentist
To find network dentists, log on to www.deltadentalco.com and follow the steps in the
chart below or go to www.sclhealthbenefits.org.
To see if your current dentist belongs to a
Delta Dental network:
To find a PPO or Premier dentist:
• Click on “Does my dentist participate?” • Enter your address or zip code in the “Find
a Dentist” box.
in the “Find a Dentist” box.
• Enter your address or zip code and your
dentist’s name; then click on “Go.”
• The site will show you which network(s)
your dentist belongs to. Or you will see a
message saying there is no dentist by that
name within 50 miles of your address or
zip code.
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2015 ENROLLMENT GUIDE
• The site will provide a list of dentists in
your area and the network(s) in which they
participate.
• EPO Plan Members: PPO dental providers
are available ONLY under the EPO plan
option. There are NO BENEFITS available to
providers outside the PPO dental network.
Learn More
For additional assistance, go to
www.deltadentalco.com or
call Delta Dental of Colorado
toll-free at 1-800-610-0201.
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VISION BENEFIT
The Vision Care Plan operates much like a PPO — see any vision care provider, and
receive the greatest benefits if you choose one of the more than 65,000 nationwide
EyeMed network providers. This vast network includes private practitioners and retail
providers such as LensCrafters, Pearle Vision, Sears Optical, Target Optical, JC Penney
Optical and more.
Learn More
To find a network provider or for additional
information, visit www.sclhealthbenefits.org
or www.eyemedvisioncare.com, or call
1-866-723-0513.
Plan Pays
Service/Product
In-Network
Out-of-Network
100%
100% up to a $60 allowance
Single Vision
100% after $10 copay
100% up to a $55 allowance
Bifocal
100% after $10 copay
100% up to a $75 allowance
Trifocal
100% after $10 copay
100% up to a $85 allowance
Standard Progressive
100% after $75 copay
100% up to a $75 allowance
UV Coating
100% after $15 copay
0%
Tint
100% after $15 copay
0%
100%
$5
Examination/Dilation
Lenses
Lens Options
Scratch Resistance
Other Add-Ons
20% discount
N/A
Frames
100% up to a $140 allowance; 20% discount on
amounts over $140
100% up to a $90 allowance
Contacts
100% up to a $140 allowance; 15% discount on
amounts over $140 for conventional contacts
100% up to a $115 allowance
15% off retail or 5% off promotional pricing
N/A
Lasik and PRK
Benefit Frequency
Examinations/eyeglass lenses/
contacts
Once every 12 months
Frames
Once every 24 months
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FLEXIBLE SPENDING ACCOUNTS (FSAs)
FSAs offer a convenient way to pay for out-of-pocket health care and
dependent care expenses while also saving on taxes.
First, you estimate the amount of your out-of-pocket expenses for
the year. That amount is then deducted from your pre-tax income
through payroll deductions from each paycheck and deposited into
a personal reimbursement account.
Then, when you use your account for eligible expenses, you do
not pay federal, social security or state (if eligible) taxes on your
contributions. SCL Health offers two FSA choices:
• Dependent Care FSA
–– You can pay for daycare and other similar expenses during your
and your spouse’s working hours away from home. To be eligible,
the providers must claim this income on their tax return.
–– The maximum annual contribution for 2015 is $5,000.
–– Associates with the status of highly compensated under IRS
rules will not be eligible for the Dependent Care FSA.
• Health Care FSA
–– You can use the funds in your FSA to pay for qualified medical
expenses not covered by insurance, such as copays, deductibles,
dental and vision expenses.
–– The maximum annual contribution for 2015 is $2,500.
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2015 ENROLLMENT GUIDE
Open Enrollment Reminder
You must re-enroll in Flexible Spending Accounts each year.
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How Do FSAs Work?
Learn More
• SCL Health has contracted with 24HourFlex to administer Health Care and Dependent
Care FSAs.
24HourFlex is the FSA program
administrator. To access your account
details or obtain claim forms, go to
www.24hourflex.com or call
1-800-651-4855.
• You set aside pre-tax dollars from each paycheck to your account(s) to pay for eligible
expenses throughout the year.
• To pay for eligible expenses, you can use your account debit card or “pay yourself back” by
filing a claim for reimbursement from your account, tax-free. This reduces your taxable income
and puts more money back in your pocket.
• Plan your contributions carefully. There is a deadline for spending your FSA funds. You can use
the money to pay for eligible expenses incurred between January 1, 2015, of the current plan
year and March 15, 2016. You must submit claims for all expenses by April 30, 2016. Any
unused funds remaining in your account(s) after the deadline will be forfeited.
What is Covered?
You can use a Health Care FSA to pay for eligible medical, dental and vision care expenses that
are not covered by your health care plans, such as deductibles, copays, coinsurance, eyeglasses,
contact lenses, hearing devices, etc., for yourself and your dependents. You cannot use your funds
to pay for things like elective cosmetic surgery, over-the-counter medications (unless you have a
prescription), health club membership fees or maternity clothes.
You can use a Dependent Care FSA to pay child and elder care expenses for your eligible
dependents, such as daycare and nursery school expenses. You cannot use the account to pay for
things like overnight camp or general babysitting.
Important FSA Considerations
• To contribute to an FSA in 2015, you must elect it when you complete your 2015 enrollment.
FSAs do not carry over from year to year.
• Over-the-counter medications cannot be reimbursed from your FSA without a prescription.
• Estimate carefully! Any money left in health care and dependent care FSAs at the end of the
year will be forfeited.
• Use the health care FSA to pay for eligible out-of-pocket expenses such as annual deductible,
copays and coinsurance responsibility.
For More Information
Go the SCL Health benefits website:
www.sclhealthbenefits.org
For a complete listing of
reimbursable FSA expenses,
you may contact:
24Hour Flex
www.24HourFlex.com
1-800-651-4855
IRS
www.irs.gov
1-800-829-3676
FSA Online Store — FSAStore.com
The Flexible Spending Account site,
www.FSAStore.com, is the only onestop-shop stocked exclusively with
FSA-eligible products and services. In
addition to more than 4,000 FSA-eligible
products, the site offers a national
provider database of FSA-eligible
services and an FSA Learning Center.
• Accepts all FSA-debit and major credit
cards.
• Offers 24/7 customer service.
• One-to-two-day turnaround and free
shipping on orders $50 or more.
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LIFE INSURANCE AND ACCIDENTAL DEATH
& DISMEMBERMENT COVERAGE (AD&D)
Designating a
Beneficiary – Online
SCL Health has a paperless
beneficiary designation
process. You can update your
beneficiary on-line at any time.
While enrolling in your 2015
benefits, you can take the
opportunity to enter or update
your beneficiaries. If you have
not designated your beneficiary
through the on-line process
before or you do not elect a
beneficiary, your Life and AD&D
Insurance benefits will be paid in
the order listed on this page.
SCL Health provides Life and Accidental Death and Dismemberment (AD&D) coverage to help
preserve your family’s standard of living in the event of your death or serious injury. SCL Health
provides, at no cost to you, basic Life and AD&D coverage. Beginning January 1, 2015, Cigna will be
the plan administrator.
You can elect additional Supplemental Life and AD&D for you, your spouse and your children. You
pay the full cost of Supplemental Life and AD&D coverage.
How Benefits are Paid
Life and AD&D insurance payments are made to you upon the death of a covered spouse or
children. Benefit payments are made in the order listed below in the event of your death unless you
designate a different beneficiary.
• Your spouse
• Your children
Learn More
• Your parents
Visit the benefits website at
www.sclhealthbenefits.org,
where you will find brochures on
Life and AD&D Insurance Benefits
as well as how to designate your
beneficiary.
• Your brothers and sisters
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2015 ENROLLMENT GUIDE
Updated for 2015
• Your estate
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How Benefits Are Paid (continued from page 26)
Benefit*
Benefit Detail
Basic Life and AD&D
SCL Health provides this benefit at
no cost to you.
• Benefit is 1x salary
Supplemental Life and AD&D
• 1x, 2x, 3x, 4x or 5x salary
• Maximum is $1 million with guaranteed
issue amount of $500,000
• Maximum is $1 million with guaranteed
issue amount of $500,000
• $25,000; $50,000; $100,000;
$150,000 or $200,000
Dependent Life and
AD&D — Spouse
• You may purchase the $25,000 or
$50,000 Dependent Life coverage
for your spouse without purchasing
Optional Life coverage for yourself
Evidence of Insurability Requirements
Any amount over $500,000 will require Evidence of
Insurability.
For 2015, eligible associates can elect the full amount
(5x annual salary if applicable up to $500,000) with
no Evidence of Insurability requirement. Elections
greater than $500,000 will require Evidence of
Insurability.
For 2015, any amount of dependent supplemental life
insurance over the $50,000 guaranteed issue amount is
subject to Evidence of Insurability.
• For higher coverage increments, you
must purchase associate Supplemental
Life coverage; Spouse coverage may not
be higher than your Supplemental
Life coverage amount
• Guaranteed issue amount
is $50,000
• $5,000; $10,000 or $25,000
Dependent Life and
AD&D — Children
None
*Age reductions begin at age 65.
Evidence of Insurability (EOI): Once enrollment elections are submitted to the life insurance carrier, an email and / or a letter will be mailed to your home
mailing address. Follow the instructions to complete the online health questionnaire in order to receive the additional life insurance amount that you have elected.
Will preparation and estate planning
Help protect your and your family’s financial future. This simple, online will preparation tool lets you create a customized will built around your
state-specific laws. You can also create other legal documents, like a living will and power of attorney document. It’s easy, safe and secure.
Get prepared: CignaWillCenter.com
Identity theft
Use our online tips and prevention kit to help stop identity theft before it happens. If your identity is stolen, we can help. Just call our personal
case managers for step-by-step help with everything from identity theft to credit card fraud to emergency travel arrangements. Real-time
support is available anytime, from anywhere in the world.
Get help: 1-888-226-45676. Let your case manager know you’re in the Cigna Identity Theft program group #57.
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DISABILITY BENEFITS
Learn More
Visit the benefits website at
www.sclhealthbenefits.org,
where you will find links to
STD and LTD brochures on the
Disability Plan page.
Updated for 2015
SCL Health provides this coverage to all benefit-eligible associates and pays the full cost of coverage
for the core plans. If you are unable to work due to an extended illness or a non-work-related injury,
your disability benefits will replace a portion of your income. Disability income will help you take
care of household expenses until you are able to return to work. Beginning January 1, 2015, Cigna
will be the plan administrator.
Short Term Disability (STD) core plan replaces income from the 8th to 90th day of qualified
disability. SCL Health provides this benefit at no cost to you.
• If your disability is approved, you may receive 60% of your weekly earnings up to a maximum of
$2,500 per month.
Long Term Disability (LTD) core plan pay begins on the 91st day of disability.
• If your disability is approved, you may receive 50% of your monthly earnings up to a maximum
of $15,000 per month.
• The benefit is reduced by certain offsets such as primary Social Security benefits.
• SCL Health pays the total cost of this benefit for you, so the premium is recorded as imputed
income on your paycheck. You will not have to pay taxes on the benefit in the event you are
disabled. You pay taxes on the cost of the employer premium; however, you pay no tax when
the benefit is paid during disability.
Disability Benefits
Short Term Disability (core plan)
• Pays 60% of pre-disability base pay for day 8 through day 90 of disability, up to a maximum
of $2,500 weekly disability.
• You may supplement the STD pay from your current extended leave balance and Paid Time
Off (PTO) hours.
• The STD benefit is taxable when paid during disability.
Long Term Disability (core plan)
• Pays 50% of pre-disability base pay after 90 days of disability.
• You pay imputed income taxes on the COST of SCL Health’s premium; however,
the LTD benefit is not taxable income during disability.
Long Term Disability (buy-up plan) • You may elect to purchase a buy-up option of 10% to increase the LTD benefits to 60%
of pre-disability base pay.
• You pay the buy-up premium in after-tax dollars, so the benefit paid during disability
remains nontaxable.
• The cost of LTD coverage SCL Health pays will be imputed to your income.
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LEGAL BENEFITS
During annual Open Enrollment, you can elect group legal
coverage through Hyatt Legal Plans, a MetLife® company,
for access to:
• Unlimited telephone and office consultations for personal legal
matters with an attorney in the Hyatt network.
• E-Services, including attorney locator; law firm e-panel; law
guide; free, downloadable legal documents; financial planning,
insurance and work/life resources.
Representative Services
• Estate Planning Documents.
• Personal Property Protection.
• Document Review.
• Financial Matters.
• Family Law.
• Juvenile Matters.
• Immigration Assistance.
• Defense of Civil Lawsuits.
Learn More
• Elder Law Matters.
• Consumer Protection.
• Real Estate Matters.
• Family Matters™.
Visit www.sclhealthbenefits.org or the Hyatt MetLaw website at
www.legalplans.com.
• Document Preparation.
• Traffic Offenses.
You also can call their Client Service Center at 1-800-821-6400
Monday through Friday, 8 a.m. to 7 p.m. (Eastern Time).
LONG-TERM CARE INSURANCE
Remaining independent, especially in retirement, often depends
on having the financial resources to pay for extended care due to
severe injuries and chronic illnesses, such as multiple sclerosis or
Alzheimer’s disease. SCL Health offers voluntary Long-Term Care
Insurance at affordable group rates through Continental Casualty
Company, a member of CNA, which has been offering insurance
coverage since 1916.
Long-Term Care Insurance can offer you a number of advantages,
such as:
• It helps cover the cost of certain extended health care situations,
like professional in-home care, assisted living facilities and skilled
nursing facilities.
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• You can choose from a range of coverage levels to match your
budget and needs.
• You may purchase coverage for yourself, your spouse, parents,
in-laws, grandparents and grandparents-in-law.
Learn More
Enrollment for Long-Term Care Insurance must be submitted to
CNA within 31 days of your date of hire or during annual open
enrollment by December 15. Elections are not entered in the
Lawson Employee Self-Service (ESS) Enrollment System.
For more information or to request an enrollment kit, call
CNA at 1-877-777-9072 or go to your benefits website
www.sclhealthbenefits.org for further information.
MAKE INFORMED CHOICES
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EMPLOYEE ASSISTANCE PROGRAM (EAP)
SCL Health recognizes that living a productive and fulfilling life
requires a healthy mind and a healthy body. Unfortunately, managing
the daily stresses of work, home and family life can have a negative
effect on your overall health and well-being. The Employee
Assistance Program (EAP) provides guidance resources to help.
The EAP offers over-the-phone consultations with experienced
clinicians who can refer you to a local counselor or other resources
near you. Here are just a few of life’s challenges that may be helped
by EAP:
In addition, your EAP provides referral services and information for
the following:
• Legal issues including divorce, bankruptcy and criminal actions.
• Financial information including debt, retirement planning and
saving for college.
Using this benefit is simple. Just call the toll-free phone line 24 hours a
day, seven days a week; or go online to find valuable information.
• Managing stress.
• Work-life needs including finding child or elder care and
planning for college.
• Handling relationship issues.
• Balancing work and life.
• Quitting tobacco, alcohol or drug use.
Learn More
If you would like more information about the EAP, call
1-800-624-5544 or go online to www.ndbh.com and enter
Company ID: SCLHS to access additional EAP benefits.
• Dealing with conflict or violence.
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2420 West 26th Avenue | Suite 100-D | Denver, CO 80211
303-813-5190 | sclhealth.org
This benefits enrollment guide provides a summary of various plans included in the SCL Health benefit program effective January 1, 2015. Complete details of
the plans are included in the official plan documents and contracts. If there is a difference between this benefits enrollment guide and the legal documents or
contracts, then the plan documents or contracts will govern in every instance. In addition, SCL Health reserves the right to change or terminate the benefits
program, individual plans or any provisions of any plans at any time.
© 2014 Sisters of Charity of Leavenworth Health System, Inc. All rights reserved.
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